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COMMISSIONERS' COURT AGENDA REQUEST
PLEASE FURNISH ONE ORIGINAL AND NINE COPIES OF THIS REQUEST AND DOCUMENTS TO BE
REVIEWED BY THE COURT.
~----
MADE BY: Pat Tinley OFFICE: County Jude
MEETING DATE: February 10, 2003 TIME PREFERRED:
SUBJECT: (PLEASE BE SPECIFIC)
Consider and discuss appointment of two representatives from Kerr County to the Alamo Senior
Advisory Committee.
EXECUTIVE SESSION REQUESTED: (PLEASE STATE REASON)
NAME OF PERSON ADDRESSING THE COURT:
ESTIMATED LENGTH OF PRESENTATION:
IF PERSONNEL MATTER -NAME OF EMPLOYEE:
County Judge
Time for submitting this request for Court to assure that the matter is posted in accordance with Title 5, Chapter
551 and 552, Government Code, is as follows:
Meeting scheduled for Mondays:
THIS REQUEST RECEIVED BY:
THIS REQUEST RECEIVED ON:
5:00 P.M. previous Tuesday.

All Agenda Requests will be screened by the County Judge's Office to determine if adequate information has been
prepared for the Court's formal consideration and action at time of Court Meetings. Your cooperation will be
appreciated and contribute towards you request being addressed at the earliest opportunity. See Agenda Request Rules
Adopted by Commissioners' Court.
//Area Agency
~~ ~~on Aging
//!i v
Funded through the Texas Department on Aging
Alamo Area Council of Governments
MEMORANDUM
TO: Judge Tinley
County Judge
Kerr County
FROM: Maggie Schreier, Program Director ,~%'~"'
Alamo Area Agency on Aging
SUBJECT: County Representation on the Alamo Senior Advisory Committee
DATE: January 13, 2003
1. I am the program director for Alamo Area Agency on Aging. Our agency provides
senior services throughout the rural counties of the AACOG region. I am enclosing
some materials to tell you more about my agency and our services. As with many
agencies I have an advisory committee that provides oversight and input.
2. The Alamo Senior Advisory Committee consists of two representatives from each
county, as well as the Alamo AAA subcontractors, at large members, and members of
the Texas Silver Haired Legislature. For some time, the number of active county
representatives has been declining. As we start a new calendar year, I urge you to
appoint individuals to fill the vacancies.
3. In Kerr County, Betty Pelton was the only representative from Kerr County. Her term
of office expires December 2002. She is not interested in serving another term.
Therefore, you have two vacancies. One is for a full three year term. The other is for a
one year term that will expire December 2003.
4. The County representatives are my link to what's happening in the county. They also
represent the county's interest in voting matters. Normally, a County representative is
asked to attend the monthly Alamo Senior Advisory committee and to serve on
committees as needed. The Advisory Committee meets on the second Friday of the
month in the afternoon. I would like to obtain replacements for the current vacancies.
The candidates do not have to be over age 60, although that is strongly encouraged.
They do need to represent the interests of seniors. I know it is sometimes difficult to
identify interested parties, but hope that you can find someone for these positions.
8700 Tesoro, Suite 700 • San Antonio, Texas • 78217 • (210) 362-5200 • Fax: (210) 225-5937 • Web site: www.aacog.com • E-mail: mail@aacog.com
Some options may include representatives from senior center board or participants,
elected officials, interagency groups, ministerial alliance, or community service
organizations.
5. As an incentive to increasing membership, I am going to offer some form of travel
reimbursement for those attending the meetings. I realize that the expense of travel
may hinder some interested parties from attending the meetings.
6. I look forward to working with you. If you have any questions, please contact me at
210-362-5240. Thank you for your support of the Alamo Senior Advisory Committee.
AACOG
ALAMO SENIOR ADVISORY COMMITTEE
ORIENTATION
February 14, 2003
DRAFT
BACKGROUND
I. Legislative Authorization-Federal
A. The Older Americans Act was first passed in 1965 as part of President
Johnson's "Great Society." The Older Americans Act is administered
through the Administration on Aging which is part of the United States
Department of Health and Human Services. There are 10 regional
offices. Our regional office is located in Dallas.
B. The Older Americans Act has been amended numerous times, most
recently in Fa112000. The most significant new changes are the addition
of a caregiver support program and the addition of language targeting
"and older individuals residing in rural areas." The Older Americans Act
can be found at Title III of the United States Code. Older Americans Act
funds are frequently referred to as Title III funds.
