S2 E3 - Title III
S2 E3 - Title III
The Older Americans Act mandates federal funding be used for meal, supportive, caregiving, and evidenced-based services for older adults across the U.S.
With these funds come complex service specifications, billing requirements, and annual monitoring.
Ann Bauman from Fiscal and Jackie Marchan-Rish from Provider Relations share how COAAA supports our amazing service providers in Central Ohio, ensuring we utilize the funding where and how it is needed, and describe the crucial impact that is made through Title III funding.
Let me know what you think of this podcast, as well as any ideas you have for an episode. Email me at kwhite@coaaa.org!
Copyright 2024 Central Ohio Area Agency On Aging
Transcript
Well, welcome, Anne and Jackie. Thank you so much for being here today. We are gonna talk about all things title 3. But before we get going, let's start with introductions. So, Jackie, tell us your name, your role, and how you came to be at CO triple a.
Jackie [: re at COAAA for in January of: Katie White [:30 years.
Jackie [:I started hear as a case manager in the senior options program. And I did that for about 4 or 5 years, and then I transferred to provider relations. And then prior to that, I worked for the attorney general's office in the crime victims program. And before that, I worked for, state representative Mike Stinziano in his, constituent service program. The elder, Stanziano, not the younger one. Oh, okay. But I did babysit the younger one, so that's my claim to fame.
Katie White [:See. Younger Michael Stinziano is a good colleague and friend of mine, so that's why my jaw dropped a little bit. Okay. And, Anne, how about you?
Anne [:Hey. I'm Anne Balmott, and I'm with the fiscal department. I've been, here about 13 years. And prior to my career hear. I was a marketing administrator for a safety products company.
Katie White [:And what company was that?
Anne [:It was Safety Solutions. They were bought out by Grainger. So I buy stuff from them now.
Jackie [:Oh, great. I just had
Katie White [:a conversation about Grainger today. Okay. Interesting. Sting. See? This is, again, selfish. I love learning about your journeys here. So today's episode's gonna be all about title 3, and we've got another episode about the Older Americans Act. We've got a different episode about the area plan.
Katie White [:So not that we need to totally revisit those, but if you reference them in an answer, hopefully, listeners should know, what we're talking about. So, let's just start with a general overview of title 3 funding. Anne, you wanna go ahead?
Anne [:Okay. Well, we have a 4 year request for funds, proposal that we send out, but the contracts are for 1 year at a time. Go at the end of the year. We'll reevaluate and, we do have the funds allocated by county, but we can kinda shuffle around between the providers depending on who, you know, our area plan and who's using more funds or requesting more funds, that type of thing.
Katie White [:Okay. And so just as a general refresher, the title 3 funds are part of our Older Americans Act funds, which, are federally mandated but flow through the state office on aging, are distributed by a formula across the state, and then we distribute those funds according to a formula across our region. And about how much, funding is that per year?
Anne [:Well, I've got it broken down here. The, the congregate meals are about 400,000. Home delivered is almost 2,000,000, and then we also have, Almost another 1,000,000 in, NCEP. I can't remember exactly what that acronym stands for, But that's added to the meal money. And then with the three b, supportive services, it's about 1,700,000 Plus, we add in, a little bit of senior community services that we get from the state of Ohio. Okay.
Katie White [:So it it's roughly 6,000,000 a year. Okay. So that's, kinda roughly how we distribute the money into each of the titles. Jackie, do you mind describing the different titles and what they're for?
Jackie [:Oh, sure. Title 3 c is typically home delivered meals end congregate meals. So that anything title 3 c is always meal related, and it can't it has to stay in meals. Okay. Title 3 b is what they call supportive services, and it can be anything from homemaking, personal care, transportation, adult day care home medical I mean, lots of different services. And then there is title 3 e, which is the national family caregiver program. And title 3 d is the Healthy Well and Wise, which does the evidence based programs. Yeah.
Katie White [:Yeah. Okay. Great. See. So the money comes in. We distribute it across formula. We put out an RFP. People apply.
