Home Services Program Annual Report 2009

Helping Families. Supporting Communities. Empowering Individuals.

Home Services Program, Volume II, FY 2009 Annual Joint Report To the Governor and the General Assembly on Public Act 81-202

Grace Hong Duffin
Acting Secretary
Illinois Department of Human Services

Robert F. Kilbury, Rh.D.
Director
Division of Rehabilitation Services

Program Overview & Background

The Home Services Program (HSP) was established in December, 1979, to prevent the premature or unnecessary institutionalization of individuals with disabilities by providing care in the home as long as it did not exceed the cost of care in a nursing facility. HSP is dedicated to promoting independence, consumer control, and choice, and continues to provide services in the homes of eligible individuals with disabilities on an individualized basis. Individuals participate in developing their own plan of care which helps to ensure that services address their needs and preferences and allows them the ability to live as independently as possible in the home and community of their choosing. Individuals may live alone or with family or friends in any kind of private residence.

Although the guiding philosophies have remained unchanged, HSP has grown much since its origins 30 years ago when, in its very first year, then Department of Rehabilitation Services (DORS) provided personal assistant, homemaker and home health services to 1,256 individuals with disabilities with a total budget of $3 million. This "revolutionary" approach to long term care for adults had begun in California just three years prior, with then Illinois Department of Public Aid (DPA) replicating it the very next year as only the second state in the nation to do so. By FY80, the DPA home care program was transferred to the Department on Aging for individuals over age 60 and to DORS for individuals with disabilities under age 60 as the more appropriate implementing agencies.

From its beginnings, HSP quickly went from being a state initiative to become one of the first Medicaid Waiver programs in the country, serving both adults and children with all types of disabilities. Over the years, as the unmet needs of customers became more apparent, and after careful consideration of potential costs and benefits, HSP gradually added new services which have proven to be a tremendous value in both human and financial terms. These include emergency home response, adult day care, home delivered meals, assistive equipment, home modifications and respite. HSP has also been able to respond to other emerging disability issues with the addition of Medicaid waivers for HIV/AIDS (October, 1990) and Brain Injury (July, 1999). These waivers utilize community-based case management services which specialize in these disabilities and are able to link customers to other services tailored to meet their unique needs.

HSP continues to be a cost effective alternative to nursing facility care which, because of the wide range of services it offers, is able to serve the vast majority of persons needing a nursing facility level of care. In particular, however, it is personal assistant services which provide the flexibility and control which often make the difference as to whether a customer's needs may be met cost effectively or not. Unique among all the services, personal assistants are utilized by more than 80% of all HSP customers because this service allows customers to select, hire, supervise and terminate their workers and to set the hours of work. These workers can also perform a wide variety of tasks and can be trained to provide care in a way best suited to meet the customer's needs and preferences.

Ultimately, the goal of HSP is to support the desire and ability of individuals with disabilities who are at risk of placement in an institution to remain in or return to their own homes; to have choices and options for quality care; to retain control over the services they receive; and to live self-directed lives, functioning as active, participating members of their homes and communities. In FY 2009, 34,309 individuals with disabilities were able to receive service through one of HSP's three Medicaid waivers as an alternative to institutional care.

Program Eligibility Determination and Service Planning

Prospective customers or those representing them may contact any one of 44 offices around the state to request assessment for HSP or may submit a request via the web-based referral for services which is on the DHS website http://www.dhs.state.il.us. A case management staff member then goes to the home of the prospective customer and administers the Determination of Need (DON) scoring tool which is used to determine program eligibility, to evaluate an individual's care needs and to identify available resources for meeting those needs. Based on the results of the DON, a service plan is jointly developed with the customer to address his or her unmet needs and to assist the customer and his or her family in coordinating safe, high quality, consumer-directed (when possible) services on the most cost-effective basis possible.

In order to be eligible to receive HSP services, an individual must:

  • Be under age 60 at time of application unless applying for the HIV/AIDS or Brain Injury Waiver Programs.
  • Have a severe disability lasting at least 12 months or the duration of life.
  • Be at imminent risk of nursing facility placement as measured by the Determination of Need assessment tool.
  • Require services whose cost will not exceed that of nursing or other health care facility services.
  • For customers age 18 or older, have less than $17,500 in non-exempt personal assets; for customers under age 18, have less than $35,000 in family assets.
  • Apply for Medicaid and cooperate with the Department of Healthcare and Family Services (HFS) in the application process.
  • Be a resident of Illinois and a U.S. Citizen or legal resident.
  • Have a physician's approval of the plan of care.
  • Score a minimum of 29 points on the Determination of Need (DON) eligibility determination tool, with at least 15 points in the "Need for Care" category.

