Fresno-Madera Area Agency on Aging

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					Fresno-Madera Area Agency on Aging




Fiscal Year 2010 – 2011 Area Plan Update
               Fiscal Year 2010-2011 Area Plan Update




Governing Board                               Advisory Council
Al Grace, Chair                               Patricia Summers, Chair
Robert Ward, 1st Vice-Chair                   Robbie Cranch, 1st Vice-Chair
Joy Hansen, 2nd Vice Chair                    Gerald Ongman, 2nd Vice-Chair
Phil Larson, Fresno County Supervisor         Merle Anderson
Max Rodriguez, Madera County Supervisor       Pat Beasley
Cynthia Sterling, Fresno City Councilmember   Joann Blancett
Rodney Ashley                                 Carol Conrow
Dave Case                                     Robert Costanzo
Vonnie Franks                                 Terri Cummins
Leonard Haggerty                              Connie Figueroa
Edward Hokokian                               Craig Fowler
Lewis Honeycutt                               Robert Hand
Beatrice Johnson                              Sandra Miller
Patty Manfredi                                Margery Minney
Lenora Salazar                                Doloris Olmstead
Bob Irwin – Emeritus                          Edward Saliba
                                              Ross Smith
                                              Shirley Tickel
                                              Virginia Wheeler
                     Fiscal Year 2010 – 2011 Area Plan Update


                                            Table of Contents
Transmittal Letter ................................................................................................. Page ii
Fiscal Year 2010-2011 Area Plan Update Checklist ........................................... Page iii
Organization Charts ......................................................................................... Section 5
Public Hearings ................................................................................................ Section 9
Area Plan Narrative Goals and Objectives ..................................................... Section 11
         Goal #1...................................................................................Section 11, Page 2
         Goal #2................................................................................... Section 11, Page 9
         Goal #3................................................................................. Section 11, Page 15
         Goal #4................................................................................. Section 11, Page 22
         Goal #5................................................................................. Section 11, Page 29
         Goal #6................................................................................. Section 11, Page 46
         Goal #7................................................................................. Section 11, Page 58
Service Unit Plan Objectives .......................................................................... Section 12
Focal Points ................................................................................................... Section 13
Priority Services ............................................................................................. Section 14
Notice of Intent to Provide Direct Services ..................................................... Section 15
Request for Approval to Provide Direct Services ........................................... Section 16
Governing Board ............................................................................................ Section 17
Advisory Council ............................................................................................ Section 18
Legal Assistance ............................................................................................ Section 19
Multipurpose Senior Center Acquisition or
Construction Compliance Review .................................................................. Section 20
Family Caregiver Support Program ................................................................ Section 21

Fresno-Madera Area Agency on Aging                                 i                                   Fiscal Year 2010-2011
                                                                                                            Area Plan Update
                                   TRANSMITTAL LETTER
                             Fiscal Year 2010-2011 Update to the
                               2009-2012 Three-Year Area Plan


AAA Name: Fresno-Madera Area Agency on Aging                           PSA Number: 14


This Area Plan Update is hereby submitted to the California Department of Aging for
approval. The Governing Board and the Advisory Council have each had the opportunity
to participate in the planning process and to review and comment on the Area Plan
Update. The Governing Board, Advisory Council, and Area Agency Director actively
support the planning and development of community based systems of care and will
ensure compliance with the assurances set forth in this Area Plan Update. The
undersigned recognize the responsibility within each community to establish systems in
order to address the care needs of older individuals and their family caregivers in this
planning and service area.


         1.



         Signed:




         2.



         Signed:




         3.



         Signed:




Fresno-Madera Area Agency on Aging              ii             FY 2010-2011 Area Plan Update
                                    Fresno-Madera Area Agency on Aging

                         FISCAL YEAR 2010-2011 AREA PLAN UPDATE CHECKLIST

                                                                                                                       Annual
  Section                            Three-Year Area Plan Update Components                                            Update
               REQUIRED
               Original Area Plan Update
               Transmittal Letter with authorized signatures or official stamp
               All Area Plan Update documents are on single-sided paper, if submitted hard copy
      5        Organization Chart
      9        Public Hearings


               REQUIRED only if changed or not previously included in the Area Plan
      2        Description of the Planning and Service Area (PSA)
      3        Description of the Area Agency on Aging (AAA)
      6        Planning Process
      7        Needs Assessment must be conducted at least once during the Area Plan cycle
      10       Identification of Priorities
      11       Goals and Objectives: (May be updated at any time and need not conform to a twelve month time frame)
                 ^ Title III B Funded Program Development (PD) Objectives
                 ^ Title III B Funded Coordination (C) Objectives
                   System-Building and Administrative Goals & Objectives
                   Title III B/VIIA Long-Term Care Ombudsman Objectives
                   Title VII B Elder Abuse Prevention Objectives
      12       * Service Unit Plan Objectives
      13       Focal Points
      14       Priority Services
      15       Notice of Intent to Provide Direct Services
      16       Request for Approval to Provide Direct Services
      17       Governing Board
      18       Advisory Council
      19       Legal Assistance
      21       Title III E Family Caregiver Support Program

     ^ Required if PD and/or C are funded with Title III B



Fresno-Madera Area Agency on Aging                               iii                                           Fiscal Year 2010-2011
                                                                                                                    Area Plan Update
SECTION 5. ORGANIZATION CHARTS

                                 Fresno-Madera Area Agency on Aging
                                 Administration Organization Chart [A]




                                                      Governing Board                       Advisory Council




                                                      Executive Director
                                             65%-Area Plan Administration
                                             35%-PD&C




                                                                  Exec. Assist./Personnel Officer
                                                                 60%-Indirect
                                                                 20%-Area Plan Administration
                                                                 20%-PD&C




                                                       Deputy Director
                                             45%-MSSP
                                             30%-Indirect
                                             10%-Title III B Case Management
                                             10%-Title III C2
                                             5%-Title III C1




                            Administrative Planner                             Controller
                       75%-Area Plan Administration               50%-Indirect
                       15%-Title III B CARS                       25%-MSSP
                       5%-PD&C                                    20%-Area Plan Administration
                       5%-Indirect                                5%-PD&C




                                                                               Accountant
               Program Coordinator II                             50%-MSSP
           80%- MSSP                                              30%-Area Plan Administration
           10%-Title III B Case Management                        20%-Indirect
           10%-Title III E Case Management



                                                                               Accountant
                Administrative Analyst                            75%- MSSP
           60%-Area Plan Administration                           25%-Title III B Case Management
           40%-Title III B CARS




                  Program Assistant
           80%-MSSP
           15%-Title III E Case Management
           5%-Title III B Case Management




Fresno-Madera Area Agency on Aging                      Section 5 – Page 1                               Fiscal Year 2010 –2011
                                                                                                               Area Plan Update
                           Fresno-Madera Area Agency on Aging
                          Care Management Organization Chart [B]




                                          Executive Director
                                     65%-Area Plan Administration
                                     35%-PD&C



                                           Clinical Manager
                                     75%-MSSP
                                     15%-Title III B Case Management
                                     10%-Title III E Care Management


                                                         Nurse Care Manager
                                                         100%-MSSP


                                                                 Care Manager
                                                         100%-Title III E
                                                         Care Management




           Care Manager                       Care Manager                      Care Manager
      100%-MSSP                           100%-MSSP                       100%-Title III B
                                                                          Case Management
           Care Manager                       Care Manager
      100%-MSSP                           100%-MSSP
                                                                                Care Manager
                                                                          100%-Title III B
           Care Manager                       Care Manager                Case Management
      100%-MSSP                           100%-MSSP




Fresno-Madera Area Agency on Aging          Section 5 – Page 2                    Fiscal Year 2010 –2011
                                                                                        Area Plan Update
                                     Fresno-Madera Area Agency on Aging
                                     Direct Services Organization Chart [C]


                                                   Deputy Director
                                      45%-MSSP
                                      30%-Indirect
                                      10%-Title III C2 5%-Title III C1
                                      10%-Title III B Case Management



                                              Direct Services Manager
                                      45%-Title III B I&A 5%-Title III B Outreach
                                      25%-Title III E I&A 5%-Title III E Outreach
                                      10%-PD&C
                                      10%-Contracted Foundation


                                                                         Registered Dietitian
                                                                45%-Title III C1
                                                                45%-Title III C2
                                                                10%-Area Plan Administration




                                                 Title V Supervisor                            Program Coordinator II
        Facilities Engineer II         40%-Title V                                   35%-Title III C2
100%-Contracted Foundation             9%-ARRA Employment Stimulus                   25%-Title III C1
                                       14%-Title III B Outreach                      25%-Title III B I&A
                                       10%-Title III B I&A      17%-Indirect         15%-Title III B Outreach
                                       5%-Title III E I&A       5%-PD&C

                                                                                        Nutrition Program Coordinator
 Facilities Maintenance Technician                                                   60%-Title III C1
100%-Contracted Foundation                                                           40%-Title III C2

                                                                                        Nutrition Program Coordinator
                                                                                     60%-Title III C2
                                                                                     40%-Title III C1
 Facilities Maintenance Assistant
100%-Contracted Foundation
                                                                                     I&A/Outreach Program Coordinator
                                                                                     45%-Title III B Outreach
                                                                                     25%-Title III B I&A
                                                                                     15%-Title III E Outreach
                                                                                     10%-Title III E I&A      5%-MIPPA


                                                                                     I&A Outreach Program Coordinator
                                                                                     35%-Title III E Outreach
                                                                                     35%-Title III E I&A
                                                                                     20%-Title III B I&A
                                                                                     5%-Title III B Outreach 5%-MIPPA




   Fresno-Madera Area Agency on Aging                   Section 5 – Page 3                               Fiscal Year 2010 –2011
                                                                                                               Area Plan Update
SECTION 9. PUBLIC HEARINGS


                                         PSA #14

                                PUBLIC HEARINGS
                Conducted for the 2009-2012 Planning Period
 CCR Title 22, Article 3, Section 7302(a)(10) and Section 7308; OAA 2006 306(a)


                                                                     Presented in   Held at a
                                                          # of
 Fiscal Year    Date                 Location                     languages other Long Term
                                                        Attendees
                                                                    than English? Care Facility?
 2009-2010      4/14/09 Senior Resource Center                  22       No              No
                        2025 E. Dakota Ave.
                        Fresno, CA 93726
 2009-2010      4/16/09    Frank A. Bergon Center               21       No              No
                           238 S. D St.
                           Madera, CA 93637
 2009-2010       3/9/10    Senior Resource Center               18       No              No
 (Amendment                2025 E. Dakota Ave.
 No.1)                     Fresno, CA 93726
 2010-2011      4/13/10 Senior Resource Center                  17       No              No
                        2025 E. Dakota Ave.
                        Fresno, CA 93726
 2010-2011      4/15/10    Frank A. Bergon Center               19       No              No
                           238 S. D St.
                           Madera, CA 93637
 2011-2012



Below items must be discussed at each planning cycle’s Public Hearings.

1.   Discuss outreach efforts used in seeking input into the Area Plan from
     institutionalized, homebound, and/or disabled older individuals.

       Section 7, Needs Assessment, of the Fresno-Madera Area Agency on Aging 2009-
       2012 Three-Year Area Plan describes activities conducted by the aging to obtain
       input for the Area Plan. In addition, all service providers and interested parties
       were mailed agendas for the Area Plan public hearings, and agendas were posted
       at various locations throughout PSA 14 in accordance with the Ralph M. Brown
       Act.




Fresno-Madera Area Agency on Aging         Section 9 – Page 1                   Fiscal Year 2010-2011
                                                                                    Area Plan Update
2.   Proposed expenditures for Program Development (PD) and Coordination (C) must
     be discussed at a public hearing. Did the AAA discuss PD and C activities at a
     public hearing?

           Yes          Not Applicable if PD and C funds are not used         No, Explain:


3.   Summarize the comments received concerning proposed expenditures for PD and C,
     if applicable.

       None

4.   Were all interested parties in the PSA notified of the public hearing and provided the
     opportunity to testify regarding setting of minimum percentages of Title III B Program
     funds to meet the adequate proportion funding for Priority Services?

           Yes          No, Explain:

5.   Summarize the comments received concerning minimum percentages of Title III B
     funds to meet the adequate proportion funding for priority services.

       None

6.   Summarize other major issues discussed or raised at the public hearings.

       At the April 14, 2009 public hearing, one individual relayed their idea for creation of
       housing for older adults at a shopping mall in Fresno.

       There were no major issues discussed or raised at the March 9, 2010 public
       hearing.

       At the April 15, 2010 public hearing, one individual reported on Fresno County In-
       Home Supportive Services wage issues.




Fresno-Madera Area Agency on Aging      Section 9 – Page 2                  Fiscal Year 2010-2011
                                                                                Area Plan Update
SECTION 11




  Fresno-Madera Area Agency on Aging

                     Area Plan Goals and Objectives

             Fiscal Year 2010-2011 Area Plan Update




Fresno-Madera Area Agency on Aging   Section 11 – Page 1   Fiscal Year 2010-2011
                                                                Area Plan Update
    Fresno-Madera Area Agency on Aging
  Area Plan Goals and Objectives

                      Goal 1
 The Fresno-Madera Area Agency on Aging will
 continue to provide leadership in developing and
 coordinating a seamless system of services,
 with particular emphasis on home and
 community based long term care for older adults
 and adults with disabilities in Planning and
 Service Area 14.


 RATIONALE
 “In 2005, 63 percent of total Medicaid expenditures for long term care were for
 nursing homes. Of the $94.5 billion spent on long term care, $59.3 billion went to
 these institutions. An estimated 20 percent of nursing home residents do not need
 skilled nursing and could be deinstitutionalized if appropriate community supports
 were available.” (Barbara A. Haley and Robert W. Gray, Section 202 Supportive
 Housing for the Elderly: Program Status and Performance Measurement, U.S.
 Department of Housing and Urban Development, Office of Policy Development and
 Research, June 2008)
 “Sixty-five percent of elderly people living in the community, and 84 percent of
 those at high risk of needing nursing home care, have assets that would pay for
 less than a year in a nursing home. Fifty-seven percent of the elderly in the
 community and 75 percent of those at high risk of needing nursing home care do
 not have enough assets to cover even a month in a nursing home.” (2008
 Alzheimer’s Disease Facts and Figures, Alzheimer’s Association)
 “Disasters disproportionately affect frail older adults. Before hurricanes Katrina and
 Rita in 2005, adults aged 60 or older made up only 15% of the population of New
 Orleans, Louisiana. However, 71% of those who died because of the hurricane were
 over age 65. During the 1995 heat wave in the Midwest, the median age of the 465
 people in Chicago whose deaths were heat-related was 75. The sheer numbers of
 the aging population give an even greater urgency to addressing the needs of older
 adults following a disaster. The U.S. population aged 65 or older is expected to
 almost double in size within the next 25 years. By 2030, some 72 million people–
 almost one of every five Americans–will be aged 65 or older. People aged 85 or
 older are the fastest growing segment of the U.S. population.” (Nancy Aldrich and
 William F. Benson, “Disaster Preparedness and the Chronic Disease Needs of
 Vulnerable Older Adults,” Public Health Research, Practice, and Policy, Volume 5:
 No. 1, January 2008)

Fresno-Madera Area Agency on Aging     Section 11 – Page 2             Fiscal Year 2010-2011
                                                                            Area Plan Update
                                              PROJECTED                  TITLE III B
  OBJECTIVES – GOAL 1                         START          PROJECTED   FUNDED
                                              DATE           END DATE    PD OR C           STATUS
 A.        Planning and Advocacy for the      7/1/2009       6/30/2012        C           Continuing
           Needs of Older Adults and
           Adults with Disabilities
 B.        Community Disaster Planning
      1.   Preparing the Sierra Resource      7/1/2009       6/30/2012        C           Continuing
           Campus
      2.   Preparing the Community of         7/1/2009       6/30/2012        C           Continuing
           Older Adults and Adults with
           Disabilities
      3.   Preparing Vulnerable               7/1/2009       6/30/2012                    Continuing
           Populations
 C.        Cooperative Outreach
      1.   Service Priority Survey            7/1/2009       6/30/2011        C           Continuing
      2.   Planning and Implementation        7/1/2010       6/30/2012        C              New
           of Cooperative Outreach
           Activities for Priority Services



A.         Planning and Advocacy for the Needs of Older Adults and Adults with
           Disabilities

           Planning for the needs of the diverse and increasing population of older adults
           and adults with disabilities is an ongoing process which must reflect the ever-
           changing economic climate; generational and cultural preferences; and a palette
           of ongoing, new, and discontinued programs at the local, state, and national
           level.

                  The Fresno-Madera Area Agency on Aging (FMAAA) will inform the
                  planning process and strengthen its position as an advocate for the needs
                  of older adults and adults with disabilities through effective and
                  continuous civic and social engagement. FMAAA staff will strengthen
                  existing alliances that have resulted in positive collaboration in the past,
                  and establish new relationships with government agencies and
                  community based organizations where the potential for partnership exists.
                  This will be accomplished by attending ten meetings or events conducted
                  by these organizations each fiscal year, networking with presenters and
                  attendees, and identifying mutual opportunities for planning and
                  increased leveraging of resources. (C)




Fresno-Madera Area Agency on Aging               Section 11 – Page 3              Fiscal Year 2010-2011
                                                                                       Area Plan Update
                Fiscal Year 2009-2010: Continuing

                The FMAAA executive director and deputy director attended meetings of
                the Fresno County Board of Supervisors, the Fresno County In-Home
                Supportive Services Advisory Committee, and the Mayor’s Committee
                Advisory Council for the City of Fresno. In August 2009, the FMAAA
                management team met with Mayor Ashley Swearengin of the City of
                Fresno and provided her with a tour of the collocated social service
                agencies on the Sierra Resource Campus.

                FMAAA staff served on the Fresno County Council of Government’s
                Social Service Transportation Advisory Council, the Central California
                Forum on Refugee Affairs, and the TAT Management Board of Directors,
                and attended meetings of The Aging Network and the Elder Abuse Round
                Table.

                At the invitation of the Fresno County Office of Emergency Services, the
                FMAAA participated as a key stakeholder in the California Emergency
                Management Agency’s 2010 Evacuation and Transportation of People
                with Access and Functional Needs Planning Project for Fresno County.
                The project workgroup included representatives from transit, health,
                education, social services, and emergency offices of local government
                agencies, as well as representatives from medical clinics, hospitals, non-
                profit organizations, and faith-based groups. At the intial project meeting
                on March 3, 2010, the workgroup identified strengths and weaknesses in
                Fresno County’s existing evacuation plans. On April 26, 2010, the
                workgroup met to refine priorities and strategies for developing an
                evacuation framework.

B.       Community Disaster Planning

         1.     Preparing the Sierra Resource Campus

                The FMAAA has created and distributed an emergency plan specific to
                the Sierra Resource Campus for use by all collocated partners. An on-
                site training room currently under construction will also function as a
                command center, complete with a satellite link for emergency
                communications, for disaster planning and response in the event of a
                campus or community emergency.

                The FMAAA will help ensure the safety of all collocated partners on the
                Sierra Resource Campus by organizing and conducting a campus-wide
                fire drill once each fiscal year, and will review the campus emergency
                plan annually to ensure it is current, producing and distributing updates to
                campus partners when content requires revision. (C)



Fresno-Madera Area Agency on Aging        Section 11 – Page 4              Fiscal Year 2010-2011
                                                                                Area Plan Update
                Fiscal Year 2009-2010: Continuing

                The FMAAA updated and distributed the campus emergency plan to all
                collocated campus partners, and conducted a successful fire drill, which
                involved evacuating the three-story Senior Resource Center’s social
                service agencies and clients. In addition, the FMAAA emergency plan
                was thoroughly reviewed, updated, and distributed to FMAAA staff.

         2.     Preparing the Community of Older Adults and Adults with
                Disabilities

                The FMAAA has successfully implemented the U.S. Department of
                Homeland Security’s Get Ready Now campaign, providing older adults
                and adults with disabilities with practical presentations to promote self-
                sufficiency during the first 24-72 hours following a disaster.




                                     FMAAA Disaster Preparedness Presentation



                Members of the FMAAA Advisory Council will continue to promote the
                health and safety benefits of the Get Ready Now Program to older adults
                and adults with disabilities by conducting six emergency/disaster
                preparedness presentations each fiscal year. Community groups, senior
                and community centers, and residential facilities for older adults will be
                targeted for presentations. The FMAAA staff will coordinate and schedule
                the presentations with hosting organizations; provide the master schedule
                and updates to the advisory council; prepare and disseminate flyers to

Fresno-Madera Area Agency on Aging            Section 11 – Page 5           Fiscal Year 2010-2011
                                                                                 Area Plan Update
                promote the presentations; maintain an inventory of materials and
                package them for each presentation; generate confirming letters to
                hosting organizations; provide presenters with checklists, materials,
                evaluation forms, copies of confirming letters, and maps; conduct
                presentations when advisory council members are not available; attend
                the presentations to assist as needed; compile and present attendees’
                evaluation results to the advisory council and/or governing board; and
                conduct Train the Trainer sessions as needed for the advisory council. (C)

                Fiscal Year 2009-2010: Continuing

                Disaster preparedness presentations were conducted for older adults at
                the Orange Cove and Reedley senior centers and the Park Kingsburg
                residential facility. Three presentations were conducted for family
                caregivers at the Valley Caregiver Resource Center in Fresno. FMAAA
                staff conducted a Train the Trainer session for FMAAA Advisory Council
                members in January 2010. FMAAA staff also procured a grant from the
                AT&T Foundation for purchase of one-day emergency kits to reinforce the
                Get Ready Now message for attendees, and for purchase of portable
                audio-visual equipment to ensure the full disaster preparedness
                presentation can be offered at sites with limited multi-media capabilities.

         3.     Preparing Vulnerable Populations

                The FMAAA currently provides participants in the Multipurpose Senior
                Services Program (MSSP) with land-line telephones to help prepare them
                for an emergency, and assists these individuals with entering emergency
                contact and medical information on the File of Life® form.

                The FMAAA will expand the reach of the Get Ready Now campaign to
                individuals receiving MSSP care management services to help ensure
                their well-being should a disaster strike. Each fiscal year, the FMAAA will
                provide 150 MSSP clients with portable emergency preparedness kits.
                Focus will be placed on clients who are isolated and do not have family or
                social supports readily available on short notice. FMAAA care managers
                will present the kit to designated clients during scheduled home visits,
                and will provide one-on-one assistance with implementing the steps
                contained in the Get Ready Now Program.

                Fiscal Year 2009-2010: Continuing

                The FMAAA’s care managers presented 150 clients with the U.S.
                Department of Homeland Security’s Preparing Makes Sense for Older
                Americans-Get Ready Now brochure and reviewed the steps involved in
                preparing an emergency kit and plan. Each client was provided with a
                portable one-day survival kit.

Fresno-Madera Area Agency on Aging        Section 11 – Page 6             Fiscal Year 2010-2011
                                                                               Area Plan Update
C.       Cooperative Outreach

         With budget reductions and program cuts, it is increasingly important for the
         FMAAA to ensure that outreach efforts are cost effective and that available
         services are promoted to those in the greatest economic and social need.

         1.     Service Priority Survey

                During fiscal year 2009-2010, the FMAAA Advisory Council, with the
                assistance of the FMAAA staff, will develop and conduct a survey of older
                adults and adults with disabilities to identify the types of services that
                could be enhanced or more effectively delivered to those most in need.
                Faith based organizations, senior and community centers, recipients of
                home-delivered meals, and older adults who volunteer with Hands On
                Central California will be targeted for survey participation. Advisory
                council members will administer the survey verbally with each participant,
                and will conduct outreach in tandem with the survey interaction. The
                FMAAA will provide the advisory council with literature and talking points
                to enhance the council’s outreach efforts. The FMAAA will tabulate survey
                results and produce a summary report. (C)

                Fiscal Year 2009-2010: Continuing

                The FMAAA Advisory Council prepared and presented survey drafts at its
                September through December 2009 meetings. FMAAA staff produced the
                final version of the survey, which ranks the importance of Older
                Americans Act services and collects basic demographic information. An
                advisory council member arranged for translation of the survey into the
                Spanish language. The FMAAA printed and distributed both the English
                and Spanish versions of the survey to its advisory council in January
                2010, along with suggested locations for survey administration and maps
                to each survey site. The FMAAA assembled give-away packets
                containing information on the FMAAA’s programs and services and
                provided them to Advisory Council members conducting surveys in
                tandem with Disaster Preparedness presentations. In order to amass a
                larger base of survey participants, the FMAAA Advisory Council will
                continue to administer the survey to older adults, adults with disabilities,
                and family caregivers during fiscal year 2010-2011.




Fresno-Madera Area Agency on Aging        Section 11 – Page 7              Fiscal Year 2010-2011
                                                                                Area Plan Update
         2.     Planning and Implementation of Cooperative Outreach Activities for
                Priority Services

                During fiscal years 2010-2011 and 2011-2012, the FMAAA will identify
                and meet with key stakeholders involved with provision of priority services
                identified in the fiscal year 2009-2010 survey results. The FMAAA will
                explore and plan cooperative outreach activities with willing organizations,
                with an objective of conducting six cooperative outreach activities for
                priority services during both fiscal years 2010-2011 and 2011-2012. (C)




Fresno-Madera Area Agency on Aging        Section 11 – Page 8              Fiscal Year 2010-2011
                                                                                Area Plan Update
    Fresno-Madera Area Agency on Aging
  Area Plan Goals and Objectives

                      Goal 2
 The Fresno-Madera Area Agency on Aging will
 strive to ensure that the service system is
 culturally and linguistically sensitive to the ethnic
 and social diversity of older adults residing in
 Fresno and Madera counties.


