NORTH CAROLINA

STUDY COMMISSION ON AGING

REPORT TO THE

GOVERNOR AND THE 2008 REGULAR SESSION OF THE

2007 GENERAL ASSEMBLY

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North Carolina

Study Commission On Aging

May 12, 2008

To: Governor Michael Easley

Lieutenant Governor Beverly Perdue, President of the North Carolina Senate

Senator Marc Basnight, President Pro Tempore of the North Carolina Senate

Representative Joe Hackney, Speaker of the North Carolina House of Representatives

Members of the 2008 Regular Session of the 2007 General Assembly

Attached is a report from the North Carolina Study Commission on Aging submitted pursuant to

North Carolina General Statute § 120- 187. The report contains recommendations and proposed

legislation from the North Carolina Study Commission on Aging based on study conducted after

the adjournment of the 2007 Regular Session of the General Assembly.

Respectfully submitted,

___________________________ ___________________________

Senator Vernon Malone Representative Jean Farmer- Butterfield

Co- Chair Co- Chair

1

North Carolina Study Commission On Aging

2007- 2008 Membership List

President Pro Tempore's Appointments Speakers' Appointments

Senator Vernon Malone, Co- Chair Representative Jean Farmer- Butterfield, Co- Chair

Senator Stan Bingham Representative Alice Bordsen

Senator Katie Dorsett Representative Joe Boylan

Senator James Forrester Representative Bob F. England, MD

Senator A. B. Swindell, IV Representative Garland Pierce

Mr. Anthony Peace Ms. Karen Gottovi

Mr. Judy Pelt Mr. David Lowa

Ms. Jean Reaves Mr. Edd Nye

Ex Officio:

Mr. Jackie Sheppard, Assistant Secretary,

Long Term Care and Family Services,

Department of Health and Human Services

Clerks:

Bonnie McNeil

919/ 733- 5880

Ruth Merkle

919/ 733- 5898

Staff:

Theresa Matula,

Shawn Parker,

Ben Popkin

Research Division

919/ 733- 2578

2

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 3

TABLE OF CONTENTS

LETTER OF TRANSMITTAL...................................................................................................... 1

MEMBERSHIP LIST...................................................................................................................... 2

PREFACE ............................................................................................................................... ........ 6

EXECUTIVE SUMMARY ............................................................................................................. 7

AGING NORTH CAROLINA: THE 2008 PROFILE ................................................................ 11

COMMISSION PROCEEDINGS .................................................................................................. 20

COMMISSION RECOMMENDATIONS..................................................................................... 26

APPENDICES

APPENDIX A.............................................................................................................................. .... 44

2007 Recommendation Status Report

Summary of Substantive Legislation Related to Aging, 2006 Session

APPENDIX B ............................................................................................................................... .. 67

Summary of Issues Most Frequently Mentioned by Organizations Representing Older Adults

APPENDIX C ............................................................................................................................... .. 73

Summary of 2008 Public Hearings

APPENDIX D.............................................................................................................................. .... 77

Legislative Proposals/ Bills

2007- SHZ- 23 AN ACT TO APPROPRIATE ADDITIONAL FUNDS TO THE SENIOR CENTER

GENERAL PURPOSE FUND, AS RECOMMENDED BY THE NORTH CAROLINA STUDY

COMMISSION ON AGING.

2007- SHZ- 24 AN ACT TO APPROPRIATE ADDITIONAL FUNDS FOR THE HOME AND

COMMUNITY CARE BLOCK GRANT, AS RECOMMENDED BY THE NORTH CAROLINA

STUDY COMMISSION ON AGING.

2007- SHZ- 25 AN ACT TO APPROPRIATE FUNDS FOR PROJECT C. A. R. E. ( CAREGIVER

ALTERNATIVES TO RUNNING ON EMPTY) WHICH PROVIDES CONSUMER- DIRECTED

RESPITE CARE AND COMPREHENSIVE SUPPORT TO DEMENTIA CAREGIVERS WITH A

GOAL OF INCREASING RESPITE AND SUPPORT SERVICES TO LOW- INCOME RURAL AND

MINORITY CAREGIVERS, AS RECOMMENDED BY THE NORTH CAROLINA STUDY

COMMISSION ON AGING.

2007- SHZ- 26 AN ACT TO APPROPRIATE FUNDS TO ENACT A PILOT PROGRAM TO ASSESS

CHANGES PROPOSED BY THE ADULT PROTECTIVE SERVICES TASKFORCE WITH A GOAL

OF IMPROVING NORTH CAROLINA'S SYSTEM OF RESPONDING TO ALLEGATIONS OF

ABUSE, NEGLECT, EXPLOITATION, OR SUBSTANTIAL RISK OF VULNERABLE OR ELDER

ADULTS, AS RECOMMENDED BY THE NORTH CAROLINA STUDY COMMISSION ON

AGING.

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 4

2007- SHZ- 29 AN ACT TO PROVIDE A COMPREHENSIVE FIVE- YEAR STATEWIDE STUDY OF

THE STATE'S READINESS TO RESPOND TO THE COMING WAVE OF OLDER ADULTS BY

ESTABLISHING A STEERING COMMITTEE FOR THE STUDY, APPROPRIATING FUNDS TO

PROVIDE STAFF TO SUPPORT THE COMMITTEE, AND APPROPRIATING FUNDS FOR THE

FIRST YEAR OF THE STUDY, AS RECOMMENDED BY THE STUDY COMMISSION ON

AGING.

2007- SHZ- 31 AN ACT TO APPROPRIATE FUNDS FOR AN ADULT CARE HOME SCREENING

PROCESS FOR MENTAL HEALTH AND DEVELOPMENTAL DISABILITY CONDITIONS,

APPROPRIATE FUNDS FOR TRANSITIONAL RESIDENTIAL TREATMENT PROGRAM PILOT

SITES, APPROPRIATE FUNDS TO SUPPORT ASSESSMENT AND SERVICE PLAN

DEVELOPMENT IN ADULT CARE HOMES, AND TO STUDY SUITABLE METHODS TO

PROVIDE DIRECT CARE WORKERS WITH TARGETED AND COST EFFECTIVE TRAINING ON

THE CARE OF INDIVIDUALS WITH MENTAL ILLNESS, AS RECOMMENDED BY THE STUDY

COMMISSION ON AGING.

2007- SQZ- 11 AN ACT TO DIRECT THE DEPARTMENT OF HEALTH AND HUMAN SERVICES TO

STUDY ISSUES RELATING TO RESPITE CARE, AS RECOMMENDED BY THE STUDY

COMMISSION ON AGING.

2007- SQZ- 12 AN ACT TO DIRECT THE DEPARTMENT OF HEALTH AND HUMAN SERVICES TO

STUDY ISSUES RELATING TO HEARING LOSS IN OLDER ADULTS IN NORTH CAROLINA,

AS RECOMMENDED BY THE STUDY COMMISSION ON AGING.

2007- RDZ- 26 AN ACT TO AUTHORIZE THE NORTH CAROLINA STATE BOARD OF EXAMINERS

FOR NURSING HOME ADMINISTRATORS TO OBTAIN CRIMINAL HISTORY RECORD

CHECKS OF APPLICANTS FOR LICENSURE AS NURSING HOME ADMINISTRATORS, AS

RECOMMENDED BY THE NORTH CAROLINA STUDY COMMISSION ON AGING.

2007- SHZ- 27 AN ACT TO RAISE THE CEILING ON THE TOTAL AMOUNT OF PERSONAL

PROPERTY A GUARDIAN IS ALLOWED TO SELL WITHOUT A COURT ORDER UNDER THE

LAWS PERTAINING TO GUARDIANSHIP, AS RECOMMENDED BY THE HOUSE STUDY

COMMITTEE ON STATE GUARDIANSHIP LAWS AND THE STUDY COMMISSION ON AGING.

2007- SHZ- 28 AN ACT AUTHORIZING THE DIVISION OF MOTOR VEHICLES TO CONSIDER

RECOMMENDATIONS FROM THE CLERK OF COURT IN DETERMINING WHETHER TO

REVOKE THE DRIVERS LICENSE OF A PERSON ADJUDICATED INCOMPETENT UNDER THE

GUARDIANSHIP LAWS, AS RECOMMENDED BY THE HOUSE STUDY COMMITTEE ON

STATE GUARDIANSHIP LAWS AND THE STUDY COMMISSION ON AGING.

HB 93 AN ACT TO DIRECT THE DEPARTMENT OF TRANSPORTATION TO STUDY ISSUES

RELATING TO INDIVIDUALS BEING TRANSPORTED IN VEHICLES WHILE SEATED IN

WHEELCHAIRS, AS RECOMMENDED BY THE NORTH CAROLINA STUDY COMMISSION ON

AGING.

HB 92 AN ACT TO DIRECT THE DEPARTMENT OF HEALTH AND HUMAN SERVICES TO

REVIEW OPTIONS FOR INCREASING MEDICAID MEDICALLY NEEDY INCOME LIMITS, AS

RECOMMENDED BY THE NORTH CAROLINA STUDY COMMISSION ON AGING.

2007- SQFZ- 14 AN ACT TO INCREASE THE LONG TERM CARE INSURANCE TAX CREDIT, AS

RECOMMENDED BY THE STUDY COMMISSION ON AGING.

2007- SQFZ- 15 AN ACT TO REQUIRE MULTIUNIT ASSISTED HOUSING WITH SERVICES ( MAHS)

PROGRAMS TO REGISTER ANNUALLY WITH THE DIVISION OF HEALTH SERVICE

REGULATION AND TO AUTHORIZE THE DEPARTMENT OF HEALTH AND HUMAN

SERVICES TO ESTABLISH CERTAIN FEES, AS RECOMMENDED BY THE STUDY

COMMISSION ON AGING.

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 5

2007- SHZ- 30 AN ACT TO DIRECT THE DEPARTMENT OF HEALTH AND HUMAN SERVICES,

DIVISION OF AGING AND ADULT SERVICES, AND DIVISION OF MEDICAL ASSISTANCE,

TO STUDY IMPLEMENTATION OF AN INCOME DISREGARD POLICY FOR CURRENT

STATE/ COUNTY SPECIAL ASSISTANCE AND MEDICAID RECIPIENTS WHO ARE

ADVERSELY IMPACTED DUE TO COST OF LIVING OR OTHER INCOME INCREASES, AS

RECOMMENDED BY THE STUDY COMMISSION ON AGING.

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 6

PREFACE

Chapter 120, Article 21, of the North Carolina General Statutes, charges the North Carolina Study

Commission on Aging with studying and evaluating the existing system of delivery of State

services to older adults, and recommending an improved system of delivery to meet the present and

future needs of older adults. The Commission consists of 17 members. Of these members, eight

are appointed by the Speaker of the House of Representatives, eight are appointed by the President

Pro Tempore of the Senate. The Secretary of the Department of Health and Human Services, or the

Secretary’s designee, serves as an ex officio, non- voting member.

This report represents the work of the North Carolina Study Commission on Aging during the 2007-

2008 interim. The Commission met on five occasions and held public hearings in Wilson and

Jamestown. During a meeting on February 28, 2008, the Commission heard brief presentations on

issues of interest or concern to organizations that represent older adults. The public hearings,

conducted in March and April, provided citizens with an opportunity to speak to Commission

members about programs and services for older adults. Based on reports received by the

Commission, input from organizations that represent older adults, and comments expressed by

citizens, the Study Commission on Aging presents the recommendations contained in this report.

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 7

EXECUTIVE SUMMARY

The North Carolina Study Commission on Aging met five times and conducted two public hearings

during the 2007- 2008 interim. In response to the study and evaluation of services to older adults,

the North Carolina Study Commission on Aging makes the following recommendations to the

Governor and the 2008 Session of the 2007 General Assembly:

Recommendation 1: Senior Center Funds

The Study Commission on Aging recommends that the General Assembly appropriate an additional

$ 500,000, for the 2008- 2009 fiscal year, to the Senior Center General Purpose Fund with the intent

that it shall become part of the continuation budget.

Recommendation 2: Additional HCCBG Funds

The Study Commission on Aging recommends that the General Assembly appropriate an additional

$ 2,500,000 to the Department of Health and Human Services, for the 2008- 2009 fiscal year, for the

Home and Community Care Block Grant ( HCCBG).

Recommendation 3: Funds for Project C. A. R. E.

The Study Commission on Aging recommends that the General Assembly appropriate $ 500,000 to

the Department of Health and Human Services, Division of Aging and Adult Services, for the 2008-

2009 fiscal year, to fund Project C. A. R. E. ( Caregiver Alternatives to Running on Empty) which

provides support to individuals with dementia and their caregivers.

Recommendation 4: Adult Protective Services Pilot Program

The Study Commission on Aging recommends that the General Assembly appropriate $ 1,497,087

to the Department of Health and Human Services, Division of Aging and Adult Services, for the

2008- 2009 fiscal year, to enact the first year of a two- year pilot program to assess proposed changes

to the adult protective services statutes and to report to the Study Commission on Aging on the

evaluation of the pilot by March 1, 2010.