As an additional consideration, since there are multiple Medicaid Waiver programs in Illinois including for those through the DHS Division of Developmental Disabilities, individuals who are eligible for more than one waiver are evaluated and directed to the waiver which most appropriately meets their needs.

Program Services

HSP services are designed to preserve the dignity of individuals and their families, as well as to provide options that reflect their personal needs and preferences. Personal Assistant, Homemaker and Home Health are considered the "major services" in that they are used by more than 95% of all customers. Nonetheless, other services are used not just alone but also to supplement the major services to address customers' unique needs. Brief descriptions of all available services follow:

Personal Assistant (PA) Services

Services provided by individuals who are selected, employed, trained and supervised by the customer. These individuals may assist with household tasks, personal care and, with the permission of a physician, perform certain health care procedures. In order to use PA services, the customer or family must be able to supervise PA's appropriately. This service has a uniform reimbursement rate statewide per a labor agreement with Service Employees International Union (SEIU).

Homemaker Services

Personal care and household tasks provided by trained and professionally supervised staff employed by homemaker agencies. Instruction and assistance in household management and self-care are also available. This service has a uniform reimbursement rate statewide and is provided under a rate agreement with HSP. It is used by customers who are unable to direct the services of a PA, or who have not yet found a PA.

Home Health Services

Services provided by a registered or licensed practical nurse, home health aide or certified nurse assistant, or physical, occupational or speech therapist. These services are those which are beyond the scope of services covered under the Medicaid State Plan or private health insurance. These services must be provided in the customer's home and may be provided through an agency or by private individuals who are appropriately credentialed.

Emergency Home Response

A rented signaling device which meets specified criteria to provide 24-hour emergency alerting coverage for medical, fire or other emergencies. The device may be worn in a variety of ways and have a variety of mechanisms to signal an emergency need. This service has uniform rates statewide and is provided under a rate agreement with HSP.

Adult Day Care

The direct care and supervision of customers provided in a location outside the home by a community-based organization to provide personal attention and to promote social, physical and emotional well-being. This service has a uniform reimbursement rate statewide and is provided under a rate agreement with HSP.

Home-Delivered Meals

One or more ready-to-eat hot meals per day which are delivered to the home. This service is provided to individuals who can feed themselves but are unable to prepare a meal and is only provided when other services are not more cost effective.

Diagnostic Services

Medical and functional evaluation services which are used to help determine program eligibility and to develop a service plan. This service is provided only when it is not available under the State Medicaid Plan or other funding source.

Assistive Equipment and Home Modifications

Devices, equipment and/or home modifications that increase an individual's independence and capability to perform household or personal care tasks safely in the home. Must be able to reduce the need for another service or address a health or safety need.

Respite Services

Intermittent care for adults and children with disabilities designed to relieve caregiver stress. Respite may be provided for vacations, rest, errands, a family crisis or other emergency. Respite services available are personal assistant, homemaker, home health, and adult day care. Respite is a stand-alone service and may not be received in conjunction with other ongoing services.

PA Background Check

Background checks provided, upon customer request, for current or prospective PA's to provide customers with information regarding the suitability of the potential employee.

Prescreening

Prescreening of individuals conducted prior to nursing facility admission to ensure they receive the same minimum DON score required for eligibility for the HSP or the Department on Aging Community Care Program (DoA CCP), and to ensure they are offered the option of receiving home care. The screening of individuals coming from hospitals to nursing facilities is performed for both programs by community-based Case Coordination Units. Prescreening for individuals under age 60 who are going from home to nursing facility may be conducted by either CCU or HSP staff.

For Brain Injury Waiver customers only

Day Habilitation

Services provided to persons with brain injuries to assist with the acquisition, retention, or improvement of self-help, socialization and adaptive skills. These services are provided in a setting separate from the customer's residence.

Pre-Vocational Services

Services provided to a person with a brain injury that prepare the individual for paid or unpaid employment by teaching concepts such as compliance, attendance, task completion, problem solving and safety.

Supported Employment Services

Services provided to a person with a brain injury for whom competitive employment is unlikely. These services include intensive ongoing support to enable the person to perform in a paid employment work setting.

Behavioral Services

Remedial therapy services provided to persons with a brain injury to decrease severe maladaptive behaviors. These services are intended to enable the customer to better manage his or her behavior and therefore be more capable of living independently.