 RATIONALE
 “Promoting and incorporating cultural competency into the study of public
 administration and moving a public agency toward cultural competence in public
 service delivery is an ongoing effort that requires the recognition of several activities.
 First, the study of public administration must acknowledge that cultural differences
 are important in the delivery of public services and public programs. When culture is
 ignored or not considered by a public agency, individuals, families and groups are
 not getting the services or support they need, or worse yet, individuals and groups
 are receiving services and assistance that is more harmful than helpful.” (Mitchell F.
 Rice, Promoting Cultural Competency in Public Administration and Public Service
 Delivery, Texas A&M University, June 12, 2006)

 “The Asian Pacific Islander American Health Forum reports that 40% of Southeast
 Asian refugees suffer from depression, 35% suffer from anxiety, and 14% from Post
 Traumatic Stress Disorder. This is significant given the fact that there are many
 barriers to addressing these health issues in Southeast Asian communities including
 stigma and shame from the community. There is also a great need for culturally
 appropriate services and effective intervention strategies as well as research specific
 to these populations. Mental health issues among Southeast Asian Americans and
 elderly refugees are not exclusively linked to their past experiences during war.
 These issues are often compounded by, but are not limited to, social isolation, the
 loss of their traditional, respected role within the family as younger generations
 integrate into American culture and the multiple barriers to attaining self-sufficiency.”
 (Khammany Mathavongsy, Southeast Asia Resource Action Center, The Health and
 Welfare Needs of Elderly Refugees and Asylees in the United States, Testimony
 before the U.S. Senate Special Committee on Aging, December 5, 2007)




Fresno-Madera Area Agency on Aging       Section 11 – Page 9              Fiscal Year 2010-2011
                                                                               Area Plan Update
                                       PROJECTED                  TITLE III B
  OBJECTIVES – GOAL 2                  START          PROJECTED   FUNDED
                                       DATE           END DATE    PD OR C           STATUS
 A.       Outreach to Diverse Social
          and Ethnic Groups
     1.   Hmong Community              7/1/2009       6/30/2012                   Continuing
     2.   Lesbian, Gay, Bisexual,      7/1/2009       6/30/2012                   Continuing
          and Transgender
          Community
 B.       Information for Isolated     7/1/2009       6/30/2012                   Continuing
          Older Adults
 C.       Community Education for
          Older Adults with Limited
          English Proficiency
     1.   Central California Legal     7/1/2009       6/30/2012                   Continuing
          Services

     2.   Valley Caregiver Resource    7/1/2009       6/30/2012                   Continuing
          Center

 D.       Caregiver Support Groups     7/1/2009       6/30/2012                   Continuing
          for Diverse Social and
          Ethnic Groups



A.        Outreach to Diverse Social and Ethnic Groups

          1.      Hmong Community

                  The Fresno-Madera Area Agency on Aging (FMAAA) has established a
                  foothold in the Southeast Asian community. An FMAAA program
                  coordinator attends monthly meetings of the Central California Forum
                  on Refugee Affairs, and serves on the forum’s employment and
                  community impact committees. Outreach is conducted at events based
                  in the Southeast Asian community, such as the annual Chinese New
                  Year celebration in Fresno’s Chinatown district, and at presentations for
                  organizations including the Nikkei Foundation and Stone Soup, a
                  nonprofit organization that assists refugee families.

                  Fresno County is home to the largest Hmong/Lao population in
                  California, and the second largest Hmong/Lao population in the nation.
                  Despite the FMAAA’s persistent efforts to connect with older adults in
                  the Hmong community, the opportunity to increase participation of these
                  individuals in the network of services remains.


Fresno-Madera Area Agency on Aging        Section 11 – Page 10             Fiscal Year 2010-2011
                                                                                Area Plan Update
                  Building upon the FMAAA’s established relationship with the Central
                  California Forum on Refugee Affairs, the FMAAA will contact leaders
                  within the Hmong community for assistance with identifying one or more
                  volunteers to serve as a peer outreach liasion to the older adult Hmong
                  population. The FMAAA will contact each potential volunteer to arrange
                  a tour of the Sierra Resource Campus to familiarize the individual with
                  the collocated agencies and organizations, and invite the individual to
                  accompany staff on an outreach event. Following these introductory
                  activities, the FMAAA will gauge the individual’s interest and availability
                  for outreach events; if favorable, the FMAAA will provide the volunteer
                  with ongoing topical training and assistance with scheduling Outreach
                  activities targeted for the Hmong community. This objective will begin in
                  fiscal year 2009-2010 and will continue through fiscal year 2011-2012.

                  Fiscal Year 2009-2010: Continuing

                  The FMAAA continues to work to identify volunteers to serve as peer
                  outreach liasions to the older adult Hmong population; however, to date
                  these efforts have not been successful.

        2.        Lesbian, Gay, Bisexual, and Transgender Community

                  Through meetings with local community groups, such as Community
                  Link and the Gray Alliance, the FMAAA is exploring opportunities for
                  outreach to older adults in the lesbian, gay, bisexual, and transgender
                  (LGBT) community.

                  The FMAAA will increase awareness of available services and
                  resources among older adults in the LGBT community by conducting
                  Outreach activities at four meetings or events presented by
                  organizations serving the LGBT population each fiscal year.

                  Fiscal Year 2009-2010: Continuing

                  The FMAAA provided information on programs and services to LGBT
                  members of the Fresno Stonewall Democrats Club and the United
                  Student Pride organization at California State University, Fresno.
                  Outreach was conducted at an Indigo Girls concert at Fresno’s Tower
                  Theater in July 2010, and a venue at upcoming meetings of the Lesbian
                  Breast Cancer Support Group has been requested.




Fresno-Madera Area Agency on Aging        Section 11 – Page 11             Fiscal Year 2010-2011
                                                                                Area Plan Update
B.      Information for Isolated Older Adults

        The FMAAA enhances Information and Assistance services for older adults who
        are socially or geographically isolated through the use of mass media.

        During each fiscal year, the FMAAA will provide information on programs and
        services for isolated older adults by completing the following activities:

                • Submit a minimum of nine articles for publication in local newspapers,
                  such as The Fresno Bee and The Madera Tribune;

                • Arrange for public service announcements, or be featured as a guest,
                  on four radio programs that broadcast in the Spanish and Hmong
                  languages;

                • Arrange for two instances of local television coverage featuring the
                  FMAAA’s programs or services; and

                • Conduct an annual review of the FMAAA Web site, FMAAA.org, to
                  determine areas requiring revision, and update the Web site on an
                  ongoing basis with outreach activity schedules, locations of cooling
                  and warming centers, governing board and advisory committee
                  meeting schedules, and other information of topical and seasonal
                  interest.

        Fiscal Year 2009-2010: Continuing

        The FMAAA arranged for ongoing inclusion of the agency’s contact information
        in the Senior Resources section of The Fresno Bee and in senior center
        newsletters. A press release on the California Senior Legislature was submitted
        to nine newspapers for publication. Additional article preparation was deferred,
        as administrative staff resources were needed to handle an increased contract
        administration and data reporting workload.

        On July 26, 2009, a news segment broadcast by KGBE, CBS Channel 47,
        featured FMAAA staff notifing case management clients of the availability of
        cooling centers. On April 6, 2010, two members of the FMAAA nutrition staff
        were featured guests on Univision 21, a Spanish-language television station.

        On November 23, 2009, an FMAAA staff member was a featured guest on
        KBIF 900 AM. The radio program, which highlighted FMAAA services and tips
        for family caregivers, was broadcast in the Hmong language. Public service
        announcements were provided to 11 radio stations, including KBIF 900 AM and
        KFSO 92.9 FM, which broadcasts in the Spanish language.

        FMAAA staff reviewed and updated the agency’s Web site monthly, posting
        InfoVan outreach schedules, governing board and advisory council meeting

Fresno-Madera Area Agency on Aging      Section 11 – Page 12           Fiscal Year 2010-2011
                                                                            Area Plan Update
        schedules, the agency’s Area Plan, cooling and warming center links, hot and
        cold weather tips, and sand bag information links.

C.      Community Education for Adults with Limited English Proficiency

        Printed information in languages other than English is available for several
        programs administered through the FMAAA. For example, the FMAAA’s Web
        page on emergency preparedness provides links to helpful information printed in
        six languages. Components of the Nutrition Education Program, Health
        Insurance Counseling and Advocacy Program, and disaster preparedness
        handouts are offered in the Spanish language. Verbal presentations in the
        individual’s native language encourage dialogue, offer a forum for questions and
        answers, and encompass individuals who may have limited literacy.

        1.      Central California Legal Services

                Central California Legal Services will conduct Community Education on
                elder abuse prevention in the Spanish and Hmong languages for older
                adults with limited English proficiency to inform them of their rights, help
                them identify incidences of abuse, and provide resources for reporting
                suspected abuse.

                During fiscal year 2009-2010, this objective will be accomplished by
                conducting 24 hours of Community Education in Spanish and 12 hours in
                Hmong.

                During fiscal years 2010-2011 and 2011-2012, Central California Legal
                Services will achieve this objective by conducting four Elder Abuse
                Prevention, Education, and Training sessions in Spanish and two in
                Hmong.

                Fiscal Year 2009-2010: Continuing

                Central California Legal Services anticipates meeting this objective by
                June 30, 2009. Spanish interpretation was provided at a well-attended
                educational event conducted at the Frank A. Bergon Center in Madera in
                January 2010. (See Goal 4, Objective B.2 for additional information on
                this event.) Efforts are underway for collaborative educational events with
                Univision 21, a Spanish-language television station, and with KQEQ
                1210 AM, Hmong-American Broadcasting.

        2.      Valley Caregiver Resource Center

                Valley Caregiver Resource Center (VCRC) will increase awareness and
                acceptance of programs and services among family caregivers and
                Medicare beneficiaries who speak Spanish. Each fiscal year, 12

Fresno-Madera Area Agency on Aging        Section 11 – Page 13             Fiscal Year 2010-2011
                                                                                Area Plan Update
                Community Education sessions will be conducted in Spanish for family
                caregivers, and 20 hours of Community Education will be provided in
                Spanish for older adults to inform them of Medicare insurance and
                prescription drug programs.

                Fiscal Year 2009-2010: Continuing

                VCRC presented 12 Community Education sessions in Spanish for family
                caregivers in Fresno and Madera counties, including the rural
                communities of Coalinga, Mendota, and Oakhurst. VCRC’s HICAP staff
                conducted 20 hours of Community Education in Spanish for Medicare
                beneficiaries in the two-county area, including the rural communities of
                Parlier, Mendota, Huron, Chowchilla, and Oakhurst.

D.      Caregiver Support Groups for Diverse Social and Ethnic Groups

        Sharing of challenges, successes, and ideas among family caregivers is greatly
        enhanced by participation in a support group of individuals with similar cultures
        and interests. VCRC offers special support groups to address the needs of
        these family caregivers.

        VCRC will conduct ongoing monthly support groups each fiscal year for family
        caregivers of diverse social and ethnic populations as follows:

                • The caregiver support group for Spanish speakers will meet once each
                  month at the Sierra Resource Campus in Fresno.

                • The men’s caregiver support group will convene once a month, also at
                  the Sierra Resource Campus.

                • A telephone support group will be offered once a month for family
                  caregivers who speak Spanish, targeting those who live in rural areas.

        Fiscal Year 2009-2010: Continuing

        VCRC’s caregiver support group for Spanish speakers met the last Friday of
        each month, with five to seven caregivers in attendance. The men’s caregiver
        support group met the third Monday of each month, with an average of five
        participants. The monthly telephone support group for family caregivers who
        speak Spanish currently has three participants; VCRC is working with rural
        congregate nutrition sites and the media to increase participation.




Fresno-Madera Area Agency on Aging       Section 11 – Page 14           Fiscal Year 2010-2011
                                                                             Area Plan Update
    Fresno-Madera Area Agency on Aging
  Area Plan Goals and Objectives

                      Goal 3
The Fresno-Madera Area Agency on Aging will
ensure the service system adequately addresses the
basic nutrition, housing, and transportation needs of
older individuals in the greatest economic and social
need through effective targeting, leveraging of funds,
and civic engagement.


 RATIONALE
 “Just as subjective ratings of health status are predicative of long term health
 outcomes, subjective experiences of resource deprivation may also be predictive of
 both health and mental health functioning. Our research has shown that there is
 accumulating evidence that perceived problems meeting basic needs play a unique
 role in the subsequent health and mental health of older adults.” (Natalie Sachs-
 Ericcson and Celia F. Hybels, “Perception of Unmet Basic Needs as a Predictor of
 Depressive Systems Among Community-Dwelling Older Adults,” Journal of
 Gerontology: Medical Sciences, 2007, Vol. 62A, No. 2, 191-195)

 “Mobility is critical to the well-being of California’s elderly and persons with
 disabilities. To live full lives and avoid social isolation, people must be able to access
 friends and relatives, health care services, shopping opportunities, and social and
 recreational activities. Given that transportation needs are directly related to land-
 use planning, alternative transportation services, driver safety education, “walkable”
 communities, and better access to public transportation need to be fully developed
 throughout California.” (Building an Aging Agenda for the 21st Century, California
 State Assembly Committee on Aging and Long Term Care, September 2006)

 “A significant percentage of older Californians face serious housing-related
 problems. Many people over age 65, burdened with high housing costs and living on
 fixed incomes are in need of affordable housing. As baby boomers age, more will
 seek ways to remain independent at home and in the community, pressing for
 policies that create and replicate new models of elderly housing options that
 integrate housing and supportive services, including access to home modifications
 and the expansion of Universal Design.” (Building an Aging Agenda for the 21st
 Century, California State Assembly Committee on Aging and Long Term Care,
 September 2006)



Fresno-Madera Area Agency on Aging       Section 11 – Page 15             Fiscal Year 2010-2011
                                                                               Area Plan Update
                                       PROJECTED                   TITLE III B
  OBJECTIVES – GOAL 3                  START          PROJECTED    FUNDED
                                       DATE           END DATE     PD OR C           STATUS
 A.       Home-Delivered Meals
     1.   Stepping Stone Program       7/1/2009       6/30/2012                    Continuing
     2.   AniMeals Program             7/1/2009       6/30/2012         C          Continuing
 B.       Congregate Nutrition         7/1/2009       6/30/2012                    Continuing
 C.       Nutrition Education          7/1/2009       6/30/2012                    Continuing
 D.       Transportation
     1.   Fresno County Economic       7/1/2009       6/30/2012                    Continuing
          Opportunities Commission
     2.   City of Madera               7/1/2009       6/30/2012                    Continuing
 E.       Housing                      7/1/2009       6/30/2012         C          Continuing



A.        Home-Delivered Meals

          The Fresno-Madera Area Agency on Aging (FMAAA) provides home-delivered
          meals for older adults and adults with disabilities who are unable to prepare or
          shop for meals on their own. More than 439,000 meals are provided for over
          1,250 individuals in Fresno and Madera counties each year through this
          program.

          1.    Stepping Stone Program

                For older adults recovering from an injury or illness, provision of home-
                delivered meals can greatly impact the individual’s ability to recuperate in
                the home environment. Through the Stepping Stone Program, these
                individuals receive home-delivered meals for up to six weeks to assist
                them with their recovery.

                Each fiscal year, the FMAAA will help 20 older adults recuperate from an
                injury or illness in the comfort of their own homes by providing home-
                delivered meals on a short-term basis through the Stepping Stone
                Program, as program funding allows.

                Fiscal Year 2009-2010: Continuing

                Through the Stepping Stone Program, 20 older adults received home-
                delivered meals while recovering in their homes from an injury or illness.

Fresno-Madera Area Agency on Aging        Section 11 – Page 16              Fiscal Year 2010-2011
                                                                                 Area Plan Update
        2.      AniMeals Program

                In past years, the FMAAA has
                partnered with Canteen of
                Fresno and the HOPE Animal
                Foundation to conduct the
                AniMeals Program, providing
                recipients of home-delivered
                meals with pet food for their
                companion      animals.   The
                impact of the economy on
                donations      to    non-profit
                organizations, such as the
                HOPE Animal Foundation,
                may require that the program
                be scaled back or eliminated.

                The FMAAA, Canteen of Fresno, and the HOPE Animal Foundation will
                help older adults continue to enjoy the benefits of pet ownership by
                providing pet food for their companion animals. The need for this service
                will be determined by the FMAAA nutrition program coordinator during the
                client assessment process. Forty home-delivered meals clients will be
                targeted for participation in the AniMeals Program each fiscal year, as pet
                food donations from the HOPE Animal Foundation allow. (C)

                Fiscal Year 2009-2010: Continuing

                The AniMeals Program met all requests for food for companion animals
                from home-delivered meals clients in Fresno County. The FMAAA staff
                continues to include the need for this service as part of the Home-
                Delivered Meals Program assessment process, and anticipates reaching
                the goal of 41 participants by June 30, 2010.

B.      Congregate Nutrition

        The Congregate Nutrition Program provides over 225,000 lunches at 39 meal
        sites for more than 4,100 older adults each year in Fresno and Madera counties.

        During fiscal year 2008-2009, for the first time in the FMAAA’s history, Older
        Americans Act funding was not sufficient to meet the demand for Congregate
        Nutrition Program meals. For example, recent renovation of the Ted C. Wills
        Community Center in downtown Fresno enabled the center to greatly expand its
        activity programs, attracting older adults who reside throughout the community;
        however, without a correlating increase in funding, the City of Fresno was forced
        to tap other resources to continue meal provision.


Fresno-Madera Area Agency on Aging        Section 11 – Page 17            Fiscal Year 2010-2011
                                                                               Area Plan Update
        The FMAAA’s objective is to help older adults meet their nutritional requirements
        and decrease occurrences of social isolation by providing healthy lunches in a
        group setting at 39 established Congregate Nutrition Program meal sites for
        every individual who requests a meal and meets the program criteria, and to
        provide these meals throughout every month of each fiscal year.

        Fiscal Year 2009-2010: Continuing

        During the past two years, Congregate Nutrition Program meal site coordinators
        have struggled to stretch limited funding while maintaining program viability.
        Creative approaches to fill in the gaps, such as coordinating pot lucks and
        soliciting local businesses to sponsor lunch for a day, have worn thin,
        particularly at sites where the coordinator’s hours were reduced due to
        decreased local funding. Provision of American Recovery and Reinvestment Act
        of 2009 (ARRA) stimulus funding, coupled with one-time-only funds provided
        through the California Department of Aging, enabled the FMAAA to increase
        meal allocations for Congregate Nutrition Program meal sites and sustain
        several jeopardized site management positions. Allocations are estimated to be
        sufficient to offer the Congregate Nutrition Program at each meal site through
        the end of the fiscal year.

C.      Nutrition Education

        Incidences of several health indicators related to nutrition exceed the state
        average by more than ten percent for older residents of Fresno and Madera
        counties; these indicators include diabetes, heart disease, high blood pressure,
        and food insecurity. In addition, this population exceeded state averages for
        obesity and inadequate fruit and vegetable consumption. (Trends in the Health
        of Older Californians, UCLA Center for Health Policy Research, 2008)

        The FMAAA will help older adults make informed food choices that reduce the
        risk of diabetes, heart disease, high blood pressure, and obesity through
        provision of 6,400 nutrition education sessions each fiscal year by FMAAA
        nutrition staff and trained college interns. Of these, 3,300 will be conducted for
        recipients of meals under the Congregate Nutrition Program, and 3,100 will be
        provided for participants of the Home-Delivered Meals Program.

        Fiscal Year 2009-2010: Continuing

        Quarterly interactive sessions of Nutrition Education were conducted at each of
        the 39 Congregate Nutrition meal sites in Fresno and Madera counties, featuring
        information on incorporating fiber into the diet (including FiberOne cereal
        samples and coupons), food safety, and proper handling of leftovers. Dietetic
        interns from California State University, Fresno assisted FMAAA nutrition staff
        with preparations and conducting the sessions.

Fresno-Madera Area Agency on Aging      Section 11 – Page 18             Fiscal Year 2010-2011
                                                                              Area Plan Update
        Home-Delivered Meals participants were provided with brochures on chilled
        foods, food safety, fiber and diet (including FiberOne cereal samples and
        coupons), and Rethink Your Drink, a guide to choosing healthy beverages.

D.      Transportation

        The ability of older adults to access
        services they need to remain living
        independently in the community is
        greatly     determined      by   their
        transportation options. Individuals
        who are accustomed to traveling at
        will in their private vehicles and no
        longer have a drivers license are
        particularly vulnerable to social and
        geographic isolation. The FMAAA
        contracts with two service providers
        for transportation services.

        1.      Fresno County Economic Opportunities Commission

                The Fresno County Economic Opportunities Commission (EOC) provides
                transportation in wheelchair-accessible vehicles for a wide range of social
                service programs, such as the Central Valley Regional Center and the
                Head Start Program. The FMAAA contracts with the Fresno County EOC
                to provide door-to-door transportation for older adults to six congregate
                nutrition meal sites.

                The Fresno County EOC will provide 11,500 one-way trips each fiscal
                year for Congregate Nutrition Program participants who live within a two-
                mile radius of six designated meal sites, affording older adults an
                opportunity to socialize and meet their nutritional requirements. These
                sites include the:

                       • Del Rey Senior Center in the rural agricultural area located
                         southeast of Fresno;

                       • Pinedale Center in northeast Fresno;

                       • Hinton Center in southwest Fresno;

                       • Mosqueda Center in southeast Fresno;

                       • Ted C. Wills Center in downtown Fresno; and

                       • Fresno Interdenominational Refugee Ministries in central Fresno.


Fresno-Madera Area Agency on Aging        Section 11 – Page 19            Fiscal Year 2010-2011
                                                                               Area Plan Update
                Fiscal Year 2009-2010: Continuing

                Participants of six Congregate Meal sites were able to enjoy a nutritional
                meal and socialize with others as a result of receiving transportation from
                the Fresno County EOC. Despite unexpected closures of some sites
                during the December holidays, the Fresno County EOC was able to meet
                its objective.

        2.      City of Madera

                Dial-A-Ride services are offered by the City of Madera in lift-equipped
                vehicles for individuals who reside within a five-mile radius of downtown
                Madera. This curb-to-curb service is offered weekdays from 7:00 a.m. to
                6:30 p.m., Saturdays from 9:00 a.m. to 4:00 p.m., and Sundays from
                8:30 a.m. to 2:30 p.m.

                The city’s Madera Area Express fixed-route service operates wheelchair-
                accessible transit on two fixed routes from 7:00 a.m. to 6:30 p.m. on
                weekdays, and from 9:00 a.m. to 4:00 p.m. on Saturdays. The routes
                encompass Madera Community Hospital, Madera County offices, the
                Pan-American Center (a congregate nutrition meal site), shopping
                centers, and other popular destinations.

                The City of Madera will provide 68,000 one-way trips each fiscal year for
                older adults and adults with disabilities through its Dial-A-Ride and
                Madera Area Express transit systems, promoting social engagement and
                access to community services.

                Fiscal Year 2009-2010: Continuing

                Madera Area Express and Madera Dial-A-Ride provided over 68,000 one-
                way trips for older adults and adults with disabilities. According to the
                Madera County Short Range Transit Development Plan adopted in
                December 2009, medical and dental appointments are the most common
                trip destinations.

E.      Housing

        The FMAAA’s vision is to expand the Sierra Resource Campus in central Fresno
        to create a multi-modal housing community offering independent living, assisted
        living, and skilled nursing options in one location for older adults, adults with
        disabilities, and the community at large, with the Senior Resource Center
        serving as the hub. This development will help meet the demand for safe,
        affordable housing for older adults; incorporate Universal Design to support
        aging in place; offer supportive services and public transportation within walking

Fresno-Madera Area Agency on Aging        Section 11 – Page 20            Fiscal Year 2010-2011
                                                                               Area Plan Update
        distance; decrease social isolation through interaction with neighbors and
        participation in activities at the Senior Resource Center; and serve as a model
        community that can be replicated in other locations.

        The FMAAA staff will assist the FMAAA Foundation with promoting and
        advocating for creation of a multi-modal housing community on the Sierra
        Resource Campus by providing the following services each fiscal year, with the
        objective of identifying a developer or consortium to lead the project by June
        2012:

                • Schedule meetings and conduct presentations for potential partners;

                • Schedule and conduct tours of the Sierra Resource Campus for
                  potential partners; and

                • Generate and gauge community support through the use of surveys
                  administered by the FMAAA Advisory Council. (C)

        Fiscal Year 2009-2010: Continuing

        The FMAAA arranged for meetings with Supervisor Debbie Poochigian of the
        Fresno County Board of Supervisors in December 2010, Congressman Jim
        Costa of the U.S. House of Representatives in April 2010, and California State
        Assembly Member Juan Arambula in April 2010, followed by tours of the Sierra
        Resource Campus. FMAAA staff served on the board of directors and attended
        monthly meetings of TAT Management, which manages the Glen Agnes, Delno
        Terrace, and Masten Towers residential facilities for older adults in Fresno.
        Distribution of service priority surveys by the FMAAA Advisory Council began in
        January 2010 and will continue through fiscal year 2010-2011.




Fresno-Madera Area Agency on Aging      Section 11 – Page 21           Fiscal Year 2010-2011
                                                                            Area Plan Update
    Fresno-Madera Area Agency on Aging
  Area Plan Goals and Objectives

                      Goal 4
   The Fresno-Madera Area Agency on Aging
   will coordinate the continued development of
   an integrated, multi-disciplinary network of
   investigative and protective services for
   vulnerable older adults and adults with
   disabilities in Planning and Service Area 14.



 RATIONALE
 "California’s senior citizens not only bear a disproportionate share of reductions in
 health and home care services, but they are particularly vulnerable to abuse. This is
 not the time to rollback the oversight and protections provided by the Long Term
 Care Senior Ombudsman program, or to silence the voices of seniors.” (California
 Assemblymember Dave Jones (D-Sacramento), California Chronicle, March 10,
 2009)

 "The exploding incidences of abuse and exploitation of elders affects more than two
 million victims annually in this country. In the economic crisis, elders are at greater
 risk than ever to be targeted by scammers, unscrupulous family members,
 caregivers and even friends and neighbors. It is critical that we redouble our efforts
 to protect our most vulnerable population." (Jenefer Duane, Elder Financial
 Protection Network, Marketwire, March 6, 2009)

 “Elder financial abuse is commonly linked with other forms of abuse and neglect and
 threatens the health, dignity, and economic security of millions of older Americans. It
 is estimated to cost Americans tens of billions of dollars annually in health care,
 social services, investigative and legal costs, and lost income and assets. Elder
 financial abuse is a problem in every community and among all social strata. It is
 underrecognized, underreported, and underprosecuted.” (Broken Trust: Elders,
 Family, and Finances, MetLife Mature Market Institute, March 2009)




Fresno-Madera Area Agency on Aging     Section 11 – Page 22             Fiscal Year 2010-2011
                                                                             Area Plan Update
                                       PROJECTED                   TITLE III B
  OBJECTIVES – GOAL 4                  START          PROJECTED    FUNDED
                                       DATE           END DATE     PD OR C           STATUS
 A.       Long Term Care                7/1/2009      6/30/2012                    Continuing
          Ombudsman
 B.       Community Education
     1.   Fresno County Sheriff’s       7/1/2009      6/30/2012                    Continuing
          Department
     2.   Central California Legal      7/1/2009      6/30/2012                    Continuing
          Services
 C.       Multi-Media Approach to       7/1/2009      6/30/2012         C          Continuing
          Elder Abuse Prevention



A.        Long Term Care Ombudsman

                                                   In September 2008, state funding for
                                                   the Long Term Care Ombudsman
                                                   Program, which constituted almost half
                                                   of the program’s overall funding, was
                                                   eliminated, retroactive to July 1, 2008.
                                                   The effects of this severe budget cut
                                                   continue to reverberate throughout the
                                                   state, with many local Ombudsman
                                                   programs reducing staff and services,
                                                   and some considering closure.

                                                  The Fresno-Madera Area Agency on
                                                  Aging (FMAAA) is committed to
                                                  protecting the rights of residents of long
                                                  term care facilities, who are especially
                                                  vulnerable to neglect and abuse.
                                                  Through     the    Long     Term     Care
                                                  Ombudsman Program, administered in
                                                  Fresno and Madera counties by Valley
                                                  Caregiver Resource Center (VCRC),
                                                  these individuals have a voice. Their
                                                  complaints are listened to and resolved
                                                  by trained staff and volunteers, who
          maintain an ongoing presence in skilled nursing and residential care facilities.
          Ombudsmen also serve as witnesses to advance health care directives and
          advocate for the rights of residents. The FMAAA will continue to strive to keep
          the Long Term Care Ombudsman Program fully functioning each fiscal year.