Recommendation 5: Statewide Aging Study

The Study Commission on Aging recommends support for a comprehensive, five- year statewide

study of the older adult population and the State's readiness to respond to the coming wave of older

adults by recommending that the General Assembly take the following steps: establish an

appointment process for a steering committee; appropriate $ 175,000 to the Department of Health

and Human Services, Division of Aging and Adult Services, for the establishment of two positions

to support the work of the study; appropriate $ 3,820,000 to the Division of Aging and Adult

Services, for the 2008- 2009 fiscal year, to fund the first year of the study; and direct the Department

of Health and Human Services, Division of Aging and Adult Services, to make annual reports to the

General Assembly on the status of the study.

Recommendation 6: Adult Care Home Residents

Recommendation 6a: Adult Care Home Admission Screening Process

The Study Commission on Aging recommends that the General Assembly appropriate $ 1,764,000,

for the 2008- 2009 fiscal year, to the Department of Health and Human Services, Division of

Medical Assistance, to design, develop, and implement on a pilot basis, a screening process for

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 8

mental health and developmental disability conditions as part of the adult care home admission

process. The process shall duplicate the nursing facility admission process and shall consist of an

automated screening tool and where indicated a face- to- face assessment by a mental health or

developmental disabilities professional. The Division of Medical Assistance shall report on the

design, development, and piloting of the screening process for mental health and developmental

disability conditions as part of the adult care home admission process on or before October 15,

2008.

Recommendation 6b: Transitional Residential Treatment Program Pilot Sites

The Study Commission on Aging recommends that the General Assembly appropriate $ 567,084, for

2008- 2009 fiscal year, to the Department of Health and Human Services, Division of Mental

Health, Developmental Disabilities, and Substance Abuse Services, to fund three ( 3) geographically

diverse Transitional Residential Treatment Program pilot sites, which shall begin in January 2009.

Recommendation 6c: Care of Individuals with Mental Illness Training for Direct Care

Workers in Adult Care Homes

The Study Commission on Aging recommends that the General Assembly direct the Department of

Health and Human Services, Division of Health Service Regulation, Division of Medical

Assistance, and Division of Mental Health, Developmental Disabilities, and Substance Abuse

Services to work with adult care home providers to build on recent studies to determine the most

appropriate and cost effective way to provide training on the care of individuals with mental illness

to direct care workers in adult care homes by tailoring the training to resident assessment results and

utilizing web- based formats as appropriate, and to provide an interim report to the Study

Commission on Aging by November 1, 2008, and a final report by November 1, 2009.

Recommendation 6d. Assessment and Service Plan Development for Adult Care Home

Residents

The Study Commission on Aging recommends that the General Assembly appropriate $ 580,000, for

the 2008- 2009 fiscal year, to the Department of Health and Human Services, Division of Medical

Assistance, to support assessment and service plan development for adult care home residents and

to provide an interim report by November 1, 2008, and a final report by November 1, 2009.

Recommendation 7: Support for a Reward System for Adult Care Homes with High Ratings

The Study Commission on Aging expresses support for the creation of a reward system for adult

care homes that achieve high ratings and at the appropriate time, the Commission anticipates

supporting the concepts outlined in the Department's report on S. L. 2007- 544, Section 3( d).

Recommendation 8: Support for Respite Care

The Study Commission on Aging recommends that the General Assembly direct the Department of

Health and Human Services, Division of Aging and Adult Services, to study the adequacy of

service standards and funding for group respite services, and whether opportunities exist to

streamline and enhance the provision of respite services; direct the Division of Medical Assistance,

Department of Health and Human Services, to study the feasibility of providing respite care as a

State Plan Service, and provide a report on both issues to the Commission on Aging by November

1, 2009.

Recommendation 9: Study Older Adult Hearing Loss

The Study Commission on Aging recommends that the General Assembly direct the Department of

Health and Human Services to study the current and anticipated impact of hearing loss on North

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 9

Carolina's older adult population and the availability and access to qualified professionals for

treatment and hearing aid purchase assistance for low income individuals; to develop an inventory

of the technology available to assist individuals; and to evaluate resources and programs available

in other states, with a report to the Study Commission on Aging by November 1, 2008.

Recommendation 10: Criminal Background Checks for Nursing Home Administrators

The Study Commission on Aging recommends that the General Assembly enact legislation to give

the North Carolina Board of Nursing Home Administrators the authority to require a criminal

history record check for nursing home administrator license applicants.

Recommendation 11: Support Guardianship Study Recommendations

The Study Commission on Aging recommends that the General Assembly enact legislation to

authorize the Division of Motor Vehicles to consider recommendations from the clerk of court in

determining drivers license revocation of an incompetent individual, and to raise the ceiling on the

amount of personal property a guardian is allowed to sell without court order, which are both based

on recommendations from the House Study Committee on State Guardianship Laws to the 2007

General Assembly.

Recommendation 12: Study Safe Transport of Passengers in Wheelchairs

The Study Commission on Aging recommends that the General Assembly enact House Bill 93,

Transport of Individuals in Wheelchairs Study, as it directs the Department of Transportation to

study appropriate methods of transporting passengers seated in wheelchairs, to develop guidelines

for the installation and use of wheelchair tie- down systems, and to report findings and

recommendations to the Study Commission on Aging and the Joint Legislative Transportation

Oversight Committee. ( House Bill 93 is currently in the Senate Committee on Transportation and

was a recommendation to the 2007 General Assembly from the Study Commission on Aging.)

Recommendation 13: Study Medically Needy Income Standard

The Study Commission on Aging recommends that the General Assembly enact House Bill 92,

Medicaid Income Limits Level Study, as it requires the Department of Health and Human Services,

Division of Medical Assistance, to study the medically needy income standard and determine the

best method of increasing the standard while providing improved consistency across long- term care

settings and report to the Study Commission on Aging. ( House Bill 92 is currently in Senate

Appropriations and was a recommendation to the 2007 General Assembly from the Study

Commission on Aging.)

Recommendation 14: Long Term Care Insurance Tax Credit

The Study Commission on Aging recommends that the General Assembly increase the Long- Term

Care Insurance Tax Credit to 75% of the premiums paid by the purchaser up to a maximum of

$ 1000.

Recommendation 15: Establish MAHS Registration Fee/ Penalty for Failing to Register

The Study Commission on Aging recommends that the General Assembly enact legislation to

require facilities meeting the definition of multiunit assisted housing with services ( MAHS) register

annually with the Division of Health Services Regulation, authorize the Division to charge a fee of

up to $ 350 per registration, and make it a Class 3 misdemeanor punishable only by fine for failing

to register.

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 10

Recommendation 16: Special Assistance Income Disregard Study

The Study Commission on Aging recommends the Department of Health and Human Services,

Division of Aging and Adult Services, and Division of Medical Assistance, study whether North

Carolina can implement an income disregard policy for current Special Assistance and Medicaid

recipients who are adversely impacted due to cost of living or other income increases.

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 11

Aging North Carolina:

The 2008 Profile

Prepared by the Department of Health and Human Services, Division of Aging and Adult Services

North Carolina’s Demographic Shift

North Carolina remains in the midst of a significant demographic change as the state’s 2.3 million

baby boomers ( those born between 1946 and 1964) are beginning to enter retirement age. Today,

the proportion of the state’s population who are seniors, ages 65 and older, is roughly 12 percent.

By 2030, when the youngest baby boomers are retirement age, the proportion should reach 17.7

percent, or 2.1 million older North Carolinians. The Baby Boomer Milestones table below shows

the milestones of the baby boomers expressed in terms of some major federal and state age- related

programs ( eligibility age in parenthesis). For example, last year ( 2006), the oldest boomers ( i. e.,

born in 1946) became eligible to receive services under the Older Americans Act, and as of January

of this year, some of the oldest boomers began receiving their first Social Security payments.

Table: Baby Boomer Milestones

Year when oldest boomers become eligible

Programs 2006 2007 2008 2009 2010 2011 2012

NC Senior Games participation ( 55)

Older Americans Act services ( 60)

Social Security at a reduced rate ( 62)

Medicare benefits ( 65)

Medicaid assistance for the Aged ( 65)

Full Social Security ( 66)

Figure A: Growth of Older North Carolinians Age 65+ ( 2000- 2030)

969,048 971,058

1,606,894

2,144,843

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

2000 2010 2020 2030

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 12

Figure A indicates the projected growth of North Carolinians age 65+ from the year 2010 to the

year 2030. [ 1] The impact of the aging baby boomers is clearly indicated. As the graph shows, there

is little expected growth in the older population between 2000 and 2010. This is because the Great

Depression and World War II were times when the entire country experienced the lowest birth rates

the country had ever experienced up until that time. The small number of people born during those

two times ( 1929 to 1945) will be 65 to 81 years old in 2010. However, due to retirement migration

to North Carolina, we will not see an actual decline in the number of older adults in that period, as

some states will, but the growth will be modest.

Figure B shows the projected growth of the older population by county between 2000 and 2030.

During this period, growth for the state as a whole is projected at 50 percent, while the population

65 and older is expected to grow 121 percent, and the population 85 and older is expected to grow

144 percent. [ 1]

The eight counties with more than 200 percent growth can be divided into two very different

categories. Union, Wake, Johnston, and Hoke counties are experiencing rapid growth in their

overall population as expanding parts of metropolitan areas, and they will remain relatively “ young”

( the proportion of their population projected to be over 65 is lower than that of the state as a whole.)

The remaining four counties— Brunswick, Camden, Currituck, and Dare— by contrast, are projected

to see disproportionate growth in their aging population. Brunswick and Dare, in particular, are

projected to have substantially higher percentages of older adults ( 26.4 percent and 24.1 percent

respectively), compared to 17.7 percent for the state as a whole.

New

Alexander

Alleghany

Ashe

Avery

Buncombe

Burke

Cabarrus

Caldwell

Catawba

Cherokee

Cleveland

Davie

Gaston

Graham

Haywood

Henderson

Iredell

Jackson

McDowell

Macon

Madison

Mecklenburg

Mitchell

Polk

Rowan

Rutherford

Surry

Swain

Union

Watauga Wilkes

Yadkin

Yancey

Clay

Transylvania

Lincoln

Granville

Nash

Alamance

Anson

Bladen

Caswell

Chatham

Columbus

Cumberland

Davidson

Durham

Forsyth Guilford Franklin

Harnett

Hoke

Johnston

Lee

Montgomery

Moore

Orange

Person

Randolph

Richmond

Robeson

Rockingham

Sampson

Scotland

Stanly

Stokes

Vance

Wake

Warren

Beaufort

Bertie

Carteret

Chowan

Craven

Dare

Duplin

Edgecombe

Gates

Greene

Halifax Hertford

Hyde

Jones

Lenoir

Martin

Hanover

Northampton

Onslow

Pamlico

Pasquotank

Pender

Perquimans

Pitt

Tyrrell

Brunswick

Washington

Wayne

Wilson

Camden

Currituck

Greater than 200%

100 to 199% increase

43 to 99% increase

Figure B. Projected Growth of Population Ages 65 and Older from 2000 to 2030

Based on 2000 Census counts ( www. census. gov) and April 2030 projections ( 2006, Demographic Unit, Office

of State Budget and Management

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 13

Figure C. Percent of County Population Projected to Be Ages 65 and Older in 2030

Figure C shows the counties that will have the largest concentration of older adults in 2030. All are

in areas attractive to retirees, but many are also counties that will continue to lose younger residents

because of modest economic opportunities.

Although decreases in both fertility and mortality are the major factors in the aging of the state’s

population, migration also plays a key role. The following factors contribute to the different rates

of aging in the state’s 100 counties [ 2]:

 Rural- to- urban migration of young adults continues to age rural counties.

 Large metropolitan counties attract large numbers of persons from outside the state as well

as from rural counties.

 Large metropolitan counties are experiencing greater growth among younger adults than

they are among older adults.

 A large number of older adults with higher incomes are retiring in some western and coastal

counties, as well as other select counties with attractions to specific groups of older adults

( e. g., golf courses).

As shown in Figure D, North Carolina ranked third nationally as a retirement migration destination

with a net migration number of 34,290 among older adults ( 60+) in the five- year period between

1995 and 2000. Along with other Sunbelt states ( Florida, South Carolina, Texas, Tennessee,

Georgia, and Virginia), North Carolina remains a popular destination for people of all ages,

including seniors. [ 3] The latest data estimate is that 30,491 older adults ( 60+) relocated to North

Carolina from other states and abroad, in just one year, between 2005 and 2006 [ 4]. That means

that in 2006, two percent of people age 60 and older currently residing in North Carolina had been

living in another state the previous year.