C. Older Americans Act funds are used to support our senior programs such
as nutrition, transportation, care coordination services, ombudsman,
benefits counseling, care giver support, and information and referral.
Funds are distributed to the states based on a funding formula that
considers the number of elderly. The state funding formula factors the
number of elderly, low income and minority seniors to distribute the
money to the Area Agencies on Aging.
II. Legislative Authorization--State
A. Creating the Alamo Area Council of Governments: AACOG is
authorized by the State Regional Planning Act of 1965, as amended and
codified. AACOG is designated as the regional clearinghouse that
reviews and comments upon grant applications submitted for state and
federal funding organizations throughout the 12-county region. Further,
AACOG provides direct assistance to member governments in their
planning functions, preparation of applications and the administration of
area wide programs. Financial support for these programs is provided
through local dues, state appropriations, state and federal grants that are
matched by local monies, and other public and private funds.
B. Creating the Area Agency on Aging: The area agency on aging was
created by the Older Americans Act of 1965, Section 305 (a)(1)(E), as
amended. The State Unit on Aging-Texas Department on Aging-
divided the state into distinct planning and service areas through the
Texas Administrative Code, Rule 254.9 Designation of Planning and
Service Areas. We are in planning and service area 18a.
1. There are 28 area agencies on aging in the state of Texas. We are
the only Council of Governments with two area agencies on aging.
2. The Alamo Area Agency on Aging covers the 11 counties
surrounding Bexar County.
III. The Texas Department on Aging acts through its staff and Board on issues of
policy and funding. They also process all required reports and do contract
monitoring. TDOA controls the dollars from the federal and state
government. TDOA is also the recipient of many grants or special funds that
are released to the AAAs. As a result there are many reports that are
forwarded to TDOA on a monthly or quarterly basis. The information in the
reports is required either by the Legislative Budget Board or the
Administration on Aging.
A. TDOA recently survived Sunset legislation that threatened to combine
TDOA with TDHS. Currently, TDOA will exist independently unti12005.
B. For FY 02 TDOA went to a new reporting and budget process. This has
initially resulted in an increased workload for both the subcontractors
and my staff.
IV. A common characteristic of aging programs is the use of state and local
advisory councils to assist the agency in its work.
A. The Texas Board on Aging meets quarterly to review policy and financial
issues. The members of the TDOA Board are listed in the attachments.
NOTE: We are fortunate to have Mr. Richard Tankerson of San Antonio
as a member of the Board. Committee meetings are normally held the
day before the Board meeting.
B. The Citizens Advisory Council meets before the Board meeting. It is
composed of representatives of each AAA. Members may attend by
phone. Normally, the president or a representative of the local advisory
committee serves on this council. The council has the opportunity to
provide input on issues the-board will consider. It may also propose
additional items for the Board.
C. The AACOG Board of Directors meets monthly. Much of my work is
with three committees. The Management Committee reviews funding
issues, grant applications, and other issues involving the spending of
resources. The Plans and Program Committee approves nominations for
subcommittees and by laws. The Judges Committee meets monthly. I
provide a written and oral report on issues in the rural counties. All
issues involving funding, plans, etc. must be approved by the AACOG
Board before implementation. Items going to the Board must normally
be available by the second Wednesday.
D. The Alamo Senior Advisory Committee consists of a maximum of 45
members. Current membership includes subcontractors, county
representative, at-large members, and local members of the Silver
Haired Legislature. The current membership list and the by laws are
attached.
1. The ASAC meets monthly on the first Friday at 1:00. Each meeting
normally contains a presentation on a senior issue. Subcontractor
meetings are normally held in the morning. Following the ASAC a
summary of the meeting is mailed to all members.
2. The ASAC votes on budget and policy issues. There are currently no
standing subcommittees. However, I would like to form an
appropriations subcommittee.
V. Funding for Aging Programs
A. The AAA receives funding through the TDOA. About 80% of the funds
are federal funds and the remainder are state funds. The state uses a
funding formula to divide the funds among the various AAAs. The
funding formula provides a base amount for each AAA. It then further
divides the money based on a formula that weighs the number of seniors,
the low income seniors, and the minority seniors.
B. Alamo AAA normally divides its Title III money using the same funding
formula. A spreadsheet reflects the current factors.