Katie White [:So now for the purposes of our conversation, we'll pretend the funds are into all of the service providers' bank accounts. Right? So what happens next? Ask who goes out to visit them, how do they start the services. Give us a little overview, probably Jackie, on this one too. Okay.
Jackie [:It's been a long time since we've had new providers in the system. So I think the for the new providers, they're gonna get information from fiscal on how to bill, And then they're gonna get trained because all the information has to be entered in a program called WellSky, which is a statewide database. So they'll have to enter the clients' names, their information, demographics, and services in there. So they'll have to get trained on that. But once you're trained on that, then they just pretty much hit the ground running. We go out and we look at their policies and procedures, insurance. We look at services billed, make sure that they billed accordingly, and they have documentation to show that they actually provided the service. We look at personnel qualifications, all kinds of different things.
Jackie [:But there's a lot of contact that goes on between me and the provider, and I'm sure Anne and the provider during the year also because they always have questions. Okay.
Katie White [:So they're trained on WellSky. After they perform a service, they put it into WellSky. And tell us more about WellSky and how that all works, Anne and what you do with it.
Anne [:Okay. Well, most of the providers have their own login, so they, would log in to the web based program. And, if the provider isn't set up, they would have to set up a profile or I'm sorry. The consumer isn't set up. They set up a profile for the consumer, and that includes, various demographic, information that is required by ACL, their gender, you know, nationality, race, all that type of thing Mhmm. And, also their address and phone, all of that information. And from then, each month, they just go in, and they would enter the number of units of service that they provided each month.
Katie White [:Okay. And then do you, pull out a report every month and that's their invoice, or how does that how do they get paid?
Anne [:Well, we give them an sell template where they can fill in the number of units and send that into us. We do that because it meets the requirements That the city auditors have for invoices. But then we compare that to a report that we pull for from WellSky just to make sure that the units match.
Katie White [:Okay. And so if, say, they are awarded $500,000, we get through half the year, and they're over or under billing. Is there a conversation that happens there?
Anne [:Yes. If they're under billing, we wanna, we'll contact them and make sure that they have a plan to spend the rest of the money. Or if things aren't working out like they had hoped, we ask them if they would like to release some of the money so that we can award it to a different provide her.
Katie White [:Okay. So if we release the money, then a provider within that same title, I assume, if it's, meal money or if it's get supportive services money. We could reach back out to someone we're already contracted with and say, hey. There's a little extra money. Could you use it to to provide more services. Correct. Okay. Got it.
Katie White [:Okay. So the general overview of how it flows, I think we've covered that. Let's talk a little bit about, as it relates to title 3, sort of your typical day or week, Jackie. What are you doing related to title 3? Lay it on us.
Jackie [:There really isn't a typical day. So, book all day. So, for example, today, I came in and I had, an email from a title 3 provider that Wanted information on the background checks and what's a disqualifying offense because they hired new staff, and they haven't had to do that for such a long time. So I provided them with all the rules, all the information that they needed. And then I had another call, some conversation. See. I did a caregiver review the other day, and there was some question on how they were doing the billing. So I had to meet with Anne to try and iron out, like, how do we get them back on track with their billing? Because it was kinda wonky.
Jackie [:So there really isn't a typical day.
Katie White [:Okay. Yeah. How about, a typical audit, though? If you go out, what what does that look like?
Jackie [:I usually will start with well, obviously, they know I'm coming, and they kinda know what what's expected because they've all been through this many times. But I usually will start with an introduction and, you know, this is what I'm gonna do today. This is what I'm gonna look at. And I do the easy stuff first, which is the policies and procedures and insurance because that's so easy. And then I get into the nitty gritty of the clients that they serviced and then the personnel. And then a lot of it is looking at their documents, But I would say an equal amount is just conversation with them on what's their process, what are they having a hard time with, what do they need help with? So there's a lot of what we call technical assistance that goes on. A lot of times, they have questions or like, how can I do this better? Or I'm having a hard time with the adult day care, with staffing, or activities, or clients that are coming in aren't appropriate. How do other providers do it.
Jackie [:They they get a I get a lot of those questions too. It's like, how can I change this? What can I do? Do you have recommendations? What do other providers do in similar situations.