New

Alexander

Alleghany

Ashe

Avery

Buncombe

Burke

Cabarrus

Caldwell

Catawba

Cherokee

Cleveland

Davie

Gaston

Graham

Haywood

Henderson

Iredell

Jackson

McDowell

Macon

Madison

Mecklenburg

Mitchell

Polk

Rowan

Rutherford

Surry

Swain

Union

Watauga Wilkes

Yadkin

Yancey

Clay

Transylvania

Lincoln

Granville

Nash

Alamance

Anson

Bladen

Caswell

Chatham

Columbus

Cumberland

Davidson

Durham

Forsyth Guilford Franklin

Harnett

Hoke

Johnston

Lee

Montgomery

Moore

Orange

Person

Randolph

Richmond

Robeson

Rockingham

Sampson

Scotland

Stanly

Stokes

Vance

Wake

Warren

Beaufort

Bertie

Carteret

Chowan

Craven

Dare

Duplin

Edgecombe

Gates

Greene

Halifax Hertford

Hyde

Jones

Lenoir

Martin

Hanover

Northampton

Onslow

Pamlico

Pasquotank

Pender

Perquimans

Pitt

Tyrrell

Brunswick

Washington

Wayne

Wilson

Camden

Currituck

More than 25% aged 65+

20 to 24.9% aged 65+

Less than 20% aged 65+

Note: The proportion in the state is 17.7%

Based on April 2030 projections ( 2006, Demographic Unit, Office of State Budget and Management

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 14

Figure D: Top Ten States with Net Number of Migrants Age 60+ ( 1995- 2000)

221,778

80,671

34,290 33,893 27,588 24,771 17,782 15,017 10,260 8383

0

50,000

100,000

150,000

200,000

250,000

FL AZ NC NV SC TX TN GA VA MO

States

Net Number of Migrants Age 60+

According to the most recent life tables from the North Carolina State Center for Health Statistics, if

age- specific mortality remains unchanged, babies born today in North Carolina are expected to live,

on average, to the age of 75.6 years. The North Carolinians who are age 60 today are expected to

live, on average, an additional 20.8 years to almost 81 years old. Generally, women live longer than

men and whites live longer than persons of other racial groups. However, at the oldest ages,

African Americans, in particular, have a life expectancy that is the same or slightly greater than that

of whites. This is known as the “ crossover effect.” [ 5]

Life Expectancies ( in Years) by Age Group, Gender, and Race

NC White All other Races*

Age Groups Combined Male Female Male Female

( At Birth) 75.6 73.8 79.6 68.0 75.8

60- 64 20.8 19.0 22.9 16.8 21.5

65- 69 17.1 15.4 18.9 13.8 17.8

70- 74 13.7 12.2 15.1 11.1 14.5

75- 79 10.6 9.3 11.6 8.8 11.4

80- 84 7.9 6.8 8.5 6.7 8.6

85+ 5.4 4.5 5.7 4.8 6.0

* This group is primarily African American, but other much smaller racial groups including Asian and

American Indian, are included. Source: NC Center for Health Statistics ( 2002). Healthy Life Expectancy in

North Carolina, 1996- 2000

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 15

What Are the Implications of this Shift?

The aging of the population is a national and international trend, and North Carolina, like the rest of

the world, must be prepared to reap the benefits and face the challenges of an older population.

Government faces decisions about the allocation of public resources from a tax base that may

experience slowed growth, especially in many aging rural counties. People must consider living

and caregiving arrangements in light of smaller nuclear and extended families. The health, human

service, employment, and education systems must adapt to the changing needs and interests of the

seniors of today and tomorrow. The business and faith communities as well as others must identify

and respond to the challenges and opportunities of these demographic shifts.

In the 2003- 2007 State Aging Services Plan, the Division of Aging and Adult Services, Department

of Health and Human Services, introduced a new initiative– Livable and Senior- Friendly

Communities– to raise awareness of the aging of our population. The initiative was also designed to

encourage North Carolina’s communities to become more senior- friendly, and livable for all people,

through collaboration among citizens, agencies, organizations, and programs, in both the public and

private arenas. This initiative formed the core around which the 2007– 2011 State Aging Services

Plan was organized. A livable and senior- friendly community in North Carolina will draw on the

talents and resources of active seniors while enhancing services for those who are vulnerable

because of their health, economic hardships, social isolation, or other conditions. A livable and

senior- friendly community will work to address a wide range of issues and concerns ( e. g., air

quality, housing, long- term care services, employment, enrichment opportunities) that, as a whole,

affect the quality of life of seniors and others in the community. Also, a livable and senior- friendly

community will assure good stewardship of its resources to meet the needs of today’s seniors, while

helping baby boomers and younger generations prepare for the future.

Demographic Highlights

Population

North Carolina ranks tenth among states in the number of persons age 65 and older and tenth in the

size of the entire population. [ 6] The fast pace of growth of the state’s older population is evident in

a US Census Bureau’s release in which North Carolina was ranked fourth nationally in the increase

of the number of older persons age 65+ ( 47,198 in NC) between April 2000 and July 2003. Only

three other states ( California, Texas, and Florida) reported a greater increase among their older

populations. Even so, when combined with the equally strong growth in other age groups, North

Carolina continues to maintain an overall healthy demographic balance among the generations, as it

is thirty- eighth among states in the proportion of the population over 65. [ 7]

 Estimated NC population age 65+ in 2006: 1,059,551 ( 12.0 percent of total population)

 Estimated NC population age 85+ in 2006: 132,412 ( 1.5 percent of the total population)

Diversity and Disparity

North Carolina is rich in diversity, but its citizens face challenges because of the disparity that exists

among all populations, including older adults. Some important differences among NC’s older

adults relate to gender, marital status, ethnicity/ race, residence, rurality, disability, health status,

grandparents raising grandchildren, and veteran status.

 Gender: Older women represent 59.8 percent of the 65+ age group and 72.4 percent of the 85+

age group. [ 8] The higher rate of poverty among older women remains a primary issue today.

For example, women age 75+ are twice as likely to be poor as men the same age. [ 9]

 Marital Status: Because men have shorter life expectancy, and because they tend to marry

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 16

younger women, at ages 65 and older, women are more than twice as likely to be unmarried as

men in their age group. [ 10] Data show that being unmarried ( widowed, divorced, separated,

or never married) increases a woman’s vulnerability to poverty. According to the Social

Security Administration, in 2005, 89% of married couples and 88% of nonmarried persons

aged 65 or older received Social Security benefits. Social Security was the major source of

income ( providing at least 50% of total income) for 54% of aged beneficiary couples and 72%

of aged nonmarried beneficiaries. It was 90% or more of income for 22% of aged beneficiary

couples and 42% of aged nonmarried beneficiaries. [ 11]

Percent of Unmarried Individuals by Age Group

Age 65- 74 Age 75- 84 Age 85+

Unmarried Women in NC 45.0 65.0 89.6

Unmarried Men in NC 20.9 26.0 41.4

Source: American Community Survey ( 2006). Table B12002.

 Ethnicity/ Race: Altogether 18.7 percent of persons age 65+ are members of ethnic minority

groups in North Carolina. [ 12] Compared to the nation as a whole, North Carolina’s

population age 65+ includes a larger proportion who are African American ( 15.6 percent in NC

compared to 8.3 percent nationally) and a smaller proportion of Latinos ( 1.2 percent in NC

compared to 6.4 percent nationally). American Indians, Asian Americans, and other ethnic

groups account for 2.0 percent of the age group 65 and older. In North Carolina, as well as

nationally, older adults from most ethnic minority groups show both a higher poverty rate and

a lower life expectancy when compared with the non- Latino white population. Poverty rates

for the two largest racial groups are shown in the table below. [ Note: See the Demographic

Shift section for the information on life expectancy.]

Percent Below Poverty Level for the Older Population of North Carolina

by Gender, Race, and Age Group

White African American

Male Female Male Female

Age Group 65 - 74 5.0 8.5 17.6 23.5

Age Group 75+ 6.5 12.6 21.9 35.0

Data from 2006 American Community Survey reflecting poverty in 2005.

 Residence: The 2000 Census showed that in North Carolina, 81.4 percent of householders age

65 and older owned their homes ( with or without mortgage), yet among homeowners in that

age group, over 61,000 reported incomes for 1999 that were below poverty. This figure

means that 11.8 percent of the homeowners over age 65 were poor, compared to 7.5 percent

for homeowners of all age groups. [ 13] This has implications for both helping some older

adults be responsible for their own needs ( e. g., reverse mortgages) and for the need for

property tax relief to older adults. Among renters age 65+ who provided information, 63.2

percent, or 72,739 households, spent more than 30 percent of their household income on rent

[ 14]. Furthermore, 5,000 North Carolina homeowners and renters age 65+ lacked complete

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 17

plumbing facilities in their homes. [ 15]

 Rurality: Among all age groups, 39.8 percent of North Carolina residents live in rural areas

compared to only 21.0 percent for the country as a whole. [ 16] The percentage among older

adults is no doubt higher ( based on the percentages of older adults in the predominantly rural

counties), but there is no age- specific figure available. In 2000, North Carolina's rural

population ( 3,202,238) was almost as large as the one in Texas ( 3,647,747), the state with the

largest number of rural residents in the nation. Not only was North Carolina's rural population

among the largest in terms of numbers, but the state also reported the highest proportion ( 39.8

percent) of rural population among the 20 most populous states in the nation. While 11 other

states reported higher proportions of rural population, ranging from 40.7 percent to 61.8

percent, all of these states are much smaller in total population than North Carolina. Thus,

North Carolina is unique among more populous states in having so large a rural contingency.

At the same time North Carolina has made the transition away from an agricultural economy

so that only 1.1 percent of its people live on farms, only slightly more than the 1.0 percent for

the nation as a whole. A 2002 report from Making a Difference in Communities ( MDC)

highlights a long list of challenges that rural residents and their communities face— isolation

by distance, lagging infrastructure, sparse resources that cannot adequately support education

and other public services, and weak economic competitiveness. [ 17]

 Disability: In North Carolina, 42.0 percent of the non- institutionalized civilian population ages

65 and older reported having one or more disabilities by the US Census definition— 45.5

percent of women and 40.7 percent of men, according to the 2006 American Community

Survey. [ 18] The Census Bureau defines disability as “ a long- lasting physical, mental, or

emotional condition that makes it difficult for a person to do activities such as walking,

climbing stairs, dressing, bathing, learning, or remembering. This condition can also impede a

person from being able to go outside the home alone or to work at a job or business.” This

definition is very broad and leads to counting a number of people who, indeed, have

difficulties but are able to function independently and would not meet the average person’s

perception of a person with a disability.

 Health Status: Heart disease is the leading cause of death among older adults both nationwide

and in North Carolina with cancer and stroke, second and third on the list. [ 19] In particular,

the coastal plain region of North Carolina has the fourth highest stroke death rate in the nation

and is labeled by some as the Buckle of the Stroke Belt [ 20]. African Americans and other

racial minorities are at substantially higher risk for certain chronic conditions such as heart

disease, stroke, and diabetes ( a major contributor to heart disease, stroke, and other

conditions). [ 5] Diabetes mellitus is the sixth leading cause of death for the older North

Carolina population in general, but like stroke, it is a more serious threat to the African-

American community, being the fourth highest cause of death in African Americans of all

ages in our state [ 19].

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 18

Five Leading Causes of Death among North Carolinians Age 65+

Rank Cause

1 Heart diseases

2 Cancer

3 Cerebrovascular diseases including stroke

4 Chronic lower respiratory diseases

5 Alzheimer’s disease

Source: NC Center for Health Statistics ( 2006). Leading Causes of

Death – 2005.

An important factor in health status is physical activity. A sedentary lifestyle is known to

increase a person’s risk of heart disease, diabetes, and other chronic conditions.

Unfortunately, in a multi- year study, North Carolinians age 65+ were ranked 48th among the

50 states in physical activity with nearly 40 percent of residents aged 65 and older reporting

that they did not engage in any physical activity in the past month. [ 21] The 2005 Behavioral

Risk Factor Surveillance System ( BRFSS) shows that nearly 66 percent of adults in that age

group do not participate in recommended levels of physical activity [ 22]. The BRFSS also

shows over one- third of people age 65+ say that their general health status is fair or poor.

 Grandparents Raising Grandchildren: According to the 2006 American Community there were

85,358 NC grandparents who reported that they had one or more grandchildren living with

them for whom they are responsible. This represents nearly half of all grandparents whose

grandchildren live with them and 1.6 percent of all North Carolina grandparents. Among

those grandparents responsible for their grandchildren, over 49 percent live in households in

which neither parent of the child is present. [ 23] According to AARP, 47 percent of NC

grandparents responsible for their grandchildren are African American; 2 percent are

Hispanic/ Latino; 2 percent are American Indian or Alaskan Native; and 47 percent are white

[ 24]. Given the relative sizes of these populations, it is clear that this is an even larger issue in

the African- American community than among other ethnic groups.[ 24]

 Veteran Status: Of the estimated 773,861 veterans living in North Carolina in 2007, over

263,755, or 34 percent, were age 65 and older. Another 260,811 ( 33 percent) were age 50 to

65, most of whom were Vietnam- era veterans. [ 25] The group of veterans from the Vietnam-era

contains proportionally more disabled members than survivors of earlier wars due to

quicker and more advanced medical treatment. [ 26] The Veterans Administration has

frequently written about the aging of the veterans as a major challenge to its health care

system in coming years.