Fresno-Madera Area Agency on Aging        Section 11 – Page 23              Fiscal Year 2010-2011
                                                                                 Area Plan Update
        In addition to providing complaint resolution and community education services,
        the Long Term Care Ombudsman Program administered by VCRC will help
        ensure that residents of long term care facilities, their families, and their friends
        are aware of the program’s services by conducting 16 outreach and marketing
        activities each fiscal year. Program staff will submit articles for publication in
        local newspapers and newsletters of non-profit organizations; update the
        program’s Web site each month with training schedules and current lists of
        Residential Care Facilities for the Elderly and Skilled Nursing Facilities; and
        promote the program at meetings of providers of services for older adults, such
        as the Elder Abuse Round Table.

        Fiscal Year 2009-2010: Continuing

        VCRC met its objective, providing articles on the Long Term Care Ombudsman
        Program to The Fresno Bee and the RSVP newsletter, updating the program’s
        Web site with topical information, and promoting the program at meetings of The
        Aging Network, The Senior Living Network, and the Elder Abuse Round Table,
        and family members of residents of long-term care facilities.

B.      Community Education

        Through contracts for Community Education with the Fresno County Sheriff’s
        Department and Central California Legal Services, the FMAAA promotes
        awareness, prevention, and reporting of elder abuse.

        1.      Fresno County Sheriff’s Department

                Operating from the Senior Resource Center in Fresno, the special elder
                abuse detective of the Fresno County Sheriff’s Department conducts
                presentations that are specifically targeted for law enforcement agencies
                and emergency first responders, providing the practical information they
                need to identify, report, and prevent elder abuse. In addition to public
                safety personnel, staff of ambulance companies and volunteer fire
                departments receive this important training. The detective also
                collaborates with Adult Protective Services and the James Rowland
                Crime Victim Assistance Center staff to conduct joint presentations, and
                is popular with community groups as a guest speaker. By partnering with
                the FMAAA Information and Assistance staff, the detective adds impact to
                outreach activities at health fairs, presentations at apartment and mobile
                home communities for older adults, and community events.

                The Fresno County Sheriff’s Department’s special elder abuse detective
                will further the prevention of elder abuse by providing Community
                Education for public safety personnel, first responders, social services
                staff, and community groups as follows: Fiscal year 2009-2010, 125
                hours; and fiscal years 2010-2011 and 2011-2012, 40 activities each
                year.


Fresno-Madera Area Agency on Aging        Section 11 – Page 24             Fiscal Year 2010-2011
                                                                                Area Plan Update
                Fiscal Year 2009-2010: Continuing

                The Fresno County Sheriff’s Department’s special elder abuse detective
                provided training for public safety and first responder staff in the rural
                communities of Auberry, Coalinga, Hume, Squaw Valley, and Shaver
                Lake, as well as in Fresno and Madera. Older adults learned about elder
                abuse during presentations conducted at four community and senior
                centers in Madera County and at ten senior residential facilities in Fresno
                County. Presentations were also conducted for community groups,
                church members, veterans, and social service providers. In all, over 125
                hours of Community Education on elder abuse were provided for over
                800 individuals.

        2.      Central California Legal Services

                Central California Legal Services (CCLS) makes use of a variety of
                venues to address elder abuse. Agencies and service providers serving
                older adults convene to exchange current topics, explore solutions, and
                learn from guest speakers at quarterly Elder Abuse Round Table
                meetings held at the Senior Resource Center. Educational presentations
                are conducted for older adults at community and senior centers. CCLS
                organizes the annual Elder Abuse Prevention Conference, which is held
                each May in downtown Fresno, drawing older adults, law enforcement
                agencies, and social service providers to workshops and discussion
                forums led by experts in the field. The conference is jointly sponsored by
                CCLS, the FMAAA, the Fresno County Bar Association, and the Elder
                Abuse Round Table.

                Central California Legal Services will advance awareness of elder abuse
                issues by providing 275 hours of Communition Education during fiscal
                year 2009-2010, and 43 sessions of Elder Abuse Prevention, Education,
                and Training during fiscal years 2010-2011 and 2011-2012. This will be
                accomplished by featuring guest speakers at quarterly meetings of the
                Elder Abuse Round Table, conducting presentations for older adults at
                community and senior centers, and coordinating logistics and presenting
                expert speakers for the annual Elder Abuse Prevention Conference.

                Fiscal Year 2009-2010: Continuing

                Central California Legal Services is on target for meeting its Community
                Education objective.

                Featured speakers and topics at Elder Abuse Round Table sessions
                included Fresno County District Attorney Tim Donovan on the newly
                established Fresno County Elder Death Review Team; members of the
                board of Elder Abuse Services, Inc. on emergency housing for victims of


Fresno-Madera Area Agency on Aging        Section 11 – Page 25            Fiscal Year 2010-2011
                                                                               Area Plan Update
                elder abuse; former elder abuse district attorney Jeff Hammerschmidt on
                community-based assisted living; and staff from Fresno County Adult
                Protective Services, who provided an overview of cases handled by their
                agency.

                On January 8, 2010, Central California Legal Services conducted a well-
                publicized event at the Frank A. Bergon Center in Madera. Three staff
                attorneys, two support staff, nine law students from the University of San
                Francisco, and three pro-bono attorneys presented information on a wide
                spectrum of legal issues facing older adults, including financial abuse,
                elder abuse restraining orders, advance health care directives, housing,
                and wills. Staff from the Public Interest Clearing House in San Francisco,
                a major collaborative partner for this event, recruited and trained the law
                students, worked with Central California Legal Services to set up the
                event, and accompanied the students to Madera on January 8th.
                Attendees were offered and provided with legal assistance. (See Goal 5,
                Objective A.4 for additional information.)

                On April 19, 2010, Central California Legal Services presented an
                educational event in the rural mountain community of Oakhurst featuring
                guest speaker Prescott Cole, senior staff attorney for Californians for
                Nursing Home Reform. Topics included trust mills, veterans aid and
                assistance scams, unsuitable annuities, and reverse mortgages. A typical
                sales seminar targeted for seniors was deconstructed, with an analysis of
                the techniques used by professional financial predators. The program
                also provided an overview of California’s long-term health care program
                and estate planning for older adults with low wealth.

                Six general informational presentations were conducted for older adults at
                the Clovis Senior Center, as well as special educational presentations on
                HMO grievances conducted in Parlier, Del Rey, and Fresno.

                The Elder Abuse Prevention Conference was renamed Senior Awareness
                Day to increase interest and participation. Conducted on May 7, 2010 at
                the Radisson Hotel in Fresno, the event featured Justice Charles S.
                Poochigian, Fifth Appellate District Court of Appeals, as the keynote
                speaker. Presenters included Prescott Cole of Californians for Nursing
                Home Reform on “Understanding Long Term Care and How to Pay for It,”
                James Waterman of SeniorCare Organizational Systems on “Safety
                Issues to Consider When Choosing Senior Care,” and Bonnie Bollwinkle
                of the Alzheimer’s Association of Northern California on “Compassionate
                Communication and Challenging Behavior.”




Fresno-Madera Area Agency on Aging        Section 11 – Page 26            Fiscal Year 2010-2011
                                                                               Area Plan Update
C.      Multi-Media Approach to Elder Abuse Prevention

        The Scamnot project, a cooperative effort between the FMAAA and the Fresno
        County Sheriff’s Department, proactively informs older adults of scams reported
        in the local area. Individuals subscribing to Scam Alerts receive real-time
        notification via e-mail of fraudulent activities directed to older adults. The
        Scamnot.org Web site lists incidences of local scams, contains educational
        information on elder abuse, advises where to call to report suspected incidences
        of abuse, and links to the FMAAA and other helpful resources.

        The FMAAA and the special elder abuse detective of the Fresno County
        Sheriff’s Department will work together each fiscal year to reduce incidences of
        elder abuse by:

                • Conducting daily reviews of local newspapers and crime reports;

                • Fielding telephone calls from the public regarding potential scams;

                • Referring incidences of suspected fraudulent activity to appropriate law
                  enforcement agencies;

                • Generating e-mails through the Scam Alert system to notify
                  subscribers of scams as they occur;

                • Providing press releases on scams to the Fresno County Sheriff’s
                  Department’s public information officer for submission to local media;

                • Reviewing and updating the Scamnot.org Web site once a month; and

                • Promoting the Scamnot project through speaking engagements at
                  meetings of community organizations and providers of services for
                  older adults. (C)

        Fiscal Year 2009-2010: Continuing

        Daily reviews of The Fresno Bee and newsfeeds from The National Center on
        Elder Abuse, as well as weekly reviews of newsfeeds from The National
        Association of Bunco Investigators, informed the FMAAA and the special elder
        abuse detective of the Fresno County Sheriff’s Department of incidences of
        elder abuse and scams that warranted public alerts. Sixteen such notifications
        were generated in the July 2009 through March 2010 time frame to the 374
        e-mail subscribers of Scam Alert, and nine press releases featuring scams of
        local interest were forwarded to the Fresno County Sheriff’s Department for
        dissemination to the public. Forty-three suspicous e-mails were forwarded from
        the FMAAA to the special elder abuse detective of the Fresno County Sheriff’s
        Department for review; of these, seven were subsequently referred to the
        Internet Crime Complaint Center (IC3, a partnership between the Federal

Fresno-Madera Area Agency on Aging       Section 11 – Page 27            Fiscal Year 2010-2011
                                                                              Area Plan Update
        Bureau of Investigation, the National White Collar Crime Center, and the Bureau
        of Justice Assistance) for further investigation.

        The FMAAA reviewed the Scamnot.org Web site an average of twice per month,
        posting new scam information, verifying Web links, and updating other content
        as needed. The Scamnot.org Web site was the focus of a pod cast presented on
        the nationally syndicated radio show Police on the Scene in August 2009.

        In addition to the Community Education sessions on elder abuse conducted by
        the special elder abuse detective of the Fresno County Sheriff’s Department
        (see Goal 4, Objective B.1), the detective and the FMAAA partnered to conduct
        a well-attended presentation on scams, fraud, and elder abuse at the Madera
        Community Forum on Elder Abuse on March 17, 2010.




Fresno-Madera Area Agency on Aging     Section 11 – Page 28           Fiscal Year 2010-2011
                                                                           Area Plan Update
    Fresno-Madera Area Agency on Aging
  Area Plan Goals and Objectives

                      Goal 5
 The Fresno-Madera Area Agency on Aging will
 promote activities for older adults in Planning and
 Service Area 14 that enhance their quality of life
 in their communities.



 RATIONALE
 Incidences of high blood pressure, heart disease, incontinence, diabetes, sedentary
 lifestyle, and asthma among residents of Fresno and Madera counties aged 65 or
 over exceed state averages by ten or more percentage points. (Trends in the Health
 of Older Californians, UCLA Center for Health Policy Research, 2008)

 “A study conducted by the University of Chicago Medical Center in 2008 found that
 one in 25 older adults are at risk for serious drug interactions; this risk increased to
 one in ten for men who are 75 to 85 years of age.” (Deborah L. Shelton, “Elderly prone
 to drug interaction,” The Fresno Bee, December 24, 2008)

 “It is imperative that federal agencies like the Administration on Aging and its national
 partners continue to seek innovative and effective ways to support state and local
 efforts that maintain seniors in their homes and communities for as long as possible.
 Legal assistance and elder rights programs funded by the Older Americans Act and
 other federal, state, and local resources continue to demonstrate indispensable value
 in protecting seniors facing the most extreme challenges to their independence and
 well-being.” (Omar Valverde, “Administration on Aging Recognizes Essential Role of
 Legal Assistance Programs in Helping Seniors Keep Their Home,” BIFOCAL, Journal
 of the American Bar Association Commission on Law and Aging, February 2009,
 Vol. 30, No. 3)

 “When pressed to name the single most important reason that they are working now,
 more than one in three (37%) mature workers in almost all income levels cited the
 need for money.” (Staying Ahead of the Curve 2007, The AARP Work and Career
 Study, AARP Knowledge Management, September 2008)

 “People who are embedded in a network of personal relationships experience a higher
 level of well-being than those who are socially isolated and they also tend to be
 healthier.” (Professor dr. Anja Machielse, Social Isolation and the Elderly: Causes and
 Consequences, Utrecht University, The Netherlands, 2006)

Fresno-Madera Area Agency on Aging      Section 11 – Page 29              Fiscal Year 2010-2011
                                                                               Area Plan Update
                                            PROJECTED                  TITLE III B
  OBJECTIVES – GOAL 5                       START          PROJECTED   FUNDED
                                            DATE           END DATE    PD OR C           STATUS
 A.          Home and Community
             Based Supportive Services
      1.     Adult Day Care
           a. Valley Caregiver Resource     7/1/2009       6/30/2012                   Continuing
              Center
           b. City of Madera                7/1/2009       6/30/2012                   Continuing
      2.     Case Management                10/1/2009      6/30/2012                   Continuing
      3.     In-Home Services               7/1/2009       6/30/2010                   Completed
      4.     Legal Assistance               7/1/2009       6/30/2012                   Continuing
 B.          Disease Prevention and
             Health Promotion
      1.     Valley Caregiver Resource      7/1/2009       6/30/2012                   Continuing
             Center
      2.     Madera County Public           7/1/2009       6/30/2012                   Continuing
             Health Department
 C.          Multipurpose Senior
             Services Program
      1.     Care Management                7/1/2009       6/30/2012                   Continuing
      2.     Healthy Moves for Aging        7/1/2009       6/30/2010                   Completed
 D.          Senior Community Service       7/1/2009       6/30/2012                   Continuing
             Employment Program

 E.          Older Americans                7/1/2009       6/30/2012        C          Continuing
             Month/Celebration of Living

 F.          Intergenerational Activities
      1.     Operation Shoe Box             7/1/2009       6/30/2012        C          Continuing
      2.     Caring Cards                   7/1/2009       6/30/2012        C          Continuing
 G.          Green Initiative               7/1/2009       6/30/2010       PD          Completed
                                            7/1/2010       6/30/2012        C            New




Fresno-Madera Area Agency on Aging             Section 11 – Page 30             Fiscal Year 2010-2011
                                                                                     Area Plan Update
 A.      Home and Community Based Supportive Services

         1.     Adult Day Care
                Adult Day Care offers supervised social
                and recreational services in a safe and
                supportive environment for individuals
                aged 60 or over who are in need of
                assistance with two or more activities of
                daily living, such as eating, transferring,
                or walking. Participants enjoy social
                and recreational activities, as well as
                assistance with daily activities, while
                their caregivers are able to continue
                working outside of the home or obtain a
                reprieve from the ongoing demands of
                their caregiving responsibilities.

                The Fresno-Madera Area Agency on
                Aging (FMAAA) contracts with Valley
                Caregiver Resource Center (VCRC) for
                operation of two Adult Day Care
                centers on the Sierra Resource
                Campus in Fresno, and with the City of Madera’s Older Adult Services
                division for provision of services at the Madera Adult Day Care and
                Respite Center. All three centers are open weekdays from 7:30 a.m. to
                5:30 p.m. to accommodate work schedules of family caregivers.

                a.      Valley Caregiver Resource Center

                        VCRC’s Older Adult Social Services (OASIS) Program is building
                        upon its successful day care program by promoting three
                        additional short-term adult day care options: 1) a reservation
                        system whereby a caregiver can reserve from three to ten hours of
                        day care with one day’s notice; 2) a half-day program running
                        weekdays from 7:30 a.m. to 11:30 a.m. or from 1:00 p.m. to
                        5:00 p.m.; and 3) a five hour program from 9:30 a.m. to 2:30 p.m.
                        the first Saturday of each month, with an increase in hours or
                        additional Saturdays as demand warrants.

                        VCRC will provide 14,575 hours of Adult Day Care each fiscal year
                        for older adults in need of supervised care through the OASIS
                        Program at its two Adult Day Care centers located on the Sierra
                        Resource Campus in Fresno.



Fresno-Madera Area Agency on Aging         Section 11 – Page 31         Fiscal Year 2010-2011
                                                                             Area Plan Update
                        Fiscal Year 2009-2010: Continuing

                        VCRC consolidated operations of its two Adult Day Care centers
                        into one facility to maintain cost-effectiveness of the program
                        following the state’s cessation of funding for the Alzheimer's Day
                        Care Resource Center Program, and met its objective of providing
                        14,575 hours of service. The center operates from 7:30 a.m. to
                        5:30 p.m. weekdays, and now offers “drop-in” day care for clients
                        who do not need a full day of care.

                b.      City of Madera

                        Program staff at the Madera Adult Day Care and Respite Center
                        have noted increasing requests for day care for older adults who
                        are frail, but do not have a cognitive impairment, as the family
                        caregiver does not feel comfortable leaving their relative at home
                        alone. The center has begun conducting field trips to local senior
                        centers for participants with mild cognitive impairments to engage
                        them in activities such as crafts and bingo, decreasing their social
                        isolation.

                        The City of Madera’s Older Adult Services division will provide
                        6,000 hours of Adult Day Care each fiscal year for older adults in
                        need of supervised care at the Madera Adult Day Care and
                        Respite Center.

                        Fiscal Year 2009-2010: Continuing

                        The City of Madera exceeded its objective for provision of Adult
                        Day Care at the Madera Adult Day Care and Respite Center for
                        older adults in need of supervision.

         2.     Case Management

                When state funding for the Linkages Program ended on September 30,
                2009, 65 program participants aged 60 or older were left in need of Case
                Management services. The FMAAA arranged to transition these
                individuals to the Title III B Supportive Services Program, utilizing the
                clients’ existing FMAAA Linkages case managers to ensure seamless
                continuation of Case Management services.




Fresno-Madera Area Agency on Aging        Section 11 – Page 32             Fiscal Year 2010-2011
                                                                                Area Plan Update
                The FMAAA will assess needs, develop care plans, and arrange services
                for vulnerable older adults to ensure the highest quality of life in a home
                environment. A minimum of 2,000 hours of Case Management services
                will be provided by FMAAA case managers through the Title III B
                Supportive Services Program each fiscal year.

                Fiscal Year 2009-2010: Continuing

                The FMAAA anticipates exceeding this objective, due to successful
                transition of former Linkages clients into the Title III B Supportive Services
                Case Management Program and rapid rebuilding of the case load by the
                program’s two case managers.

         3.     In-Home Services
                With the right assistance, older adults at risk of losing their independence
                can continue to enjoy the benefits of living in their own home. Help with
                preparing meals, shopping, housework, and yard work presents the older
                individual with this option, while ongoing visits provide reassurance.
                Respite care ensures that older individuals receive necessary supportive
                services during a caregiver’s temporary absence.

                VCRC will offer Chore, Homemaker, Respite Care, and Visiting services
                to contribute to the independence of older adults. Services will be
                provided with one-time-only funds during fiscal year 2009-2010 as
                follows:

                        •   Chore, 133 Hours;
                        •   Homemaker, 560 Hours;
                        •   Respite Care, 912 Hours; and
                        •   Visiting, 60 Hours.

                Fiscal Year 2009-2010: Completed

                VCRC is on target for meeting its in-home services objectives. Chore and
                Homemaker services are being promoted to faith-based organizations.
                Respite Care is offered one Saturday per month in Fresno, and each
                Tuesday in the rural mountain community of Oakhurst. Visiting is
                conducted by a staff member who is bilingual in English and Spanish, and
                is also a trained ombudsman for the Long Term Care Ombudsman
                Program. During each visit to the client’s home, VCRC conducts a safety
                check, correcting any identified safety hazards that can be easily
                resolved, and providing recommendations and referrals for those
                requiring more complex solutions.




Fresno-Madera Area Agency on Aging        Section 11 – Page 33              Fiscal Year 2010-2011
                                                                                 Area Plan Update
         4.     Legal Assistance

                Requests for assistance with housing issues dominate all other legal
                matters handled by Central California Legal Services (CCLS) on behalf of
                older adults with low income. CCLS also helps these individuals resolve
                debt collection issues, file public benefit claims, prepare wills and trusts,
                prepare advance health care directives, prepare income tax returns,
                obtain guardianship of their grandchildren, and address other legal
                matters.

                CCLS will help protect the rights of older adults with low income by
                providing 800 hours of legal assistance at no charge for these individuals
                each fiscal year. CCLS will achieve this objective by:

                        • Offering legal intake sessions on a monthly basis in Clovis and
                          Madera;

                        • Assisting older adults with applying for tax credits and refunds,
                          with a particular focus on individuals with limited English
                          proficiency;

                        • Conducting Senior Volunteer Day at the CCLS office in
                          downtown Fresno each month, where older adults can obtain a
                          pro bono consultation with an attorney on the spot;

                        • Collaborating with the Fresno County Superior Court and the
                          Fresno County Law Library to provide guardianship clinics for
                          grandparents seeking guardianship of their grandchildren;

                        • Collaborating with the Fresno County Superior Court to provide
                          volunteer attorneys to assist victims of elder abuse during the
                          special calendar of the court; and

                        • Collaborating with the San Joaquin College of Law and the
                          Clovis Senior Center to offer Senior Law Day, another
                          opportunity for older adults to receive legal assistance free of
                          charge.

                Fiscal Year 2009-2010: Continuing

                Central California Legal Services offered legal intake sessions in Clovis
                an average of once per month, and in Madera on the third Thursday of
                each month.

                Eighty older adults, of which 28% were Spanish speakers, were provided
                with assistance filing their 2009 federal and state tax returns.

Fresno-Madera Area Agency on Aging        Section 11 – Page 34             Fiscal Year 2010-2011
                                                                                Area Plan Update
                Central California Legal Services conducted Senior Law Day at the San
                Joaquin College of Law on September 12, 2009, with registration handled
                by Clovis Senior Center staff. Workshops offered assistance with wills
                and trusts; using family mediation in the estate planning process;
                grandparents as guardians; legal documents used in emergencies;
                qualifying for veterans benefits; Medi-Cal and saving assets; and
                palliative care versus hospice care.

                In response to low attendance at Senior Volunteer Day events held in
                downtown Fresno, Central California Legal Services shifted the focus to
                bringing volunteer attorneys out into the older adult community, providing
                educational presentations followed by on-the-spot legal assistance. Over
                40 older adults requested and received individual legal assistance on
                matters including wills, advance health care directives, and bankruptcy at
                an educational event conducted in January at the Frank A. Bergon Center
                in Madera. An attendee indicated that his father, a mono-lingual Spanish
                speaker, needed assistance with an advance health care directive; an
                attorney and interpreter were dispatched immediately to the father’s home
                to prepare the directive. Legal assistance was also provided for older
                adults attending a similar educational event in Oakhurst in April 2010.

                Guardianship clinics were conducted the third Thursday of each month.
                Of those attending the clinics, three individuals aged 65 or over requested
                and received additional legal assistance from Central California Legal
                Services.

                Ramp-up of the program to assist victims of elder abuse during the
                special calendar of the court took place during July-December 2009.
                Central California Legal Services worked with staff from the Fresno
                County Superior Court to develop protocols, obtain Memorandums of
                Understanding, and pursue additional grant funding opportunities for the
                Elder Abuse Access to Justice Partnership, for which a grant was
                awarded in December 2009. In February 2010, Central California Legal
                Services began offering legal assistance to older adults from an office at
                the Fresno County Courthouse on Mondays, Wednesdays, and
                Thursdays from 9:00 a.m. to 4:00 p.m. Through this program, older adults
                receive assistance with preparation and processing of elder abuse
                restraining orders, and are accompanied to court proceedings.

 B.      Disease Prevention and Health Promotion

         The FMAAA contracts with VCRC and the Madera County Public Health
         Department to help reduce the prevalence of high blood pressure, heart
         disease, diabetes, asthma, poor nutrition, a sedentary lifestyle, and other
         indicators of poor health among older residents of Fresno and Madera counties
         through provision of practical information, tools, and support.



Fresno-Madera Area Agency on Aging       Section 11 – Page 35            Fiscal Year 2010-2011
                                                                              Area Plan Update
         1.     Valley Caregiver Resource Center

                The array of programs provided by VCRC provides staff and volunteers
                with daily opportunities for one-on-one interaction with Medicare
                beneficiaries, residents of long term care facilities, family caregivers, and
                individuals seeking information on behalf of a friend or family member in
                need of services. Staff from VCRC’s Family Caregiver Support, Health
                Insurance Counseling and Advocacy, Long Term Care Ombudsman,
                Alzheimer's Day Care Resource Center, and OASIS programs conduct
                educational sessions at senior and community centers, housing facilities
                for older adults, churches, health fairs, and community events throughout
                Fresno and Madera counties, with special emphasis on older adults who
                reside in rural and underserved areas. Because of these ongoing
                encounters, VCRC is uniquely positioned to identify individuals in need of
                disease prevention and health promotion services.

                VCRC will help older adults ensure effective use of health services and
                resources and inform them of preventive measures to avoid disease or
                manage an existing health condition.

                During fiscal year 2009-2010, this will be accomplished through provision
                of the following services:

                Medication Management       700 Sessions
                Counseling                  700 Hours
                Family Support              140 Sessions
                Home Security               50 Clients
                Information                 500 Individuals
                Outreach                    700 Contacts
                Community Education         50 Hours
                Nutrition Education         125 Sessions

                During fiscal years 2010-2011 and 2011-2012, the following services will
                be provided to achieve VCRC’s Disease Prevention and Health
                Promotion objectives:

                Medication Management                            700 Contacts
                Nutrition Education                              125 Sessions
                Disease Prevention and Health Promotion          1,200 Contacts



Fresno-Madera Area Agency on Aging        Section 11 – Page 36             Fiscal Year 2010-2011
                                                                                Area Plan Update
                Fiscal Year 2009-2010: Continuing

                VCRC met its Disease Prevention and Health Promotion objectives.

                Medication Management was provided on an individual basis with older
                adults during in-home assessments for VCRC programs and with family
                caregivers following support group meetings. During these sessions,
                VCRC provided the File of Life® and assisted clients with entering their
                medications on the form, stressed the need to take medications in the
                frequencies prescribed by the physician, encouraged individuals who
                indicated alcohol consumption to discuss their alcohol use with their
                physician, and assisted these clients with understanding the interaction of
                alcohol with their prescribed medications.

                VCRC offered Counseling to older adults in their homes following
                assessments conducted for VCRC programs. The need for counseling on
                health services and programs was also identified during VCRC’s
                interactions with HICAP beneficiaries, caregivers, and Adult Day Care
                clients, and following educational presentations conducted by VCRC staff
                throughout Fresno and Madera counties.

                The need for Family Support was identified and arranged during
                interactions with families of recipients of Adult Day Care services, families
                of residents of long-term care facilities, family caregivers following
                caregiver support group meetings, and individuals attending educational
                presentations conducted by VCRC staff.