C. We have not yet received our funds for FY02. We do know that Congress
approved a 9% overall increase in funds for the Older Americans Act. It
is unknown how much of an increase we will see locally.
D. Another important part of Aging Programs is that they are not "need
based." Everyone can participate. We can not charge a fee. However,
we do request donations. All donations must be confidential. No one can
be dropped from a service because of failing to contribute. Every effort
must be made to preserve the dignity of our clients.
E. Speaking of funding just a little information on the relationship
between our subcontractors and the money we provide. The dollars from
the AAA are not designed to cover all their program or to provide for the
cost of all the meals they will serve that year. The subcontractors are
dependent upon participant contributions, fundraising, and careful
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budgeting to keep their programs going. I am attaching a spreadsheet
that shows the proportion of units served paid for by TDOA.
VI. Payment Process
A. The payment process for the subcontractors is a detailed process
requiring verification of much information. At the end of the month, the
subcontractor prepares a request for reimbursement (RFR). On this
request they include: the number of units served, the number of units
claimed for reimbursement, dollars reimbursed YTD, and balance of
funds. Additionally, there are numerous other pieces of information that
must be reported monthly. These include: USDA meal count, nutrition
education count, number of new unduplicated clients, low income clients,
program income, match, and in kind income. These reports must be
turned in by the fifth working day.
B. The AAA then processes these reports looking for completeness and
accuracy. Each item is verified against client data in the computer as well
as fiscal logs to ensure there is no overpayment.
C. The RFR is then forwarded to fiscal who prepares the payment request to
TDOA. TDOA takes about Two and a half weeks to forward a payment
to the AAA. The AAA forwards the payment to the subs normally within
three days.
VII. Programs Operated by Alamo AAA
A. Home delivered and congregate meals are provided through 8
subcontractors.
1. Dietert, Golden Hub, Rainbow, and Silver Sage provide meals in
their counties.
2. Medina provides meals in Medina County and the city of Lytle in
Atascosa County.
3. Pleasanton provides meals in the City of Pleasanton in Atascosa
County.
4. Community Council of South Central Texas (CCSCT) provides meals
in all of Frio, Wilson, Karnes, and Guadalupe Counties.
5. CCSCT also provides meals in parts of Comal and Atascosa County.
6. Comal County Senior Citizen's Center provides meals in most of New
Braunfels and those areas within 10 miles.
B. Alamo Regional Transportation provides transportation in the rural
counties. Part of this transportation is funded through AAA funds.
TxDOT also provides a partial reimbursement for services.
1. Dietert provides transportation services in Kerr County. -~
2. CCSCT provides transportation services in Atascosa, Frio,
Guadalupe, Karnes, and Wilson Counties.
3. Medina provides transportation in Bandera, Comal, Kendall, and
Medina Counties.
4. AADC provides transportation in Atascosa, Frio, Karnes, Gillespie,
and Wilson Counties. AADC took over the service from either
CCSCT or Gillespie County in December 2002.
5. This is a public transportation system providing transportation to
people of all ages. Typically, the units purchased by the AAA are only
a small part of the total service.
C. Care Coordination Services are offered throughout the 11 county area.
1. Dietert provides care coordination services of personal assistance,
homemaker, and emergency response services to Bandera, Kendall,
Kerr, and Gillespie Counties.
2. Alamo AAA provides care coordination services of personal
assistance, homemaker, prescription assistance, and residential repair
to Atascosa, Comal, Frio, Guadalupe, Karnes, Medina, and Wilson
Counties.
D. Ombudsman Services are provided through both staff and volunteers.
1. There are two staff persons whose primary responsibilities are
ombudsman. There are approximately 20+ volunteers in the
program.
2. The purpose of the ombudsman program is to advocate for the rights
of the nursing home residents. They do this through routine visits,
problem solving, and letting people know about the ombudsman
program.
3. Volunteers are asked to spend two hours a week visiting their
assigned nursing home. Over the course of several visits, they are
encouraged to visit all residents-alert, confused, and non-
communicative.
4. Staff and volunteers participate in resident and family council
meetings as well as the annual state survey.
5. Staff provides numerous presentations to local groups on topics
dealing with nursing home issues including choosing a nursing home,
paying for a nursing home, and advocating for quality care in a
nursing home.
6. Volunteers are always needed. Training is provided in the volunteer's
community.