Summary

In summary, North Carolina has a large, economically and ethnically diverse older population.

With this diversity come both special assets and special challenges. Even the most vulnerable older

adults often give as much to their communities as they receive. Nevertheless, we must be aware that

those who face disabilities, disparities of income and health care, and the responsibilities of caring

for grandchildren are more likely to need public services and supports. While meeting these

disparate needs of today’s older adults, our state is also witnessing the first minor steps of the

transition of the baby boomers into retirement ages. This will transform the age structure of the

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 19

state and bring a new generation of older adults with some of the same historic issues, but also new

attitudes, new challenges, new opportunities, and new resources.

Sources of Information

[ 1] Demographic Unit, Office of State Budget and Management ( 2006). " County Projected Age Groups: April 2010,

April 2020, and April 2030.

[ 2 ] NC Division of Aging and Adult Services ( 2003). The Aging of North Carolina: The 2003- 2007 North Carolina

Aging Services Plan

[ 3] Charles Longino ( 2003). States Ranked by the Net Number of Migrants Age 60+, 1985- 1990 and 1995- 2000.

[ 4] US Census Bureau ( 2008). 2006 American Community Survey Table B07001.

[ 5] NC Center for Health Statistics ( 2002). Healthy Life Expectancy in North Carolina, 1996- 2000.

[ 6] US Administration on Aging ( 2008). Population for States by Age Group: July 1, 2006 “ File

stterr2006. xls: 2006- 50+ rank#”

[ 7] US Administration on Aging ( 2008). Population for States by Age Group: July 1, 2006 “ File

stterr2006. xls: 2006- 50+ rank%”

[ 8] US Administration on Aging ( 2008). Population for States by Age Group: July 1, 2006 “ files

stterr2006. xls: 2006- 50+ x5,“ “ stterr2005. xls: 2006- 50+ x5- M” and “ stterr2006. xls: 2006- 50+ x5- F”

[ 9] Institute for Research on Women & Gender ( 2002). Difficult Dialogues Program Consensus Report: Aging in

the Twenty- first Century.

[ 10] US Census Bureau ( 2008). 2006 American Community Survey. Table B12002.

[ 11] US Social Security Administration ( 2008). Fast Facts & Figures about Social Security.

[ 12] US Administration on Aging ( 2008). Number of Persons 65+ by Race and Hispanic Origin- by State- 2006. File:

stterr2006. xls: 65+% xRace- HO

[ 13] US Census Bureau ( 2003). Census 2000 Summary File 3. Tables HCT2 and HCT24

[ 14] US Census Bureau ( 2003). Census 2000 Summary File 3. Table H71

[ 15] NC State Library ( 2003). Special tabulation from the Census 2000 data as requested by the NC Division of

Aging and Adult Services.

[ 16] US Census Bureau ( 2003). Census 2000 P5 ( Summary File 3).

[ 17] Making a Difference in Communities in the Sought ( MDC) ( 2002). State of the South 2002.

[ 18] US Census Bureau ( 2008). 2006 American Community Survey. Table B18001.

[ 19] NC Center for Health Statistics ( 2008). Leading Causes of Death- 2006

http:// www. schs. state. nc. us/ SCHS/ deaths/ lcd/ 2006/ pdf/ TblsA- F. pdf.

[ 20] Tri- State Stroke Network. ( 2006) Facts and Statistics: Stroke in the United States

http:// www. tristatestrokenetwork. org/ facts. html# buckle

[ 21] NGA Center for Best Practices ( 2004). Measuring the Years: State Aging Trends & Indicators.

[ 22] NC Department of Health and Human Services ( 2006). Behavioral Risk Factor Surveillance Calendar Year 2005

Results.

[ 23] US Census Bureau ( 2008). 2006 American Community Survey. Table B10050.

[ 24] AARP ( 2006). A State Fact Sheet for Grandparents and Other Relatives Raising Children.

[ 25] US Department of Veterans’ Affairs VetPop2006 Version 1.0 State and National Tables ( yearly projections)

http:// www1. va. gov/ vetdata/ docs/ 1l. xls

[ 26] US Department of Veterans’ Affairs ( 2002) VA History in Brief http:// webpages. charter. net/ wisconsinlegion-

7thdistrict/ VA_ History. htm# Vietnam_ War

Web Sites for Related Information

 NC Division of Aging and Adult Services ( http:// www. dhhs. state. nc. us/ aging/ demo. htm)

 Demographics Unit, NC Office of Budget and Management ( http:// demog. state. nc. us/)

 NC State Center for Health Statistics ( http:// www. schs. state. nc. us/ SCHS/)

 US Census Bureau ( http:// www. census. gov)

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 20

COMMISSION PROCEEDINGS

January 24, 2008

The North Carolina Study Commission on Aging met on Thursday, January 24, 2008, at 10: 00 a. m..

in Room 643 of the Legislative Office Building. Senator Vernon Malone presided. Following

introductions, Theresa Matula, Commission staff, presented an overview of the Commission's

responsibilities and statutory authority, the tentative meeting schedule for the interim, and the

Commission's budget. The Commission approved the budget.

Next the Commission heard from Shawn Parker, Commission staff, who presented a status report of

the Study Commission on Aging's recommendations to the Governor and the 2007 General

Assembly. A copy of the 2007 Recommendation Status Report is included in Appendix A. Ben

Popkin, Commission staff, then presented a document containing summaries of substantive

legislation related to older adults that was enacted during the 2007 Session. The Summary of

Substantive Legislation Related to Aging is included in Appendix A. Mr. Popkin was followed by

Melanie Bush of the Fiscal Research Division who provided an overview of 2007- 2009 legislative

budget actions and special provisions which are also provided in Appendix A.

The next presentation was an overview of older adults in North Carolina provided by Ms. Matula.

Her presentation focused on: who they are, how many there are, where they live, and what types of

programs and services are available for older adults in North Carolina. The presentation included

data on changes in the North Carolina population which depict the probability of significant growth

in the older adult population. The presentation included a brief summary of the range of services

provided in the State which include: Senior Games, Senior Centers, Adult Day Care and Adult Day

Health Care, State/ County Special Assistance, the State/ County Special Assistance In- Home

Program, the services provided by Home and Community Care Block Grant funds, the Community

Alternatives Program for Disabled Adults ( CAP/ DA), assisted living, Multiunit Assisted Housing

with Services, Adult Care Homes, Nursing Homes, and Continuing Care Retirement Communities.

Ms. Matula ended her presentation by mentioning additional information and resources including

the Area Agencies on Aging and various divisions within the Department of Health and Human

Services that serve older adults.

The last presentation for this meeting was a report required by S. L. 2007- 355, Section 2. In

response to the growth projections for the age 60+ population, the Division of Aging and Adult

Services, Department of Health and Human Services, was required to make recommendations on a

study to include all counties in North Carolina. The legislation required that the recommendation

specify the criteria that should be included in a study and an appropriate funding level for such a

study. Dennis Streets, Director, Division of Aging and Adult Services, reported that of the states

surveyed, 15 states indicated that they had undertaken a comprehensive statewide study in the past

five years. The reported costs ranged from $ 20,000 to $ 500,000 for the survey, but the states

emphasized that the important work does not end in a study. In fact, the study is just the beginning.

In response to these findings, the Division recommended the following: the State create a strategic

steering team; assess consumer needs, assets, and expectations; assess State and local awareness and

preparedness; conduct special studies; support State and local planning; and create an aging data

warehouse. The Division estimated a cost of $ 175,000 for the establishment of two positions to

support the work of the study, and $ 3,820,000 to fund the first year of the study. Of the $ 3,820,000,

$ 1,470,000 would be used to strengthen the capacity of Area Agencies on Aging ( AAA) for support

of regional and local planning ( including $ 270,000 to restore AAA State support reduced in 2001,

and $ 1,200,000 to add a position at each AAA to facilitate regional and community planning for

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 21

aging). The remaining $ 2,000,000 would provide $ 20,000 to each county to aid the work of citizen-driven

local aging leadership planning teams.

For a period of time, the agenda and handouts for this meeting are available on the internet at:

http:// www. ncleg. net/ gascripts/ DocumentSites/ browseDocSite. asp? nID= 38. ( Look under 2007- 08

Interim Committee Meetings, 1- 24- 08 Meeting.)

February 28, 2008

The North Carolina Study Commission on Aging met on February 28, 2008, at 1: 00 p. m. in Room

544 of the Legislative Office Building. Representative Jean Farmer- Butterfield was the presiding

Co- Chair.

During this meeting, the Commission heard brief presentations from 21 associations and

organizations that represent older adults. Each organization presented their legislative priorities and

or issues of concern to the Commission. For summary purposes, the issues mentioned with the

greatest frequency were: Increase Home and Community Care Block Grant Funds, Increase Senior

Center Funds, Provide Funding for Project C. A. R. E., Support for Adult Protective Services/ Enact

and Fund the Adult Protective Services Clearinghouse Model Pilot, and Increase Funds for New and

Existing Special Care Dental Programs ( Care in Underserved Areas, Long- term Care, Disabled

Seniors at Home). A Summary of Issues Most Frequently Mentioned by Organizations

Representing Older Adults is located in Appendix B.

The Commission also heard a report on Project C. A. R. E. ( Caregiver Alternatives to Running on

Empty). Steve Freedman, Service Operations Section Chief, Division of Aging and Adult Services,

Department of Health and Human Services; Dr. Charles Dickens, Speaker, Senior Tar Heel

Legislature; and Lisa Gwyther, Family Support Program Director, Duke Center for the Study of

Aging and Human Development; provided information about Project C. A. R. E. The goal of Project

C. A. R. E is to increase quality, access, choice, and use of respite and support services to low- income

rural and minority families caring for a person with dementia at home or within a hospital setting.

The program currently has three pilot sites that serve 14 counties and is administered through the

Division of Aging and Adult Services. The Division receives consultation and technical assistance

from the Duke Aging Center Family Support Program and is currently based within the

Mecklenburg County Department of Social Services, and two area offices of the Western Carolina

Alzheimer's Chapter. Project C. A. R. E. has received national recognition by numerous

organizations as a best practice model. Funding thus far has been provided by the U. S.

Administration on Aging's Alzheimer's Disease Demonstration Grants, leveraged through grants

provided by private foundations, and supplemented by Family Caregiver Support Programs.

However, grant funding is no longer an option for this particular program and State funding is

needed to continue the program. It was reported that the Department of Health and Human Services,

Division of Aging and Adult Services, would need $ 500,000 to sustain Project C. A. R. E. activities

in 14 western and piedmont counties.

For a period of time, the agenda and handouts for this meeting are available on the internet at:

http:// www. ncleg. net/ gascripts/ DocumentSites/ browseDocSite. asp? nID= 38. ( Look under 2007- 08

Interim Committee Meetings, 2- 28- 08 Meeting.)

March 6, 2008

The North Carolina Study Commission on Aging conducted the first of two public hearings this

interim on March 6, 2008, at 10: 00 a. m. in the Upper Coastal Plain business Development Center,

Wilson, North Carolina. Representative Jean Farmer- Butterfield was the presiding Co- Chair. At

this hearing, forty- two ( 42) people spoke to Commission members about a number of concerns

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 22

including: Increase Funding/ Continue Support for Senior Centers, Increase/ Continue Support for

Senior Games, Increase/ Continue Funding for Alzheimer's and Project C. A. R. E., Increase Funding

for Home and Community Care Block Grant ( HCCBG), Resolve Issues Related to Mentally Ill in

Long- Term Care Facilities, Increase Funding/ Support for Senior Friendly Housing. Appendix C

contains a summary of the public hearing comments.

March 28, 2008

The North Carolina Study Commission on Aging met on Friday, March 28, 2008, at 10: 00 a. m. in

Room 544 of the Legislative Office Building. Senator Vernon Malone was the presiding Co- Chair.

At this meeting, the Commission received a summary of the issues most frequently mentioned

during organization presentations and public hearings; heard a presentation from Dr. Victor

Marshall, Director, UNC Institute on Aging; and received reports on Respite Care, Mentally Ill in

Adult Care Homes, and a Reward System for Adult Care Homes with High Ratings.

Theresa Matula, Commission staff, presented summaries of the issues most frequently mentioned

on February 28, 2008, by organizations representing older adults, and a summary of the issues most

frequently mentioned during the public hearing on March 6, 2008. These summaries are located in

Appendix B and Appendix C.

Next, Victor Marshall, Director, UNC Institute on Aging, provided the Commission with

information about UNC Institute on Aging and the projects and programs that it supports. Dr.

Marshall also expressed: recommendations for a statewide aging study; the importance of

addressing public health issues of older adults; support for the Win A Step Up program; and

concerns related to aging workforce initiatives, specifically mentioning the Forum on North

Carolina's Aging Workforce, a two- day conference scheduled for September 23- 24, 2008.