Katie White [:Okay.
Jackie [:And since I'm the only one that monitors the older Americans act providers, I have all that knowledge, switch is nice.
Katie White [:That is nice. And, you know, in a in a different episode, we talked about how difficult and how much advocacy goes into getting those older Americans act dollars. But once they're in, they're also pretty difficult to make sure that we're spending them. But it is our role to make sure not only that we're getting into our region, put into the hands of the service providers to provide the things that our residents really need. And so, Anne, how about you? A typical day or week as it relates to title 3?
Anne [:Well, lately, we've been trying to get some of the new providers that we picked up, into WellSky and get them familiar with it. So we've been doing a lot of assistance with that. And, I also, deal with some different login issues or reporting issues wear, you know, maybe a provider is trying to run a report, and they can't get it to come out right. Or, I run reports monitor the missing data points that are required, and we'll, contact the providers if they have Missing data. Maybe they're missing the gender identity or something like that on a number of clients. So I'll get with them on that.
Katie White [:Okay. So we really are doing a lot of technical assistance. It's like I knew that, but even hearing about it is, you know, almost on a daily or weekly basis where we're making sure that people, know what to do and how to do it and how to get paid for it.
Jackie [:There's a lot of moving parts. There really are.
Katie White [:So then, each service under the Older Americans Act also has a service specification. Correct? Correct. And those are federal, but then there's also a layer of Ohio revised code that we have to put into those service specs. Right? Okay. Do you mind explaining that
Jackie [:a bit? There are certain services that the service specifications are through the Ohio Department of Aging that we follow, and the Ohio Department of Aging defines those, see the requirements. Most a lot of that is from the actual Older Americans Act. So there's a lot that we're there's no way we can change if we don't like it. It's in the Older Americans Act, for example. Home delivered meals, there's some nutrient requirements, And that is specified in the Older Americans Act. So
Anne [:Okay.
Jackie [:There's no way to get around that. Okay. But there are some other service specifications that the Ohio Department of Aging defines, like homemaking and personal care that can be somewhat modified. And then there are other services that are able to be provided under the Old Americans Act that do not have set service specifications so we can define those ourselves here at c o triple a.
Katie White [:Okay. And we did that recently with
Jackie [:I think financial navigator, some mental health counseling, some other services that we defined Mhmm. And again were needed in in the community.
Katie White [:Yes. And, again, those come from, our area plan and conversations with stations with case managers that work here and other service providers to say what else are we really needing in the community. And if it's not already a defined service, okay, we'll we'll try it out. Let's put some service specifications on it. And then any of those new ones, you're going out somewhat early in their process to really touch base and make sure things are going well.
Jackie [:Yes. And I think, historically, we've always had the traditional services, personal care, homemaking, transportation, rotation adult day care. But now with the labor shortage Mhmm. It's nice to have other options of services to help people rather than a person laying hands on someone. Definitely.
Katie White [:Yeah. And it's it's we need both. And, we know if there's a shortage and people are waiting for caregivers, switch they are. What else might we be able to do in terms of home modification or something like that? Okay. Got it. So when we think about the title 3 in the Older Americans Act specifications, we talked in an episode about advocacy. But the Older Americans Act is up for reauthorization next year, and that's our opportunity to really say, these are some of those things in that act that we think need to change, need to be deleted, need to be modernized. So when you think about some of those service specifications, Jackie, that people have challenges with or that need to be updated, what comes to mind in terms of, you know, if you had the magic wand to update the Older Americans Act?
Jackie [:If I had the magic wand, I and this might be a personal thing. I would take it to the meal rules Okay. Because they're very specific, very strict on the dietary requirements. And I think that it could be changed a little bit, loosened a little bit to allow more
Katie White [:more options.
Jackie [:More options and not to be so restrictive on providers. Like, having to have 1 heard of the required dietary intake and I mean, each meal has to meet a certain dietary requirement just to kinda open it up a little bit.
Katie White [:Yeah. Yeah. To be a little more realistic about things.
