State Plan Content

The State plan is made up of:

1. Signed Verification of Intent Page from State Governor or designee;

2. Narrative;
   • Executive Summary
   • Context
   • Goals and Objectives
   • Strategies
   • Outcomes and Performance Measures
3. Intrastate Funding Formula; and
4. Attachments
   
   

It is important that the state plan be signed by Governor or the individual (designee) to whom the Governor has granted signature authority.  Such authority should be obtained in writing from the Governor’s office and be on file should AoA need to verify the designation.

It is recommended that the narrative of State Plan be comprised of 20 - 30 pages and clearly address the following areas:

• Executive Summary
• Context
  
• Goals and Objectives
• Strategies
• Outcomes and Performance Measures

Specific resources are available for each of the above sections on “The State Plan” drop down menu of this site.

1. Executive Summary

The Executive Summary in a State Plan is a stand-alone section meant to communicate the entire Plan in brief form.  Considering that is may be the only part of the State Plan document that some people read, the Executive Summary must capture the essential points of the Plan concisely.  Ideally, the information should be presented in the same order as the larger document itself.

The Executive Summary should clearly and concisely:

• Tell the whole Plan in a nutshell

• Describe the current system

• Highlight major issues and trends

• Answer these questions:

  • What will we do?

  • How will it improve the system?

  • How will we know and measure change?
    

The Executive Summary should be written in plain, jargon-free language, and should be approximately three pages in length.

2. Context

The State Plan Context sets the stage for the State Plan and describes the issues to be addressed in the rest of the document.  The Context conveys a clear understanding of the current and future service and support needs of the state's older residents, and the issues, challenges and opportunities facing the Aging Network. 

This section of the State Plan identifies the mission and values that will guide the Plan.  The Administration on Aging's strategic goals should be acknowledged up front, and there should be a brief discussion about how the state and federal visions interrelate.

DECISION POINT: Mission and Values.  See also AoA Strategic Action Plan 2007-2012.

The Context should consider history, current conditions, and the future, and should answer these questions:

1. Who comprises the current and future population of older adults?  What are their needs?

2. How are the Aging Network and Long-Term Care system organized to support older persons?  What is the role of the SUA in long-term care?

3. What are the critical issues/trends?  What are the future implications?

4. What are the strategic opportunities to leverage to improve the state system?

5. What are the challenges?

6. What are the resources?

Q-1 Who comprises the current and future population of older adults? What are their needs?

The Aging Network operates in both internal and external environments, or contexts. State demographic trends and service utilization patterns are both key to understanding these contexts. Data and statistics in the State Plan should focus on factors most applicable to the state. The State Plan Context provides an excellent opportunity to discuss targeting services to under-served populations. For example, a targeted population may include specific racial and ethnic minorities, people living in rural areas, and/or people on waiting lists.

DECISION POINTS: Environmental Scans; Needs Identification.  See also Strategic Planning Process.

Aging and Disability Demographics

• State population figures, including numbers of people who can be considered the "oldest old"
  

• State ranking compared to national data

• Special populations (e.g. Alzheimer's and related dementias; caregivers; persons with disabilities)

• Underserved populations, those purchasing private pay services, persons with life long disabilities who are aging, other future populations
  
  

Service Utilization/Service Users

• Persons served by Medicaid; Medicare; state general revenues; Older Americans Act; Social Services Block Grant; other funding sources

• HCBS utilization versus institutional care (expenditures, utilization rates)
  

• Waiting lists

• Persons who are under-served by HCBS and other aging programs
  
  

Q-2 How are the Aging Network and Long-Term Care System organized to support older persons? What is the role of the SUA in long-term care?

The State Plan Context should include detailed information about the State Aging Network and the state long-term care system.  The State Aging Network's pivotal role in addressing the needs of older individuals living at home and in institutions must be considered.  The state agency's capacity to play a key role in long-term care reform depends, at least in part, upon its placement within the state government and current administrative responsibilities. 

DECISION POINT: Environmental Scans

Organizational Structure

• SUA location in state government

• Organization of the Aging Network

• Administrative responsibilities of the state agency on aging and the area agencies on aging
  
  

Long-Term Care Organization

• Who administers HCBS (Medicaid, state-funded, SSBG, other) for the elderly?

• Role of the SUA in setting policy and direction for HCBS and other long-term care services

• Role of the Aging Network in serving persons with disabilities
  
  

Q-3 What are the critical issues/trends? What are the future implications? What are the challenges?

The political and economic conditions that support or hinder the SUA's influence are important considerations for the future development of the Aging Network.  Historical state trends, such as the degree to which spending for nursing facility care dominate the Medicaid budget or a priority on serving populations other than older adults in the community, must be considered.  Such developments may challenge the Aging Network's ability to move toward a community based service system for older people.