                VCRC assisted over 50 family caregivers with creating a safer
                environment for the care recipient through provision of Home Security
                services. Smoke detectors, grab bars, and garage alerts, which are less
                expensive than a full security system, proved to be effective solutions to
                the most frequently identified safety issues.

                VCRC’s Information objective was met by providing health information to
                caregivers attending classes and workshops, distributing health
                information at HICAP and Family Caregiver Support Program
                presentations, and staffing a table in the lobby of the Community Cancer
                Center in Fresno the first Tuesday of each month.

                VCRC met its Outreach objective by interacting with older adults and
                family caregivers at health fairs in Fresno and Madera counties, and at
                the Disability Awareness Day in Fresno, encouraging use of available
                programs and services that promote good health.

                VCRC provided Community Education on health-related issues and
                services for groups of older adults at congregate nutrition meal sites.
                Exercise and healthy eating were emphasized at VCRC’s individual
                Nutrition Education sessions for older adults at senior centers in Madera,

Fresno-Madera Area Agency on Aging        Section 11 – Page 37             Fiscal Year 2010-2011
                                                                                Area Plan Update
                Oakhurst, and Coalinga, and for family caregivers at support group
                sessions in Kingsburg, Fresno, Madera, and Oakhurst.

         2.     Madera County Public Health Department

                The Madera County Public Health Department has established a
                presence among older adults throughout the rural and urban areas of
                Madera County, visiting senior and community centers, health clinics,
                church groups, and apartment complexes, as well as offering services
                through its office in Madera and at community events.

                Medication Management services provided by the Madera County Public
                Health Department include one-on-one screening of medications and
                provision of pill boxes and medication record booklets. The service is
                offered to older individuals attending flu clinics and to those receiving
                health risk assessments.

                Health education is augmented through the Madera County Public Health
                Department’s partnership with California State University, Fresno.
                Nursing interns from California State University, Fresno assist department
                staff with operating information tables at the Madera District Fair in
                September, Madera’s annual Picnic in the Park in May, and the Madera
                Swap Meet during the summer months. Topics including the relationship
                of nutrition and exercise to good health and fall prevention, high blood
                pressure, heart disease, diabetes, asthma, and flu prevention.

                Staff from the Madera County Public Health Department travel to 15 sites,
                including the mountain communities of North Fork and Oakhurst, the
                foothill communities of Coarsegold and Raymond, the surburban
                communities of Madera Ranchos and Chowchilla, and within the Madera
                urban area to provide health risk assessments and screenings to help
                ensure the good health of older adults. Specialized clinics, including
                screening for breast cancer, prostate cancer, and osteoporosis, are
                offered each month in Madera and Oakhurst. Each individual’s health
                needs are evaluated to determine the necessary supportive or other
                appropriate services to meet their needs.

                The Madera County Public Health Department will assist older adults with
                maintaining or improving their health by decreasing incidences of adverse
                drug reactions, providing early detection of disease, and providing
                education on health-related topics.

                During fiscal year 2009-2010, this will be accomplished through provision
                of the following services:




Fresno-Madera Area Agency on Aging       Section 11 – Page 38            Fiscal Year 2010-2011
                                                                              Area Plan Update
                Medication Management            50 Sessions
                Community Education              20 Hours
                Comprehensive Assessment         100 Hours

                During fiscal years 2010-2011 and 2011-2012, the following services will
                be provided to achieve the Madera County Public Health Department’s
                Disease Prevention and Health Promotion objectives:

                Medication Management                           50 Contacts
                Disease Prevention and Health Promotion         275 Contacts

                Fiscal Year 2009-2010: Continuing

                The Madera County Public Health Department is on track to meet its
                Disease Prevention and Health Promotion objectives by the end of the
                fiscal year.

                Medication Management services were offered to older adults receiving
                Comprehensive Assessments and attending health fairs, farmers
                markets, and health education presentations. Medication management
                record booklets, health education handouts, and program fliers were
                provided as part of the medication counseling sessions.

                Partnership and mentorship with the California State University, Fresno
                Nursing Program continues. Staff nurses help students learn more about
                the health of older adults through shadowing and clinical observation.
                Students provide Community Education for older adults on hypertension,
                adult vaccination, osteoporosis and fall prevention, and arthritis.
                Education was provided at nutrition sites and senior housing complexes
                located throughout Madera County, the Madera District Fair, the Picnic in
                the Park event, the Madera Swap Meet, and the Madera Farmers Market,
                at which 150 Senior Farmers Market Program coupons were distributed.
                In addition, oral presentations and health program flyers were presented
                to older adults attending seasonal and H1N1 flu vaccination clinics.

                Comprehensive Assessments were conducted at ten sites in Madera
                County. Specialized clinics for Pap smears, breast exam screenings, and
                prostate examinations were offered at the Madera County Public Health
                Department’s facility in Madera. Program fliers and brochures were
                distributed during each clinic. Women who were 60 years of age or over
                and in need of breast health services (e.g. mammograms) were provided
                with referrals to local “Every Woman Counts” program providers and to
                medical facilities offering free mammography screenings as appropriate.



Fresno-Madera Area Agency on Aging       Section 11 – Page 39           Fiscal Year 2010-2011
                                                                             Area Plan Update
 C.      Multipurpose Senior Services Program

         The Multipurpose Senior Services Program (MSSP) provides older adults aged
         65 or over who are frail, eligible for Medi-Cal, and qualify for placement in a
         long term care facility with a cost effective, community based alternative.

         1.     Care Management

                The FMAAA’s care managers assess each MSSP client’s unique health
                and social needs, coordinate an array of services to meet these needs,
                and continually monitor and reassess the client, adjusting the plan of care
                as needed. Medical alert and lifeline subscriptions, minor home repairs,
                items for personal care, in-home respite care, and translation are some of
                the services arranged for MSSP clients that help them remain in their
                homes.

                During each fiscal year, the FMAAA’s care managers will provide a
                monthly average of 282 individuals aged 65 or over who meet MSSP
                eligibility requirements with Care Management services, enabling MSSP
                clients to continue living in a home environment and avoid premature
                institutionalization.

                Fiscal Year 2009-2010: Continuing

                The FMAAA’s six MSSP care managers maintained a combined average
                caseload of 282 clients each month. Of these, 31% were aged 85 or over,
                and 56% lived alone.

         2.     Healthy Moves for Aging Program

                The FMAAA encourages older adults to realize the health benefits of
                increased physical activity through the Healthy Moves for Aging Program.
                This evidence-based health promotion program, which is funded through
                June 2010, is offered to MSSP clients who are frail and sedentary.
                FMAAA care managers visit the client in the home to create a
                personalized exercise plan appropriate to the individual’s capabilities and
                needs, and provide ongoing coaching and support.

                During fiscal year 2009-2010, the FMAAA will promote healthy lifestyles
                for older adults who are at risk for being placed in an institution by
                enrolling 30 MSSP clients in the Healthy Moves for Aging Program.




Fresno-Madera Area Agency on Aging       Section 11 – Page 40            Fiscal Year 2010-2011
                                                                              Area Plan Update
                Fiscal Year 2009-2010: Completed

                The FMAAA care managers promoted the Healthy Moves for Aging
                Program to each MSSP client; seventeen opted to participate. The low
                number of participants is in line with the requirement that older adults
                receiving MSSP services must be certifiable for placement in a nursing
                home. FMAAA staff encouraged participants to continue their program
                through follow-up calls and home visits.

 D.      Senior Community Service Employment Program

         The Senior Community Service Employment Program is a federal program,
         administered locally by the FMAAA, that offers a pathway to economic self-
         sufficiency for adults aged 55 or over who have low income and are in need of
         marketable job skills. Community organizations, such as the Best Dressed Kids
         project located in the Senior Resource Center in Fresno, serve as host
         organizations, receiving assistance from program participants while providing
         them with practical work experience. The program also offers participants
         counseling and assistance with job placement.

         The FMAAA will provide training through the Senior Community Service
         Employment Program for individuals aged 55 or over who have low income and
         are in need of job skills to obtain employment as follows:

                 Fiscal year 2009-2010, 50 participants;
                 Fiscal year 2010-2011, 50 participants; and
                 Fiscal year 2011-2012, 41 participants.

         Fiscal Year 2009-2010: Continuing

         The FMAAA is striving to meet its objective of 50 Senior Community Service
         Employment Program participants. Placement in unsubsidized positions has
         been particularly difficult, with an unemployment rate of 18.7% in Fresno
         County and 17.5% in Madera County, compared to 10.2% nationwide. (State
         of California, Employment Development Department, April 16, 2010)

 E.      Older Americans Month/ Celebration of Living

         Older residents of Fresno and Madera counties contribute their well-honed
         skills and dedicate countless hours to local programs that support and enrich
         the lives of others. The Celebration of Living and “Seniors Serving Seniors”
         Volunteer Awards Luncheon pays tribute to these devoted volunteers with a
         festive awards ceremony and elegant luncheon that has become a much
         anticipated tradition among valley residents.



Fresno-Madera Area Agency on Aging       Section 11 – Page 41          Fiscal Year 2010-2011
                                                                            Area Plan Update
         Community centers, non-
         profit organizations, and
         other community groups
         nominate     older    adult
         volunteers who provide
         exceptional service for
         awards in the categories
         of leadership, community
         service, nutrition, and
         senior center activities.
         The FMAAA forwards
         these nominations to the
         Council on Aging of the
         Silicon Valley for an
         objective determination of
         award recipients for each of the four award categories, as well as selection of
         the Volunteer of the Year for each of three geographical areas: Fresno County,
         Madera County, and the City of Fresno. Three perpetual awards complete the
         slate: the Orval Daggs/George A. Kral Community Service Award; the Ted C.
         Wills/Al Grace Leadership Award; and the Lorraine Person Advocacy Award.

         The Celebration of Living includes presentation of certificates and letters of
         commendation to award nominees by elected officials. In past years,
         certificates have been signed by Governor Arnold Schwarzenegger, U.S.
         Senators Dianne Feinstein and Barbara Boxer, members of the U.S. Congress,
         and state senators and assembly members. In addition, the Fresno County
         Board of Supervisors, the Madera County Board of Supervisors, and the
         Fresno City Council issue proclamations each year recognizing Older
         Americans Month, and provide letters of commendation for nominees.

         The FMAAA will continue to stimulate interest in volunteerism in the older adult
         community and promote interaction between government officials, service
         providers, and older adults by producing the Celebration of Living and “Seniors
         Serving Seniors” Volunteer Awards Luncheon during Older Americans Month
         each May, targeting a minimum of 600 older adults and their guests for
         participation. The FMAAA staff will handle all arrangements for this event,
         including conducting planning meetings; negotiating facility and catering
         contracts; obtaining corporate sponsorships; obtaining signatures from elected
         officials on award certificates; contacting public officials to arrange for their
         attendance; publicizing the event; handling reservations; requesting and
         processing award nominations; obtaining in-kind donations of door prizes from
         local businesses and organizations; transporting door prizes and decorations to
         the event site; decorating the event room and individual tables; assisting
         vendors with setting up information booths; welcoming attendees; distributing
         door prizes; cleaning up following the event; providing letters of appreciation to
         sponsors, public officials, and providers of door prizes; and other tasks involved
         with production of a major event. (C)


Fresno-Madera Area Agency on Aging       Section 11 – Page 42            Fiscal Year 2010-2011
                                                                              Area Plan Update
         Fiscal Year 2009-2010: Continuing

         On May 19, 2010, the New Exhibit Hall at the Fresno Convention Center was
         transformed into a “Safari Adventure” for the 18th Annual Celebration of Living
         and “Seniors Serving Seniors” Volunteer Awards Luncheon. With local
         celebrities Patty Manfredi (Executive Director, Ronald McDonald House
         Charities of the Central Valley) and Angelo Stalis (Weathercaster, Action News,
         ABC-30) as hosts, over 600 older adults enjoyed a full program honoring their
         peers for outstanding volunteer service.

 F.      Intergenerational Activities

         Nearly 25,000 individuals aged 65 or over who reside in Fresno and Madera
         counties live alone, placing them at risk for social isolation. The U.S.
         Environmental Protection Department’s Aging Initiative reports that
         integenerational activities enhance socialization, stimulate learning, increase
         emotional support, and improve             the health of older adults.
         (http://www.epa.gov/agingepa/ia/benefits.htm) The FMAAA will work with youth
         groups and elementary schools to develop and implement intergenerational
         projects to decrease the effects of social isolation on older adults who live
         alone.

         1.     Operation Shoe Box

                During each fiscal year, the FMAAA will partner with the Assistance
                League of Fresno to provide 200 older adults who are homebound with
                holiday presents through the Operation Shoe Box Program. The
                Assistance League operates the Bargain Boutique, staffed by volunteers,
                including teenagers participating in the league’s Assisteen Program.
                Money raised through the boutique is used to fund the Assistance
                League’s programs, including Operation Shoe Box. The FMAAA will
                develop a list of practical items for inclusion in the boxes. Assistance
                League volunteers will purchase the gifts and procure donations of
                additional items from local retailers. Elementary school children and the
                Assisteens will help decorate the boxes, giving each one a special touch.
                FMAAA Direct Services staff will personally deliver the boxes to clients
                who are homebound and at the highest risk for social isolation. (C)

                Fiscal Year 2009-2010: Continuing

                Through its partnership with the Assistance League of Fresno, the
                FMAAA was able to present 626 homebound older adults with festively
                decorated boxes containing practical gifts during the December 2009
                holiday season.




Fresno-Madera Area Agency on Aging       Section 11 – Page 43           Fiscal Year 2010-2011
                                                                             Area Plan Update
         2.     Caring Cards

                Each fiscal year, the celebration of seasonal holidays, such as Valentine’s
                Day, St. Patrick’s Day, or Thanksgiving Day, will be extended to 300 older
                adults who are homebound through delivery of cards by the FMAAA
                Direct Services staff and FMAAA service providers. The FMAAA will
                contact youth groups and elementary schools to request preparation of
                hand-made cards. The FMAAA will follow-up on the requests, identify
                clients who are homebound and most in need of a cheerful card, and
                deliver the cards, or arrange for delivery by a service provider, to clients
                in Fresno and/or Madera counties. (C)

                Fiscal Year 2009-2010: Continuing

                Thanksgiving was a happier holiday for over 500 older adults confined to
                their homes, thanks to provision of 160 cards prepared by a local Girl
                Scout troop and 500 placemats created by children from Birney
                Elementary School in central Fresno. The Girl Scouts continued the cheer
                with 195 holiday cards, which were distributed to older adults receiving
                home-delivered meals in December 2009.

 G.      Green Initiative

         Heavy ozone concentration, landfills replete with recyclable items, power
         outages, water restrictions: these environmental issues and many more
         negatively impact the quality of life not only for older adults and disabilities, but
         for all residents of Fresno and Madera counties.

         The FMAAA recognizes that the choices made each day by organizations and
         individuals can contribute to cleaner air, efficient use and re-use of natural
         resources, and ultimately to the health and safety of the people we serve.
         During fiscal year 2009-2010, the FMAAA will research successful
         environmental stewardship programs implemented by other organizations, with
         an objective of creating a Green Initiative by June 30, 2010. The initiative will
         be designed to create awareness of the benefits of conserving energy and
         resources, and to promote simple steps that anyone can take to help improve
         the quality of life in their own community. (PD)




Fresno-Madera Area Agency on Aging        Section 11 – Page 44              Fiscal Year 2010-2011
                                                                                 Area Plan Update
         Fiscal Year 2009-2010: Program Development Completed

         Preparation of the FMAAA’s Green Initiative is underway and will be completed
         by June 30, 2010. The agency is aligning its program with applicable strategies
         from the Fresno Green vision, which is set forth in The City of Fresno’s Strategy
         for Achieving Sustainability published in October 2009. The FMAAA has
         requested a business waste assessment from the City of Fresno’s recycling
         staff, and has contacted the nine awardees of the City of Fresno’s 2009
         Mayor’s Business Recycling Award to obtain their input.

         The FMAAA will promote the Green Initiative with FMAAA staff and the
         FMAAA’s collocated partners on the Sierra Resource Campus during fiscal
         year 2010-2011. This initial rollout will create a base of familiarity and buy-in to
         the initiative’s purpose throughout the campus, help reduce the campus’ energy
         consumption and increase the quantity of material that is recycled, and serve
         as a training ground for fine-tuning the project prior to its implementation in the
         community. (C)

         During fiscal year 2011-2012, the FMAAA will promote the Green Initiative to
         the FMAAA Advisory Council, older adults, and adults with disabilities. This will
         be accomplished through short presentations and/or one-on-one outreach by
         Advisory Council members and FMAAA staff in conjunction with outreach,
         community education, and civic engagement activities conducted for programs
         administered by the FMAAA. (C)




Fresno-Madera Area Agency on Aging       Section 11 – Page 45              Fiscal Year 2010-2011
                                                                                Area Plan Update
    Fresno-Madera Area Agency on Aging
  Area Plan Goals and Objectives

                      Goal 6
 The Fresno-Madera Area Agency on Aging will
 continue to provide leadership in developing and
 coordinating a seamless system of services in
 Fresno and Madera counties for family caregivers.




 RATIONALE
 “Although family members commonly undertake care for an ill or elderly loved one
 willingly and find it to be a great source of personal satisfaction, caregivers
 themselves need support services. A large and growing body of evidence confirms
 that providing care for a chronically ill person can have harmful physical, mental and
 emotional consequences for the caregiver. Recent medical advances, shorter
 hospital stays, limited discharge planning, a shortage of homecare workers, and the
 expansion of home care technology have increased the caregiving responsibilities of
 families. Family caregivers are being asked to shoulder greater burdens for longer
 periods of time. In addition to more complex care, conflicting demands of jobs and
 family, increasing economic pressure, and the physical and emotional demands of
 long term caregiving can result in major health impacts on caregivers.” (Caregiving
 in California: Issue Paper #1, Family Caregiver Alliance, 2007)

 “Because strong commitment to providing home care may delay or prevent
 institutionalization of dependent elders, and because the majority of family
 caregivers are daughters or other younger generation family members, an
 understanding of the characteristics of highly committed intergenerational caregivers
 Is needed. Research on predictors of desire to institutionalize persons with dementia
 has suggested that primary caregivers in well-functioning families with satisfactory
 levels of social support express low levels of desire to institutionalize.” (Kathleen W.
 Piercy, “Characteristics of Strong Commitments to Intergenerational Family Care of
 Older Adults,” Journal of Gerontology: Social Services 2007, Vol. 62B, No. 6, S381-
 387)




Fresno-Madera Area Agency on Aging      Section 11 – Page 46             Fiscal Year 2010-2011
                                                                              Area Plan Update
                                                                       TITLE III B
   OBJECTIVES – GOAL 6                    PROJECTED        PROJECTED   FUNDED
                                          START DATE       END DATE    PD OR C        STATUS
  A.         Information Services
       1.    Public Information on        7/1/2009         6/30/2012                 Continuing
             Caregiving
       2.    Community Information on     7/1/2009         6/30/2012                 Continuing
             Caregiving
  B.         Access Assistance
       1.    Caregiver Outreach
            a.Fresno-Madera Area Agency   7/1/2009         6/30/2012                 Continuing
              on Aging
            b.Valley Caregiver Resource   7/1/2009         6/30/2012                 Continuing
              Center
       2.    Caregiver Information and    7/1/2009         6/30/2012                 Continuing
             Assistance
       3.    Caregiver Interpretation/    7/1/2009         6/30/2012                 Continuing
             Translation
       4.    Caregiver Legal Resources    7/1/2010         6/30/2012                   New
  C.         Support Services
       1.    Caregiver Assessment         7/1/2009         6/30/2012                 Continuing
       2.    Caregiver Counseling         7/1/2009         6/30/2012                 Continuing
       3.    Caregiver Support Groups                                                Continuing
            a.Fresno-Madera Area Agency   7/1/2009         6/30/2012                 Continuing
              on Aging
            b.Valley Caregiver Resource   7/1/2009         6/30/2012                 Continuing
              Center
       4.    Caregiver Training           7/1/2009         6/30/2012                 Continuing
       5.    Case Management              7/1/2009         6/30/2012                 Continuing
  D.         Respite Care
    1.       Fresno-Madera Area Agency    7/1/2009         6/30/2012                 Continuing
             on Aging
    2.       Valley Caregiver Resource    7/1/2009         6/30/2012                 Continuing
             Center
  E.         Supplemental Services
    1.       Fresno-Madera Area Agency    7/1/2009         6/30/2012                 Continuing
             on Aging
    2.       Valley Caregiver Resource    7/1/2009         6/30/2012                 Continuing
             Center


Fresno-Madera Area Agency on Aging        Section 11 – Page 47              Fiscal Year 2010-2011
                                                                                 Area Plan Update
 Note: All Family Caregiver Support Program services listed in this section are provided
 under “Caregiving Caring for Elderly,” a new service category designation implemented
 by the California Department of Aging effective July 1, 2010.

 A.       Information Services

          1.      Public Information on Caregiving

                  Public Information on Caregiving encompasses media campaigns,
                  dissemination of newsletters and other publications, and maintenance of
                  electronic information systems for the purpose of informing the public on
                  caregiver resources and services.

                  Valley Caregiver Resource Center (VCRC) will conduct 26 public
                  information activities during each fiscal year through the Family Caregiver
                  Support Program, including distribution of a newsletter to program clients,
                  arranging for publication of articles on caregiving in local newspapers,
                  and updating the center’s Web site, valleycrc.org, with schedules for
                  caregiver support groups, training sessions, and events.

                  Fiscal Year 2009-2010: Continuing

                  VCRC met its objective by publishing two articles on family caregiving in
                  The Fresno Bee, posting monthly caregiver support group and training
                  schedules on its Web site and in The Fresno Bee, mailing notification of
                  training classes to all program clients on a quarterly basis, and publishing
                  articles and program schedules in an online local newsletter, The
                  Network News.

          2.      Community Information on Caregiving

                  Community Information on Caregiving is designed to educate groups of
                  current or potential caregivers, as well as providers of services to these
                  individuals, on the Family Caregiver Support Program and other
                  resources for caregivers.

                  During each fiscal year, VCRC will connect caregivers to the resources
                  they need by conducting 34 presentations for faith based organizations,
                  residents of mobile home and apartment communities for older adults,
                  and members of community groups throughout the urban and rural areas
                  of Fresno and Madera counties.




Fresno-Madera Area Agency on Aging        Section 11 – Page 48             Fiscal Year 2010-2011
                                                                                Area Plan Update
                  Fiscal Year 2009-2010: Continuing

                  In addition to the activities listed in this objective, VCRC convened its
                  first-ever Ministers’ Forum in March 2010 at the Central Valley Regional
                  Center in Fresno. Clergy and staff from fifteen congregations attended
                  the event, at which VCRC conducted a presentation on available
                  programs and services for family caregivers. As a result of this forum,
                  several congregations indicated they will take action to connect with older
                  adults and their caregivers, including adding adult day care during church
                  services, offering resources to members of the congregation who are
                  older or who are family caregivers but no longer attending services, and
                  providing VCRC with a venue for outreach and educational sessions.

 B.       Access Assistance

          1.      Caregiver Outreach

                  The busy schedule of the family caregiver can make it difficult to take the
                  time to explore available services. Through Caregiver Outreach, the
                  Fresno-Madera Area Agency on Aging (FMAAA) and VCRC connect with
                  family caregivers at the places where they conduct their daily business
                  and activities, offering one-on-one information and encouraging their use
                  of support services.

                  a.      Fresno-Madera Area Agency on Aging

                          The FMAAA has dedicated staff and an InfoVan to travel
                          throughout Fresno and Madera counties to meet family caregivers
                          and promote the Family Caregiver Support Program. The InfoVan
                          serves as the backdrop for a colorful literature display table, with
                          an awning extending from the van to offer comfortable shade for
                          individuals while dialoging with a trained outreach program
                          coordinator.

                          During each fiscal year, the FMAAA will initiate 3,403 one-on-one
                          contacts with current and potential family caregivers by setting up
                          and staffing the InfoVan at grocery stores, health and safety fairs,
                          shopping malls, and community events, providing information on
                          available resources.

                          Fiscal Year 2009-2010: Continuing

                          The FMAAA is on target for meeting its Caregiver Outreach
                          objective. Outreach was conducted at eight medical facilities, three
                          social service agencies, five senior centers, three information fairs,

Fresno-Madera Area Agency on Aging         Section 11 – Page 49             Fiscal Year 2010-2011
                                                                                 Area Plan Update
                          one county fair, three flu clinics, a senior residential facility, a
                          public library, and a farmworker appreciation event. The FMAAA
                          was also invited to participate in the Islamic Cultural Center of
                          Fresno’s Eid Al-Fitr Carnival In September 2009, which attracted
                          over 600 attendees.

                  b.      Valley Caregiver Resource Center

                          VCRC initiates contacts with family caregivers by staffing an
                          information table at a variety of venues, offering literature on
                          available services and answering questions on caregiver
                          programs.

                          Each fiscal year, 1,400 potential and current caregivers will learn
                          of Family Caregiver Support Program services through one-on-one
                          contact with VCRC staff at health clinics, churches, and
                          congregate meal sites.

                          Fiscal Year 2009-2010: Continuing

                          VCRC met its objective by conducting Caregiver Outreach
                          throughout Fresno and Madera counties. In addition to congregate
                          nutrition sites and health clinics, outreach locations included the
                          Nikkei Service Center in Fresno, Our Lady of Perpetual Help
                          Catholic Church in Clovis, Cedar Creek Retirement Community in
                          Madera, two mobile home communities in Fresno, and a senior
                          residential facility in Parlier.

          2.      Caregiver Information and Assistance

                  Through Caregiver Information and Assistance, family caregivers learn of
                  services available within their communities that offer them support with
                  meeting their own needs and helping the family member remain in the
                  home.

                  The FMAAA will link a minimum of 2,485 family caregivers each fiscal
                  year to available support services in response to telephone, e-mail, Web
                  site, and walk-in inquiries, and will conduct follow-up calls wherever
                  practicable to ensure the information provided meets the individual’s
                  needs.

                  Fiscal Year 2009-2010: Continuing

                  Despite aggressive outreach activities, incoming requests for information
                  from family caregivers were less than projected, with 981 requests

Fresno-Madera Area Agency on Aging         Section 11 – Page 50            Fiscal Year 2010-2011
                                                                                Area Plan Update
                  received through the end of March 2010. Increased use of the Internet by
                  family caregivers to access resources may be a contributing factor.

          3.      Caregiver Interpretation/Translation

                  Family caregivers who speak a language other than English may not
                  have access to someone to interpret or translate information needed to
                  receive support or assistance with their caregiving responsibilities.

                  VCRC will provide ten hours of interpretation or translation each fiscal
                  year for caregivers with limited English proficiency to assist them with
                  completing a task or tasks that are critical to their caregiving role.

                  Fiscal Year 2009-2010: Continuing

                  VCRC completed this objective, with staff providing translation for
                  caregivers as needed in the Spanish and Hmong languages.