E. Benefits Counseling
1. Legal Awareness-including Medicare, Medicare Supplement
Insurance, Medicare dual eligibility programs, Medicaid, long term
care insurance, fraud targeting seniors, advanced directives, and
many other topics.
a. Presentations are normally done by staff, but occasionally they
will bring in an outside expert.
b. Participation in Health Fairs or other community events.
c. We are always willing to speak to groups-we'll work with you on
topics and times. This year we are making an effort to work with
libraries and housing projects.
d. Volunteers primarily work out of our San Antonio office. There is
an extensive training program. More volunteers are always
needed.
2. Legal Assistance-the staff are certified Benefits Counselors, trained
to represent individuals in hearings on administrative benefits. We
have done social security, medicaid, and HMO appeals. Several staff
members are in the process of obtaining certification to do advanced
directives.
3. Attorney assistance-we are currently developing a program to
provide limited attorney assistance in the rural counties.
F. Information and Referral
1. Toll free number-1-866-231-4922. Provide basic information on a
variety of topics. We have literally hundreds of handouts we can mail
to callers.
Z. Additionally we maintain an up to date book containing referrals in
the various counties. This includes information on TDHS offices,
local programs, etc. We also have listings for Bexar County resources
that either will provide services in the rural counties or will help
someone if they come to Bexar County.
3. We handle around 100 phone calls per month.
G. Implementation of Caregiver Support Program
1. The Older Americans Act authorized funds for a new caregiver
support program. Our initial allotment was $142,000. BUT, the
legislation was clear this is to develop a program, not just put money
into existing programs. For example, no more than 20% of the funds
can be used for direct programs for the care recipient such as home
maker, personal assistance, residential repair, and emergency ,~
response. There are no funding limits on the dollars spent for respite
services. 10% of the funds may also be used for a Grandparent
Program. The funds contain a 25% match requirement. Match can
be in the form of actual dollars or in kind services.
2. Bexar and Alamo are jointly hiring an individual to conduct initial
needs assessment and identification of resources.
3. Public hearings, meetings, etc. will be conducted as we implement this
program. A key to remember is this is a caregiver support program.
Our emphasis needs to be on the caregiver.
VIII. On Going or Current Projects
A. Implementation of Regional Access Plan.
The Regional Access Plan for coordinating access to social services
was initially developed in early 2000. Bexar and Alamo AAAs did a
joint plan. Input was provided by numerous sources.
2. Workgroups are currently meeting to discuss surveys of existing
computer equipment in the various social services offices, common
intake form, and-tr-aiming-for agencies.
B. Area Plan: this year we will develop a new area plan. The area plan is
developed through a series of public hearing identifying the primary
issues impacting seniors.
C. TDOA Performance Measure Testing: during FY02, TDOA initiated a
program of performance measure testing. Congregate and
transportation services were tested last summer. We are scheduled' for
repeat testing during January for transportation
1. Internal Performance Measure Testing: the AAA has been
conducting continuous performance measure testing with the
subcontractors. We are still identifying errors in reporting, client
eligibility, and failure to maintain required records
IX. Other areas of information
A. TAC-Texas Administrative Code. The source of regulations governing
our programs. Available on the Internet at http://info.sos.state.tx.us
B. Contract Manager-our contact person at TDOA. This person is
responsible for our monitoring as well as answering policy questions:
C. For those of you who use the Internet, I am attaching a list of frequently
used web sites.
D. Annual budget and budget amendments. Our annual budget for FY2003
was submitted in December 2002based on estimated allocations. We are
still awaiting our actual allocations and will have to revise the budget at
that time.
E. Title XX or TDHS Meals: Six of my eight subcontractors provide meals
through TDHS. These meals are for low income individuals.
F. Communication is very important to me. I will try to keep you
informed-with meeting summaries and program information. In
return, I ask that you keep me informed also-about problems,
community needs, and resources. Working together we can make good
things happen.
G. Policies and procedures. I am slowly developing policies and procedures
for my program. This includes information on reports, monitoring,
contracts, etc. The TAC also requires the subcontractors to have written
policies in many areas. I am working with them and will share these
items whenever possible.
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H. AIM. This is the TDOA computer program for reporting information
about all programs except ombudsman. Each subcontractor must make
monthly reports on units served to individuals, program income, etc. We
have to validate these reports at our level before approving the
subcontractor's request for reimbu~-seirznt. The AIM system is not
always user friendly and may cause repeated efforts to ensure accurate
data.
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