In response to S. L. 2007- 39, Larry Nason, Chief, Facility and Community Care Section, Division of

Medical Assistance, Department of Health and Human Services ( DHHS), provided a report on

respite care. The report included information on the availability of respite care in North Carolina,

respite care in other states, and outlined four model programs. The respite care study group made

the following findings: separate statutory language for respite care is not needed; the existing

licensure and certification systems used by the Division of Health Service Regulation and the

Division of Aging and Adult Services allow for appropriate regulation of all levels and types of

respite care; consistent and predictable State funding for current respite care models is needed;

currently NC Medicaid only provides respite care as a billable service under its waiver programs

and as such, respite care is not provided as a " regular Medicaid" benefit under the State Plan. The

study group recommended that the North Carolina General Assembly provide an appropriation for

Project C. A. R. E., increase the State Adult Day Care Fund, and expand the Aging and Disability

Resource Connections to increase information and access on respite care services. The study group

also recommended that the Division of Aging and Adult Services study the place of group respite

programs in the long- term care continuum and assess the adequacy of service standards and

funding, and that the Division of Medical Assistance continue to study the potential of respite as a

State Plan Service.

S. L. 2007- 156 required the Department of Health and Human Services to study rules and

regulations regarding housing individuals with mental illness in the same facility vicinity as

individuals without mental illness, and to recommend staff training requirements for direct care

workers in adult care homes to provide appropriate care to residents with mental illness. Jackie

Sheppard, Assistant Secretary, Long Term Care and Family Services, DHHS, and Bonnie Morrell,

Best Practice & Community Innovations Team Leader, Division of Mental Health, Developmental

Disabilities and Substance Abuse Services, DHHS presented the report. The report includes: an

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 23

overview of how eight other states handle placement of mentally ill individuals in assisted

living/ adult care home facilities; information on the limited use of adult care home special care units

for residents with mental health disorders; revisions to staffing rules; recommendations and cost

figures on the screening, assessment, and the provision of services to mentally ill individuals in

adult care homes; and proposed training recommendations and associated costs.

The report recommended six items at a cost of $ 20.9 million dollars in recurring funds and

approximately $ 1.8 million in nonrecurring funds. The recommended system includes: developing

and automating a comprehensive assessment and care plan system for residents in adult care homes;

expanding required minimum training levels; requiring Preadmission Screening and Annual

Resident Review ( PASARR) Level II assessments of adult care home residents or potential

residents who are referred for this level of evaluation; determination of specialized mental health

care needs based on PASARR Level II assessments; development of additional capacity to serve

residents in adult care homes who need mental health services; and the implementation of a pilot to

develop a residential program for people with mental illness currently in adult care homes but who

require a different residential setting. The report included a flow chart depicting the steps for an

individual with a history of mental illness. The first step included screening adult care home

residents using the Medicaid Uniform Screening Tool ( MUST) which would identify the need for a

face to face mental health evaluation. If the mental health assessment was needed, a professional

assessment would be given using PASARR Level II. For those individuals that need specialized

mental health services, care would be provided either in a mental health residential setting, or the

person would live in the adult care home and mental health care would be provided by community

mental health services. The key to implementation of most, if not all, of these changes seem to

hinge on screening and assessment of adult care home residents to determine individual needs.

The final report for this meeting presented by Jeff Horton, Chief Operating Officer, Division of

Health Service Regulation, DHHS, was on a reward system for adult care homes with high ratings.

The report, developed pursuant to S. L. 2007- 544, Section 3d., recommended a system modeled after

a nursing home program that has been successful in making facilities better places for residents to

live and better places for employees to work. The report recommends that adult care homes

achieving a four star rating ( 100 points or higher on two consecutive annual surveys by the Division

of Health Service Regulation), under the Star Rating System, are deemed to have received a high

rating and are therefore eligible for the reward.

The nursing home program is funded with civil monetary penalties. However, under North

Carolina law, fines collected from adult care homes are transferred to local education agencies. As

such the General Assembly would have to appropriate funds for the reward system for adult care

homes. The Star Rating System is effective January 2009, thus January 2010 would be the first time

facilities might be eligible for rewards, assuming a score of 100 points during the 2009 cycle and

during the 2010 cycle.

For a period of time, the agenda and handouts for this meeting are available on the internet at:

http:// www. ncleg. net/ gascripts/ DocumentSites/ browseDocSite. asp? nID= 38. ( Look under 2007- 08

Interim Committee Meetings, 3- 28- 08 Meeting.)

April 10, 2008

The North Carolina Study Commission on Aging met at 10: 00 a. m. on April 10, 2008, in Room 421

of the Legislative Office Building. Representative Jean Farmer- Butterfield presided. Presentation

topics included: criminal background checks for nursing home administrators, guardianship issues,

hearing challenges for older adults, and a report on the aging service levels and needs study.

Jane Baker, Executive Director, North Carolina State Board of Examiners for Nursing Home

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 24

Administrators, and Steve Fleming, Chair, North Carolina State Board of Examiners for Nursing

Home Administrators, presented information on a statutory amendment that would grant the Board

the authority to conduct criminal history record checks. Information presented to the Commission

indicated that the Board desires the authority to require criminal history record checks on:

applicants from North Carolina, applicants seeking licensure by reciprocity, and persons renewing

their licenses.

Pamela W. Best, Deputy Legal Counsel, Administrative Office of the Courts, gave the Commission

an overview of guardianship in North Carolina. Her presentation focused on the determination of

incompetency, the appointment of a guardian, and the powers and responsibilities of guardians.

Representative Melanie Goodwin followed the presentation with information on two

recommendations from the House Study Committee on State Guardianship Laws to the 2007

General Assembly. The Study Committee on State Guardianship Laws found that guardians

currently have the authority to sell up to $ 1,500 worth of personal property without a court order in

order to meet the monetary needs of the ward, but determined that this amount was outdated and

insufficient, and recommended that the total amount of personal property allowed to be sold without

a court order be increased to $ 15,000. In response to the findings, House Bill 794 was introduced

but did not crossover to the Senate and is not eligible for consideration during the 2008 Session.

During the course of their work, the Committee on State Guardianship Laws also found it

unnecessary for the Division of Motor Vehicles to automatically revoke the drivers license of an

individual who has been declared incompetent. In response, the Committee recommended that the

Division of Motor Vehicles be authorized to not automatically revoke the drivers license of an

incompetent if the clerk of superior court recommends the incompetent be allowed to retain the

drivers license. House Bill 796 was introduced during the 2007 Session, but did not crossover to the

Senate and is not eligible for consideration during the 2008 Session.

Dennis Streets, Director, Division of Aging and Adult Services, Department of Health and Human

Services presented a report in response to S. L. 2007- 355, Section 1. The law directed the Division

of Aging and Adult Services, to work with the Division of Health Service Regulation; Division of

Medical Assistance; Division of Public Health; and the Division of Mental Health, Developmental

Disabilities, and Substance Abuse Services; to study programs and services for older adults in

Brunswick, Buncombe, Gaston, Henderson, Moore, and New Hanover Counties which currently

have, or are projected by 2030 to have, the largest numbers of individuals age 60+ when compared

to individuals age 17 and younger. In conducting the study, the Division was directed to utilize

existing data and resources, to include the Area Agencies on Aging serving each county studied,

and to report to the Study Commission on Aging and to the board of county commissioners of each

county studied. The study included the following elements: a profile of the current older adult

population; a profile of the projected growth for the older adult population; an assessment of the

anticipated impact on programs and services that address the needs of the older adult population;

identification of programs and services that are currently in place; identification of programs and

services that are needed to meet the growth projections; current funding sources for programs and

services serving the older adult population; anticipated funding needs for programs and services

serving the older adult population; and a delineation of the programs and services that are shared or

offered jointly with another county. Mr. Streets outlined the approach taken, the products provided

to each of the six counties, and highlighted particular findings for the Commission. The

presentation also listed the top areas of concern identified by the survey.

Next, Theresa Matula, Commission staff, presented draft recommendations for the Commission's

consideration. The draft recommendations represented a range of programs and issues heard by the

Commission during the interim. Ms. Matula presented 13 recommendations with background

information for each and explained that once the Commission approved recommendations, they

would be compiled in a report, including bill drafts as applicable, for the Governor and the 2008

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 25

General Assembly. During this meeting, the Commission approved 13 recommendations contained

in this report and agreed to consider several additional recommendations presented by a

Commission member at the final meeting on May 12, 2008.

For a period of time, the agenda and handouts for this meeting are available on the internet at:

http:// www. ncleg. net/ gascripts/ DocumentSites/ browseDocSite. asp? nID= 38. ( Look under 2007- 08

Interim Committee Meetings, 4- 10- 08 Meeting.)

April 24, 2008

The North Carolina Study Commission on Aging conducted a second public hearing this interim at

10: 00 a. m. on April 24, 2008 at the Town Hall in Jamestown, North Carolina. The Commission

heard from fifty- two ( 52) individuals during this hearing. The issues mentioned with greatest

frequency during the Jamestown hearing were: Funding for Project C. A. R. E., Continued Support

for the Star Rating System, Support for the Adult Protective Services Pilot Program, Increased

Funding for the Home and Community Care Block Grant ( HCCBG), Support for Access Dental

Care and Mobile Dental Units, Support for Adult Day Care, and Support for Senior Centers.

Appendix C contains a summary of the public hearings and information on which topics were

mentioned most frequently at both hearings.

May 12, 2008

The North Carolina Study Commission on Aging met on May 12, 2008, at 10: 00 a. m. in Room 544

of the Legislative Office Building. Senator Malone was the presiding Co- Chair. During the

meeting, staff reviewed the Commission's draft report to the Governor and the 2008 Regular

Session of the 2007 General Assembly. The Commission voted to approve the draft report as

amended.

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 26

COMMISSION RECOMMENDATIONS

The North Carolina Study Commission on Aging makes the recommendations presented in this

report to the Governor and the 2008 Session of the 2007 General Assembly. Each recommendation

is followed by background information, and corresponding legislative proposals, if applicable,

appear Appendix D of this report.

Recommendation 1: Senior Center Funds

The Study Commission on Aging recommends that the General Assembly appropriate an additional

$ 500,000, for the 2008- 2009 fiscal year, to the Senior Center General Purpose Fund with the intent

that it shall become part of the continuation budget.

Background 1: Senior Center Funds

During 2007, the Study Commission on Aging recommended that the General Assembly

appropriate an additional $ 500,000 for the 2007- 2008 fiscal year ( FY) and $ 500,000 for the 2008-

2009 FY, to the Senior Center General Purpose Fund to provide additional support for Senior

Centers. The Health and Human Services Conference Report for S. L. 2007- 323 ( HB 1473)

contained $ 200,000 in non- recurring funding for the 2007- 2008 FY for the Senior Center General

Purpose Fund.

Increasing senior center funds generally, or specifically making the 2007- 2008 FY increase

recurring, were the most frequently mentioned items during the Wilson public hearing on March 6,

2008 and was mentioned often during the public hearing in Jamestown. Increasing senior center

funding was the second most frequently mentioned item during the February 28, presentations to

the Commission by organizations representing older adults. It was listed as a priority by the

Governor's Advisory Council on Aging, and the Senior Tar Heel Legislature, among others.

Services offered through senior centers include: health and wellness programs, arts and humanities,

intergenerational programs, employment assistance, transportation services, and volunteer

opportunities. The National Institute of Senior Centers defines a senior center as a, " place where

older adults come together for services and activities that reflect their experience and skills,

respond to their diverse needs and interests, enhance their dignity, support their independence, and

encourage their involvement in and with the center and the community."

The Division of Aging and Adult Services reports that there are currently 164 recognized senior

centers in North Carolina. Primary sources of funding are: 1) the Home and Community Care

Block Grant, 2) local government, and 3) the State's Senior Center General Purpose and Outreach

Funds.

The State supports senior centers by funding the Senior Center Outreach and General Purpose

funds. The Senior Center General Purpose Fund was initiated in 1997 and is used for any purpose

that supports operations or development including: equipment purchases/ repairs, building

maintenance, supplies, administrative costs, activities, and construction.

The State appropriation for the 2007- 2008 FY is $ 1,465,316 for the Senior Center General Purpose

Fund and $ 100,000 for Senior Center Outreach. An additional 25% local cash or in- kind match is

required for receipt of State funds. For FY 2007- 08, Senior Centers received a $ 200,000 increase

in General Purpose funds on a non- recurring basis.

Senior Centers receive funding in " shares" – one share for Uncertified Centers ( 108 centers), two

shares for Centers of Merit ( 8 centers), and three shares for Centers of Excellence ( 48 centers). The

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 27

State allocation distribution for the 2007- 2008 FY is: $ 5,467 for Uncertified Centers, $ 10,936 for

Centers of Merit, and $ 16,404 for Centers of Excellence.

The Study Commission on Aging recognizes the importance of senior centers and supports

enactment of 2007- SHz- 23 to provide additional funding for the 2008- 2009 fiscal year.