Conversely, a trend such as the emergence of a strong advocacy voice on behalf of home and community long-term care options for older people may enable the SUA to develop ambitious goals in the coming planning cycle.

The focus of the State Plan is on the activities to be undertaken during the current planning cycle, as well as anticipate trends impacting the Aging Network and the state's older residents in the future.  The Plan laid out should not focus solely on current conditions and challenges.  A future orientation will ensure that the Aging Network is positioned to seize opportunities and respond to future challenges.

• Long-term care service available to older people

• Funding patterns for institutional and home and community based services

• The degree of integration between long-term care programs and the SUA (i.e., access, program policies and practices, and administration)

• New/anticipated initiatives at the state and federal level

• Funding opportunities

• Significant research findings related to aging and long-term care

• Trends in Medicare, Medicaid, Social Security, housing, transportation, health care, prevention and chronic care, long-term care
  

• The emergence of advocacy/interest groups

• Disasters

• Major economic, social, political events
  
  

The strategic direction articulated in the State Plan should consider:

• Long-term care reform/rebalancing efforts in the state

• Vulnerable populations

• Gubernatorial and state legislative initiatives
  

• State strategic goals

• 2006 Amendments to the Older Americans Act

• AoA Strategic Action Plan

• CMS Strategic Plan, HHS Annual Plan

• Program and regulatory directives
  
  

National trends and developments likely to influence the Aging Network (e.g., Money Follows the Person, Choices for Independence) and state developments and initiatives (e.g., legislative study of the long-term care workforce, hearings on nursing home quality, gubernatorial directives to reorganize long-term care) must be considered in the Plan.

The State Plan Context responds to Questions 1-3 listed above and lays the groundwork for responding to the following Questions 4-7 in the rest of The Plan.

• To what extent are older people in the state able to access home and community based services responsive to their needs and preferences?

• To what extent do we have an integrated elder rights system to ensure the state is able to quickly and effectively protect seniors from threats to independence, well-being and financial security?  (focus area: elder rights)

• How has the Aging Network worked to address the identified issues in the past?
  

• What is the overall direction in which the Network is moving?

• What opportunities will support older people and the Aging Network moving toward a community based long term care system?

• What challenges need to be addressed to achieve the overall goal of balanced long term care in the state?

• How will the Network's planned activities for the coming 2 to 4 years provide greater access for older people to community long-term care options?

• How will the Network's planned activities for the coming 2 to 4 years provide a stronger, more visible role for the network in long-term care?
  
  

The State Plan on Aging may need to address a number of side issues related to the critical question listed above.  Additional questions may also need to be answered related to state-specific issues, such as new initiatives of the Governor of State Legislature or priorities identified by a master comprehensive state plan.

DECISION POINTS: Environmental Scans; Needs Identification; Asset Identification; Barrier Identification

3. Goals & Objectives

A responsive, consumer-directed long-term care system that supports older people needing services in the community is a central priority of the Aging Network. Thus goals, objectives, and strategies related to home and community long-term care should be woven into the State Plan.

Goals and objectives describe the issues, conditions, and needs the state expects to focus during the planning cycle. Ideally, goals and objectives will lay out the opportunities and challenges to achieving a balanced long-term care system, and provide assurance that the services provided by the Aging Network are of high quality.

Defining Goals: What do you hope to achieve? What is the Aging Network's strategic direction?

Goals are broad, visionary statements that describe the strategic direction in which the state is moving. A Comprehensive State Plan on Aging will describe the intended results, for example, in reforming long-term care. To illustrate, the 2006 New Mexico State Plan identified as one of its goals to:  "Increase the number of older people who have access to an integrated array of health and social supports."

Defining Objectives: What strategy will you use to achieve your goals?

An objective, as shown in the example below from the 2006 New Mexico Plan, is more specific than a goal. Objectives should be attainable, specific, and measurable. An objective may best be thought of as a step to achieve a goal.  "Implement a statewide Aging and Disability Resource Center...to improve access to home and community based services."

A State Plan's goals and objectives should align closely with:

• The vision and expectations contained in the OAA

• Guidance from the Administration on Aging, gubernatorial and legislative directives.

• Special initiatives

• Expectations set for the programs the SUA administers (including Medicaid waiver programs and programs for younger adults with disabilities)
  
  

Critical Questions

1. What opportunities in the Plan will support older people and the Aging Network in moving toward a community based long-term care system?