Jackie [:Yes. Okay. Yes. Especially with it is in Franklin County, the different populations That we have in the different cultures. They're not I mean, I I hate the thought of somebody getting fruit or milk, And they're just throwing it away because it's not something they're ever gonna eat. And a meal provider has a hard time adjusting just for that one Or those few people adjusting. Well, I'm not gonna give them milk. I'm gonna give them something else.
Jackie [:It's it it's it's a lot.
Katie White [:Yeah. Pull in. Particularly, as our region diversifies more and more, we really should be reactive to making sure we culturally aware. Yeah. Yeah. So, Anne, if I gave you the magic wand, to make updates to title 3 or WellSky or the Older Americans Act, what would you do?
Anne [:Well, Wells Fargo can be really picky on some things. There's a lot of different settings, and, we run into some issues trying to do the reporting and the recording of services due to those. So I spent a lot of troubleshooting time, and it would be nice to have a A program that moved a little bit more smoothly.
Katie White [:Yeah. And I know, in talking with different providers and recipients of the title 3 funds. They really do appreciate all of the time and energy that you both, and I'm sure many others put into it because it is a little clunky. It's a little hard, and it's like there are some barriers in place to even just being able to do what we need to do. Right? Like, we know the service is needed. It shouldn't be so hard.
Jackie [:Go. Every provider does complain about WellSky.
Katie White [:Oh, really?
Jackie [:Yes. It is cumbersome. Okay.
Katie White [:Tennessee recently updated they are no longer using WellSky. They're using a new system. Mhmm. So maybe they'll be, again, some modernization or sort of, rebalancing how that system might work. So speaking of barriers, let's talk about challenges. So, and what are some of your biggest challenges related to title 3?
Anne [:Well, I guess, just making sure that, we spend the money effectively. Okay. You know, sometimes, as I said, the providers, maybe they're short staffed, and they can't, provide services do as many consumers as they thought. And, it they don't wanna necessarily give up the money because they keep hoping things will get better. Sure. But, we see that they're not spending it, and we're kind of talk at that point because, we can't overcontract the funding. But, you know, at the same time, we wanna make sure it's all used. Yeah.
Katie White [:And what happens if funding goes unused?
Anne [:We can, in certain cases, you know, reallocate a little bit. Hopefully, there's other providers around that can use it. Sometimes we can get an extension to use it. But in other cases, we just the money goes unused. It goes back to ODA
Jackie [:Okay.
Anne [:And it's reallocate it from there.
Katie White [:And part of the challenge in being able to reuse the money is because it's distributed by formula. We really try to make sure it's used in the same county where it should be for the same service that it should be in. So you might be in a rural county that only has 1 transportation provider. And if they have a provider shortage and they can't provide the units, it's nearly impossible for us to find another provider to provide transportation units in that same county. So, yeah, it's it's sort of a moving target constantly. Right? Yes. And, Jackie, how about you? What would your biggest challenge be?
Jackie [:I think along with what Anne said, I think it's just the providers being able to provide the service. And I think a lot of it is the requirements are somewhat restrictive, you know, for transportation in particular. The driving requirements and the vehicle requirements, it's a lot Mhmm.
Katie White [:To do.
Jackie [:Staffing shortages is just a huge thing across the board for providers and not having enough funding. A lot of our, outer county providers, like the senior centers that are doing all the services, Homemaking, personal care, transportation, and meals. They are so short staffed and so underfunded That, you know, you might have the executive director is, you know, mopping the floors.
Katie White [:Yes. We absolutely
Jackie [:have that. Yeah. A lot. And it's just it's sad. Yeah. Where where we
Katie White [:we'll have regional meetings, and they'll say, sorry. I can't come today. Our bus driver is ill, and so I'm I'm picking people up and bringing them into the senior center. Yeah. Was it always like that or like this, or has that changed over the last couple of decades as the need has gone up and the service providers have gone down?
Jackie [:I feel like it's changed in the last few years? And I don't know if it's just COVID related or if maybe it started right before COVID, but it just seems it there's kind of a I don't wanna say desperation, but when you talk to some of these smaller title 3 providers out in the county, you really feel for them because there There is a little bit of a sense of hopelessness and desperation. Okay. And it's hard.