Special Programs

Within HSP, there are two other major program initiatives which are interrelated with each other but which are distinct in themselves:

Community Reintegration Program

Illinois' innovative Community Reintegration Program (CRP) was created as a natural adjunct to the Home Services Program to assist interested individuals with disabilities between the ages of 18-59 who were already in nursing facilities in being able to transition back to the community. Since the inception of CRP as a small pilot in FY98, the program has grown to offer services statewide, and through FY09 has assisted more than1,600 individuals in moving back to the community from nursing facilities. Staff of Centers for Independent Living (CILs) throughout the state provide the intensive case management services that customers need during the transition process from nursing facility to home as partners with HSP staff and provide a wide range of one-time services. This includes everything from assistance in finding housing, arrangement of home modifications for accessibility purposes, or funding for such items as housing deposits or furniture. Individuals very often are unable to leave nursing facilities because they no longer have homes to which to return, all of their income goes toward their care in the nursing facility, and/or it can be difficult to handle necessary logistics for transitioning from the nursing facility. Upon return to the community, CILs follow up and provide assistance with the many other issues to be handled such as using public transportation to get to desired destinations, transferring prescriptions to local pharmacies, or linking with community programs. Once customers are fully settled in the community, their case is transferred to the local HSP office.

CRP, together with HSP as a whole, is one of the centerpieces of the Olmstead plan in Illinois, dramatically increasing the quality of life of those served and embodying core independent living values, such as choice, independence, and community integration. In addition, this program has resulted in significant long-term savings for the State. Each person returned to the community saves a minimum of $10,000 per year in total costs to the State. This means that for every 100 people who return home rather than remaining in a nursing facility, the State saves at least $1 million per year. Over time, CRP alone has therefore saved the State tens of millions of dollars, making it a program offering both important societal and public funding benefits.

Money Follows the Person (MFP)

In FY07, the federal Medicaid agency offered all states the opportunity to participate in their Money Follows the Person initiative. At the federal level, this program was developed in response to independent living advocates nationwide who believed that, as in the Olmstead decision, if funding could be provided to maintain an individual in a nursing facility or other institution that those same funds could instead be used to allow the person to live in the community. Since the Medicaid program is a shared state and federal expense, and since there are many state and federal regulations and laws governing how Medicaid funds may or my not be spent, this concept is not as easily implemented as it sounds. Therefore, the federal initiative was intended to pilot such a program.

The Illinois Department of Healthcare and Family Services (HFS), as the State Medicaid agency, took the lead in coordinating the initial application process with the Department on Aging, the Department of Human Services, and the Illinois Housing Development Authority, since the Medicaid waiver programs, Medicaid-funded institutional programs, and housing were required partners for the effort. The initial application was accepted and HFS then took the lead in coordinating the even more involved formal application process which was completed near the end of FY08. Approval of the formal application was received in FY09. The state is very pleased to be able to participate in this partnership as it is a key component of the state's commitment to community living.

Pilot Projects in Review

Rapid Reintegration Pilot

In FY08, given intensive discussions surrounding the implementation of Money Follows the Person within CRP, the Rapid Reintegration Pilot was initiated to address the population being discharged from hospitals directly to nursing facilities because there is insufficient time to arrange for home care as a real alternative. The individuals involved have care needs at hospital discharge that are significantly greater or different from those before their hospitalizations and are being discharged from the hospital before any arrangements can be made for them to return home. Even when individuals wish to return home, there is not enough time to arrange for a hospital bed, wheelchair, home health care, a ramp, or whatever might be needed by the individual. It is even more time-consuming to arrange for the ongoing in-home services which are needed by the majority of these individuals. In addition, many families need guidance regarding their ability to provide care, the equipment or services they may need to obtain for the long term, and linkages to community agencies that could assist them.

In the current system, there is no real opportunity for HSP to be contacted until doctors have decided on discharge which is generally no more than a few hours' notice. In most instances, HSP staff are not available on such short notice because they have home visits scheduled or other pressing needs to handle regarding their existing caseload. Even if they were available, a few hours is not enough time to meet with the individual, determine eligibility, develop a service plan, find providers, and arrange for any needed medical equipment or assistive technology. When these individuals are then sent to nursing facilities for convalescence, HSP has no way to obtain this information, so there is no opportunity for follow up.