Recommendation 2: Additional HCCBG Funds

The Study Commission on Aging recommends that the General Assembly appropriate an additional

$ 2,500,000, to the Department of Health and Human Services, for the 2008- 2009 fiscal year, for the

Home and Community Care Block Grant ( HCCBG).

Background 2: Additional HCCBG Funds

Increasing Home and Community Care Block Grant ( HCCBG) Funds was the issue mentioned

most frequently during the February 28, presentations to the Commission by organizations

representing older adults, the second most frequently mentioned item at the public hearing in

Wilson and one of the most frequently mentioned items at the Jamestown public hearing. Eight of

the 21 organizations that spoke on February 28, supported increasing HCCBG Funds including the

Governor's Advisory Council on Aging and the Senior Tar Heel Legislature.

In 2007, the Study Commission on Aging recommended the General Assembly appropriate an

additional $ 5,000,000 to the Department of Health and Human Services for the 2007- 2008 fiscal

year and $ 5,000,000 for the 2008- 2009 fiscal year for the Home and Community Care Block Grant

( HCCBG). The Health and Human Services Conference Report for S. L. 2007- 323 ( HB 1473)

contained $ 536,000 in recurring funding for the 2007- 2008 fiscal year and the 2008- 2009 fiscal

year.

The HCCBG, established by G. S. 143B- 181.1( a)( 11), is the consolidation of several funding

sources ( i. e., the Older Americans Act, the Social Services Block Grant in support of respite care,

portions of the State In- Home and Adult Day Care funds, and other relevant State appropriations).

The HCCBG includes federal funds, State funds, local funds, and a consumer contribution

component. It gives counties discretion, flexibility, and authority in determining services, service

levels, and service providers, and streamlines and simplifies the administration of services.

With input from older adults, county commissioners approve an annual funding plan that defines

the services to be provided, the funding levels for these services, and the community service

agencies to provide the services. Counties can select from among 18 eligible services including:

Adult Day Care, Adult Day Health Care, Care Management, Congregate Nutrition, Group Respite,

Health Promotion and Disease Prevention, Health Screening, Home Delivered Meals, Housing and

Home Improvement, Information and Assistance, In- Home Aide, Institutional Respite Care, Mental

Health Counseling, Senior Center Operations, Senior Companion, Skilled Home ( Health) Care,

Transportation, and Volunteer Program Development. Counties decide which services to provide,

however congregate nutrition and home- delivered meals are provided in almost every county under

the HCCBG.

Any person age 60 and older is eligible for services under the HCCBG. Although, the HCCBG

program places an emphasis on reaching those most in need of services. The Older Americans Act

( OAA), a funding source in the HCCBG, gives priority to serving the " socially and economically

needy" and focuses particular attention on the low income minority elderly and on older individuals

residing in rural areas. Additionally, the OAA calls for reaching out to older individuals with severe

disabilities, limited English- speaking ability, and Alzheimer's disease or related disorders and

caregivers of these individuals.

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 28

The focus of the HCCBG is to support the frail elderly that are cared for at home; improve and

maintain the physical and mental health of older adults; assist older adults and their caregivers with

accessing services and information; provide relief to family caregivers so that they can continue

their caregiving; and allow older adults to remain actively engaged with their communities.

The Study Commission on Aging recognizes the importance of the services provided through the

Home and Community Care Block Grant and supports increased funding through enactment of

2007- SHz- 24.

Recommendation 3: Funds for Project C. A. R. E.

The Study Commission on Aging recommends that the General Assembly appropriate $ 500,000, to

the Department of Health and Human Services, Division of Aging and Adult Services, for the

2008- 2009 fiscal year, to fund Project C. A. R. E. ( Caregiver Alternatives to Running on Empty)

which provides support to individuals with dementia and their caregivers.

Background 3: Support Project C. A. R. E.

Providing funding for Project C. A. R. E. ( Caregiver Alternatives to Running on Empty) was the

most frequently mentioned item during the public hearing in Jamestown and the third most

frequently mentioned item during the presentations to the Commission by organizations

representing older adults. The Governor's Advisory Council and the Senior Tar Heel Legislature

both mentioned this item as a legislative priority for their organizations.

In 2007, the Study Commission on Aging recommended that the General Assembly appropriate

$ 500,000 to the Department of Health and Human Services, Division of Aging and Adult Services,

for the 2007- 2008 fiscal year, and $ 500,000 for the 2008- 2009 fiscal year, to fund Project C. A. R. E.

which provides support to individuals with dementia and their caregivers. In response to this

recommendation, SB 165 and HB 96 were introduced during the 2007 Session and referred to

Appropriation Committees, but did not receive further action.

A statistical abstract, " 2008 Alzheimer's Disease Facts & Figures," of US data on Alzheimer's

disease published by the Alzheimer's Association recently reported that it is anticipated that

between 2000 and 2010, North Carolina will experience a 31% increase in the number of people

age 65+ with Alzheimer's disease. According to the report, in 2007, there were 311,578

Alzheimer/ dementia caregivers providing 268,953,971 hours of unpaid care per year with an

economic value of $ 2,845,533,016. The report notes that in 2005, Alzheimer's disease was the

seventh- leading cause of death for people of all ages and the fifth- leading cause of death for people

age 65 and over.

The Commission heard a presentation on Project C. A. R. E. during the meeting on February 28,

2008. The goal of Project C. A. R. E. is to increase quality, access, choice, and use of respite and

support services to low- income rural and minority families caring for a person with dementia at

home or within a hospital setting. The program is administered through the Division of Aging and

Adult Services with assistance from the Duke Aging Center Family Support Program. A Project

C. A. R. E. in- home visit: assesses the family care environment; identifies the needs and preferences

of both the caregiver and the person with dementia; facilitates discussion and mutual understanding

among family members; connects the family with community resources; and ensures the provision

of quality respite care and support services.

Project C. A. R. E. began with the Alzheimer's Association, Western Chapter, in 2001. Funding thus

far has been provided by the U. S. Administration on Aging's Alzheimer's Disease Demonstration

Grants, leveraged through grants provided by private foundations, and supplemented by Family

Caregiver Support Programs. Initially, the program served six ( 6) counties. There are currently

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 29

three ( 3) Project C. A. R. E. pilot sites set up to serve 14 counties: Charlotte ( Mecklenburg County);

Winston- Salem ( Forsyth, Surry, and Stokes); and Asheville ( Polk, Henderson, Transylvania,

Rutherford, Madison, McDowell, Buncombe, Haywood, Jackson, and Swain). The program

received national recognition as a model and best practice in 2004 and 2005. Grant funding is no

longer an option for this particular program and State funding is needed to continue the program.

The total budget for the program is $ 433,333, which includes a 25% local match. The federal

funding portion of that total is $ 325,000 and will end June 30, 2008. The Department of Health

and Human Services, Division of Aging and Adult Services, needs $ 500,000 to sustain Project

C. A. R. E. activities in 14 western and piedmont counties. If $ 500,000 is appropriated, there would

be a 25% matching requirement in the amount of $ 166,666, for total funds amounting to $ 666,666.

It is anticipated that the level of local interest and current activity in services in the 14- county area

will yield sufficient funding to meet matching requirements. A possible advantage to this

appropriation is that if the State funds the existing program infrastructure and service capacity,

North Carolina may be eligible to receive grants to replicate Project C. A. R. E. in Eastern North

Carolina, moving toward the ultimate goal of statewide expansion.

The Study Commission on Aging appreciates caregivers, recognizes the importance of respite,

supports State funding for Project C. A. R. E., and therefore encourages enactment of 2007- SHz- 25.

Recommendation 4: Adult Protective Services Pilot Program

The Study Commission on Aging recommends that the General Assembly appropriate $ 1,497,087,

to the Department of Health and Human Services, Division of Aging and Adult Services, for the

2008- 2009 fiscal year, to enact the first year of a two- year pilot program to assess proposed

changes to the adult protective services statutes and to report to the Study Commission on Aging on

the evaluation of the pilot by March 1, 2010.

Background 4: Adult Protective Services Pilot Program

Support for Adult Protective Services/ Enact and Fund the Adult Protective Services ( APS)

Clearinghouse Model Pilot was the fourth most frequently mentioned item during the organization

presentations on February 28, and was among the most frequently mentioned items during the

public hearings in Wilson and Jamestown.

In 2007, the Study Commission on Aging recommended that the General Assembly appropriate

$ 1,492,000 to the Department of Health and Human Services, Division of Aging and Adult

Services, for the 2007- 2008 fiscal year and $ 1,930,000 for the 2008- 2009 fiscal year to enact a pilot

program to assess proposed changes to the adult protective services statutes and to report on the

evaluation of the pilot by March 1, 2009. In response to this recommendation, HB 198 and SB 108

were introduced and referred to Appropriations Committees, but no further action was taken.

S. L. 2005- 23 directed the Adult Protective Services ( APS) Task Force to collaborate with

stakeholders and others interested in improving APS and to report those findings to the Study

Commission on Aging and the House Study Committee on Guardianship Laws. The APS

Clearinghouse Model: NC's System of Protection, is the product of a collaborative effort among the

Division of Aging and Adult Services, the NC Association of County Directors of Social Services,

representatives from the Attorney General's office, stakeholders, and other interested parties. The

goals of the APS Clearinghouse Model are to: increase North Carolina's ability to reach out to

citizens to offer voluntary services; enable North Carolina to respond to high risk situations before

harm occurs and provide the opportunity to assist older adults who are victimized, but not

incapacitated; allow APS to intervene before the adult's health deteriorates to life- threatening

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 30

levels; and allow APS to provide information and services to a greater number of adults.

Exploring feasibility of the APS Clearinghouse Model requires implementation of a pilot. The

pilot will require funding for staff in county departments of social services to carry out the pilot,

and funding for three ( 3) staff positions in the Division of Aging and Adult Services ( DAAS) to

plan and conduct the pilot. The total budget for the APS Pilot in the 2008- 2009 fiscal year is

$ 1,497,087, broken down as follows: $ 1,212,805 for county staff ( 24.103 FTEs for 9- months),

$ 159,532 for DAAS staff ( 3.0 FTEs for 9- months), $ 18,000 for public education, $ 6,750 for

essential services, and $ 100,000 for evaluation of the pilot. An additional $ 1,930,107 is needed for

the 2009- 2010 fiscal year which would be utilized for the following: $ 1,617,308 for county staff,

$ 188,049 for DAAS staff, $ 18,000 for public education, and $ 6,750 for essential services, and

$ 100,000 for evaluation of the pilot.

The Study Commission on Aging realizes the vital importance of safeguarding our older adults and

supports the enactment of 2007- SHz- 26.

Recommendation 5: Statewide Aging Study

The Study Commission on Aging recommends support for a comprehensive, five- year statewide

study of the older adult population and the State's readiness to respond to the coming wave of older

adults by recommending that the General Assembly take the following steps: establish an

appointment process for a steering committee; appropriate $ 175,000 to the Department of Health

and Human Services, Division of Aging and Adult Services, for the establishment of two positions

to support the work of the study; appropriate $ 3,820,000 to the Division of Aging and Adult

Services, for the 2008- 2009 fiscal year, to fund the first year of the study; and direct the

Department of Health and Human Services, Division of Aging and Adult Services, to make annual

reports to the General Assembly on the status of the study.

Background 5: Statewide Aging Study

S. L. 2007- 355, Section 1, required several Divisions within the Department of Health and Human

Services to study programs and services for older adults in Brunswick, Buncombe, Gaston,

Henderson, Moore, and New Hanover Counties. These counties currently have, or are projected by

2030 to have, the largest numbers of individuals age 60+ when compared to individuals age 17 and

younger.

Since growth projections for the age 60+ population are anticipated to increase overall in North

Carolina, S. L. 2007- 355, Section 2, required the Division of Aging and Adult Services to make a

recommendation on a study to include all counties in North Carolina. The Division was required to

evaluate similar studies conducted by other states and to make recommendations on the criteria that

should be included and an appropriate funding level for a study to include all North Carolina

counties. On January 24, 2008, the Division made a report to the Commission on a statewide

study.

The report recommends the establishment of a steering committee to: oversee the design and

implementation of a consumer needs assessment and an expectations assessment; oversee the

design and implementation of a State and local awareness and preparedness assessment; identify

the need for and to obtain additional studies to supplement the information needed for

comprehensive planning; produce reports for the Governor and General Assembly to guide policy

and program development based on the findings of the assessments and studies; and to identify

action needed to ready North Carolina for its growing older adult population. The Committee

would be appointed by the General Assembly and the Governor.

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 31

The report recommends two positions to support the steering committee: a Human Services

Planner/ Evaluator IV ( pay grade 74), and an Administrative Assistant III ( pay grade 67). The cost

for these positions is $ 175,000.

Use of a consumer survey is recommended in years one and four of the statewide study, for design,

implementation, analysis, and reporting associated with conducting a survey of consumer needs,

assets, and expectations. The anticipated cost is $ 200,000 for the 2008- 2009 fiscal year and

$ 175,000 for the 2011- 2012 fiscal year. ( It is anticipated that there would be some savings in

survey design the second year.) The report recommends funds for design, implementation, analysis

and reporting associated with conducting a survey of state and local governments at a cost of

$ 75,000 in the 2008- 2009 fiscal year, 2010- 2011 fiscal year, and 2012- 2013 fiscal year.