2. What challenges need to be addressed to achieve the goal of re-balancing long-term care in the state?

Strategic Direction, Guiding Principles

I. The Older Americans Act
II. AoA's Strategic Plan 2007-2012
III. AoA's FY 2011 Focus Areas

I. Older Americans Act

Several key principles are embedded within the Older Americans Act 2006 Amendments, which should guide the development of the State Plan on Aging. These include:

• Choice

• Control

• Full-participation in decision-making

• Community living

• Evidence-based practice

• Comprehensive and coordinated services to support living in the community

II. AoA's Strategic Action Plan 2007-2012

The set of principles put forth in the Older Americans Act forms the basis for the strategic direction and goals identified in AoA's Strategic Action Plan 2007-2012.  State Plans are expected to include implementing objectives for the following four national goals:

Goal 1: Empower older people, their families, and other consumers to make informed decisions about, and be able to easily access, existing health and long-term care options.  This goal may be addressed through the development, expansion and coordination of Aging and Disability Resource Centers (ADRCs) or using other approaches to integrate information and access to long-term care services.  Additional tools may be found at the National Resource Center for Participant Directed Services.

Goal 2: Enable seniors to remain in their own homes with high quality of life for as long as possible through the provision of home and community-based services, including supports for family caregivers.  This goal may be addressed through the implementation of a variety of consumer-directed strategies and methods to provide increased choice, including the use of Cash & Counseling models, which give consumers more control over the care they receive.

Goal 3: Empower older people to stay active and healthy through Older Americans Act services and the new prevention benefits under Medicare. This goal may be addressed through implementation of evidence-based health promotion/disease and disability prevention programs, such as those programs that have been proven effective through the AoA Evidence-Based Disease Prevention Grants Initiative.

Goal 4: Ensure the rights of older people and prevent their abuse, neglect and exploitation.  This goal may be addressed through promotion of a comprehensive elder justice system comprised of long-term care ombudsman program; elder abuse prevention and response, such as adult protective services; and state legal assistance development, including the legal assistance developer and local legal services providers; and may include multidisciplinary approaches or State Coordinating Councils and/or activities designed to prevent, detect, assess, treat/respond to, intervene in, or investigate elder abuse, neglect, and exploitation. Additional information to assist in implementing this goal can be found in the "Elder Rights Programs" section on the "Resource Links" page of this website.

III. FY 2013 AoA Focus Areas for State Plans on Aging

In accordance with the AoA’s Program Instructions for the development of FY 2011 state plans, states are asked to develop at least one measurable objective that addresses each of the focus areas below: Older Americans Act Core Programs, AoA Discretionary Grants, and Consumer Control and Choice.

Focus Area A: Older Americans Act (OAA) Core Programs.  OAA core programs are encompassed in Titles III (Supportive Services, Nutrition, Disease Prevention/Health Promotion and Caregiver Programs), VI (Native American Programs), and VII (Elder Rights Programs), and serve as the foundation of the national aging services network.  Describe plans to coordinate with the Title VI Native American programs, and strengthen or expand the Title III & VII services, as well as how they will be integrated with AoA discretionary programs addressed in Focus Area B below.  Specific resources to assist states in maximizing coordination and planning efforts in Core programs are available on the “Resource Links” page of this website.

Focus Area B: AoA Discretionary Grants.  For each of the following AoA Discretionary Grant programs received by your state, develop measurable objectives that include integration of these programs with OAA core programs above (Focus Area A):  Community Living Programs (CLP); Alzheimer’s Disease Supportive Services Program (ADSSP); and Evidence-Based Disease and Disability Prevention Program.  Note: For ADRC Discretionary grants, list your 1) Projected Objectives, 2) Partners, and 3) Budget leading to the statewide expansion of ADRCs and full integration with OAA core programs.  Specific resources to assist states in developing objectives for respective AoA discretionary grants are available on the “Resource Links” page of this website.

Focus Area C: Consumer Control and Choice.  Making fundamental changes in state policies and programs which support consumer control and choice is recognized as critical focus for State Plans.  OAA Title VII programs and services are designed to support this effort, and opportunities also exist for maximizing consumer control and choice in Title III and VI programs.  Describe your planned efforts (measurable objectives) to support consumer control and choice across the spectrum of long term care services, including home, community and institutional settings.  Specific resources to assist states with building consumer choice and control into aging programs are available on the “Resource Links” page of this website.

4. Strategies

How will the Goals and Objectives of the State Plan be achieved:  The "How" is an essential element of planning.  Strategies are needed to translate the vision and overarching direction of the State Plan into a plan of action.

Strategy: The road map to getting where you want to go.

This portion of the State Plan maps out each major strategy or action step to achieve the Plan's objectives and goals.  This description includes who is responsible for implementing the strategy and the time frame for implementation.