The Rapid Reintegration model was intended to provide the availability of intensive case management assistance upon notification by hospital staff of potential discharge to attempt to provide the help people need to go directly home from the hospital at discharge. If nursing facility placement was not desired but could not be avoided because of short timeframes or because short term therapy or treatment was required, immediate and intensive Community Reintegration Program assistance after nursing facility placement was provided in order to allow people to return home as soon as possible. This not only addressed individual preferences but maintained homes. Too often people lose their homes or apartments when they go to nursing facilities and then have nowhere to return. Since locating accessible, affordable housing is probably the single greatest barrier to the reintegration of individuals from nursing facilities back to the community, maintaining existing residences where possible and desired is also very cost effective.

Rockford and Springfield were selected as pilot sites for Rapid Reintegration and specific HSP and CRP staff were designated to handle these cases on a primary and back up basis. Because this is a very different approach than existing programs, it required the development of pilot protocols, new forms and procedures, and staff training. It also required work with the involved hospital social service departments, nursing facility prescreening entities, and HSP and Center for Independent Living Center CRP staff. Staff training was conducted in fall, 2008, followed by implementation of the pilot.

During FY09, a total of 204 individuals were assessed for participation in the pilot. Of these, 84 received HSP services and 9 had applications pending at the end of FY09. Another 39 individuals were assessed but not served for a variety of reasons including financial or other ineligibility, refusal of service, death prior to service planning, and other. The final 67 went to nursing facilities, nine of whom are being served under CRP and two of whom requested only assistance in maintaining their existing homes. Without this pilot, more than half of these individuals would have gone to nursing homes with few being able to return home. Because of this pilot, 95 individuals were deflected from nursing homes.

The pilot concept was good public policy, sound fiscal management of government resources, and received an enthusiastic and positive response from those involved in the local offices and community. However, the pilot was too staff intensive to implement for the long term given the availability of State and hospital resources. It is being re-evaluated for future implementation.

MFTD Pilot

Since the early 1980's, the Division of Specialized Care for Children (DSCC), on behalf of the Department of Healthcare and Family Services (HFS), has operated the state's Medically Fragile/Technology Dependent Children's Waiver (MFTD) for children with extremely complex and fragile medical conditions, most of whom rely on devices such as ventilators for breathing, gastrostomy tubes for nutrition or the like. Children such as these receive a greater array of services than do adults, both in quality and quantity, under Medicaid law. In addition, under State law, when parents are not home, minor children cannot receive health care at home from a credentialed health care provider other than a nurse. When these children turn 21, they age out of the MFTD waiver. Their only current options for continued long term, Medicaid-funded care are HSP services or nursing facilities. Since HSP must stay within nursing home rates, its topmost level of reimbursement for care for both types of care is a bit less than half of what the children are receiving through MFTD.

This "cliff affect" has been an issue for some time and was the subject of Public Act 95-0622 which was a three year pilot program intended to smooth this transition. A multi-pronged effort was initiated by HFS as the lead agency regarding this issue. This included the development of objective eligibility and service planning measures for MFTD which, after study and revision, might be used in whole or part with the adult population in HSP. The next undertaking was an analysis of available data to determine a defensible methodology for establishing service limits based on disability and need for service within the MFTD waiver. Existing data proved inadequate for this effort which was therefore postponed until a later stage of the project when data from the new eligibility and service planning tools would be available. The first full year of data for the MFTD waiver population after waiver-wide implementation of the new eligibility criteria will be in FY10 after which renewed efforts to establish cost parameters will be made.

Program Accomplishments in FY 2009

  • Illinois completed the year long process required to submit application for the five year renewal of its HSP Medicaid Waiver for Persons with Disabilities (PWD) which was approved for an effective start date of October 1, 2009. This waiver allows the State of Illinois to receive Federal Financial Participation (FFP) for expenditures under this waiver. HSP in collaboration with the HFS Bureau of Interagency Coordination developed and submitted the comprehensive application required among other necessary renewal activities. As the largest of HSP's three waivers, the PWD waiver serves nearly 29,000 individuals with a broad cross section of disabilities each year.
  • Money Follows the Person (MFP) began its third year with intensive efforts by all involved agencies to obtain formal approval of the Operational Protocol submitted to Centers for Medicaid and Medicare (CMS) which was submitted in spring, 2008. CMS required clarification and refinement of certain aspects of the Protocol, but ultimately approval was received. Project implementation began in spring, 2009, on a limited basis in order to work the "kinks" out of program procedures and IT systems with the University of Illinois, the contractual manager of all MFP case coordination activities by the involved state agencies. The process ultimately required by CMS is very complex and extensive, with very detailed documentation requirements and many more forms than are required for the existing waiver and reintegration programs.
  • A second part of the MFP initiative was a new Peer Training model program offered as an adjunct to CRP in the Chicago area. This program was finalized and implementation initiated just prior to the end of FY09.
  • As described earlier, the Rapid Reintegration Pilot was implemented in FY09 in Rockford and Springfield and assessed a total of 204 individuals of whom 95 were deflected from nursing homes. None of these individuals would otherwise have been seen by HSP staff prior to discharge from hospitals directly to nursing facilities.