Katie White [:It is hard.
Jackie [:You wanna help them, and you wanna give them more money, and and you wanna make them whole, and you can't. Because there's just
Katie White [:not enough to go around.
Jackie [:Yes. Yeah. Mhmm. And even the the counties that have levies, some of the other counties that do have levies, a lot of our providers get very little from the levy so it doesn't really make them whole.
Katie White [:So some providers that we work with are, contracted with us you receive Older Americans Act funds. Then they might have a grant with their local levy that kinda adds to all of those services, and then they maybe charge a little bit or fundraise a little bit. And they're, like, what do they say? Blending and braiding all of these different funding sources just to be able to provide these services in their county. So, our providers are so important and so crucial and really facing some pretty big challenges.
Anne [:Yes.
Jackie [:And we have a meal provider told me recently that get getting to the point where they'll have a wait list for meals, which we never really have here. Wow. And it's because not because they can't produce the amount of meals, but they don't have drivers to get the meals out. Interesting.
Katie White [:Whereas some other providers have talked about how the rising food costs
Jackie [:Mhmm.
Katie White [:Have really shift it the number of meals. Because if you're the amount of funding that you get is fixed and the meal costs go up, then, of course, you're gonna be able to provide less meals. So,
Jackie [:yeah. It's really It's not fun out there for them.
Katie White [:Yeah. Is that hard for you?
Jackie [:It is because they're they're just so nice, end. So caring. And they really want they know their county. They know all the people in their county. And they really, really want to help them, and they can't. Yeah. And it's it's hard. Yeah.
Jackie [:It's hard.
Katie White [:It seems like it would be, even just sitting you know, I'm not out there, though. I should go out there with you and and do a sit. But, yeah, it when you're really out there and you know their hearts are in it and they wanna do it and they just can't because of the money, that's pretty that's pretty rough. But I will say, I think, again, we're all dedicated in making sure that to the extent possible within our control, we're making it as easy and seamless as we can, and we're flexible, and we're constantly having those conversations right around. Okay. You you might not be able to do it here, but if you move it over here and that sort of thing. Right. So let's talk about success now that we've, you know, meet each other all sad.
Katie White [:Sorry about that. What are some of your, you know, most successful memories or favorite things about the title 3 program, Anne?
Anne [:Well, I would say just, being able to come up with a solution to help make things go a little bit smoother for people. Doesn't happen often, but we're always trying to come up with ways to make the reporting easier.
Katie White [:Yeah. I know there's a lot of times where I pop into your office and sit in your comfy chair, and I'm like, okay. And, you know, what's going on? This service provider needs this or that, and we really it's just all about sort of finding whatever option we can to make sure that people can provide the services and get the funding for those services. And Right. Yeah. Yeah. How about you, Jackie? What's your favorite or any success stories?
Jackie [:I kind of agree with Anne. I think being able I like it when providers call and they have hard they have an issue, and they don't really know what to do. And they just need an outside person to look in with a different perspective and help them figure it out. I love that. Yeah. I I love that. And I I think with the title 3 providers, it's a little bit different because you also have more of an opportunity, not so much lately, but more of an opportunity to go out in the community and help them. Like, you know, flip pancakes at their annual pancake breakfast fist or, you know, scoop ice cream at their ice cream social.
Jackie [:And you
Katie White [:get to do that kind of stuff?
Jackie [:I have in the past. I have in the last couple years because COVID, and it's just too busy. But those are the fun things that you really you can really learn a lot about a provider and how they operate. Yeah.
Katie White [:And I would imagine that means a
Jackie [:lot. Fun.
Katie White [:Yeah. You know? It probably means a lot to them
Jackie [:too for us to show up. A few years ago, I packed helped pack the Christmas baskets for all the Licking County aging program clients that they were sending out. You know, put in the ham and the green beans and the little present in the calendar, and it was it just makes you feel good.
Katie White [:Yeah.
Jackie [:Those are the things that make you feel good
Katie White [:Yeah.
Jackie [:And remind you why you're doing this. The bright spots. Yes.