          4.      Caregiver Legal Resources

                  Note: The fiscal year 2009-2010 objective for Caregiver Legal Assistance
                  is contained in Goal 6, Objective E.2. The California Department of Aging
                  renamed Caregiver Legal Assistance to Caregiver Legal Resources
                  effective July 1, 2010, and reclassified this service from the
                  Supplemental Services category to the Access Assistance category.

                  Caregivers may be faced with a myriad of legal issues in providing care
                  for their family member, such as power of attorney, guardianships or
                  conservatorships, and health care proxies.

                  During fiscal years 2010-2011 and 2011-2012, VCRC will arrange for
                  eight instances of provision of Caregiver Legal Resources by an attorney,
                  or an individual under the supervision of an attorney, to assist family
                  caregivers with resolving legal issues associated with caregiving.

 C.       Support Services

          1.      Caregiver Assessment

                  Through the assessment process, the caregiver’s needs for training,
                  social support, and health services are identified. Resources and options
                  are explored and planned to meet these needs, including a back-up plan
                  for meeting the care recipient’s needs in the event the caregiver is unable
                  to continue caring for their family member.

Fresno-Madera Area Agency on Aging        Section 11 – Page 51            Fiscal Year 2010-2011
                                                                               Area Plan Update
                  VCRC will conduct 900 hours of one-on-one Caregiver Assessments
                  each fiscal year to determine services, training, and support that will meet
                  the family caregiver’s needs, and to assist the caregiver with planning for
                  back-up coverage for care of their family member.

                  Fiscal Year 2009-2010: Continuing

                  VCRC met its objective, with staff completing Caregiver Assessments on
                  a one-on-one basis with family caregivers in their homes and helping
                  them create a back-up plan for instances when an alternate caregiver is
                  needed.

          2.      Caregiver Counseling

                  Through counseling, caregivers receive guidance and therapy to help
                  them manage stress, depression, and loss.

                  VCRC will help caregivers cope with the psychological effects of caregiving
                  through provision of counseling by the center’s licensed clinical social
                  worker or by a licensed therapist, either in person or by telephone,
                  depending on the individual’s need. During fiscal year 2009-2010, 450
                  hours of Caregiver Counseling will be provided; service will increase to 550
                  hours in fiscal years 2010-2011 and 2011-2012 due to the California
                  Department of Aging’s inclusion of Care Receiver Placement in the
                  Caregiver Counseling service category effective July 1, 2010.

                  Fiscal Year 2009-2010

                  VCRC exceeded its objective for this high-demand service, providing
                  nearly 300 caregivers with over 600 hours of counseling.

          3.      Caregiver Support Groups

                  Family caregivers reduce feelings of isolation
                  and learn practical approaches to shared
                  challenges by participating in caregiver
                  support groups. Support groups facilitated by
                  the FMAAA and VCRC are offered in a
                  variety of locations and time frames to help
                  family caregivers include this important
                  service in their schedules.




Fresno-Madera Area Agency on Aging        Section 11 – Page 52             Fiscal Year 2010-2011
                                                                                Area Plan Update
                  a.      Fresno-Madera Area Agency on Aging

                          The FMAAA will help provide support systems for family
                          caregivers by devoting 24 hours each fiscal year to facilitating
                          Caregiver Support Groups at the Sierra Resource Campus in
                          Fresno. Topics of interest to caregivers, such as healthy breathing,
                          identification of strengths, depression, home safety, and coping
                          strategies, will be introduced as focal points for each session.

                          Fiscal Year 2009-2010: Continuing

                          The FMAAA exceeded its objective, dedicating over 28 hours to
                          preparing and conducting Caregiver Support Group sessions.
                          Seventeen family caregivers attended one or more of the support
                          group sessions offered by the agency.

                  b.      Valley Caregiver Resource Center

                          VCRC will dedicate 400 hours each fiscal year to conducting
                          Caregiver Support Groups for family caregivers to help them
                          establish a support network. Offerings at the Sierra Resource
                          Campus in Fresno will include a group for caregivers who speak
                          Spanish and a group specifically for male caregivers. Monthly
                          groups will be also be offered in Kingsburg at the Kingsburg
                          Evangelical Church, in Madera at the Madera Adult Day Care and
                          Respite Center, and in Oakhurst at the Oakhurst Lutheran Church.

                          Fiscal Year 2009-2010: Continuing

                          VCRC met its objective, providing six monthly support group
                          options for family caregivers, as well as a monthly telephone
                          support group for Spanish speakers. The popularity of the
                          Oakhurst support group warranted addition of a second monthly
                          session. In all, over 50 family caregivers participated in one or
                          more of the support group sessions.

          4.      Caregiver Training

                  Many individuals have assumed the responsibilities of being a caregiver
                  as a result of a sudden illness or injury of a family member. Others have
                  been providing care for many years, but find themselves in need of new
                  information and tools to help them manage different aspects of
                  caregiving.




Fresno-Madera Area Agency on Aging         Section 11 – Page 53            Fiscal Year 2010-2011
                                                                                Area Plan Update
                  VCRC will help family caregivers expand their knowledge of skills,
                  resources, and issues that will help them provide high quality care by
                  providing 300 hours of Caregiver Training each fiscal year. A
                  comprehensive curriculum will be offered in workshop format. Popular
                  classes include Powerful Tools for Caregivers, Learning From Our
                  Emotions, Long Term Care, Understanding Difficult Dementia Behavior,
                  Controlling Your Frustration, and Cuidando El Cuidador (Caring for the
                  Caregiver, conducted in Spanish). Sessions will be offered in Fresno at
                  the Sierra Resource Campus, in Oakhurst at the Oakhurst Lutheran
                  Church, and at additional locations as resources allow.

                  Fiscal Year 2009-2010: Continuing

                  VCRC is on target for meeting its Caregiver Training objective. The most
                  popular classes are Controlling Your Frustration and Learning from Our
                  Emotions. A new class on Death and Dying has also been well attended.
                  VCRC has determined that one two-hour session is the most desirable
                  class duration, as many caregivers are unable to commit to the longer
                  six-week sessions needed for classes such as Powerful Tools for
                  Caregivers.

          5.      Case Management

                  The strain of caring for another person can take its toll in stress and
                  depression, negatively impacting the ability of the caregiver to manage
                  the household, handle the needs of their families, and address their own
                  health issues. Case Management assists family caregivers with
                  restabilizing their caregiving role through coordination and monitoring of
                  services by a trained and experienced care manager.

                  Each fiscal year, the care manager for the FMAAA’s Family Caregiver
                  Support Program will provide a minimum of 50 family caregivers with
                  1,636 hours of Case Management services to help them manage their
                  circumstances and continue to effectively serve in their caregiving role.
                  The care manager will conduct a comprehensive assessment for each
                  client, work with the client to create an individual plan of care, and
                  coordinate and monitor provision of caregiver-related services.

                  Fiscal Year 2009-2010

                  The FMAAA provided over 60 caregivers with Case Management
                  services through the Family Caregiver Support Program; thirty-percent of
                  these caregivers were aged 75 or over. The care manager continues to
                  conduct comprehensive assessments for each program participant,
                  establish and update the individual plan of care, and coordinate and
                  monitor arranged services.

Fresno-Madera Area Agency on Aging        Section 11 – Page 54           Fiscal Year 2010-2011
                                                                              Area Plan Update
 D.       Respite Care

          An occasional break from the many duties associated with caregiving can make
          all the difference in the caregiver’s ability to maintain optimal health and
          continue to provide quality care for their family member. Respite care provides
          the caregiver with the opportunity to participate in a support group, attend a
          training class, or attend a special event with the assurance that their family
          member is receiving quality care in a safe environment. Respite care is also
          needed when a caregiver requires hospitalization or is recovering from an illness
          or injury.

          1.      Fresno-Madera Area Agency on Aging

                  The FMAAA will arrange for 80 hours of Respite Care each fiscal year for
                  family caregivers most in need of a brief period of relief or rest to help
                  them meet their caregiving responsibilities. Caregiver respite needs are
                  projected as follows: Respite Homemaker Assistance, 30 hours per year;
                  and Respite In-Home Supervision, 50 hours per year.

                  Fiscal Year 2009-2010: Continuing

                  The FMAAA exceeded its objectives for Respite Homemaker Assistance
                  and Respite In-Home Supervision. This is due to the expressed need by
                  family caregivers to attend to personal appointments, recover from
                  medical procedures, and receive a much needed psychological and
                  physical break from the job of caregiving in order to continue providing
                  care to their care recipient and prevent burnout.

          2.      Valley Caregiver Resource Center

                  VCRC will offer respite services on an intermittent, occasional, or
                  emergency basis to help family caregivers attend to their own needs
                  through provision of 3,400 hours of Respite Care each fiscal year.
                  Projections for respite needs include 2,800 hours of Respite In-Home
                  Supervision, 300 hours of Respite Out-of-Home Day service, and 300
                  hours of Respite Out-of-Home Overnight service.

                  Fiscal Year 2009-2010: Continuing

                  VCRC is on track for meeting its overall objective for Respite Care, with
                  Respite In-Home Supervision in high demand.




Fresno-Madera Area Agency on Aging       Section 11 – Page 55            Fiscal Year 2010-2011
                                                                              Area Plan Update
 E.       Supplemental Services

          An assessment of a caregiver’s needs may indicate that the individual would
          benefit from special assistance to support and strengthen their caregiving role.
          Such needs range from construction of an entry ramp to provision of food during
          a difficult time.

          Note: Effective July 1, 2010, the California Department of Aging incorporated
          Care Receiver Placement into Caregiver Counseling in the Support Services
          category (see Goal 6, Objective 2); renamed Caregiver Legal Assistance to
          Caregiver Legal Resources and reclassified this service as an Access Service
          (see Goal 6, Objective B.4); and eliminated Caregiver Transportation as a
          separate service and incorporated this function into Caregiving Emergency
          Cash/Material Aid (see Goal 6, Objective E.2 below).

          1.      Fresno-Madera Area Agency on Aging

                  The FMAAA will offer the following supplemental services for family
                  caregivers each fiscal year:
                          Assistive Devices for Caregiving             85 Devices
                          Home Adaptations for Caregiving              5 Modifications
                          Caregiving Emergency Cash/ Material Aid      5 Assistances

                  Fiscal Year 2009-2010: Continuing

                  The FMAAA met its objective for Home Adapations for Caregiving, and all
                  identified needs for Assistive Devices for Caregiving were met. All
                  requests for Caregiving Emergency Cash/Material aid were met by other
                  community resources.

          2.      Valley Caregiver Resource Center

                  VCRC will offer the following supplemental services for family caregivers
                  during fiscal year 2009-2010:
                          Assistive Devices for Caregiving             10 Devices
                          Home Adaptations for Caregiving              6 Modifications
                          Caregiver Services Registry                  75 Hours
                          Caregiver Legal Assistance                   8 Hours
                          Caregiving Emergency Cash/ Material Aid      10 Assistances
                          Caregiver Transportation                     6 One-Way Trips
                          Care Receiver Placement                      100 Hours

Fresno-Madera Area Agency on Aging        Section 11 – Page 56          Fiscal Year 2010-2011
                                                                             Area Plan Update
                  VCRC will offer the following supplemental services for family caregivers
                  during fiscal years 2010-2011 and 2011-2012:
                          Assistive Devices for Caregiving             10 Devices
                          Home Adaptations for Caregiving              6 Modifications
                          Caregiver Services Registry                  75 Hours
                          Caregiving Emergency Cash/ Material Aid      16 Occurrences

                  Fiscal Year 2009-2010: Continuing

                  VCRC anticipates meeting its objectives for Supplemental Services.




Fresno-Madera Area Agency on Aging        Section 11 – Page 57          Fiscal Year 2010-2011
                                                                             Area Plan Update
    Fresno-Madera Area Agency on Aging
  Area Plan Goals and Objectives

                      Goal 7
 The Fresno-Madera Area Agency on Aging will
 continue to facilitate the integration of the
 community based, state funded programs into the
 service continuum in Planning and Service Area
 14 for older adults and adults with disabilities.


 RATIONALE
 “A great deal has been achieved in the last 15 years in the awareness, diagnosis,
 and treatment of Alzheimer's disease. But much more still needs to be done. We
 must continue to make Alzheimer's a national priority. The more we learn, the further
 we travel on the path toward a world without Alzheimer's–and we know that we
 cannot travel on that road quickly enough.” (Former Senator Hillary Clinton, Federal
 Response to the Alzheimer’s Epidemic, Testimony before the U.S. Senate
 Subcommittee on on Retirement and Aging, July 17, 2007)
 “The Part D Low-Income Subsidy, also called “Extra Help” or the LIS, offers great
 potential for low-income beneficiaries to receive substantial help with Part D
 premiums and cost-sharing. Although they are entitled to this financial assistance,
 however, millions of beneficiaries do not receive it. …Three of the reasons cited
 most commonly by beneficiaries and their counselors for low enrollment in the Low-
 Income Subsidy are that beneficiaries do not know how to apply for the subsidy; they
 do not understand the financial eligibility rules and therefore think they are not
 eligible for the subsidy; or they do not complete the application because the process
 is too complicated.” (Laura Sumner, Georgetown University Health Policy Institute,
 Seniors at Risk: Improving Medicare for Our Most Vulnerable, Testimony before the
 U.S. Senate Special Committee on Aging, May 22, 2008)
 “Given the diversity of the disability population across the age spectrum, our country
 requires a long term care system that affords people real choice in how and in what
 environment they will receive the supports they need to live. This means a system
 built to work for all people without regard to age or disability. One that begins with
 the assumption that adults with disabilities want to work, children with disabilities
 want to learn and play with their neighborhood friends, and the vast majority of
 individuals in need of long term services and supports would rather receive those
 supports at home with family and friends.” (Andrew J. Imparato, American
 Association of People with Disabilities, Community Services and Supports: Planning
 Across the Generations, Testimony before the U.S. Senate Health, Education,
 Labor, and Pensions Committee, July 10, 2007)

Fresno-Madera Area Agency on Aging     Section 11 – Page 58            Fiscal Year 2010-2011
                                                                            Area Plan Update
                                     PROJECTED                   TITLE III B
  OBJECTIVES – GOAL 7                START           PROJECTED   FUNDED
                                     DATE            END DATE    PD OR C           STATUS
 A.      Alzheimer's Day Care         7/1/2009       9/30/2009                   Completed
         Resource Center
 B.      Health Insurance             7/1/2009       6/30/2012                   Continuing
         Counseling and Advocacy
         Program
 C.      Linkages Program             7/1/2009       9/30/2009                   Completed



A.       Alzheimer's Day Care Resource Center

         The Alzheimer's Day Care Resource Center Program, administered in Fresno
         and Madera counties by Valley Caregiver Resource Center’s (VCRC) Older
         Adult Social Services (OASIS) staff, provides an array of services to ensure
         quality care for individuals with Alzheimer’s disease and related dementias,
         enabling them to remain living in a community setting as long as possible.
         Specialized day programs that address the unique needs of individuals in the
         moderate to severe stages of the disease are offered from three locations, two
         of which are located on the Sierra Resource Campus in Fresno, and one at the
         Adult Day Care Center in Madera. Family members who care for these
         individuals benefit from support groups and counseling. Community Education
         sessions and an up-to-date resource library provide caregivers, social service
         professionals, college interns, volunteers, and the public with current
         information on care and treatment of individuals with Alzheimer’s disease and
         related dementias.

         The State of California ceased funding of the Alzheimer's Day Care Resource
         Center Program effective September 30, 2009. As the program winds down
         operations, VCRC’s OASIS staff will conduct three Caregiver Support Groups,
         facilitate one Community Education session, provide 87 hours of Counseling for
         families of patients, and provide 911 participant days of Day Care. Individuals
         with Alzheimer’s disease and related dementias who are aged 60 or over and
         meet Title III B Supportive Services Program eligibility criteria will be offered
         Adult Day Care and other supportive services as applicable; those under the
         age of 60 will be provided with referrals to other agencies and programs.
         Caregivers who are eligible for the Family Caregiver Support Program will be
         offered appropriate Title III E funded services.




Fresno-Madera Area Agency on Aging       Section 11 – Page 59             Fiscal Year 2010-2011
                                                                               Area Plan Update
         Fiscal Year 2009-2010: Completed

         During the Alzheimer's Day Care Resource Center’s last three months of
         funded operations (July-September 2009), VCRC’s OASIS staff provided 911
         participant days of Day Care specifically designed for individuals with
         Alzheimer’s disease and related dementias. Day Care participants aged 60 or
         over were transitioned to Adult Day Care under the Title III B Supportive
         Services Program, while those under the age of 60 were provided with referrals
         to other agencies and programs. Families of these individuals were provided
         with 87 hours of Counseling, while caregivers benefited from three Caregiver
         Support Group sessions and were offered services under the Title III E Family
         Caregiver Support Program. One session of Community Education on
         Alzheimer’s disease was conducted for the public.

B.       Health Insurance Counseling and Advocacy Program

         The Fresno-Madera Area Agency on Aging (FMAAA) contracts with VCRC for
         provision of Health Insurance Counseling and Advocacy Program services in
         Fresno and Madera counties. Through this program, Medicare beneficiaries
         receive unbiased, one-on-one assistance with navigating their options for
         medical and prescription drug insurance and selecting the best plan to meet
         their individual needs. The program also helps individuals resolve issues with
         bills from medical providers, which in some cases involves filing claims and
         appeals. Volunteer counselors undergo extensive training and obtain state
         certification, and work closely with program staff to meet the high demand for
         services. Referrals to the program are generated by educational presentations
         conducted for staff of community based organizations, such as the Center for
         Independent Living, Central Valley Regional Center, Medi-Cal, county mental
         health departments, county libraries, senior and community centers, skilled
         nursing facilities, and residential care facilities for the elderly, as well as for
         participants in nursing programs at local colleges and high schools. Outreach to
         Medicare beneficiaries is conducted at health fairs, congregate nutrition meal
         sites, county fairs, flu clinics, libraries, and local pharmacies.

         VCRC’s Health Insurance Counseling and Advocacy Program staff will increase
         access to health insurance information for older adults by collaborating with a
         minimum of four agencies each fiscal year to conduct education and outreach
         activities. Targeted agencies include the Social Security Administration,
         National Alliance of Mental Illness, Fresno County Department of Behavioral
         Health, and Madera County Behavioral Health Services. As a result of these
         joint efforts and ongoing HICAP outreach activities, a minimum of 1,700
         individuals will be provided with counseling by HICAP staff and volunteers on
         medical and prescription drug insurance each fiscal year.




Fresno-Madera Area Agency on Aging       Section 11 – Page 60             Fiscal Year 2010-2011
                                                                               Area Plan Update
         Fiscal Year 2009-2010: Continuing

         VCRC’s HICAP staff collaborated with:

                 • Staff from the National Alliance of Mental Health to conduct an
                   educational workshop in Fresno on November 10, 2009;

                 • The Fresno County Department of Behavioral Health to conduct an
                   educational workshop in May 2010;

                 • Madera County Behavioral Health Services to conduct an educational
                   workshop in May 2010; and

                 • Staff from the Social Security Administration on Dia de las Madres,
                   celebrated each year on May 10th, to conduct an educational and
                   enrollment event in Spanish at the Elderberry Apartments in Sanger.
                   The Senior Medicare Patrol was featured, as well as presentations on
                   Medicare fraud, the Low Income Subsidy, and mental illness.

C.       Linkages Program

         Some individuals who are at risk for institutionalization do not qualify for care
         management services through the Multipurpose Senior Services Program, the
         Family Caregiver Support Program, or social service programs offered through
         other agencies. Through the Linkages Program, adults aged 18 or over who are
         frail and have difficulty conducting daily activities, such as dressing, bathing,
         shopping, and managing medications, are paired with a care manager from the
         FMAAA to plan and coordinate services and activities that help them remain
         living in their home and increase their quality of life.

         The State of California ceased funding of the Linkages Program effective
         September 30, 2009. During the July-September 2009 period, the FMAAA will
         provide 95 Linkages clients with Care Management services. The 30 program
         participants who are less than 60 years of age will be provided with referrals to
         other programs and agencies; the 65 clients who are 60 years of age or over
         will be transitioned to Case Management services under the Title III B
         Supportive Services Program (see Objective 5, Goal A.2).

         Fiscal Year 2009-2010: Completed

         The FMAAA met its objective of providing Care Management through the
         Linkages Program for 95 individuals during the program’s last three months of
         state funding (July-September 2009). All program participants were 60 years or
         age or over, and were transitioned to Case Management services under the
         Title III B Supportive Services Program.



Fresno-Madera Area Agency on Aging       Section 11 – Page 61            Fiscal Year 2010-2011
                                                                              Area Plan Update
                           SECTION 12. SERVICE UNIT PLAN OBJECTIVES
                               Title III/VII Service Unit Plan Objectives
                                    CCR Article 3, Section 7300(d)
                                             PSA #14
                               2009–2012 Three-Year Planning Period

The Service Unit Plan uses the National Aging Program Information System (NAPIS) categories
and units of service, as defined in PM 97-02. For services not defined in NAPIS, refer to Division
4000 of the Management Information Systems Manual. Report units of service to be provided with
all funding sources. Related funding is reported in the annual Area Plan Budget (CDA 122) for
Titles III B, III C-1, III C-2, III D, VII (a) and VII (b). This Service Unit Plan does not include
Title III E services.



  1.   Personal Care (In-Home)                     III B                 No Units Planned

  2.   Homemaker                                   III B            Unit of Service = One Hour
              Proposed
Fiscal Year                           Goal Numbers                Objective Numbers (if applicable)
            Units of Service
2009-2010            560                    5                                   A.3
2010-2011             --                    --                                   --
2011-2012             --                    --                                   --

  3.   Chore                                       III B            Unit of Service = One Hour
                 Proposed
Fiscal Year                           Goal Numbers                Objective Numbers (if applicable)
               Units of Service
2009-2010            133                    5                                   A.3
2010-2011             --                    --                                   --
2011-2012             --                    --                                   --

  4.   Home-Delivered Meals                      III C-2            Unit of Service = One Meal
              Proposed
Fiscal Year                           Goal Numbers                Objective Numbers (if applicable)
            Units of Service
2009-2010         434,732                   3                                 A.1, A.2
2010-2011         409,433                   3                                 A.1, A.2
2011-2012         409,433                   3                                 A.1, A.2




Fresno-Madera Area Agency on Aging          Section 12 - Page 1                       Fiscal Year 2010-2011
                                                                                           Area Plan Update
  5.   Adult Day Care/Adult Day Health  III B                     Unit of Service = One Hour
               Proposed
Fiscal Year                     Goal Numbers                    Objective Numbers (if applicable)
             Units of Service
2009-2010          20,575                 5                               A.1.a, A.1.b
2010-2011          20,575                 5                               A.1.a, A.1.b
2011-2012          20,575                 5                               A.1.a, A.1.b

  6.   Case Management                          III B             Unit of Service = One Hour
              Proposed
Fiscal Year                          Goal Numbers               Objective Numbers (if applicable)
            Units of Service
2009-2010           2,000                 5                                   A.2
2010-2011           2,000                 5                                   A.2
2011-2012           2,000                 5                                   A.2

  7.   Congregate Meals                       III C-1             Unit of Service = One Meal
              Proposed
Fiscal Year                          Goal Numbers               Objective Numbers (if applicable)
            Units of Service
2009-2010         202,371                 3                                    B
2010-2011         179,936                 3                                    B
2011-2012         179,936                 3                                    B

  8.   Nutrition Counseling                   III C-1    No Units Planned
  9.   Assisted Transportation                III B      No Units Planned

 10.   Transportation                         III B         Unit of Service = One One-Way Trip
               Proposed
Fiscal Year                          Goal Numbers               Objective Numbers (if applicable)
             Units of Service
2009-2010          79,500                 3                                 D.1, D.2
2010-2011          79,500                 3                                 D.1, D.2
2011-2012          79,500                 3                                 D.1, D.2

 11.   Legal Assistance                       III B               Unit of Service = One Hour
               Proposed
Fiscal Year                          Goal Numbers               Objective Numbers (if applicable)
             Units of Service
2009-2010            800                  5                                   A.4
2010-2011            800                  5                                   A.4
2011-2012            800                  5                                   A.4




Fresno-Madera Area Agency on Aging        Section 12 - Page 2                      Fiscal Year 2010-2011
                                                                                        Area Plan Update
 12. Nutrition Education III C-1 & III C-2 Unit of Service = One Session per Participant
   Fiscal     Proposed
                              Goal Numbers           Objective Numbers (if applicable)
  Year      Units of Service
2009-2010           6,400                 3                                    C
2010-2011           6,400                 3                                    C
2011-2012           6,400                 3                                    C

 13.   Information and Assistance      III B                    Unit of Service = One Contact
                Proposed
Fiscal Year                     Goal Numbers                    Objective Numbers(if applicable)
             Units of Service
2009-2010           8,078                 2                                    B
2010-2011           8,078                 2                                    B
2011-2012           8,078                 2                                    B

 14.   Outreach                               III B             Unit of Service = One Contact
               Proposed
Fiscal Year                          Goal Numbers               Objective Numbers(if applicable)
             Units of Service
2009-2010           6,136                1, 2                      1.C.1, 1.C.2, 2.A.1,2.A.2
2010-2011           6,136                1, 2                      1.C.1, 1.C.2, 2.A.1,2.A.2
2011-2012           6,136                1, 2                      1.C.1, 1.C.2, 2.A.1,2.A.2




Fresno-Madera Area Agency on Aging        Section 12 - Page 3                      Fiscal Year 2010-2011
                                                                                        Area Plan Update
NAPIS Service Category 15 – “Other” Title III Services
•     In this section, identify Title III D services (required); and also identify all Title III B services
      (discretionary) to be funded that were not reported in NAPIS categories 1–14 above. Identify
      the specific activity under the Service Category on the “Units of Service” line when applicable.
•     Specify what activity constitutes a unit of service (1 hour, 1 session, 1 contact, etc.).
      (Reference Division 4000 of the MIS Operations Manual, January 1994.)
•     Each Title III B “Other” service must be an approved NAPIS Program 15 service listed on the
      “Schedule of Supportive Services (III B)” page of the Area Plan Budget (CDA 122). [Title III B
      Example: Service Category: Community Services/Senior Center Support. Units of Service:
      1 hour – Activity Scheduling]

Title III D, Disease Prevention/Health Promotion
•     Service Activity: Identify the Title III D specific allowable service activity provided (i.e.
      Physical Fitness, Counseling Advocacy, Community Education, Health Screening, Outreach,
      Therapy, Information, Comprehensive Assessment, Home Security, Equipment, Family
      Support, Nutrition Education, Nutrition Counseling, Nutrition Screening).
•     Units of Service: Specify what constitutes a unit of service (i.e. one participant, one client
      served, one hour, one presentation, one piece of equipment, one session, one client
      counseled. (Reference Division 4000 of the MIS Operations Manual, January 1994.)
•     Insert the number of proposed units of service in the Disease Prevention/Health Promotion
      and Medication Management tables in the Title III D Service Unit Plan Objectives.
•     Title III D and Medication Management require a narrative program goal and objective. The
      objective should clearly explain the activity that is being provided to fulfill the service unit
      requirement.
•     Title III D and Medication Management: Insert the program goal and objective numbers in all
      Title III D Service Plan Objective Tables.