Program Plans for FY 2010

  • A program utilizing spouses as paid caregivers of HSP customers will be developed as a pilot for a limited number of individuals living in counties selected to provide a good cross-section of the HSP population. Spouses will be able to provide only "exceptional care," that is care which is required because of the disability and which spouse would not ordinarily provide such as bathing and dressing. The program will be limited to customers with the most severe disabilities. Other criteria will also be required such as the customer's ability to direct the care, a limit on the number of hours per week which a spouse can provide so as to prevent burnout, and the ability of the spouse to provide the needed care. Background checks will also likely be required to ensure there is no history of domestic violence, abuse or neglect, or fraud involving DHS or HFS.
  • Processing personal assistant (PA) timesheets is one of the largest and most labor intensive activities in HSP. In an effort to provide greater accountability by providing more and more accurate timekeeping information, HSP will pursue development of an automated timekeeping system. One of the most promising models in the country has PA's call in start and end times for each work shift from the customer's home or personal telephone. The customer telephone is registered in the system so this system confirms that the PA is at the job site and the actual hours of work.
  • HSP will complete implementation of Money Follows the Person in CRP including the new Peer Training model for community reintegration being piloted in the Chicago area. This will involve finalization of procedures and ongoing training of CIL's, particularly in areas where changes were required.
  • Because HSP, the Division of Developmental Disabilities, and the Department on Aging have waivers with potentially overlapping populations, there will be renewed effort to conduct regular interagency meetings between HSP and these agencies to discuss issues of mutual interest. This will likely involve maximizing Medicaid claim, streamlining intersecting policies and procedures, and pursuing solutions which may have potential benefit to more than one of these interagency partners.
  • HSP will continue pursuing solutions to the issue of children transitioning from the MFTD waiver to HSP.

As always, HSP will continue to review and update its rules and procedures and continue its training and other efforts to ensure that they reflect the historic mission, purpose and design of the program and that they maintain program integrity. HSP will also continue to strive to support any efforts which allow or improve customers' maximum choice, dignity and independence in long term care.

Historical Program Overview FY 2002 through FY 2009

Category FY 2003 FY 2004 FY 2005 FY 2006 FY 2007 FY 2008 FY 2009
Program Administration $14,400,333 $15,038,807 $16,425,127 $16,638,547 $20,536,461 $20,277,902 $23,494,016
Other Provider Costs & Benefits - - - - $1,320,420 - $4,800,000
Customer Services $266,832,386 $300,655,201 $343,171,116 $351,955,381 $381,018,497 $433,285,736 $476,528,337
Total Spending $281,232,719 $315,694,008 $359,596,243 $368,593,928 $402,875,378 $453,563,638 $504,822,353
% Admin to Total Spending 5.12% 4.76% 4.57% 4.51% 5.43% 4.47% 5.60%
Average All Service Cost Per Customer $948 $986 $1,073 $1,112 $1,176 $1,296 $1,386
% Increase of Average Cost from Prior Year - 3.97% 8.83% 3.67% 5.79% 10.17% 6.95%
% Annual Rate Increases - 3.22% 3.41% 3.75% 5.89% 11.08% 5.05%
Customers Receiving Paid Services 28,926 31,071 32,549 32,704 32,944 33,662 34,309
Total New Customer Service Plans 5,766 5,554 6,021 4,858 5,144 5,061 6,135
Total Customer Applications 8,102 8,511 8,274 7,596 8,339 8,564 8,902