Additionally, the report recommends $ 75,000 per year to secure the services of consultants to

conduct special studies and otherwise support the work of the steering committee.

With regard to support for program services, the report recommends:

 $ 1,470,000 per year to strengthen the capacity of Area Agencies on Aging ( AAA) for

support of regional and local planning ( this includes restoring the $ 270,000 in recurring

AAA State support reduced in 2001, and adding a position at each AAA to facilitate

regional and community planning for aging at a cost of $ 1,200,000 million per year ( which

would total $ 1.6 million with a 25% match participation rate)).

 Awarding $ 20,000 to each county to aid the work of citizen- driven local aging leadership

planning teams for a total cost of $ 2,000,000 per year.

The Study Commission on Aging believes that it is necessary for the State to make preparations

now to care for the anticipated increase in the older adult population and supports a statewide study

of the State's readiness to respond through the enactment of 2007- SHz- 29.

Recommendation 6: Adult Care Home Residents

Recommendation 6a: Adult Care Home Admission Screening Process

The Study Commission on Aging recommends that the General Assembly appropriate $ 1,764,000,

for the 2008- 2009 fiscal year, to the Department of Health and Human Services, Division of

Medical Assistance, to design, develop, and implement on a pilot basis, a screening process for

mental health and developmental disability conditions as part of the adult care home admission

process. The process shall duplicate the nursing facility admission process and shall consist of an

automated screening tool and where indicated a face- to- face assessment by a mental health or

developmental disabilities professional. The Division of Medical Assistance shall report on the

design, development, and piloting of the screening process for mental health and developmental

disability conditions as part of the adult care home admission process on or before October 15,

2008.

Recommendation 6b: Transitional Residential Treatment Program Pilot Sites

The Study Commission on Aging recommends that the General Assembly appropriate $ 567,084,

for the 2008- 2009 fiscal year, to the Department of Health and Human Services, Division of Mental

Health, Developmental Disabilities, and Substance Abuse Services, to fund three ( 3) geographically

diverse Transitional Residential Treatment Program pilot sites, which shall begin in January 2009.

Recommendation 6c: Care of Individuals with Mental Illness Training for Direct Care

Workers in Adult Care Homes

The Study Commission on Aging recommends that the General Assembly direct the Department of

Health and Human Services, Division of Health Service Regulation, Division of Medical

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 32

Assistance, and Division of Mental Health, Developmental Disabilities, and Substance Abuse

Services to work with adult care home providers to build on recent studies to determine the most

appropriate and cost effective way to provide training on the care of individuals with mental illness

to direct care workers in adult care homes by tailoring the training to resident assessment results

and utilizing web- based formats as appropriate, and to provide an interim report to the Study

Commission on Aging by November 1, 2008, and a final report by November 1, 2009.

Recommendation 6d. Assessment and Service Plan Development for Adult Care

Home Residents

The Study Commission on Aging recommends that the General Assembly appropriate $ 580,000,

for the 2008- 2009 fiscal year, to the Department of Health and Human Services, Division of

Medical Assistance to support assessment and service plan development for adult care home

residents and to provide an interim report by November 1, 2008, and a final report by November 1,

2009.

Background 6: Adult Care Home Residents

S. L. 2007- 156 ( SB 164) directed the Department of Health and Human Services to study rules and

regulations regarding housing individuals with mental illness in the same facility vicinity as

individuals without mental illness, and to recommend staff training requirements for direct care

workers in adult care homes to provide appropriate care to residents with mental illness.

On March 28, 2008, the Commission heard a presentation of the report prepared in response to S. L.

2007- 156. The report provides an overview of how eight ( 8) other states handle placement of

mentally ill individuals in assisted living/ adult care home facilities; information on the limited use

of adult care home special care units for residents with mental health disorders; revisions to staffing

rules; recommendations and cost figures on the screening, assessment, and the provision of services

to mentally ill individuals in adult care homes; and proposed training recommendations and

associated costs.

The report indicates the percentage of residents with mental illness as compared to the total number

of residents. The report indicates that family care homes ( facilities with six or fewer beds) had in

the following years, the percentage of adults with mental illness: 2002 = 38.1%, 2003 = 52.7%,

2004 = 60%, 2005 = 44.4%, 2006 = 45.5%, and 2007 = 46.3%. Adult care homes ( seven or greater

beds) had in the following years, the percentage of adults with mental illness: 2002 = 18.2%, 2003

= 27.7%, 2004 = 30.8%, 2005 = 20.2%, 2006 = 20.2%, and 2007 = 19%.

The report provides a process to assess and provide care to meet the needs of adult care home

residents, especially mentally ill residents. The key first step to providing care is to assess the type

of care needed through the implementation of screening and assessment programs. Currently a

physician designates the appropriate level of care for a potential resident using the FL- 2 form. The

Department has developed the Medicaid Uniform Screening Tool ( MUST, Level I) which is

anticipated to replace the FL- 2 form in September 2008. If the MUST screening determines that

additional mental health assessment is needed, the individual would be referred for the Pre-

Admission Screening and Resident Review ( PASARR), Level 2 Assessment. The PASARR Level

2 Assessment will determine whether the individual needs a specialized mental health service.

According to the report, if a PASARR Level 2 assessment indicates that specialized mental health

services are needed, the Division of Mental Health, Developmental Disabilities and Substance

Abuse Services ( DMH/ DD/ SAS) will be notified and service needs will be communicated to the

Local Management Entity ( LME). The LME will then contact the individual. The Department

estimates the PASARR Level II costs for fiscal year 2008- 2009 as $ 1,764,000 and $ 281,840 on a

recurring basis.

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 33

The report outlines the need for $ 580,000 to develop and automate a comprehensive assessment

and care plan system for residents in adult care homes. This assessment, care planning, and

training system is being developed through VieBridge, Inc. with funding from the North Carolina

Association Long Term Care Facilities ( NCALTCF). The NCALTCF and the Department of

Health and Human Services, Divisions of Health Service Regulation and Medical Assistance, have

worked in a collaborative arrangement on this system. The funding would be used to support the

assessment and care planning system for adult care home residents and statewide implementation is

anticipated January 1, 2009.

The report provides information on development of Transitional Residential Treatment Programs.

This new type of 6- bed residential facility would provide 24- hour residential treatment and

rehabilitation of adults who have a pattern of difficult behaviors related to mental illness which

exceed the capabilities of traditional community residential settings. The Department would like to

pilot three ( 3) sites at an annual cost of $ 378,056/ site and anticipates being able to utilize funds

beginning in January 2009. This would require an appropriation of $ 567,084 for FY 2008- 2009

($ 378,056 x 3 = $ 1,134,168 / 2= $ 567,084.)

The report outlines three layers of training: Two ( 2) hours of Basic Orientation training for all

facility staff; Twelve ( 12) hours of Specialized ( Phase Two) Training for aides and direct

supervisors of all facilities serving one or more persons with mental illness; and four ( 4) hours of

Annual Training for aides and direct supervisors of all facilities serving one or more persons with

mental illness. An annual cost of $ 4,500,00 was provided for the training.

The report also suggests the following to take place after screening and assessment: $ 334,000 for

PASAAR Level II assessments to determine specialized mental health care needs and $ 14,860,000

to develop capacity to care for adult care home residents needing mental health services.

After the April 10, 2008 meeting and approval of the Commission's initial recommendation on this

topic, the Department of Health and Human Services decided to scale back implementation of the

Medicaid Uniform Screening Tool ( MUST), which was the basis for the recommendation to

develop and implement PASARR, Level II screening prior to adult care home admission. Although

MUST will not be ready for Statewide implementation, the Department anticipates that it will have

a screening tool in place in by fall 2008, and that this initial screening tool will be able to identify

those residents that will need a face- to- face mental health evaluation. Therefore, the Commission is

recommending that the General Assembly appropriate $ 1,764,000 for FY 08- 09 to the Department

of Health and Human Services, Division of Medical Assistance, to design, develop, and implement

on a pilot basis, a screening process, for mental health and developmental disability conditions as

part of the adult care home admission process. It is anticipated that the process will duplicate the

nursing facility admission process and will consist of an automated screening tool and where

indicated a follow- up face- to- face assessment by a Mental Health or Developmental Disabilities

professional.

In it's report to the Commission, the Department provided that after a mental health assessment is

completed, Division of Mental Health, Developmental Disabilities, and Substance Abuse Services

( DMH/ DD/ SAS) staff would make the final determination about whether the individual needed

specialized mental health screening, contact the LME to arrange for services, and follow- up to be

sure services are provided. The report requested $ 334,000 for five additional positions to provide

this function. For the pilot implementation of the mental health evaluation contained in this

recommendation, it is anticipated that DMH/ DD/ SAS will absorb this function.

This revised recommendation also requires the Division of Medical Assistance, Division of Health

Service Regulation, and DMH/ DD/ SAS to report on the design, development, and piloting of the

screening process for mental health and developmental disability conditions as part of the adult care

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 34

home admission process in an interim report by October 15, 2008, with a final report due October

15, 2009. The Division's report must contain findings and recommendations to include: results on

how many individuals were received initial screening prior to admission, how many needed an

additional mental health evaluation, and how many of those screened were admitted to an adult care

home; a process chart of the screening for adult care home admissions, who performs the screening,

and turnaround times for each step in the process; whether there are delays due to pre- admission

screening and how these are handled; whether the process should be expanded to all adult care

home admissions on a Statewide basis; whether statutory or policy changes are needed for

Statewide implementation; and costs associated with Statewide implementation.

In an effort to begin to address the issue of mixed populations in adult care homes, the Study

Commission on Aging supports enactment of 2007- SHz- 31.

Recommendation 7: Support for a Reward System for Adult Care Homes with High Ratings

The Study Commission on Aging expresses support for the creation of a reward system for adult

care homes that achieve high ratings and at the appropriate time, the Commission anticipates

supporting the concepts outlined in the Department's report on S. L. 2007- 544, Section 3( d).

Background 7: Support for a Reward System for Adult Care Homes with High Ratings

In response to recommendations from the Study Commission on Aging, S. L. 2007- 544 was enacted

and Section 3 contained provisions related to a rating system for adult care homes. Section 3( d)

required the Department of Health and Human Services to study the structure and cost of a system

to reward adult care homes that receive high ratings and to report findings and recommendations to

the Study Commission on Aging no later than March 1, 2008.

On March 28, 2008, the Commission heard the report on the structure and cost of a system to

reward adult care homes receiving high ratings. The report recommended a system modeled after

the grant program for nursing homes that is funded on civil monetary penalties. According to the

report, the program for nursing homes, which was started in 1996, has been a highly successful,

cooperative effort among regulators, providers, advocates, and others to make facilities better

places for residents to live and better places for employees to work. Under North Carolina law,

fines collected from adult care homes are transferred to local education agencies and therefore, the

General Assembly would have to appropriate funds for the reward system for adult care homes.

The report recommends that an adult care homes that achieves a 4 Star Rating ( 100 points or higher

on two consecutive annual surveys by the Division of Health Service Regulation) would receive a

high rating and therefore eligible for the reward. The Star Rating System is effective January 2009,

thus January 2010 would be the first time facilities might be eligible for rewards, assuming a score

of 100 points during the 2009 cycle and during the 2010 cycle. The Department also requested an

administrative officer position at a cost of $ 50,000, to coordinate and administer the grants in

response to decisions made by a Grant Committee, which consists of adult care home stakeholders

including provider representatives, advocates, Division of Health Service Regulation staff, and

others. As such, the estimated costs for this reward system are $ 300,000 for FY 2009- 2010

($ 250,000 for rewards and $ 50,000 for the position) and $ 550,000 for the 2010- 2011 fiscal year.

The Study Commission on Aging supports rewarding adult care homes with high ratings.

Recommendation 8: Support for Respite Care

The Study Commission on Aging recommends that the General Assembly direct the Department of

Health and Human Services, Division of Aging and Adult Services, to study the adequacy of

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 35

service standards and funding for group respite services, and whether opportunities exist to

streamline and enhance the provision of respite services; direct the Division of Medical Assistance,

Department of Health and Human Services, to study the feasibility of providing respite care as a

State Plan Service, and provide a report on both issues to the Commission on Aging by November

1, 2009.

Background 8: Support for Respite Care

S. L. 2007- 39 directed the Department of Health and Human Services to study the availability and

delivery of respite care. On March 28, 2008, the Commission heard a presentation on the

Department's report. The Department reported that there is a need for respite care and that the

provision of respite care is important for the State from an economic perspective. The report

provided an overview of the various respite programs available in North Carolina as well as

information on programs in other states. One of the issues noted was the fragmentation of services

both in North Carolina and other states. The fragmentation is due to varying eligibility criteria,

target client populations, regulatory requirements, programs, and funding streams. The report

suggested that, " While the fragmentation makes respite care more difficult to administer, it does

provide for the needs of a diverse population." Four model programs for respite care are defined in

the report: Project C. A. R. E, Jackson County Family Resource Center, A Small Miracle, Inc. and

Senior Companion Respite Program.