Title III D, Disease Prevention/Health Promotion

    15.   Medication Management                       III D         Unit of Service:
                                                                    FY 2009-2010 = One Client Served
                                                                    FY 2010-2011 &
                                                                    FY 2011-2012 =One Contact
                  Proposed
Fiscal Year                               Goal Numbers                Objective Numbers(if applicable)
                Units of Service
2009-2010              750                       5                                B.1, B.2
2010-2011              750                       5                                B.1, B.2
2011-2012              750                       5                                B.1, B.2




Fresno-Madera Area Agency on Aging            Section 12 - Page 4                    Fiscal Year 2010-2011
                                                                                          Area Plan Update
 15.   Disease Prevention & Health Promotion         III D     Unit of Service = One Contact
               Proposed
Fiscal Year                           Goal Numbers             Objective Numbers(if applicable)
             Units of Service
                                     New Service Effective July 1, 2010 per
2009-2010
                           California Department of Aging Program Memo No. 10-07
2010-2011           1,475                        5                             B.1, B.2
2011-2012           1,475                        5                             B.1, B.2

 15.   Nutrition Education               III D       Unit of Service = One Session per Participant
                Proposed
Fiscal Year                          Goal Numbers                Objective Numbers(if applicable)
              Units of Service
2009-2010            125                  5                                    B.1
2010-2011            125                  5                                    B.1
2011-2012            125                  5                                    B.1

 15.   Community Education/Advocacy   III D                       Unit of Service = One Hour
              Proposed
Fiscal Year                   Goal Numbers                       Objective Numbers(if applicable)
            Units of Service
2009-2010            70                   5                                  B.1, B.2
2010-2011                          Service Discontinued Effective July 1, 2010 per
2011-2012                    California Department of Aging Program Memo No. 10-07


 15.   Comprehensive Assessments     III D                        Unit of Service = One Hour
              Proposed
Fiscal Year                  Goal Numbers                        Objective Numbers(if applicable)
            Units of Service
2009-2010            100                  5                                    B.2
2010-2011                          Service Discontinued Effective July 1, 2010 per
2011-2012                    California Department of Aging Program Memo No. 10-07


 15.   Counseling                                III D            Unit of Service = One Hour
               Proposed
Fiscal Year                          Goal Numbers                Objective Numbers(if applicable)
            Units of Service
2009-2010            700                  5                                    B.1
2010-2011                          Service Discontinued Effective July 1, 2010 per
2011-2012                    California Department of Aging Program Memo No. 10-07




Fresno-Madera Area Agency on Aging         Section 12 - Page 5                    Fiscal Year 2010-2011
                                                                                       Area Plan Update
 15.   Family Support                           III D           Unit of Service = One Session
               Proposed
Fiscal Year                          Goal Numbers               Objective Numbers(if applicable)
             Units of Service
2009-2010            140                  5                                   B.1
2010-2011                          Service Discontinued Effective July 1, 2010 per
2011-2012                    California Department of Aging Program Memo No. 10-07


 15.   Home Security                          III D         Unit of Service = One Client Served
              Proposed
Fiscal Year                          Goal Numbers               Objective Numbers(if applicable)
            Units of Service
2009-2010            50                   5                                   B.1
2010-2011                          Service Discontinued Effective July 1, 2010 per
2011-2012                    California Department of Aging Program Memo No. 10-07


 15.   Information                            III D         Unit of Service = One Client Served
                Proposed
Fiscal Year                          Goal Numbers               Objective Numbers(if applicable)
             Units of Service
2009-2010            500                  5                                   B.1
2010-2011                          Service Discontinued Effective July 1, 2010 per
2011-2012                    California Department of Aging Program Memo No. 10-07


 15.   Outreach                               III D             Unit of Service = One Contact
               Proposed
Fiscal Year                          Goal Numbers               Objective Numbers(if applicable)
             Units of Service
2009-2010            700                  5                                   B.1
2010-2011                          Service Discontinued Effective July 1, 2010 per
2011-2012                    California Department of Aging Program Memo No. 10-07




Fresno-Madera Area Agency on Aging        Section 12 - Page 6                    Fiscal Year 2010-2011
                                                                                      Area Plan Update
Title III B, Other Supportive Services

 15.   Community Education                         III B       Unit of Service:
                                                               FY 2009-2010 = One Hour
                                                               FY 2010-2011 &
                                                               FY 2011-2012 =One Activity
                Proposed
Fiscal Year                          Goal Numbers                Objective Numbers(if applicable)
              Units of Service
2009-2010            125                    4                                  B.1
2010-2011            40                     4                                  B.1
2011-2012            40                     4                                  B.1



 15.   Senior Center Staffing                      III B        Unit of Service = One Staff Hour
               Proposed
Fiscal Year                          Goal Numbers                Objective Numbers(if applicable)
             Units of Service
2009-2010           1,560                1, 3, 5                       1.B.1, 3.E, 5.D, 5.G
2010-2011           1,560                1, 3, 5                       1.B.1, 3.E, 5.D, 5.G
2011-2012           1,560                1, 3, 5                       1.B.1, 3.E, 5.D, 5.G



 15.   Respite Care                                III B          Unit of Service = One Hour
                Proposed
Fiscal Year                          Goal Numbers                Objective Numbers(if applicable)
             Units of Service
2009-2010            912                    5                                  A.3
2010-2011             --                   --                                   --
2011-2012             --                   --                                   --



 15.   Visiting                                    III B          Unit of Service = One Hour
                Proposed
Fiscal Year                          Goal Numbers                Objective Numbers(if applicable)
              Units of Service
2009-2010            60                     5                                  A.3
2010-2011             --                   --                                   --
2011-2012             --                   --                                   --




Fresno-Madera Area Agency on Aging       Section 12 - Page 7                   Fiscal Year 2010-2011
                                                                                    Area Plan Update
                                  Title III B and Title VII (a)
                       Long Term Care Ombudsman Program Outcomes
                                            PSA #14
                              2009–2012 Three-Year Planning Period

As mandated by the Older Americans Act, the mission of the Long Term Care (LTC) Ombudsman
Program is to seek resolution of problems and advocate for the rights of residents of LTC facilities
with the goal of enhancing the quality of life and care of residents. Baseline numbers are obtained
from the local LTC Ombudsman Program’s Fiscal Year (FY) 2006-2007 National Ombudsman
Reporting System (NORS) data as reported in the State Annual Report to the Administration on
Aging (AoA).

Targets are established jointly by the AAA and the local LTC Ombudsman Program Coordinator.
Use the baseline as the benchmark for determining FY 2009-2010 targets. For each subsequent
FY target, use the previous FY target as the benchmark to determine realistic targets and
percentage of change given current resources available. Refer to your local LTC Ombudsman
Program’s last three years of NORS data for historical trends and take into account current
resources available to the program. Targets should be reasonable and attainable.

Complete all Measures and Targets for Outcomes 1-3.

Outcome 1. The problems and concerns of long-term care residents are solved through
complaint resolution and other services of the Ombudsman Program. [OAA Section
712(a)(3)(5)]

Measures and Targets:

A. Complaint Resolution Rate (AoA Report, Part I-E, Actions on Complaints)
    The average California complaint resolution rate for FY 2006-2007 was 73%.
1. FY 2006-2007 Baseline Resolution Rate: 95.3%
   Number of complaints resolved (1,391) + Number of partially resolved complaints (79)
   divided by Total Number of Complaints Received (1,542) = Baseline Resolution Rate (95.3%)
2. FY 2009-2010 Target: Resolution Rate: 90%

3. FY 2010-2011 Target: Resolution Rate: 90%

4. FY 2011-2012 Target: Resolution Rate: 90%

Program Goals and Objective Numbers: 4.A

B. Work with Resident Councils (AoA Report, Part III-D, #8)

1. FY 2006-2007 Baseline: Number of meetings attended = 9

2. FY 2009-2010 Target Number = 8 (11% decrease)

3. FY 2010-2011 Target Number = 8 (no increase or decrease)

4. FY 2011-2012 Target Number = 8 (no increase or decrease)

Program Goals and Objective Numbers: 4.A


Fresno-Madera Area Agency on Aging        Section 12 - Page 8                  Fiscal Year 2010-2011
                                                                                    Area Plan Update
C. Work with Family Councils (AoA Report, Part III-D, #9)

1. FY 2006-2007 Baseline: Number of meetings attended = 2

2. FY 2009-2010 Target Number = 2 (no increase or decrease)

3. FY 2010-2011 Target Number = 2 (no increase or decrease)

4. FY 2011-2012 Target Number = 2 (no increase or decrease)

Program Goals and Objective Numbers: 4.A

D. Consultation to Facilities (AoA Report, Part III-D, #4)
1. FY 2006-2007 Baseline: Number of consultations = 93
(Note: FY 2006-2007 baseline was listed in Consultation to Individuals which included citizens,
family members, residents, and facility contacts. Projections for FY 2009-2010 through 2011-
2012 are reported for each consultation category, rather than in aggregate.)
2. FY 2009-2010 Target Number = 720 (774% increase)

3. FY 2010-2011 Target Number = 720 (no increase or decrease)

4. FY 2011-2012 Target Number = 720 (no increase or decrease)

Program Goals and Objective Numbers: 4.A

E. Information and Consultation to Individuals (AoA Report, Part III-D, #5)
1. FY 2006-2007 Baseline: Number of consultations = 2,015
   (Note: FY 2006-2007 baseline included citizens, family members, residents, and some
   facilities. Projections for FY 2009-2010 through 2011-2012 do not include facilities).
2. FY 2009-2010 Target Number = 1,284 (36% decrease)

3. FY 2010-2011 Target Number = 1,284 (no increase or decrease)

4. FY 2011-2012 Target Number = 1,284 (no increase or decrease)

Program Goals and Objective Numbers: 4.A

F. Community Education (AoA Report, Part III-D, #10)

1. FY 2006-2007 Baseline: Number of sessions = 77

2. FY 2009-2010 Target Number of Sessions = 50 (29% decrease)

3. FY 2010-2011 Target Number of Sessions = 50 (no increase or decrease)

4. FY 2011-2012 Target Number of Sessions = 50 (no increase or decrease)

Program Goals and Objective Numbers: 4.A




Fresno-Madera Area Agency on Aging       Section 12 - Page 9               Fiscal Year 2010-2011
                                                                                Area Plan Update
G. Systems Advocacy

     1. FY 2009-2010 Activity: In narrative form, please provide at least one systemic advocacy
        effort that the local LTC Ombudsman Program will engage in during the fiscal year.
        (Examples: Work with LTC facilities to improve pain relief, increase access to oral health
        care, work with law enforcement to improve response and investigation of abuse
        complaints, collaborate with other agencies to improve quality of care and quality of life,
        participate in disaster preparedness planning, conduct presentations to legislators and
        local officials regarding quality of care issues, etc.)

         Systemic Advocacy Efforts
         The Fresno-Madera Ombudsman Program will improve its response time to reports of
         suspected cases of elder and dependent adult abuse by providing additional training for
         existing program staff, and by recruiting and training college students majoring in the
         Humanities discipline. These specially trained staff and students will investigate Class A
         emergencies within 24 hours, Class B cases within 3 days, and Class C cases within 10
         days.

Outcome 2. Residents have regular access to an Ombudsman. [(OAA Section 712(a)(3)(D),
(5)(B)(ii)]

Measures and Targets:

A. Facility Coverage (other than in response to a complaint), (AoA Report, Part III-D, #6)
   Number of Nursing Facilities visited (unduplicated) at least once a quarter not in response to a
   complaint (based on current resources available to the program).
1. FY 2006-2007 Baseline: 100%
   Number of Nursing Facilities visited at least once a quarter not in response to a complaint
   (43) divided by the number of Nursing Facilities (43).
2. FY 2009-2010 Target: 100% (no increase or decrease)

3. FY 2010-2011 Target: 100% (no increase or decrease)

4. FY 2011-2012 Target: 100% (no increase or decrease)

Program Goals and Objective Numbers: 4.A

B. Facility Coverage (other than in response to a complaint) (AoA Report, Part III-D, #6)
   Number Board and Care Facilities (RCFEs) visited (unduplicated) at least once a quarter not
   in response to a complaint (based on current resources available to the program).
1. FY 2006-2007 Baseline: 100%
      Number of RCFEs visited at least once a quarter not in response to a complaint (189)
      divided by the number of RCFEs (189) =100%
2.   FY 2009-2010 Target: 100% (no increase or decrease)

3.   FY 2010-2011 Target: 100% (no increase or decrease)

4.   FY 2011-2012 Target: 100% (no increase or decrease)

Program Goals and Objective Numbers: 4.A


Fresno-Madera Area Agency on Aging        Section 12 - Page 10                 Fiscal Year 2010-2011
                                                                                    Area Plan Update
C. Number of Full-Time Equivalent (FTE) Staff (AoA Report Part III. B.2. - Staff and Volunteers)
   (One FTE generally equates to 40 hours per week or 1,760 hours per year.) Verify number of staff
   FTEs with Ombudsman Program Coordinator.

1. FY 2006-2007 Baseline: FTEs = 3

2. FY 2009-2010 Target Number of FTEs: 3 (no increase or decrease)

3. FY 2010-2011 Target: number of FTEs: 3 (no increase or decrease)

4. FY 2011-2012 Target: number of FTEs: 3 (no increase or decrease)

Program Goals and Objective Numbers: 4.A

D. Number of Certified LTC Ombudsman Volunteers (AoA Report Part III. B.2. – Staff and
   Volunteers) Verify numbers of volunteers with Ombudsman Program Coordinator.
1. FY 2006-2007 Baseline: Number of certified LTC Ombudsman volunteers
   as of June 30, 2007: 43
2. FY 2009-2010 Projected Number of certified LTC Ombudsman volunteers
   as of June 30, 2010 = 31 (28% decrease)
   (Note: The program was unable to reimburse volunteers for mileage during the first quarter of
   FY 2008-2009 due to the state budget impasse, and lost four volunteers as a result. An
   additional eight volunteers left the program due to the fingerprinting requirement.)
3. FY 2010-2011 Projected Number of certified LTC Ombudsman volunteers
   as of June 30, 2011 = 33 (6% increase)
4. FY 2011-2012 Projected Number of certified LTC Ombudsman volunteers
   as of June 30, 2012 = 33 (no increase or decrease)
Program Goals and Objective Numbers: 4.A

Outcome 3. Ombudsman representatives report their complaint processing and other
activities accurately and consistently. [OAA Section 712(c)]

Measures and Targets:

A. Each Ombudsman Program provides regular training on the National Ombudsman
   Reporting System (NORS).
1. FY 2006-2007 Baseline number of NORS Part I, II, III or IV training sessions completed: 1
  Please obtain this information from the local LTC Ombudsman Program Coordinator.
2. FY 2009-2010 Target: number of NORS Part I, II, III or IV training sessions planned : 1

3. FY 2010-2011 Target: number of NORS Part I, II, III or IV training sessions planned: 1

4. FY 2011-2012 Target: number of NORS Part I, II, III or IV training sessions planned: 1

Program Goals and Objective Numbers: 4.A




Fresno-Madera Area Agency on Aging        Section 12 - Page 11                  Fiscal Year 2010-2011
                                                                                     Area Plan Update
                                 Title VII (b) Elder Abuse Prevention
                                     Service Unit Plan Objectives
                                             PSA #14
                               2009–2012 Three-Year Planning Period

Units of Service: AAA must complete at least one category from the Units of Service below.

A Unit of Service may include public education sessions, training sessions for professionals,
training sessions for caregivers served by Title III E Program, educational materials distributed, or
other hours of activity spent developing a coordinated system which addresses elder abuse
prevention, investigation, and prosecution.

AAAs must provide one or more of the service categories below:

   •   Public Education Sessions – Please identify the total number of education sessions for
       the general public on the identification, prevention, and treatment of elder abuse, neglect,
       and exploitation.

   •   Training Sessions for Professionals – Please identify the total number of training
       sessions for professionals (service providers, nurses, social workers) on the identification,
       prevention, and treatment of elder abuse, neglect, and exploitation.

   •   Training Sessions for Caregivers Served by Title III E – Please identify the total
       number of Title VII/B training sessions for caregivers who are receiving services under
       Title III E of the Older Americans Act on the identification, prevention, and treatment of
       elder abuse, neglect, and exploitation.

   •   Hours Spent Developing a Coordinated System to Respond to Elder Abuse – Please
       identify the number of hours to be spent developing a coordinated system to respond to
       elder abuse.

   •   Educational Materials Distributed – Please identify the type and number of educational
       materials distributed to the general public, professionals, and caregivers (this may include
       materials that have been developed by others) to help in the identification, prevention, and
       treatment of elder abuse, neglect, and exploitation.




Fresno-Madera Area Agency on Aging        Section 12 - Page 12                  Fiscal Year 2010-2011
                                                                                     Area Plan Update
                                   Title VII (b) Elder Abuse Prevention
                                       Service Unit Plan Objectives
                                             PSA #14
                               2009–2012 Three-Year Planning Period

                        Total # of Public                                        Total # of Training Sessions
     Fiscal Year                                                  Fiscal Year
                       Education Sessions                                              for Professionals
      2009-10                   39                                    2009-10                 4
      2010-11                   39                                    2010-11                 4
      2011-12                   39                                    2011-12                 4

                       *Total # of Training                                        **Total # of Hours Spent
     Fiscal Year     Sessions for Caregivers                      Fiscal Year     Developing a Coordinated
                       served by Title III E                                                System
      2009-10                   *                                     2009-10                 **
      2010-11                   *                                     2010-11                 **
      2011-12                   *                                     2011-12                 **


*    Community Education sessions for the public may include family caregivers receiving Title III E
     services; however, Title VII (b) Community Education (renamed Elder Abuse Prevention, Education,
     and Training by the California Department of Aging effective July 1, 2010), is not a registered service,
     and as such, it is not possible to determine how many attendees receive Title III E services. Community
     Education sessions conducted specifically for family caregivers are reported under Title III E.
**   The Fresno-Madera Area Agency on Aging contracts with Central California Legal Services (CCLS) for
     Title VII (b) Community Education/Advocacy services (renamed Elder Abuse Prevention, Education,
     and Training by the California Department of Aging effective July 1, 2010). CCLS continually works with
     other community based organizations to maintain the existing coordinated system of care across
     programs. This includes not only the Long Term Care Ombudsman Program and the elder abuse units
     of local law enforcement agencies, but other organizations as described in Section 19, Legal
     Assistance, Item 10, of this Area Plan document.


                     Total # of Copies of
                    Educational Materials
     Fiscal Year                                      Description of Educational Materials or Products
                      or Products to be
                         Distributed
     2009-2010               400            Booklet: Elder Abuse Awareness
                             400            Booklet: Elder Financial Abuse
                             400            Brochure: The Abuse Nobody Talks About

     2010-2011               400            Booklet: Elder Abuse Awareness
                             400            Booklet: Elder Financial Abuse
                             400            Brochure: The Abuse Nobody Talks About

     2011-2012               400            Booklet: Elder Abuse Awareness
                             400            Booklet: Elder Financial Abuse
                             400            Brochure: The Abuse Nobody Talks About




Fresno-Madera Area Agency on Aging             Section 12 - Page 13                    Fiscal Year 2010-2011
                                                                                            Area Plan Update
                              Title III E Service Unit Plan Objectives
                                   CCR Article 3, Section 7300(d)
                                            PSA #14
                              2009–2012 Three-Year Planning Period

This Service Unit Plan (SUP) utilizes the five broad federal service categories defined in PM 08-03.
Refer to the FCSP Service Matrix in this PM for eligible activities and service unit examples covered
within each category. Specify proposed audience size or units of service for all budgeted funds.


                                            Direct Services
    Service Categories                           1                        2                3
         Direct III E                       Proposed
                                                                       Required         Optional
  Family Caregiver Services               Units of Service


 Information Services           # of Activities        Est. Audience    Goal #       Objective #(s)
         2009-2010                    —                     —            —                 —
         2010-2011                    —                     —            —                 —
         2011-2012                    —                     —            —                 —


 Access Assistance                        Total Contacts                Goal #       Objective #(s)
         2009-2010                            5,888                       6           B.1.a, B.2
         2010-2011                            5,888                       6           B.1.a, B.2
         2011-2012                            5,888                       6           B.1.a, B.2


 Support Services                           Total Hours                 Goal #       Objective #(s)
         2009-2010                            1,660                       6           C.3.a, C.5
         2010-2011                            1,660                       6           C.3.a, C.5
         2011-2012                            1,660                       6           C.3.a, C.5


 Respite Care                               Total Hours                 Goal #       Objective #(s)
         2009-2010                                80                      6               D.1
         2010-2011                                80                      6               D.1
         2011-2012                                80                      6               D.1


 Supplemental Services                 Total Occurrences                Goal #       Objective #(s)
         2009-2010                                95                      6               E.1
         2010-2011                                95                      6               E.1
         2011-2012                                95                      6               E.1


Fresno-Madera Area Agency on Aging            Section 12 - Page 14                Fiscal Year 2010-2011
                                                                                       Area Plan Update
                                Direct Grandparent Services
    Service Categories                           1                       2                3
         Direct III E                       Proposed
                                                                      Required         Optional
    Grandparent Services                  Units of Service


 Information Services           # of Activities       Est. Audience    Goal #       Objective #(s)
         2009-2010                    —                    —            —                 —
         2010-2011                    —                    —            —                 —
         2011-2012                    —                    —            —                 —


 Access Assistance                        Total Contacts               Goal #       Objective #(s)
         2009-2010                                —                     —                 —
         2010-2011                                —                     —                 —
         2011-2012                                —                     —                 —


 Support Services                           Total Hours                Goal #       Objective #(s)
         2009-2010                                —                     —                 —
         2010-2011                                —                     —                 —
         2011-2012                                —                     —                 —


 Respite Care                               Total Hours                Goal #       Objective #(s)
         2009-2010                                —                     —                 —
         2010-2011                                —                     —                 —
         2011-2012                                —                     —                 —


 Supplemental Services                 Total Occurrences               Goal #       Objective #(s)
         2009-2010                                —                     —                 —
         2010-2011                                —                     —                 —
         2011-2012                                —                     —                 —




Fresno-Madera Area Agency on Aging            Section 12 - Page 15               Fiscal Year 2010-2011
                                                                                      Area Plan Update
                                       Contracted Services
    Service Categories                         1                           2                3
       Contracted III E                   Proposed
                                                                        Required         Optional
  Family Caregiver Services             Units of Service


 Information Services           # of Activities         Est. Audience    Goal #       Objective #(s)
         2009-2010                    60                  147,600          6             A.1, A.2
         2010-2011                    60                  147,600          6             A.1, A.2
         2011-2012                    60                  147,600          6             A.1, A.2


 Access Assistance                         Total Contacts                Goal #       Objective #(s)
         2009-2010                             1,410                       6           B.1.b, B.3
         2010-2011                             1,418                       6         B.1.b, B.3, B.4
         2011-2012                             1,418                       6         B.1.b, B.3, B.4


 Support Services                           Total Hours                  Goal #       Objective #(s)
         2009-2010                             2,050                       6       C.1, C.2, C.3.b, C.4
         2010-2011                             2,150                       6       C.1, C.2, C.3.b, C.4
         2011-2012                             2,150                       6       C.1, C.2, C.3.b, C.4


 Respite Care                               Total Hours                  Goal #       Objective #(s)
         2009-2010                             3,400                       6               D.2
         2010-2011                             3,400                       6               D.2
         2011-2012                             3,400                       6               D.2


 Supplemental Services                 Total Occurrences                 Goal #       Objective #(s)
         2009-2010                                215                      6               E.2
         2010-2011                                107                      6               E.2
         2011-2012                                107                      6               E.2




Fresno-Madera Area Agency on Aging            Section 12 - Page 16                 Fiscal Year 2010-2011
                                                                                        Area Plan Update
                             Contracted Grandparent Services
    Service Categories                           1                       2                3
      Contracted III E                      Proposed
                                                                      Required         Optional
    Grandparent Services                  Units of Service


 Information Services           # of Activities       Est. Audience    Goal #       Objective #(s)
         2009-2010                    —                    —            —                 —
         2010-2011                    —                    —            —                 —
         2011-2012                    —                    —            —                 —


 Access Assistance                        Total Contacts               Goal #       Objective #(s)
         2009-2010                                —                     —                 —
         2010-2011                                —                     —                 —
         2011-2012                                —                     —                 —


 Support Services                           Total Hours                Goal #       Objective #(s)
         2009-2010                                —                     —                 —
         2010-2011                                —                     —                 —
         2011-2012                                —                     —                 —


 Respite Care                               Total Hours                Goal #       Objective #(s)
         2009-2010                                —                     —                 —
         2010-2011                                —                     —                 —
         2011-2012                                —                     —                 —


 Supplemental Services                 Total Occurrences               Goal #       Objective #(s)
         2009-2010                                —                     —                 —
         2010-2011                                —                     —                 —
         2011-2012                                —                     —                 —




Fresno-Madera Area Agency on Aging            Section 12 - Page 17               Fiscal Year 2010-2011
                                                                                      Area Plan Update
                           Title V/SCSEP Service Unit Plan Objectives
                                  CCR Article 3, Section 7300(d)
                                            PSA #14
                              2009–2012 Three-Year Planning Period

The Service Unit Plan utilizes the new Data Collection System developed by the U.S. Department
of Labor (DOL), which captures the new performance measures per the Older Americans Act of
1965 as amended in 2000, and the Federal Register 20 CFR Part 641. The related funding is
reported in the annual Title V/SCSEP Budget.

Note: Before the beginning of each federal Program Year, the DOL negotiates with the California
Department of Aging to set the baseline levels of performance for California. Once determined,
those baseline levels will be transmitted to the AAA.



                                                National Grantee
                          CDA Authorized
                                                Authorized Slots     Objective Number
       Fiscal Year            Slots
                                                 (if applicable)
        2009-2010                40                    —                   5.D
        2010-2011                40                      —                 5.D
        2011-2012                30                      —                 5.D




Fresno-Madera Area Agency on Aging         Section 12 - Page 18            Fiscal Year 2010-2011
                                                                                Area Plan Update
                              Community Based Services Programs
                              Service Unit Plan (CBSP) Objectives
                                 CCR Article 3, Section 7300(d)
                                           PSA #14
                              2009-2012 Three-Year Planning Period

 The Service Unit Plan (SUP) follows the instructions for layouts provided in PM 98-26 (P) and
 updated in PM 00-13 (P). The related funding is reported in the annual Area Plan Budget
 (CDA 122). Report units of service to be provided with all funding sources.