Historical Summary of Medicaid Claim & Reimbursement FY 2002 through FY 2009

Category FY 2003 FY 2004 FY 2005 FY 2006 FY 2007 FY 2008 FY 2009 FY02 - 09
Total Program Spending $281,232,719 $315,694,008 $359,596,243 $368,593,928 $402,875,378 $453,563,638 $504,822,353 $2,686,378,267
Administrative Medicaid Claim $22,265,414 $24,796,989 $26,469,839 $24,768,082 $30,642,078 $30,885,910 $35,971,261 $195,799,574
Customer Service Medicaid Claims $173,813,118 $212,348,800 $239,797,400 $244,134,288 $259,607,641 $280,309,892 $336,471,801 $1,746,482,940
Total Medicaid Claim $196,078,532 $237,145,789 $266,267,239 $268,902,370 $290,249,719 $311,195,802 $372,443,062 $1,942,282,514
Total Medicaid Reimbursement $98,039,266 $118,572,895 $133,133,619 $134,451,185 $145,124,860 $155,597,901 $186,221,531 $971,141,257
% Medicaid Claim to Total Spending 69.72% 75.12% 74.05% 72.95% 72.04% 68.61% 73.78% 72.30%
Total Customers Receiving Paid Services 28,926 31,071 32,549 32,704 32,944 33,662 34,309 226,165
Customers with Medicaid Claim 22,211 24,538 25,072 24,616 25,554 26,457 26,844 175,292
% Customers with Medicaid Claim 76.79% 78.97% 77.03% 75.27% 77.57% 78.60% 78.24% 77.51%

NOTE: Medicaid claims, and therefore Medicaid reimbursement, may be modified for up to 26 months from the date submitted to HFS, so FY 07 - FY09 reflect claims through FY09

Waiver Summary by Year FY 2006 - 2009

FY2006 FY2007 FY2008 FY2009
Waiver # Served Avg. Cost Per Mo. Total Spending # Served Avg. Cost Per Mo. Total Spending # Served Avg. Cost Per Mo. Total Spending # Served Avg. Cost Per Mo. Total Spending
Persons with Disabilities 24,895 $1,038 $255,701,438 24,570 $1,097 $270,605,521 24,629 $1,087 $290,788,840 25,588 $1,374 $333,597,131
Persons with Brain Injury 5,912 $1,433 $73,695,736 6,599 $1,505 $88,174,546 7,287 $1,608 $118,780,830 7,005 $1,745 $118,647,549
Persons with HIV/AIDS 1,897 $1,212 $21,689,375 1,775 $1,242 $21,315,086 1,746 $1,325 $22,750,417 1,716 $1,292 $23,225,767
TOTAL 32,704 $1,112 $351,086,549 $32,944 $1,176 $380,095,153 33,662 $1,296 $432,320,087 34,309 $1,386 $475,470,447

Note: Excludes prescreening.

Summary of Spending by Waiver & Type of Service FY 2009

TOTAL Brain Injury Waiver HIV/AIDS Waiver General Waiver
Type of Service Customers Served Total Expenditures Customers Served Total Expenditures Customers Served Total Expenditures Customers Served Total
Personal Assistant 28,014 $381,064,442 5,663 $89,272,209 1,519 $18,805,471 20,832 $272,986,762
Homemaker 5,144 $51,651,426 882 $10,648,144 169 $1,604,851 4,093 $39,398,431
Maintenance Home Health 1,432 $15,531,017 319 $3,395,923 31 $261,059 1,082 $11,874,035
Home-Delivered Meals 3,162 $6,324,842 1,255 $2,986,758 33 $37,513 1,874 $3,300,571
Home Remodeling 263 $1,031,532 42 $229,016 1 $3,139 220 $799,377
Adult Day Care 265 $2,147,712 77 $489,564 0 $0 188 $1,658,148
Assistive Equipment 569 $598,675 67 $78,653 32 $8,677 470 $511,345
Electronic Home Response 6,418 $1,762,172 1,519 $404,507 139 $38,371 4,760 $1,319,294
Brain Injury Services (duplicated) 1,393 $1,649,665 1,380 $1,639,620 0 $0 13 $10,045
Respite 616 $1,302,749 22 $52,195 1 $3,300 593 $1,247,254
Diagnostic Services 1,704 $46,125 159 $5,955 2 $45 1,543 $40,125
PA Background Check/Other 2,093 $73,847 313 $13,255 8 $665 1,772 $59,927
Case Management Services 9,334 $12,286,243 6,832 $9,409,074 1,679 $2,457,752 823 $419,417
Prescreening 11,735 $1,057,890 300 $29,481 55 $5,103 11,380 $1,023,306
Total (excl. Prescreening) 34,309 $475,470,447 7,005 $118,624,873 1,716 $23,220,843 25,588 $333,624,731
Total (with Prescreening) 44,581 $476,528,337 7,137 $118,654,354 1,719 $23,225,946 35,725 $334,648,037

Note: Total numbers are unduplicated; customers may receive multiple services.