The report indicated that the study group did not see a need for separate statutory language for

respite care, but believed that consistent state funding was needed under the existing systems. The

study group agreed that respite care delivery could be enhanced if Medicaid included respite as a

State Plan Service. The report stated that, a respite service, defined as an Optional Medicaid State

Plan Service, should be offered to all who qualify, regardless of where the recipient lives or the

recipient's diagnosis, and should be based on needs. Further, the report suggested the State may

limit the definition, duration, and scope, and that an assessment of caregiver capability was integral

to the process. The report indicated that the Division of Medical Assistance would pursue an

internal review of this option. Additionally, the report supported study by the Division of Aging

and Adult Services, Department of Health and Human Services, on the place of group respite

programs in the long- term care continuum and the adequacy of service standards and funding.

The Commission supports caregivers and the provision of respite services and therefore

recommends the enactment of 2007- SQz- 11 to require the Department of Health and Human

Services continue to study ways to make respite care more accessible.

Recommendation 9: Study Older Adult Hearing Loss

The Study Commission on Aging recommends that the General Assembly direct the Department of

Health and Human Services to study the current and anticipated impact of hearing loss on North

Carolina's older adult population and the availability and access to qualified professionals for

treatment and hearing aid purchase assistance for low income individuals; to develop an inventory

of the technology available to assist individuals; and to evaluate resources and programs available

in other states, with a report to the Study Commission on Aging by November 1, 2008.

Background 9: Study Older Adult Hearing Loss

On April 10, 2008, the Commission heard a presentation from the Department of Health and

Human Services on hearing loss for older adults. Based on NC demographic information, the

Department of Health and Human Services, Division of Services for the Deaf and the Hard of

Hearing, estimated " the current hearing loss population among senior adults to be 166,420 for ages

65- 74 with a projected increase in 2030 to 342,897. For senior adults ages 75 and up, current

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 36

numbers indicate 207,483 persons with hearing loss and a projected increase to 438,801 for the

year 2030." Although hearing loss occurs at all ages, the Department shared that the National

Institute on Deafness and Other Communication Disorders ( NIDCD) reports that one ( 1) out of

every three persons by age 65 has some form of hearing loss. The Department's report highlighted

a lack of readily- available and accurate information on the impact, treatment, and adaptive

technology options for individuals with hearing loss. The lack of information is compounded by

the often gradual loss of hearing.

The Department pointed out the following issues faced by older adults with hearing loss:

 " Hearing Aids and Limited Insurance Coverage- One of the first challenges that the hard of

hearing person faces is the cost of hearing aids. These devices can often cost several thousand

dollars and are rarely covered by any insurance. Generally neither Medicare nor NC

Medicaid offer hearing aid coverage for adults. North Carolina along with bordering states of

Virginia, Kentucky, South Carolina, Georgia, and Tennessee are in the list of 16 states that do

not provide this coverage. In addition, there is virtually no insurance coverage for hearing

aids in North Carolina.

 Many people report difficulty finding a trustworthy professional to assist them with hearing

aids. The lack of a 30- day mandated trial period for hearing aids in North Carolina, one of 14

states without such a policy, instills in some individuals this lower level of trust toward the

hearing health care professional.

 A myriad of emotional responses resulting from difficulties in communicating often lead to

increased mental health concerns for senior adults. Better Hearing Institute reports that

hearing loss, particularly in older individuals not using hearing aid or assistive devices, has

been directly linked to short- term memory loss, fatigue, anxiety and depression.

 Among senior adults, hearing loss is one of the most prevalent and chronic, but treatable,

disabling condition[ s]. Hearing loss is ranked third, only behind arthritis and hypertension.

Hearing loss has also been linked to lower incomes— on average, those with hearing loss but

do not wear hearing aids earn up to $ 12,000 per year less than peers using hearing aids."

The Study Commission on Aging recognizes the challenges that hearing loss presents and

recommends the enactment of 2007- SQz- 12 to require the Department of Health and Human

Services study this issue and explore ways to provide assistance to individuals with hearing loss.

Recommendation 10: Criminal Background Checks for Nursing Home Administrators

The Study Commission on Aging recommends that the General Assembly enact legislation to give

the North Carolina Board of Nursing Home Administrators the authority to require a criminal

history record check for nursing home administrator license applicants.

Background 10: Criminal Background Checks for Nursing Home Administrators

G. S. 131E- 265 provides that an offer of employment by a nursing home to an applicant to fill a

position that does not require the applicant to have an occupational license is conditioned on

consent to a criminal history record check of the applicant.

G. S. 90- 278 gives the NC State Board of Examiners for Nursing Home Administrators the

authority to issue licenses to qualified persons as nursing home administrators. Therefore, a

criminal record background check is not required for nursing home administrators because they

have an occupational license.

On April 10, 2008, the Commission heard a presentation on this issue by the North Carolina State

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 37

Board of Examiners for Nursing Home Administrators who requested the ability to perform

criminal history record checks for nursing home administrator license applicants.

The Study Commission on Aging believes that it is imperative to provide safe and secure

environments in the State's long- term care facilities and supports allowing the North Carolina State

Board of Examiners for Nursing Home Administrators to require criminal history record checks for

nursing home administrator applicants through the enactment of 2007- RDz- 26.

Recommendation 11: Support Guardianship Study Recommendations

The Study Commission on Aging recommends that the General Assembly enact legislation to

authorize the Division of Motor Vehicles to consider recommendations from the clerk of court in

determining drivers license revocation of an incompetent individual, and to raise the ceiling on the

amount of personal property a guardian is allowed to sell without court order, which are both based

on recommendations from the House Study Committee on State Guardianship Laws to the 2007

General Assembly.

Background 11: Support Guardianship Study Recommendations

The House Study Committee on State Guardianship Laws was established by the Speaker of the

House on February 17, 2006. The Committee was directed to submit a final report on the results of

its study on or before December 31, 2006.

In the final report, Finding 6 indicates that the Committee found that guardians currently have the

authority to sell up to $ 1,500 worth of personal property without a court order in order to meet the

monetary needs of the ward. The Committee further found that the amount of a ward's personal

property that guardians are allowed to sell is outdated and insufficient. As a result, the House

Study Committee on State Guardianship recommended that the total amount of personal property

that can be sold without a court order be increased to $ 15,000. In response to this recommendation,

House Bill 794 was introduced. A Committee Substitute for House Bill 794 received a favorable

report in the House Committee on Aging and was referred to House Judiciary II. It was not heard

in House Judiciary II and House Bill 794 is not eligible for consideration during the 2008 Session.

In the final report, Finding 7 indicates that the Committee on State Guardianship Laws found it

unnecessary for the Division of Motor Vehicles to automatically revoke the drivers license of an

individual who has been declared incompetent. The Committee recommended that the Division of

Motor Vehicles be authorized to not automatically revoke the drivers license of an incompetent if

the clerk of superior court recommends the incompetent be allowed to retain the drivers license. In

response to this recommendation, House Bill 796 was introduced. House Bill 796 received a

favorable report in the House Committee on Aging and was referred to House Judiciary II. It was

not heard in House Judiciary II and House Bill 796 is not eligible for consideration during the 2008

Session.

On April 10, the Commission heard a presentation on guardianship and on the issues surrounding

an increase in the amount of a ward's personal property that a guardian can sell, and on the

automatic revocation of the driver license of an incompetent.

The Study Commission on Aging supports the work of the House Study Committee on State

Guardianship Laws and recommends the enactment of 2007- SHz- 27 to address drivers license

revocation of an incompetent individual, and enactment of 2007- SHz- 28 to raise the ceiling on the

amount of personal property a guardian is allowed to sell without court order.

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 38

Recommendation 12: Study Safe Transport of Passengers in Wheelchairs

The Study Commission on Aging recommends that the General Assembly enact House Bill 93,

Transport of Individuals in Wheelchairs Study, as it directs the Department of Transportation to

study appropriate methods of transporting passengers seated in wheelchairs, to develop guidelines

for the installation and use of wheelchair tie- down systems, and to report findings and

recommendations to the Study Commission on Aging and the Joint Legislative Transportation

Oversight Committee. ( House Bill 93 is currently in the Senate Committee on Transportation and

was a recommendation to the 2007 General Assembly from the Study Commission on Aging.)

Background 12: Study Safe Transport of Passengers in Wheelchairs

The Study Commission on Aging recommended that the 2007 General Assembly direct the

Department of Transportation to study appropriate methods of transporting passengers seated in

wheelchairs, to develop guidelines for the installation and use of wheelchair tiedown systems, and

to report findings and recommendations to the Study Commission on Aging and the Joint

Legislative Transportation Oversight Committee. House Bill 93 and Senate Bill 57 were

introduced. House Bill 93 was referred to the Senate Committee on Transportation on March 13,

2007 and is still eligible for consideration during the 2008 Session.

This recommendation to the 2007 Session was based on a wheelchair transportation safety

restraints presentation made to the Commission on November 15, 2006. During the presentation,

the Commission learned that transportation of passengers seated in wheelchairs within motor

vehicles is a relatively new experience and that while certified passenger restraint systems are

mandated for adults and children seated in vans, there is no law regulating restraint systems for

persons seated in wheelchairs. The presentation pointed out that the majority of incidents involving

persons transported in wheelchairs occur during ordinary driving maneuvers without a collision.

Statistical tabulations often omit these events since police are rarely summoned and the injured are

driven for medical care by the vehicle operator. However, the Division of Facility Services

tabulates incident reports filed by nursing homes which yields the following insights: problems

occur despite well- intentioned efforts to secure the chairs and apply restraints; van operators lack

knowledge that wheelchairs must be specifically designed for use in vehicles, restraint systems

must be property attached to the chair, and restraint systems must be property applied to the

passenger seated in the chair; and finally, the situation resembles that of child safety restraints.

The report distributed to the Commission included letters from the following entities expressing

support for exploring the safe transport of individuals in wheelchairs: The University of North

Carolina Highway Safety Research Center, NC Health Care Facilities Association, AARP of North

Carolina, NC Coalition on Aging, the Governor's Advisory Council on Aging, and the Senior Tar

Heel Legislature.

The presentation offered the following solutions from research by the University of Michigan

Traffic Research Institute:

1) Whenever possible, transfer the rider to a seat and use the seatbelt.

2) If transfer to a seat is not possible, use a wheelchair and tiedown system that protects the

occupant.

a. Use a Transit Wheelchair ( WC/ 19 compliant) with securement points for tiedown

straps, arm rests that permit the lap belt to cross the pelvis and a shoulder strap to

cross the chest.

b. Secure the wheelchair to the vehicle with four tiedown straps.

Apply both lap and shoulder belts to the rider. The seatbelt must fit snugly cross the

pelvis and be anchored at a 45 degree angle on each side. The shoulder strap must be

North Carolina Study Commission on Aging

Report to the Governor and the 2008 Session of the 2007 General Assembly 39

in contact with the middle of the chest and shoulder and it must avoid contact with the

neck.

The Study Commission on Aging continues to support House Bill 93, a recommendation to the

2007 Session of the General Assembly, which requires a study of appropriate methods of

transporting passengers seated in wheelchairs.

Recommendation 13: Study Medically Needy Income Standard

The Study Commission on Aging recommends that the General Assembly enact House Bill 92,

Medicaid Income Limits Level Study, as it requires the Department of Health and Human Services,

Division of Medical Assistance, to study the medically needy income standard and determine the

best method of increasing the standard while providing improved consistency across long- term care

settings and report to the Study Commission on Aging. ( House Bill 92 is currently in Senate

Appropriations and was a recommendation to the 2007 General Assembly from the Study

Commission on Aging.)

Background 13: Study Medically Needy Income Standard

The Study Commission on Aging recommended that the 2007 General Assembly direct the

Department of Health and Human Services to review options for increasing Medicaid Medically

Needy Income Limits. House Bill 92 and Senate Bill 110 were introduced. House Bill 92 was

referred to the Senate Committee on Appropriations on March 14, 2007 and is still eligible for

consideration during the 2008 Session.

This recommendation to the 2007 Session was based on presentations to the Commission on the

Medicaid Institutional Bias Study. The study was mandated by Section 10.3 of S. L. 2004- 124 for

the purpose of identifying any bias that favors support for individuals in institutional settings over

support for individuals living at home.

In response to a Commission recommendation, S. L. 2006- 110 was enacted and required the

Department of Health and Human Services to collaborate with providers and advocates of home

and community- based long- term care services to review the Institutional Bias Report and make

recommendations on ways to address the identified biases. On December 13, 2006, the

Commission heard a presentation on recommendations to address two of the biases. One of the

identified biases stated that medically needy requirements leave little money for persons to pay for

living expenses if they prefer to remain in the community, whi