Strategies include such actions as:

• Making regulatory or policy changes

• Conducting public education
  

• Training Aging Network staff

• Making changes in contracting and reimbursement procedures

• Recruiting additional providers

• Building coalitions

• Conducting advocacy activities
  
  

For each objective in the State Plan, ask the questions:

1. What strategies will be used?
   

2. Who is responsible for each strategy?

3. What is the time frame for each strategy?

4. What is the relationship, if any, of this strategy to another goal and objective?

A strategy for developing an ADRC, for example, might include determining the lead agency, developing intra- and inter-agency coordination procedures, expanding the information and assistance database, and creating a comprehensive assessment tool, single application form.

GOAL: Have at least one ADRC in each planning and service area by 2010

OBJECTIVE: Develop a pilot ADRC

Strategy	Responsible for Completion	Date
1. Select planning and service area for pilot	SUA Field Operation Section Chief	March 30, 2008
2. Determine lead agency	AAA Director	April 30, 2008
3. Develop intra-/inter-agency coordination proceedures	AAA Program Developer	September 30, 2008
4. Expand the information, referral and assistance database	I&R/A Director	January 30, 2009
5. Develop a comprehensive assessment tool	SUA HCBS Section Chief	May 30, 2009
6. Create a single application form	SUA Planning Chief	July 1, 2009

5. Outcomes & Performance Measures

   "Not everything can be counted counts and not everything that counts can be counted." --Albert Einstein

The State Plan should include a statement regarding the outcomes expected to result from the goals, objectives, and strategies identified in the Plan.  Outcomes measure the benefits to consumers to be derived from the State Aging Plan.

The outcomes developed by the Aging Network will respond to the desires of older adults and their caregivers for services and supports to enable them to remain in the community.  A related outcome is the need to ensure a stronger, more visible role for the Aging Network in the state's long-term care system.

Critical Questions

• How will the Plan provide older adults greater access to community long-term care options?

• How will the Plan provide for a stronger, more visible role for the Aging Network in long-term care?

• How will we know the State Plan goals and objectives were accomplished?

Reliable and valid performance measures are critical to documenting the success of the Aging Network in meeting its goals.  Performance measures should be selected based on their usefulness in demonstrating progress and achievements in relation to the Plan goals, objectives and the state's vision for the long-term care system.

While tied to the Plan's goals and objectives, it is important to keep in mind that performance measures are not needed for every objective.  The focus should be on performance measures that have the most relevance in relation to the overall goals that have been set for the planning period.  Another critical factor to consider is the availability of data to provide an accurate picture of the current situation and measure progress in achieving a specific benchmark.

At a minimum, the State Aging Plans should describe and provide information relative to:

• Performance measures and methodologies used to evaluate program implementation

• Quality measures used to evaluate the performance of specific programs.

Given the importance of responding to the 2006 Older Americans Act Amendments and AoA Strategic Plan priorities, it is necessary to ensure that performance measures address such issues as: 1) empowering older people and families to make informed decisions about long-term care; 2) enabling seniors to remain in their homes and communities; 3) supporting healthy and active aging through evidence-based prevention programs; and 4) ensuring elder rights and freedom from abuse, neglect and exploitation.

Individual performance measures may focus upon a specific area.  Some examples include:

• Financial performance

• Resource utilization (efficiency/productivity)

• Quality of services

• Innovation

• Consumer wants

• Consumer satisfaction

• Employee/provider satisfaction
  

• Service system results
  

In addition, the performance measures form the basics for evaluating State Plan implementation.  The Plan should include a planned schedule for reviewing progress in achieving the performance measures.  The Plan should be seen as a living document.  Based upon the progress review, it may be necessary to modify the Plan, such as making changes in programs and services to respond to demographic shifts or utilization patterns, altering timelines, or identifying new strategies to ensure success.

DECISION POINT: Outcomes & Performance Measurement

Each new State Plan submittal must include a copy of the current intrastate funding formula (IFF) and the resulting funding allocation to the planning service areas.  Any revisions to the IFF must be clearly indicated and musttake into consideration the statutory requirements listed in Attachment B, Intrastate Funding Formula Requirements.  Any change to IFF factors or weights requires approval by the Assistant Secretary.  Revisions that do not coincide with a new State Plan submittal must be submitted as a State Plan amendment.  Attachment B to this PI, Intrastate Funding Formula (IFF) Requirements, is a guide to the development of new or revised IFFs and is provided for informational purposes. 

The number and type of State Plan attachments will vary from state to state but every state plan must include Attachment A from AoA-PI-10-01, State Plan Assurances, Provisions and Information Requirements.  Other attachments to the plan could include demographic data, needs analysis, special initiatives, etc.  The Intrastate Funding Formula may be included as an attachment or in another clearly marked section of the plan.