Summary of Spending by Type of Service FY 2006 - 2009

FY2006 FY2007 FY2008 FY2009
Type of Service Customers Served Total Expenditures Customers Served Total Expenditures Customers Served Total Expenditures Customers Served Total Expenditures
Personal Assistant 26,805 $275,735,651 27,043 $298,964,556 27,689 $346,642,122 28,014 $381,064,442
Homemaker 4,834 $36,314,535 5,026 $42,066,892 5,123 $43,783,449 5,144 $51,651,426
Maintenance Home Health 1,908 $18,304,856 1,691 $16,731,619 1,601 $16,450,678 1,432 $15,531,017
Home-Delivered Meals 2,463 $4,114,653 2,678 $4,661,210 3,064 $5,779,000 3,162 $6,324,842
Home Remodeling 273 $836,575 199 $647,452 216 $822,220 6,418 $1,762,172
Adult Day Care 257 $1,524,011 260 $1,808,248 267 $1,895,090 265 $2,147,712
Assistive Equipment 829 $979,709 658 $574,687 566 $569,418 1,393 $1,649,665
Electronic Home Response 5,009 $1,690,048 5,386 $1,689,845 5,906 $1,605,874 616 $1,302,749
Brain Injury Services (duplicated) 1,013 $1,136,319 1,331 $1,464,029 1,428 $1,680,978 263 $1,031,532
Respite 67 $141,876 83 $194,682 487 $586,685 569 $598,675
Diagnostic Services 1,173 $40,382 1,550 $42,356 1,571 $43,970 2,093 $73,847
PA Background Check /Other 1,419 $75,985 1,447 $69,700 1,459 $70,289 1,704 $46,125
Case Management Services 7,806 $10,191,949 8,276 $11,179,877 9,109 $12,390,314 9,334 $12,286,243
Prescreening 9,554 $868,832 10,144 $923,344 10,631 $965,649 11,735 $1,057,890
Total (excl. Prescreening) 32,704 $351,086,549 32,944 $380,095,153 33,652 $432,320,087 34,309 $475,470,447
Total (with Prescreening) $42,258 $351,955,381 $43,088 $381,018,497 $44,283 $433,285,736 46,044 $476,528,337

Note: Total numbers are unduplicated; customers may receive multiple services.

Demographics FY 2006 - 2009

Age

FY06 FY07 FY08 FY09
AGE # Customers % of Total # Customers % of Total # Customers % of Total # Customers % of Total
less than 20 2,057 6.43% 1,973 5.99% 1,893 5.63% 1,799 5.24%
20 TO 29 2,722 8.51% 2,728 8.28% 2,806 8.33% 2,884 8.40%
31 TO 39 3,387 10.59% 3,423 10.39% 3,352 9.96% 3,322 9.68%
40 TO 49 7,093 22.18% 6,964 21.14% 6,858 20.37% 6,750 19.68%
50 TO 59 10,590 33.11% 10,978 33.32% 11,226 33.35% 11,535 33.62%
60 TO 69 4,727 14.78% 5,223 15.85% 5,650 16.78% 6,055 17.65%
70 TO 79 993 3.10% 1,118 3.39% 1,275 3.79% 1,326 3.87%
80 + 413 1.29% 537 1.63% 602 1.79% 638 1.86%
TOTAL 31,982 100.00% 32,944 100.00% 33,662 100.00% 34,309 100.00%
AVERAGE AGE 46.96 47.64 48.2 48.67

Race

FY2006 FY2007 FY2008 FY2009
RACE # Customers % of Total # Customers % of Total # Customers % of Total # Customers % of Total
White 16,721 51.13% 16,585 50.34% 16,756 49.78% 16,890 49.23%
Black 13,486 41.24% 13,785 41.84% 14,211 42.22% 14,607 42.58%
Hispanic 1,987 6.08% 2,048 6.22% 2,142 6.36% 2,249 6.56%
Asian 365 1.12% 383 1.16% 409 1.22% 422 1.23%
Indian 117 0.36% 109 0.33% 111 0.33% 103 0.30%
Hawaiian 28 0.08% 34 0.10% 33 0.10% 38 0.11%
TOTAL 32,704 100.00% 32,944 100.00% 33,662 100.00% 34,309 100.00%