           For services that will not be provided, check the Not Applicable box

Alzheimer’s Day Care Resource Center:

1. Goals and Objectives:
 Fiscal Year               Goal Numbers                  Objective Numbers (If applicable)
  2009-2010                       7                                      A
  2010-2011
                 State Funding for This Program Discontinued Effective September 30, 2009
  2011-2012

2. In-Service Training Sessions for Staff (A minimum of 6 sessions required per year)
   Fiscal Year                             In-Service Training Sessions
  2009-2010                                  2 (July-September 2009)
  2010-2011
                   State Funding for This Program Discontinued Effective September 30, 2009
  2011-2012

3. Professional/Intern Educational Training Sessions (A minimum of 4 sessions required per year)
   Fiscal Year                  Professional/Intern Educational Training Sessions
 2009-2010                                  1 (July-September 2009)
 2010-2011
                   State Funding for This Program Discontinued Effective September 30, 2009
 2011-2012

4. Caregiver Support Group Sessions (A minimum of 12 sessions required per year)
   Fiscal Year                        Caregiver Group Support Sessions
  2009-2010                                3 (July-September 2009)
  2010-2011
                  State Funding for This Program Discontinued Effective September 30, 2009
  2011-2012

5. Public/Community Education Training Sessions (A minimum of 1 session required per year)
   Fiscal Year                 Public/Community Education Training Sessions
  2009-2010                               1 (July-September 2009)
  2010-2011
                 State Funding for This Program Discontinued Effective September 30, 2009
  2011-2012

6. List of ADCRC sites in your PSA:

   • Valley Caregiver Resource Center, 3845 N. Clark St., Suite 201, Fresno, CA 93726




Fresno-Madera Area Agency on Aging       Section 12 - Page 19               Fiscal Year 2010-2011
                                                                                 Area Plan Update
Brown Bag:         Not Applicable


Linkages:

1. Goals and Objectives:
 Fiscal Year                  Goal Numbers                          Objective Numbers (Optional)
 2009-2010                          7                                            C
 2010-2011
                   State Funding for This Program Discontinued Effective September 30, 2009
 2011-2012

2. Unduplicated Clients Served
                                     Number of Unduplicated Clients Served
 Fiscal Year        (Include Targeted Case Management and Handicapped Parking Revenue)
 2009-2010                                 95 (July-September 2009)
 2010-2011
                   State Funding for This Program Discontinued Effective September 30, 2009
 2011-2012

3. Active Monthly Caseload
                                            Active Monthly Caseload
 Fiscal Year         (Include Targeted Case Management and handicapped parking revenue)
 2009-2010                                            93
 2010-2011
                   State Funding for This Program Discontinued Effective September 30, 2009
 2011-2012



Senior Companion:           Not Applicable



Respite Purchase of Service:         Not Applicable




Fresno-Madera Area Agency on Aging           Section 12 - Page 20                 Fiscal Year 2010-2011
                                                                                       Area Plan Update
                       Health Insurance Counseling and Advocacy Program
                                        Service Unit Plan
                                  CCR Article 3, Section 7300(d)
                                             PSA #14
                               2009-2012 Three-Year Planning Period
                                Fiscal Years 2010-2011 and 2011-2012

The Service Unit Plan (SUP) uses definitions found at www.aging.ca.gov/aaa/
reporting_instructions/hicap/Current_Forms.asp. This link takes you to the page titled “Health
Insurance Counseling and Advocacy Program (HICAP) Reporting Instructions and Forms”. On this
page you will find the current HICAP report forms, instructions, definitions, and acronyms critical to
answering this SUP. If you have related goals in the Area Plan to Service Unit Plan, please list them
in the 3rd column.
IMPORTANT NOTE FOR MULTIPLE PSA HICAPs: If you are a part of a multiple PSA HICAP where
two or more AAAs enter into agreement with one “Managing AAA,” then each AAA must enter its
equitable share of the estimated performance numbers in each AAA’s respective SUP. Please do
this in cooperation with the Managing AAA. The Managing AAA is responsible for providing HICAP
services in all the covered PSAs in a way that is agreed upon and equitable among the participating
parties.
IMPORTANT NOTE FOR HICAPs WITH HICAP PAID LEGAL SERVICES: If your Master Contract
contains a provision for using HICAP funds to provide HICAP Legal Services, you must complete
Section 2.
IMPORTANT NOTE REGARDING FEDERAL PERFORMANCE TARGETS: The Centers for
Medicare and Medicaid Services require all State Health Insurance and Assistance Programs
(SHIP) meet certain targeted performance measures. To help AAAs complete Section 2, the
California Department of Aging (CDA) will annually provide AAAs with individual PSA federal
performance measure targets.


Section 1. Primary HICAP Units of Service

                1.1 Estimated Number of Unduplicated Clients                   Goal         Objective
 Fiscal Year
                Counseled                                                     Number        Number
  2010-2011                               1,700                                   7             B
  2011-2012                               1,700                                   7             B
 Note: Clients Counseled equals the number of Intakes closed and finalized by the Program Manager.

                                                                               Goal         Objective
 Fiscal Year    1.2 Estimated Number of Public and Media Events
                                                                              Number        Number
  2010-2011                                170                                    7             B
  2011-2012                                170                                    7             B
 Note: Public and Media events include education/outreach presentations, booths/exhibits at health/
 senior fairs, and enrollment events, excluding public service announcements and printed outreach.




 Fresno-Madera Area Agency on Aging           Section 12 - Page 21                    Fiscal Year 2010-2011
                                                                                           Area Plan Update
Section 2. Federal Performance Benchmark Measures

                2.1 Estimated Number of Contacts for All Clients                 Goal         Objective
 Fiscal Year
                Counseled                                                       Number        Number
 2010-2011                                 5,000                                    7              B
 2011-2012                                 5,000                                    7              B
 Note: This includes all counseling contacts via telephone, in-person at home, in-person at site, and
 electronic contacts (e-mail, fax, etc.) for duplicated client counts.

                2.2 Estimated Number of Persons Reached at Public                Goal         Objective
 Fiscal Year
                and Media Events                                                Number        Number
 2010-2011                                555,000                                   7              B
 2011-2012                                555,000                                   7              B
 Note: This includes the estimated number of attendees (e.g., people actually attending the event, not
 just receiving a flyer) reached through presentations, and those reached through booths/exhibits at
 health/senior fairs, and those enrolled at enrollment events, excluding public service announcements
 (PSAs) and printed outreach materials.

                2.3 Estimated Number of Beneficiaries with Medicare              Goal         Objective
 Fiscal Year
                Status Due to a Disability Contact                              Number        Number
 2010-2011                                  150                                     7              B
 2011-2012                                  150                                     7              B
 Note: This includes all counseling contacts via telephone, in-person at home, in-person at site, and
 electronic contacts (e-mail, fax, etc.) duplicated client counts with Medicare beneficiaries due to
 disability and not yet age 65.

                2.4 Estimated Number of Low Income Beneficiaries                 Goal         Objective
 Fiscal Year
                Unduplicated                                                    Number        Number
 2010-2011                                  300                                     7              B
 2011-2012                                  300                                     7              B
 Note: This is the number of unduplicated low-income Medicare beneficiary contacts and/or contacts
 that discussed low-income subsidy (LIS). Low income means 150 percent of the Federal Poverty
 Level (FPL).

                2.5 Estimated Number of Enrollment and Enrollment                Goal         Objective
 Fiscal Year
                Assistance Contacts                                             Number        Number
 2010-2011                                 1,600                                    7              B
 2011-2012                                 1,600                                    7              B
 Note: This is the number of unduplicated enrollment contacts during which one or more qualifying
 enrollment topics were discussed. This includes all enrollment assistance, not just Part D.

                2.6 Estimated Part D Enrollment and Enrollment                   Goal         Objective
 Fiscal Year
                Assistance Contacts                                             Number        Number
 2010-2011                                  130                                     7              B
 2011-2012                                  130                                     7              B
 Note: This is a subset of all enrollment assistance in 2.5. It includes the number of unduplicated Part
 D enrollment contacts during which one or more qualifying Part D enrollment topics were discussed.




 Fresno-Madera Area Agency on Aging            Section 12 - Page 22                     Fiscal Year 2010-2011
                                                                                             Area Plan Update
                                                                                  Goal         Objective
 Fiscal Year     2.7 Estimated Number of Counselor FTEs in PSA
                                                                                 Number        Number
 2010-2011                                   18                                      7             B
 2011-2012                                   18                                      7             B
 Note: This is the total number of counselor FTEs (i.e. the total number of active counselors; paid, in-
 kind paid and volunteer working 2000 hours per year).


Section 3. HICAP Legal Services Units of Service (if applicable)

Not Applicable




 Fresno-Madera Area Agency on Aging            Section 12 - Page 23                      Fiscal Year 2010-2011
                                                                                              Area Plan Update
                      Health Insurance Counseling and Advocacy Program
                                       Service Unit Plan
                                 CCR Article 3, Section 7300(d)
                                             PSA #14
                               2009-2012 Three-Year Planning Period
                                       Fiscal Year 2009-2010

The Service Unit Plan (SUP) uses definitions that can be found at www.aging.ca.gov. After
connecting with the Home Page, select “AAA” tab, “Reporting”, “Reporting Instructions and Forms”,
and “Health Insurance Counseling and Advocacy Program” (HICAP) to find current instructions,
definitions, acronyms, and reporting forms. HICAP reporting instructions, specifications, definitions,
and forms critical to answering this SUP are all centrally located there. If you have related goals in
the Area Plan to Service Unit Plan, please list them in the 3rd column.
IMPORTANT NOTE FOR MULTIPLE PSA HICAPs: If you are a part of a multiple PSA HICAP where
two or more AAAs enter into agreement with one “Managing AAA,” then each AAA must enter its
equitable share of the estimated performance numbers in the respective SUPs. Please do this in
cooperation with the Managing AAA. The Managing AAA has the responsibility of providing the
HICAP services in all the covered PSAs in a way that is agreed upon and equitable among the
participating parties.
IMPORTANT NOTE FOR HICAPs WITH HICAP PAID LEGAL SERVICES: If your Master Contract
contains a provision for HICAP funds to be used for the provision of HICAP Legal Services, you
must complete Section 2.
IMPORTANT NOTE REGARDING FEDERAL PERFORMANCE TARGETS: The Centers for
Medicare and Medicaid Services require all State Health Insurance and Assistance Programs meet
certain targeted performance measures. These have been added in Section 4 below. The California
Department of Aging (CDA) will annually provide AAAs, via a Program Memo, with individual PSA
targets in federal performance measures to help complete Section 4.

Section 1. Three Primary HICAP Units of Service

 State Fiscal   Total Estimated Persons Counseled Per SFY                 Goal        Objective
 Year (SFY)     (Unit of Service)                                        Number       Number
  2009-2010                            2,303                                7             C

                Total Estimated Number of Attendees Reached in            Goal        Objective
     SFY
                Community Education Per SFY (Unit of Service)            Number       Number
  2009-2010                            3,815                                7             C

                Total Estimated Number of Community Education             Goal        Objective
     SFY
                Events Planned per SFY (Unit of Service)                 Number       Number
  2009-2010                             168                                 7             C




 Fresno-Madera Area Agency on Aging        Section 12 - Page 24                 Fiscal Year 2010-2011
                                                                                     Area Plan Update
Section 2. Three HICAP Legal Services Units of Service (if applicable)

Not Applicable

Section 3. Two HICAP Counselor Measures

     SFY          Planned Average Number of Registered Counselors for the SFY1
2009-2010                                                           27

     SFY          Planned Average Number of Active Counselors for the SFY2
2009-2010                                                           17

Section 4. Eight Federal Performance Benchmark Measures

Fiscal Year       4.1 - Beneficiaries Reached Per 10k Beneficiaries in PSA
   (FY)           Note: This includes counseling contacts and community education contacts.
2009-2010          1,866 (per California Department of Aging (CDA) Program Memo 09-02, Attachment A)

      FY          4.2 - One-on-One Counseling Per 10k Beneficiaries in PSA
2009-2010                         664 (per CDA Program Memo 09-02, Attachment A)

                  4.3 - Beneficiaries with Disabilities Contacts Reached Per 10k Beneficiaries with
      FY          Disabilities in PSA
                  Note: These are Medicare beneficiaries due to disability and not yet age 65.
2009-2010                           277 (per CDA Program Memo 09-02, Attachment A)

                  4.4 - Low Income Contacts Per 10k Low Income Beneficiaries in PSA
      FY
                  Note: Use 150% Federal Poverty Line (FPL) as Low Income.
2009-2010                         163 (per CDA Program Memo 09-02, Attachment A)

                  4.5 – All Enrollment and Assistance Contacts Per 10k Beneficiaries in PSA
      FY
                  Note: This includes all enrollment assistance, not just Part D.
2009-2010                           265 (per CDA Program Memo 09-02, Attachment A)

                  4.6 - Part D Enrollment and Assistance Contacts Per 10k Beneficiaries in PSA
      FY
                  Note: This is a subset of all enrollment assistance in 4.5.
2009-2010                            9 (per CDA Program Memo 09-02, Attachment A)

      FY          4.7 - Total Counselor FTEs Per 10k Beneficiaries in PSA
2009-2010                           39 (per CDA Program Memo 09-02, Attachment A)

      FY          4.8 - Percent of Active Counselors That Participate in Annual Update Trainings
2009-2010                          181% (per CDA Program Memo 09-02, Attachment A)



2 The number of registered Counselors will vary throughout the year. This includes Paid Counselors, In-kind Paid Counselors, and
  Volunteer Counselors. For “average,” how many Counselors do you intend to keep on registered rolls at any given time through the
  year?
3 The number of active Counselors will vary throughout the year. This includes Paid Counselors, In-kind Paid Counselors, and
  Volunteer Counselors. The average number of active Counselors cannot be greater than the total average registered Counselors.
  At any given time, how many of the registered Counselors do you anticipate will actually be counseling? For example, you may
  anticipate that 85% of your Counselors would be working in the field at any given time. Use the number of Counselors this
  represents for the average active Counselors, a subset of all registered Counselors.



Fresno-Madera Area Agency on Aging                    Section 12 - Page 25                             Fiscal Year 2010-2011
                                                                                                            Area Plan Update
                                     SECTION 13. FOCAL POINTS
                                 Community Focal Points List
  CCR Title 22, Article 3, Section 7302(a)(14), 45 CFR Section 1321.53(c), OAA 2006 306(a)
                                              PSA #14
                               2009-2012 Three-Year Planning Cycle

Provide an updated list of designated community focal points and their addresses. This
information must match the National Aging Program Information System SPR 106.



             Fresno City                    Fresno County              Madera County

   Senior Resource Center              City of Clovis             City of Madera
   Sierra Resource Campus              Clovis Senior Center       Older Adult Services
   2025 E. Dakota Ave.                 850 4th St.                1030 S. Gateway Dr.
   Fresno, CA 93726                    Clovis, CA 93612           Madera, CA 93637




Fresno-Madera Area Agency on Aging          Section 13 - Page 1              Fiscal Year 2010-2011
                                                                                  Area Plan Update
                                         SECTION 14. PRIORITY SERVICES
                      Funding for Access, In-Home Services, and Legal Assistance
                                                     PSA #14
                                        2009-2012 Three-Year Planning Cycle

The CCR, Article 3, Section 7312, requires that the AAA allocate an “adequate proportion” of federal
funds to provide Access, In-Home Services, and Legal Assistance in the PSA. The annual minimum
allocation is determined by the AAA through the planning process. The minimum percentages of
applicable Title III B funds1 listed below have been identified for annual expenditure throughout the
four-year planning period. These percentages are based on needs assessment findings, resources
available within the PSA, and discussions at public hearings on the Area Plan.

                      Category of Service & Percentage of Title III B Funds
              Expended In Or To Be Expended in FY 2009-2010 through FY 2011-2012


Category                                                             2009-2010              2010-2011              2011-2012

Access Services                                                         52.5%                  49.3%                  49.3%

Access Services include Case Management, Assisted Transportation, Transportation,
Information and Assistance, and Outreach.


Category                                                             2009-2010              2010-2011              2011-2012

In-Home Services                                                        21.5%                   8.2%                   8.2%
In-Home Services include Personal Care, Homemaker and Home Health Aides, Chore, In-Home
Respite, Daycare as respite services for families, Telephone Reassurance, Visiting, and Minor
Home Modification.


Category                                                             2009-2010              2010-2011              2011-2012

Legal Assistance Required Services                                       3.7%                   5.2%                   5.2%

Legal Assistance Required Activities include Legal Advice, Representation, Assistance to the
Ombudsman Program and Involvement in the Private Bar.


1.    Explain how allocations are justified and how they are determined to be sufficient to meet the
      need for the service within the PSA.

                The ongoing needs assessments and funding constraints are the determinate factors
                for the allocation of funding for all services; however, the Fresno-Madera Area
                Agency on Aging (FMAAA) remains resolute in maintaining funding levels for priority
                services.

1 Minimum percentages of applicable funds are calculated on the annual Title III B baseline allocation, minus Title III B administration
  and minus Ombudsman. At least one percent of the final Title III B calculation must be allocated for each “Priority Service” category
  or a waiver must be requested for the Priority Service category(s) that the AAA does not intend to fund.



Fresno-Madera Area Agency on Aging                        Section 14 - Page 1                              Fiscal Year 2010-2011
                                                                                                                Area Plan Update
2.   This form must be updated if the minimum percentages change from the initial year of the
     four-year plan.

3.   Provide documentation that prior notification of the Area Plan public hearing(s) was provided
     to all interested parties in the PSA and that the notification indicated that a change was
     proposed, the proposed change would be discussed at the hearing, and all interested parties
     would be given an opportunity to testify regarding the change.

             Area Plan public hearings are conducted as part of the FMAAA’s Governing Board
             and Advisory Council meetings, and as such, are included in agendas for these
             meetings. The FMAAA adheres to the tenets of the Ralph M. Brown Act, and
             agendas for the FMAAA Governing Board and Advisory Council meetings are posted
             according to the act’s requirements. Agendas are also mailed to all interested parties,
             including the FMAAA’s contracted service providers. As indicated in Section 9, Public
             Hearings, of this Area Plan document, minimum funding percentages for Title III B
             priority services were discussed at Area Plan public hearings and public input was
             encouraged.

4.   Submit a record (e.g., a transcript of that portion of the public hearing(s) in which adequate
     proportion is discussed) documenting that the proposed change in funding for this category
     of service was discussed at Area Plan public hearings.

             Transcripts of all FMAAA Governing Board and Advisory Council meetings are
             available from the FMAAA’s Administration office.




Fresno-Madera Area Agency on Aging         Section 14 - Page 2                   Fiscal Year 2010-2011
                                                                                      Area Plan Update
             SECTION 15. NOTICE OF INTENT TO PROVIDE DIRECT SERVICES
                                                 PSA 14

                CCR Article 3, Section 7320 (a)(b) and 42 USC Section 3027(a)(8)(C)

 If an AAA plans to directly provide any of the following services, it is required to provide a
 description of the methods that will be used to assure that target populations throughout the
 PSA will be served. If not providing any of the direct services below, check this box .

     Check Applicable Direct Services                       Check Each Applicable Fiscal Year

  Title III B: Information and Assistance                  FY 2009-10    FY 10-11      FY 11-12

  Title III B: Case Management                             FY 2009-10    FY 10-11      FY 11-12

  Title III B: Outreach                                    FY 2009-10    FY 10-11      FY 11-12

  Title III B: Program Development                         FY 2009-10    FY 10-11      FY 11-12

  Title III B: Coordination                                FY 2009-10    FY 10-11      FY 11-12

  Title III B: Long Term Care Ombudsman                    FY 2009-10    FY 10-11      FY 11-12

  Title III D: Disease Prevention                          FY 2009-10    FY 10-11      FY 11-12
   and Health Promotion

  Title III E: Information Services                        FY 2009-10    FY 10-11      FY 11-12

  Title III E: Access Assistance                           FY 2009-10    FY 10-11      FY 11-12

  Title III E: Support Services                            FY 2009-10    FY 10-11      FY 11-12

  Title VII (a): Long Term Care Ombudsman                  FY 2009-10    FY 10-11      FY 11-12

  Title VII (b) Prevention of Elder Abuse,                 FY 2009-10    FY 10-11      FY 11-12
   Neglect and Exploitation

Describe the methods that will be used to assure that target populations will be served
throughout the PSA: The Fresno-Madera Area Agency on Aging (FMAAA) conducts strategic
Outreach activities to target individuals eligible for available programs and services, with special
emphasis on populations identified in Section 8, Targeting, of this Area Plan document. Use of
the InfoVans are an integral part of the ongoing effort to bring service information and assistance
to locations specifically selected to access these segments of the service population. These
locations include, but are not limited to, migrant farming communities, food commodity distribution
sites, rural medical clinics, grocery store parking lots, flu clinic sites, senior housing facilities,
libraries, medical facilities, health fairs, and Indian gaming casinos. The FMAAA also networks
with community based service organizations to obtain referrals, and works with local media to
broadcast information on programs and services in English, Spanish, and Hmong.



Fresno-Madera Area Agency on Aging           Section 15 - Page 1                 Fiscal Year 2010-2011
                                                                                      Area Plan Update
            SECTION 16. REQUEST FOR APPROVAL TO PROVIDE DIRECT SERVICES
                                                           PSA #14

                                  Older Americans Act, Section 307(a)(8)
                          CCR Article 3, Section 7320(c), W&I Code Section 9533(f)


If an AAA plans to provide direct services other than those specified in Section 15, a separate
Section 16 must be completed for each type of service provided. The submission for CDA
approval may be for multiple funding sources for a specific service. If not requesting approval to
provide any direct services in Section 16, check this box .

Identify Service Category: Case Management

Check applicable funding source:1

      III B       III C-1          III C-2     III E           VII (a)
      CBSP (Identify the specific CBSP program or service on the “Service Category” line above)
      HICAP

Basis of Request for Waiver:

      Necessary to Assure an Adequate Supply of Service, OR

      More economical if provided by the AAA than comparable services purchased from a service
      provider.

Check each applicable Fiscal Year:

  If the AAA intends to provide this service for three years, check all boxes. If all boxes are not
  checked and the AAA intends to provide this service in subsequent years then this Section must
  be submitted yearly.

      FY 2009-10                               FY 2010-11                                  FY 2011-12

Justification: In the space below and/or through additional documentation, AAAs must provide a
cost-benefit analysis that substantiates any requests for direct delivery of the above stated service.2
The Fresno-Madera Area Agency on Aging provides care management services as part of the
Title III E Family Caregiver Support Program, the Multipurpose Senior Services Program, the
Title III B Supportive Services Program, and, through September 2009, the Linkages Program. This
administratively integrated and cost efficient system of care management allows the agency to
appropriately serve its clientele, providing an array of purchased services through provider contracts
negotiated for the most cost effective method of quality client care. In addition, the collocation aspect
of the Sierra Resource Campus allows the agency to quickly and effectively coordinate and maintain
the quality of its care management services.



1 Section 16 does not apply to Title V (SCSEP).
2 For a HICAP direct services waiver, the managing AAA of HICAP services must also document that all affected AAAs are in
  agreement.



Fresno-Madera Area Agency on Aging                     Section 16 - Page 1                            Fiscal Year 2010-2011
                                                                                                           Area Plan Update
            SECTION 16. REQUEST FOR APPROVAL TO PROVIDE DIRECT SERVICES
                                                           PSA #14

                                  Older Americans Act, Section 307(a)(8)
                          CCR Article 3, Section 7320(c), W&I Code Section 9533(f)

If an AAA plans to provide direct services other than those specified in Section 15, a separate
Section 16 must be completed for each type of service provided. The submission for CDA
approval may be for multiple funding sources for a specific service. If not requesting approval to
provide any direct services in Section 16, check this box .
Identify Service Category: Congregate Meals and Nutrition Education
Check applicable funding source:1
      III B       III C-1          III C-2     III E           VII (a)
      CBSP (Identify the specific CBSP program or service on the “Service Category” line above)
      HICAP

Basis of Request for Waiver:

      Necessary to Assure an Adequate Supply of Service, OR

      More economical if provided by the AAA than comparable services purchased from a service
      provider.

Check each applicable Fiscal Year:

  If the AAA intends to provide this service for three years, check all boxes. If all boxes are not
  checked and the AAA intends to provide this service in subsequent years then this Section must
  be submitted yearly.

      FY 2009-10                               FY 2010-11                                  FY 2011-12

Justification: In the space below and/or through additional documentation, AAAs must provide a
cost-benefit analysis that substantiates any requests for direct delivery of the above stated service.2
The Fresno-Madera Area Agency on Aging (FMAAA) has operated the Title III C-1 Congregate Nutrition
Program under a service waiver since 1994, which in that year allowed absorption of a $300,000 loss
due to the Intrastate Funding Formula. The FMAAA contracts for site management, and purchase meals
for the Congregate Nutrition Program through vendor agreements. Thirty-nine meal sites have been
established in the following locations: Fresno County rural, 14; Fresno County urban, 2; Madera County
rural, 4; Madera County urban, 3; and Fresno City, 16 (all urban). The agency retains contractual
oversight, including menu approval, in-service training for site coordinators, and site and kitchen
monitoring. The FMAAA’s registered dietitian is responsible for approving menus, providing nutrition
education for program participants, and conducting contractual monitoring to ensure compliance with all
current regulations and requirements.


1 Section 16 does not apply to Title V (SCSEP).
2 For a HICAP direct services waiver, the managing AAA of HICAP services must also document that all affected AAAs are in
  agreement.



Fresno-Madera Area Agency on Aging                     Section 16 - Page 2                               Fiscal Year 2010-2011
                                                                                                              Area Plan Update
            SECTION 16. REQUEST FOR APPROVAL TO PROVIDE DIRECT SERVICES
                                                           PSA #14

                                  Older Americans Act, Section 307(a)(8)
                          CCR Article 3, Section 7320(c), W&I Code Section 9533(f)


If an AAA plans to provide direct services other than those specified in Section 15, a separate
Section 16 must be completed for each type of service provided. The submission for CDA
approval may be for multiple funding sources for a specific service. If not requesting approval to
provide any direct services in Section 16, check this box .
Identify Service Category: Home-Delivered Meals and Nutrition Education
Check applicable funding source:1
      III B       III C-1          III C-2     III E           VII (a)
      CBSP (Identify the specific CBSP program or service on the “Service Category” line above)
      HICAP

Basis of Request for Waiver:
      Necessary to Assure an Adequate Supply of Service, OR
      More economical if provided by the AAA than comparable services purchased from a service
      provider.
Check each applicable Fiscal Year:
  If the AAA intends to provide this service for three years, check all boxes. If all boxes are not
  checked and the AAA intends to provide this service in subsequent years then this Section must
  be submitted yearly.
     FY 2009-10                                FY 2010-11                                  FY 2011-12

Justification: In the space below and/or through additional documentation, AAAs must provide a
cost-benefit analysis that substantiates any requests for direct delivery of the above stated service.2
The Fresno-Madera Area Agency on Aging (FMAAA) has operated the Title III C-2 Home-
Delivered Meals Program under a service waiver since 1994. The FMAAA purchases the meals
directly through vendor agreements. Fresno County recipients are delivered 14 meals once a
week, including seven breakfasts and seven frozen dinners, and participants in Madera County
are delivered a hot meal each weekday. The FMAAA’s registered dietitian is responsible for
approving menus, providing nutrition education, and conducting kitchen monitoring to ensure
compliance with all current regulations and requirements. PSA 14’s meal costs are some of the
lowest in the state, without compromising quality. As a result, there is no waiting list for the Home-
Delivered Meals Program.