Katie White [:And I would imagine a lot of our staff would be interested in some of those too, again, as as more of these group events are coming back. I've heard from different staff members about, like, an all staff volunteer day or, you know, just being able to do some of those bright spot activities amongst the really, really difficult work that we're doing day in and day out. Okay. I'm excited about this question because we've got a 30 year veteran here and a 13 year veteran here. So, what is one thing you would change or add about COAAA?
Jackie [:Oh, that's a hard one.
Anne [:Well, I really like the flexibility here. So that part is good. It's not something that I would wanna change, but it's something that, was a welcome change from where I used to work.
Katie White [:Okay, that's good. I like that.
Jackie [:I will agree with that. I think the flexibility has kept a lot of people here. Okay.
Katie White [:In terms of, like, work schedules or yeah. Okay.
Jackie [:I'm trying to think something I would change. And I don't I don't know how to go about this because we're so large now. When I first started at COAAA, there was less than a 100 employees and less send a 100 providers total.
Katie White [:Wow.
Jackie [:It's just grown so much, but I feel like you'd there's people that I've worked with probably for 10 years that I I don't even know. Yeah. And I don't like that. Yeah. That's right. Know how to how to go how to change that.
Katie White [:Yeah. Some of those interactions. It is hard in an agency of this size. I mean, even when we talk about our year end celebration, you know, we can't all fit in our room our education room at the same time. Yeah. That's tricky.
Jackie [:I think if we could one thing I would change, if we could do this, so I don't know how you can, is to everybody spend a day in a different department to see what they do because I think no people don't know what we all do. Yeah. And they probably think I I don't know what Jackie does in provider relations. Just move on to the right.
Katie White [:All the time.
Jackie [:That's all
Katie White [:she's doing? Jeez.
Jackie [:So I I think it would be nice. And I know years many years ago, I had a case manager do that was fairly new that asked to come along to a review. And I think it was eye opening for them to see, like, how it all fits in together. But, I mean, just even with go. How does it all I mean, we're all at 1 agency, and we all have a little bit of part in each other's division.
Katie White [:But definitely It
Jackie [:would be nice, I think.
Katie White [:Yeah. We all have intersecting and overlapping roles that all are working shin. Yeah. And you couldn't meet the mission wholly without all of the different pieces and parts. I will say that's one thing I'm hoping that the podcast can do so you can hear from different people. But when I first started in shadowing people, that was huge a huge, huge, huge learning opportunity for me and just so important in things that I just consider around the home visits, around all of that. So, yeah, I like that idea. So a shadow day for everybody.
Katie White [:Okay. Well, what are your final thoughts that you want staff to know about title 3, Anne?
Anne [:Just that, it does a lot of good for the community, and, we have it and that we have the flexibility that we do. It's not like passport where the rates are fixed that we can work with the providers and come up with solutions. Yeah.
Katie White [:And I'm so glad that you're in the role that you are. We didn't even talk about all the other things that you do, but your dedication and flexibility and just brilliance around making sure that we can do what we need to do to get the services is I I appreciate that
Anne [:a lot.
Jackie [:I don't know how she keep sit all in our head. But I'm constantly darkening her doorways with Me too. Title 3 questions.
Katie White [:Yeah.
Jackie [:I come in.
Katie White [:I sit right in that little chair right around the corner.
Jackie [:Yeah. Mhmm.
Katie White [:And you always have an answer.
Jackie [:It's Yes.
Katie White [:Pretty impressive.
Jackie [:Always does. Yeah.
Katie White [:Mhmm. And, Jackie, how about you? What do you want Steph to know about title 3?
Jackie [:There really is a huge part of this agency. I mean, it's a it funds a lot of services in all of our counties. And that it's It's more I don't wanna say grassroots, but, I mean, these are providers out in the county that are finding their own people to service. We're not feeding them the people, so they are really busy.
Katie White [:Yeah. Yeah. And so dedicated. Very dedicated.
Jackie [:Very, very dedicated. Yes. They might not be as sophisticated with their, you know, Bookkeeping, accounting, computers, all of that, but they are extremely dedicated to providing service. Thank you
Katie White [:so much for being on. Thank you.