Gender

FY2006 FY2007 FY2008 FY2009
GENDER # Customers % of Total # Customers % of Total # Customers % of Total # Customers % of Total
Male 14,414 44.07% 14,395 43.69% 14,739 43.78% 15,052 43.87%
Female 18,290 55.93% 18,549 56.31% 18,923 56.22% 19,257 56.13%
TOTAL 32,704 100.00% 32,944 100.00% 33,662 100.00% 34,309 100.00%

Type of Disability

FY2006 FY2007 FY2008 FY2009
TYPE OF DISABILITY # Customers % of Total # Customers % of Total # Customers % of Total # Customers % of Total
Orthopedic, Amputation, Other Mobility & Manipulation 14,298 43.72% 14,346 43.55% 14,076 41.81% 13,959 40.69%
All Other Disabilities 8,344 25.51% 8,440 25.62% 9,159 27.21% 9,941 28.98%
Brain Injury 3,267 9.99% 3,449 10.47% 3,627 10.78% 3,520 10.26%
Developmental Disability 2,380 7.28% 2,391 7.26% 2,515 7.47% 2,578 7.51%
Mental Illness, Alcohol &/or Substance Abuse 1,782 5.45% 1,791 5.44% 1,816 5.39% 1,887 5.50%
AIDS 1,923 5.88% 1,808 5.49% 1,786 5.31% 1,742 5.08%
Hearing &/or Vision 710 2.17% 719 2.18% 683 2.03% 682 1.99%
TOTAL 32,704 100.00% 32,944 100.00% 33,662 100.00% 34,309 100.00%

Summary by DON Score FY 2006 - 2009

FY06

DON Score Number of Customers Percent of Customers Expenditure Amount Expenditure Percent Avg. Annual Cost Per Customer
29-32 544 22.53% $6,983,875.40 13.35% $12,835.70
33-40 519 21.51% $8,327,370.29 15.92% $16,032.45
41-49 425 17.60% $8,417,830.70 16.09% $19,812.56
50-59 353 14.63% $8,598,740.52 16.44% $24,349.21
60-69 265 10.99% $7,986,348.99 15.26% $30,082.70
70-79 180 7.45% $6,451,014.90 12.33% $35,837.62
80-100 128 5.28% $5,554,141.95 10.62% $43,525.89
Total 32,704 100.00% $351,086,549.00 100.00% $10,735.28

Average DON Score = 46.76

FY07

DON Score Number of Customers Percent of Customers Expenditure Amount Expenditure Percent Avg. Annual Cost Per Customer
29-32 542 22.12% $7,347,813 12.84% $13,549.14
33-40 532 21.68% $9,145,674 15.98% $17,202.17
41-49 436 17.80% $9,273,692 16.20% $21,249.09
50-59 364 14.86% $9,622,320 16.81% $26,408.57
60-69 272 11.11% $8,912,529 15.57% $32,709.44
70-79 181 7.37% $7,020,517 12.27% $38,875.86
80-100 124 5.05% $5,910,805 10.33% $47,700.00
Total 32,944 100.00% $380,095,153 100.00% $11,537.61

Average DON Score = 47.25

FY08

DON Score Number of Customers Percent of Customers Expenditure Amount Expenditure Percent Avg. Annual Cost Per Customer
29-32 7,412 22.02% $55,865,199 12.92% $7,537.07
33-40 7,547 22.42% $71,441,878 16.53% $9,465.68
41-49 5,965 17.72% $71,133,830 16.45% $11,925.74
50-59 4,984 14.81% $72,464,463 16.76% $14,539.09
60-69 3,723 11.06% $67,721,093 15.66% $18,187.64
70-79 2,415 7.17% $52,319,323 12.10% $21,667.79
80-100 1,616 4.80% $41,374,301 9.57% $25,609.97
Total 33,662 100.00% $432,320,087 100.00% $12,842.97

Average DON Score = 47.04

FY09

DON Score Number of Customers Percent of Customers Expenditure Amount Expenditure Percent Avg. Annual Cost Per Customer
29-32 7,457 21.74% $61,455,962 12.93% $8,240.92
33-40 8,045 23.45% $84,878,848 17.86% $10,550.44
41-49 6,116 17.82% $78,786,469 16.58% $12,882.98
50-59 5,086 14.83% $79,885,752 16.81% $15,705.72
60-69 3,648 10.63% $71,133,149 14.97% $19,496.65
70-79 2,452 7.15% $57,233,350 12.04% $23,343.99
80-100 1,504 4.38% $41,925,166 8.82% $27,869.12
Total 34,309 100.00% $475,298,696 100.00% $13,853.47

Average DON Score = 46.74