1 Section 16 does not apply to Title V (SCSEP).
2 For a HICAP direct services waiver, the managing AAA of HICAP services must also document that all affected AAAs are in
  agreement.



Fresno-Madera Area Agency on Aging                     Section 16 - Page 3                               Fiscal Year 2010-2011
                                                                                                              Area Plan Update
            SECTION 16. REQUEST FOR APPROVAL TO PROVIDE DIRECT SERVICES
                                                           PSA #14

                                  Older Americans Act, Section 307(a)(8)
                          CCR Article 3, Section 7320(c), W&I Code Section 9533(f)


If an AAA plans to provide direct services other than those specified in Section 15, a separate
Section 16 must be completed for each type of service provided. The submission for CDA
approval may be for multiple funding sources for a specific service. If not requesting approval to
provide any direct services in Section 16, check this box .

Identify Service Category: Linkages

Check applicable funding source:1

      III B       III C-1          III C-2     III E           VII (a)
      CBSP (Identify the specific CBSP program or service on the “Service Category” line above)
      HICAP

Basis of Request for Waiver:

      Necessary to Assure an Adequate Supply of Service, OR

      More economical if provided by the AAA than comparable services purchased from a service
      provider.

Check each applicable Fiscal Year:

  If the AAA intends to provide this service for three years, check all boxes. If all boxes are not
  checked and the AAA intends to provide this service in subsequent years then this Section must
  be submitted yearly.

      FY 2009-10                               FY 2010-11                                  FY 2011-12

Justification: In the space below and/or through additional documentation, AAAs must provide a
cost-benefit analysis that substantiates any requests for direct delivery of the above stated service.2
The Fresno-Madera Area Agency on Aging provides care management services as part of the
Title III E Family Caregiver Support Program, the Multipurpose Senior Services Program, the Title III B
Supportive Services Program, and, through September 2009, the Linkages Program. This
administratively integrated and cost efficient system of care management allows the agency to
appropriately serve its clientele, providing an array of purchased services through provider
contracts negotiated for the most cost effective method of quality client care. In addition, the
collocation aspect of the Sierra Resource Campus allows the agency to quickly and effectively
coordinate and maintain the quality of its care management services.



1 Section 16 does not apply to Title V (SCSEP).
2 For a HICAP direct services waiver, the managing AAA of HICAP services must also document that all affected AAAs are in
  agreement.



Fresno-Madera Area Agency on Aging                     Section 16 - Page 4                               Fiscal Year 2010-2011
                                                                                                              Area Plan Update
            SECTION 16. REQUEST FOR APPROVAL TO PROVIDE DIRECT SERVICES
                                                           PSA #14

                                  Older Americans Act, Section 307(a)(8)
                          CCR Article 3, Section 7320(c), W&I Code Section 9533(f)


If an AAA plans to provide direct services other than those specified in Section 15, a separate
Section 16 must be completed for each type of service provided. The submission for CDA
approval may be for multiple funding sources for a specific service. If not requesting approval to
provide any direct services in Section 16, check this box .

Identify Service Category: Respite Care: Respite Homemaker Assistance

Check applicable funding source:1

      III B       III C-1          III C-2     III E           VII (a)
      CBSP (Identify the specific CBSP program or service on the “Service Category” line above)
      HICAP

Basis of Request for Waiver:

      Necessary to Assure an Adequate Supply of Service, OR

      More economical if provided by the AAA than comparable services purchased from a service
      provider.

Check each applicable Fiscal Year:

  If the AAA intends to provide this service for three years, check all boxes. If all boxes are not
  checked and the AAA intends to provide this service in subsequent years then this Section must
  be submitted yearly.

      FY 2009-10                               FY 2010-11                                  FY 2011-12

Justification: In the space below and/or through additional documentation, AAAs must provide a
cost-benefit analysis that substantiates any requests for direct delivery of the above stated service.2
The Fresno-Madera Area Agency on Aging provides care management services as part of the
Title III E Family Caregiver Support Program, the Multipurpose Senior Services Program, the Title III B
Supportive Services Program, and, through September 2009, the Linkages Program. This
administratively integrated and cost efficient system of care management allows the agency to
appropriately serve its clientele, providing an array of purchased services through provider
contracts negotiated for the most cost effective method of quality client care. One of these
purchased service categories under the Title III E Family Caregiver Support Program is Respite
Homemaker Assistance.



1 Section 16 does not apply to Title V (SCSEP).
2 For a HICAP direct services waiver, the managing AAA of HICAP services must also document that all affected AAAs are in
  agreement.



Fresno-Madera Area Agency on Aging                     Section 16 - Page 5                               Fiscal Year 2010-2011
                                                                                                              Area Plan Update
            SECTION 16. REQUEST FOR APPROVAL TO PROVIDE DIRECT SERVICES
                                                           PSA #14

                                  Older Americans Act, Section 307(a)(8)
                          CCR Article 3, Section 7320(c), W&I Code Section 9533(f)


If an AAA plans to provide direct services other than those specified in Section 15, a separate
Section 16 must be completed for each type of service provided. The submission for CDA
approval may be for multiple funding sources for a specific service. If not requesting approval to
provide any direct services in Section 16, check this box .

Identify Service Category: Respite Care: Respite In-Home Supervision

Check applicable funding source:1

      III B       III C-1          III C-2     III E           VII (a)
      CBSP (Identify the specific CBSP program or service on the “Service Category” line above)
      HICAP

Basis of Request for Waiver:

      Necessary to Assure an Adequate Supply of Service, OR

      More economical if provided by the AAA than comparable services purchased from a service
      provider.

Check each applicable Fiscal Year:

  If the AAA intends to provide this service for three years, check all boxes. If all boxes are not
  checked and the AAA intends to provide this service in subsequent years then this Section must
  be submitted yearly.

      FY 2009-10                               FY 2010-11                                  FY 2011-12

Justification: In the space below and/or through additional documentation, AAAs must provide a
cost-benefit analysis that substantiates any requests for direct delivery of the above stated service.2
The Fresno-Madera Area Agency on Aging provides care management services as part of the
Title III E Family Caregiver Support Program, the Multipurpose Senior Services Program, the Title III B
Supportive Services Program, and, through September 2009, the Linkages Program. This
administratively integrated and cost efficient system of care management allows the agency to
appropriately serve its clientele, providing an array of purchased services through provider
contracts negotiated for the most cost effective method of quality client care. One of these
purchased service categories under the Title III E Family Caregiver Support Program is Respite
In-Home Supervision.



1 Section 16 does not apply to Title V (SCSEP).
2 For a HICAP direct services waiver, the managing AAA of HICAP services must also document that all affected AAAs are in
  agreement.



Fresno-Madera Area Agency on Aging                     Section 16 - Page 6                               Fiscal Year 2010-2011
                                                                                                              Area Plan Update
            SECTION 16. REQUEST FOR APPROVAL TO PROVIDE DIRECT SERVICES
                                                           PSA #14

                                  Older Americans Act, Section 307(a)(8)
                          CCR Article 3, Section 7320(c), W&I Code Section 9533(f)


If an AAA plans to provide direct services other than those specified in Section 15, a separate
Section 16 must be completed for each type of service provided. The submission for CDA
approval may be for multiple funding sources for a specific service. If not requesting approval to
provide any direct services in Section 16, check this box .

Identify Service Category: Supplemental Services: Assistive Devices for Caregiving

Check applicable funding source:1

      III B       III C-1          III C-2     III E           VII (a)
      CBSP (Identify the specific CBSP program or service on the “Service Category” line above)
      HICAP

Basis of Request for Waiver:

      Necessary to Assure an Adequate Supply of Service, OR

      More economical if provided by the AAA than comparable services purchased from a service
      provider.

Check each applicable Fiscal Year:

  If the AAA intends to provide this service for three years, check all boxes. If all boxes are not
  checked and the AAA intends to provide this service in subsequent years then this Section must
  be submitted yearly.

      FY 2009-10                               FY 2010-11                                  FY 2011-12

Justification: In the space below and/or through additional documentation, AAAs must provide a
cost-benefit analysis that substantiates any requests for direct delivery of the above stated service.2
The Fresno-Madera Area Agency on Aging provides care management services as part of the
Title III E Family Caregiver Support Program, the Multipurpose Senior Services Program, the Title III B
Supportive Services Program, and, through September 2009, the Linkages Program. This
administratively integrated and cost efficient system of care management allows the agency to
appropriately serve its clientele, providing an array of purchased services through provider
contracts negotiated for the most cost effective method of quality client care. Supplemental
Services are provided administratively by staff, with no out of pocket expense, for Title III E Family
Caregiver Support Program clients. One of these purchased Supplemental Services under the
Title III E Family Caregiver Support Program is Assistive Devices for Caregiving.


1 Section 16 does not apply to Title V (SCSEP).
2 For a HICAP direct services waiver, the managing AAA of HICAP services must also document that all affected AAAs are in
  agreement.



Fresno-Madera Area Agency on Aging                     Section 16 - Page 7                               Fiscal Year 2010-2011
                                                                                                              Area Plan Update
            SECTION 16. REQUEST FOR APPROVAL TO PROVIDE DIRECT SERVICES
                                                           PSA #14

                                  Older Americans Act, Section 307(a)(8)
                          CCR Article 3, Section 7320(c), W&I Code Section 9533(f)


If an AAA plans to provide direct services other than those specified in Section 15, a separate
Section 16 must be completed for each type of service provided. The submission for CDA
approval may be for multiple funding sources for a specific service. If not requesting approval to
provide any direct services in Section 16, check this box .

Identify Service Category: Supplemental Services: Home Adaptations for Caregiving

Check applicable funding source:1

      III B       III C-1          III C-2     III E           VII (a)
      CBSP (Identify the specific CBSP program or service on the “Service Category” line above)
      HICAP

Basis of Request for Waiver:

      Necessary to Assure an Adequate Supply of Service, OR

      More economical if provided by the AAA than comparable services purchased from a service
      provider.

Check each applicable Fiscal Year:

  If the AAA intends to provide this service for three years, check all boxes. If all boxes are not
  checked and the AAA intends to provide this service in subsequent years then this Section must
  be submitted yearly.

      FY 2009-10                               FY 2010-11                                  FY 2011-12

Justification: In the space below and/or through additional documentation, AAAs must provide a
cost-benefit analysis that substantiates any requests for direct delivery of the above stated service.2
The Fresno-Madera Area Agency on Aging provides care management services as part of the
Title III E Family Caregiver Support Program, the Multipurpose Senior Services Program, the Title III B
Supportive Services Program, and, through September 2009, the Linkages Program. This
administratively integrated and cost efficient system of care management allows the agency to
appropriately serve its clientele, providing an array of purchased services through provider
contracts negotiated for the most cost effective method of quality client care. Supplemental
Services are provided administratively by staff, with no out of pocket expense, for Title III E Family
Caregiver Support Program clients. One of these purchased Supplemental Services under the
Title III E Family Caregiver Support Program is Home Adaptations for Caregiving.


1 Section 16 does not apply to Title V (SCSEP).
2 For a HICAP direct services waiver, the managing AAA of HICAP services must also document that all affected AAAs are in
  agreement.



Fresno-Madera Area Agency on Aging                     Section 16 - Page 8                               Fiscal Year 2010-2011
                                                                                                              Area Plan Update
            SECTION 16. REQUEST FOR APPROVAL TO PROVIDE DIRECT SERVICES
                                                           PSA #14

                                  Older Americans Act, Section 307(a)(8)
                          CCR Article 3, Section 7320(c), W&I Code Section 9533(f)


If an AAA plans to provide direct services other than those specified in Section 15, a separate
Section 16 must be completed for each type of service provided. The submission for CDA
approval may be for multiple funding sources for a specific service. If not requesting approval to
provide any direct services in Section 16, check this box .

Identify Service Category: Supplemental Services: Caregiving Emergency Cash/Material Aid

Check applicable funding source:1

      III B       III C-1          III C-2     III E           VII (a)
      CBSP (Identify the specific CBSP program or service on the “Service Category” line above)
      HICAP

Basis of Request for Waiver:

      Necessary to Assure an Adequate Supply of Service, OR

      More economical if provided by the AAA than comparable services purchased from a service
      provider.

Check each applicable Fiscal Year:

  If the AAA intends to provide this service for three years, check all boxes. If all boxes are not
  checked and the AAA intends to provide this service in subsequent years then this Section must
  be submitted yearly.

      FY 2009-10                               FY 2010-11                                  FY 2011-12

Justification: In the space below and/or through additional documentation, AAAs must provide a
cost-benefit analysis that substantiates any requests for direct delivery of the above stated service.2
The Fresno-Madera Area Agency on Aging provides care management services as part of the
Title III E Family Caregiver Support Program, the Multipurpose Senior Services Program, the Title III B
Supportive Services Program, and, through September 2009, the Linkages Program. This
administratively integrated and cost efficient system of care management allows the agency to
appropriately serve its clientele, providing an array of purchased services through provider
contracts negotiated for the most cost effective method of quality client care. Supplemental
Services are provided administratively by staff, with no out of pocket expense, for Title III E Family
Caregiver Support Program clients. One of these purchased Supplemental Services under the
Title III E Family Caregiver Support Program is Caregiving Emergency Cash/Material Aid.


1 Section 16 does not apply to Title V (SCSEP).
2 For a HICAP direct services waiver, the managing AAA of HICAP services must also document that all affected AAAs are in
  agreement.



Fresno-Madera Area Agency on Aging                     Section 16 - Page 9                               Fiscal Year 2010-2011
                                                                                                              Area Plan Update
                                SECTION 17. GOVERNING BOARD
                                            PSA #14
                              2009-2012 Three-Year Area Plan Cycle

                                   CCR Article 3, Section 7302(a)(11)


                              Fresno-Madera Area Agency on Aging
                                    Governing Board Roster
                                             2010

                              Number of Members on the Board: 15

                                                Officers

             Officer            JPA Representative                 Title    Term Expiration
  Al Grace                     Fresno City                 Chair               1/2/2012
  Robert Ward                  Fresno County               1st Vice-Chair      1/3/2011
                                                            nd
  Joy Hansen                   Madera County               2 Vice-Chair        1/26/2012


                                           Elected Officials

                Elected Official                    JPA Representative      Term Expiration
  Phil Larson                                  Fresno County                   1/2/2011
  Max Rodriguez                                Madera County                   1/8/2011
  Cynthia Sterling                             Fresno City                     1/5/2011


                                           Board Members

                Board Member                        JPA Representative      Term Expiration
  Dave Case                                     Fresno County                  1/2/2012
  Leonard Haggerty                             Fresno County                   1/3/2011
  Edward Hokokian                              Fresno County                   1/2/2012
  Lewis Honeycutt                              Madera County                   2/28/2011
  Patty Manfredi                               Madera County                   1/6/2011
  Lenora Salazar                               Madera County                   1/6/2011
  Rodney Ashley                                 Fresno City                    1/8/2011
  Vonnie Franks                                Fresno City                     1/1/2012
  Beatrice Johnson                             Fresno City                     1/8/2011




Fresno-Madera Area Agency on Aging           Section 17 - Page 1            Fiscal Year 2010-2011
                                                                                 Area Plan Update
                                SECTION 18. ADVISORY COUNCIL
                                            PSA #14
                               2009-2012 Three-Year Planning Cycle

                                    45 CFR, Section 1321.57
                                 CCR Article 3, Section 7302(a)(12)

Total Council Membership (including vacancies):              21
Number of Council Members 60+:                               16

Race/Ethnic Composition                  % of PSA’s 60+ Population     % on Advisory Council
   White                                               61.4%                  86.6%
   Hispanic                                            25.8%                   6.7%
   Black                                                3.4%
   Asian/Pacific Islander                               7.3%                   6.7%
   Native American/Alaskan Native                       1.0%
   Other                                                1.1%

A copy of the current FMAAA Advisory Council membership roster is attached.

Indicate which member(s) represent each of the “Other Representation” categories listed below.
(Information regarding members in the following categories is available from the FMAAA
Administration office.)
                                                       Yes        No
Low Income Representative
Disabled Representative
Supportive Services Provider Representative
Health Care Provider Representative
Local Elected Officials
Individuals with Leadership Experience in
the Private and Voluntary Sectors

Explain any “No” answer.
The FMAAA actively recruits for FMAAA Advisory Council members representative of the older adult
population in Fresno and Madera counties.

Briefly describe the process designated by the local governing board to appoint advisory
council members.
The FMAAA was established in 1980 as a Joint Powers Authority (JPA), with Fresno County,
Madera County, and the city of Fresno designated as the joint power entities. The FMAAA
Advisory Council consists of 21 individuals, seven from each JPA area. The FMAAA Governing
Board’s ad hoc selection committee interviews individuals who indicate interest in advisory
council membership, and recommends appointments to the governing board.


Fresno-Madera Area Agency on Aging          Section 18 - Page 1             Fiscal Year 2010-2011
                                                                                 Area Plan Update
                              Fresno-Madera Area Agency on Aging
                                    Advisory Council Roster
                                             2010


    Council Member             Title                JPA Representative   Term Expiration
    Patricia Summers           Chair                Fresno City             6/30/2010

    Robbie Cranch              1st Vice-Chair       Fresno County           6/30/2010

    Gerald Ongman              2nd Vice-Chair       Madera County           6/30/2010

    Carol Conrow                                    Fresno County           6/30/2012

    Connie Figueroa                                 Fresno County           6/30/2010

    Sandra Miller                                   Fresno County           6/30/2012

    Doloris Olmstead                                Fresno County           6/30/2011

    Vacant                                          Fresno County

    Vacant                                          Fresno County

    Merle Anderson                                  Madera County           6/30/2012

    Joann Blancett                                  Madera County           6/30/2011

    Robert Costanzo                                 Madera County           6/30/2011

    Terri Cummins                                   Madera County           6/30/2012

    Robert Hand                                     Madera County           6/30/2010

    Shirley Tickel                                  Madera County           6/30/2011

    Pat Beasley                                     Fresno City             6/30/2011

    Craig Fowler                                    Fresno City             6/30/2011

    Margery Minney                                  Fresno City             6/30/2011

    Edward Saliba                                   Fresno City             6/30/2012

    Ross Smith                                      Fresno City             6/30/2012

    Virginia Wheeler                                Fresno City             6/30/2010




Fresno-Madera Area Agency on Aging         Section 18 - Page 2              Fiscal Year 2010-2011
                                                                                 Area Plan Update
                                SECTION 19. LEGAL ASSISTANCE
                                            PSA #14
                            2009-2012 Three-Year Area Planning Cycle

This section must be completed and submitted with the Three-Year Area Plan. Any changes to
this Section must be documented on this form and remitted with Area Plan Updates.

1. Specific to legal services, what is your AAA’s Mission Statement or Purpose Statement?
   Statement must include Title III B requirements.

       The Fresno-Madera Area Agency on Aging (FMAAA) seeks to protect older adults and
       adults with disabilities, particularly those with the greatest social and economic need, from
       direct challenges to independence, choice, and financial security through provision of
       Title III B legal services. These legal services help older individuals and adults with
       disabilities understand their rights, exercise options through informed decision making,
       and achieve optimal benefit from the support and opportunities promised by law.

2. Based on your local needs assessment, what percentage of Title III B funding is allocated to
   legal services? Fiscal Year 2009-2010, 3.7%; Fiscal Years 2010-2011 & 2011-2012, 5.2%

3. Specific to legal services, what is the targeted senior population and mechanism for reaching
   targeted groups in your PSA?

       Older adults with low income and limited English proficiency in both the urban and rural
       areas of Fresno and Madera counties are targeted for legal services. In addition to the
       outreach methods described in item 5 below, the FMAAA’s Direct Services staff, the city
       of Madera’s Older Adult Services staff, and staff and volunteers of seven senior and
       community centers inform older adults of available services, including legal services.

4. How many legal assistance providers are in your PSA?

          Fiscal Year        # of Legal Services Providers
          2009-2010                         1
          2010-2011                         1
          2011-2012                         1

5. What methods of outreach are providers using?

       Central California Legal Services, the FMAAA’s contracted legal services provider,
       conducts presentations at senior and community centers located in rural areas, conducts
       outreach at community events, and uses local media to publicize services. In addition,
       door-to-door outreach is conducted in targeted neighborhoods to promote the federal
       Earned Income Tax credit to individuals with low income and limited English proficiency.

6. What geographic regions are covered by each provider?

       Fiscal Year               Name of Provider                  Geographic Region Covered
       2009-2010        Central California Legal Services, Inc.    Fresno and Madera Counties
       2010-2011        Central California Legal Services, Inc.    Fresno and Madera Counties
       2011-2012        Central California Legal Services, Inc.    Fresno and Madera Counties


Fresno-Madera Area Agency on Aging           Section 19 - Page 1                Fiscal Year 2010-2011
                                                                                     Area Plan Update
7.    Discuss how older adults access legal services in your PSA:

         Central California Legal Services (CCLS) offers monthly legal intake sessions at senior
         and community centers in Fresno and Madera counties. CCLS conducts Senior
         Volunteer Day once each month in downtown Fresno, where older adults can obtain a
         pro bono consultation with an attorney on the spot. CCLS provides assistance for older
         adults with applying for the federal Earned Income Tax Credit, with a particular focus on
         individuals with low income and limited English proficiency. Referrals to CCLS are
         generated from inquiries to the Fresno-Madera Area Agency on Aging’s (FMAAA)
         Information and Assistance department, as well as through the FMAAA’s contracted
         service providers. Services can also be accessed through the CCLS Web site,
         www.centralcallegal.org.

8.    Discuss the major legal issues in your PSA. Include new trends of legal problems in your
      area:

         Requests for assistance with housing issues dominate all other legal issues handled by
         CCLS on behalf of older adults with low income. CCLS has seen an increase in
         requests for resolution of debt collection issues, as well as increased requests from
         grandparents for assistance with obtaining guardianship of their grandchildren.

9.    What are the barriers to accessing legal assistance in your PSA? Include proposed
      strategies for overcoming such barriers.

         The variety of languages spoken within Fresno and Madera counties can present a
         barrier for individuals who wish to access legal assistance. Among the languages
         spoken by CCLS staff members are Spanish, Hmong, Lao, and Cambodian; other
         languages, including sign language and deaf services, are accommodated through use
         of professional interpreters. Funding constrictions limit the number of senior and
         community centers where legal intake sessions can be offered; CCLS’ strategy is to
         divide these sessions between urban centers with large numbers of participants, and
         centers located in rural agricultural communities. Collaboration with other community
         based organizations significantly expands access to services (see item 10 below).

10.   What other organizations or groups does your legal service provider coordinate services
      with?

         CCLS collaborates with the Fresno County Superior Court and the Fresno County Law
         Library to provide clinics for grandparents seeking guardianship of their grandchildren.
         CCLS also collaborates with the San Joaquin College of Law and the Clovis Senior
         Center to offer Senior Law Day, another opportunity for older adults to receive legal
         assistance free of charge. CCLS maintains a Memorandum of Understanding with
         Valley Caregiver Resource Center for the Long Term Care Ombudsman Program.
         CCLS is a member of the Hmong Health Collaborative, a group of ten community based
         organizations, including the Fresno Center for New Americans and Fresno
         Interdenominational Refugee Ministries, working to improve access to cultural and
         linguistic-sensitive health care for the Hmong community in the San Joaquin Valley.
         CCLS helped to form the Fresno Area EITC Partnership, a group of 16 organizations,
         such as Centro La Familia Advocacy and the Fresno West Coalition for Economic
         Development, that work together to promote the federal Earned Income Tax Credit to
         individuals with low income and limited English proficiency.


Fresno-Madera Area Agency on Aging       Section 19 - Page 2                   Fiscal Year 2010-2011
                                                                                    Area Plan Update
           SECTION 20. MULTIPURPOSE SENIOR CENTER (MPSC) ACQUISTION OR
                         CONSTRUCTION COMPLIANCE REVIEW
                                            PSA #14
                            2009-2012 Three-Year Area Planning Cycle

                             CCR Title 22, Article 3, Section 7302(a)(15)
                                  20-Year Tracking Requirement

   No, Title III B funds have not been used for MPSC Acquisition or Construction.
   Yes, Title III B funds have been used for MPSC Acquisition or Construction.
   If yes, complete the chart below.
                                                                 Recapture Period  Compliance
Title III Grantee and/or   Type        III B Funds % of Total
                                                                   MM/DD/YY         Verification
     Senior Center       Acq/Const       Awarded     Cost
                                                                 Begin      Ends (State Use Only)
Name:
Address:



Name:
Address:



Name:
Address:



Name:
Address:




Fresno-Madera Area Agency on Aging         Section 20 - Page 1                 Fiscal Year 2010-2011
                                                                                    Area Plan Update
                   SECTION 21. FAMILY CAREGIVER SUPPORT PROGRAM
                                            PSA #14
                               2009-2012 Three-Year Planning Cycle

   Notice of Intent for Non-Provision of FCSP Multifaceted Systems of Support Services
                         Older Americans Act Section 373(a) and (b)

Based on PSA review of current support needs and services for family caregivers and
grandparents (or other older relative of a child), does the AAA intend to use Title III E and/or
matching FCSP funds to provide each of the following federal Title III E services for both family
caregivers and grandparents? Check YES or NO for each of the services identified below.
NOTE: Refer to PM 08-03 for definitions for Title III E categories.


                 FAMILY CAREGIVER SUPPORT PROGRAM for FY 2009-2012

Family Caregiver Information Services                           YES           NO

Family Caregiver Access Assistance                              YES           NO

Family Caregiver Support Services                               YES           NO

Family Caregiver Respite Care                                   YES           NO

Family Caregiver Supplemental Services                          YES           NO

       and

Grandparent Information Services                                YES           NO

Grandparent Access Assistance                                   YES           NO

Grandparent Support Services                                    YES           NO

Grandparent Respite Care                                        YES           NO

Grandparent Supplemental Services                               YES           NO


Justification: For each above service category that is checked “no”, explain how it is being
addressed within the PSA:

   The mandate to include grandparents as eligible participants for FCSP services was not
   accompanied by a corresponding increase in resources. Existing resources are being used at
   full capacity to provide services for family caregivers. When additional resources are
   provided, the FMAAA will be in a position to consider promotion and expansion of FCSP
   services for grandparents; until such time, this is a mandate for which funding is not available.
   To date, there have been no referrals for provision of FCSP services for grandparents.
   However, the FMAAA would not deny FCSP services for a grandparent if existing family
   caregiver clients’ service requirements are met and funds remain in the FCSP budget.


Fresno-Madera Area Agency on Aging        Section 21 - Page 1                  Fiscal Year 2010-2011
                                                                                    Area Plan Update

				
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