Title 76 W. Va. C.S.R.

Senior Services Senior Services

Series 01 Hearing And Appeals Procedure

W. Va. Code R. § 76-1-1 General

1.1. Scope. -- This rule governs the West Virginia Bureau of Senior Services hearings and appeals process.

1.2. Authority. -- W. Va. Code §16-5P-1, et seq. and §45CFR, et seq.

1.3. Filing Date. -- January 26, 2010.

1.4. Effective Date. -- February 26, 2010.

W. Va. Code R. § 76-1-2 Definitions

2.1. Bureau of Senior Services. The agency created by the Legislature pursuant to W. Va. Code §16-5P-1, et seq. to promote services; enhance the health, safety and welfare of West Virginia’s senior population; and serve as the primary agency within State Government to provide service to the senior population.

2.2. Commissioner. The chief administrative officer appointed to administer the duties and responsibility of the Bureau of Senior Services.

2.3. Area Agency on Aging (AAA). An agency designated by the Bureau of Senior Services to develop and administer the area plan for a comprehensive and coordinated system of services for older persons. The AAA serves as the advocate and focal point for older persons in the planning and service area.

2.4. Adverse action. An action or decision not to act which directly affects the complainant and with which the complainant disagrees and wishes to appeal.

2.5. Service provider. An entity that is awarded a grant/contract from an Area Agency to provide services. (Note: An Area Agency on Aging or the Bureau of Senior Services contract with a profit-making organization requires prior approval from the Bureau of Senior Services.)

2.6. Hearing. A proceeding where the relevant facts and applicable law will be addressed and considered.

2.7. Complainant. A party who makes the complaint in a formal action or proceeding.

2.8. Respondent. The party against whom the appeal or complaint is brought.

2.9. Hearing Examiner. A person designated by the Bureau of Senior Services to preside at hearings, take evidence and make factual and legal findings.

2.10. Parties. The complainant and respondent.

W. Va. Code R. § 76-1-3 Hearings and Appeals - Procedure for Service Providers

3.1. The Area Agency on Aging shall provide an opportunity for a hearing to any service provider whose contract/grant is suspended, terminated or non-renewed.

3.2. The Bureau of Senior Services shall provide an opportunity for a hearing where a service contract/grant between a service provider and the Bureau of Senior Services has been suspended, terminated, or non-renewed. Any hearing on this issue shall be conducted pursuant to Section 4.1 of this Rule and shall not involve the area agency. Provided that where an Area Agency on Aging holds a service contract/grant with the Bureau of Senior Services any hearing thereon will be conducted pursuant to Section 5.1, et seq. of this Rule.

3.3. Continuity of Services.

3.3.1. During the hearing and appeal process, any service provider specified in 3.1 and 3.2 whose contract/grant is suspended, terminated, or non-renewed shall:

3.3.1.a. Continue operating until this hearing and appeal process is final and a decision rendered; provided, however, should the Commissioner of the Bureau of Senior Services determine that termination of the contract should occur immediately, the Commissioner may order that the parties cease performance under the contract immediately.

3.3.1.b. During unusual circumstances the Bureau of Senior Services shall determine if alternative contractual arrangements are necessary to assure that services continue. Should the Commissioner, in his or her discretion, determine that alternative contractual arrangements are necessary, the Commissioner shall take any and all appropriate action to ensure the continuation of necessary and appropriate services as required by W. Va. Code §§16-5P-1 and 16-5P-6.

3.4. Request for Area Agency on Aging hearing.

3.4.1. If an entity wishes to appeal the decision of the Area Agency on Aging, it must file a written request for an informal hearing to the Area Agency on Aging within ten (10) working days after receipt of the adverse action.

3.4.2. A written request for a hearing shall contain the following information:

3.4.2.a. The name, address and telephone number of the complainant.

3.4.2.b. A concise statement of the complaint.

3.4.2.c. A statement of all relevant facts and the grounds on which the complaint is based.

3.4.2.d. The relief being sought.

3.4.3. Within five (5) working days of the request, the Area Agency on Aging shall schedule a hearing date. The hearing before the Area Agency on Aging shall be completed within thirty (30) days following receipt of the request.

3.4.4. The Area Agency on Aging shall notify the complainant, in writing, of the date, time and location of the hearing, allowing for at least ten (10) working days' notice.

3.4.5. The hearing shall be informal and shall provide for participation by the complainant and the Area Agency on Aging.

3.5. The Area Agency on Aging decision.

3.5.1. Within five (5) working days following the hearing, the Area Agency on Aging shall issue a written decision notifying the complainant of its decision.

3.5.2. The decision shall include:

3.5.2.a. A statement setting forth the reason(s) for and the evidence on which the decision was based.

3.5.2.b. Any instructions necessary to facilitate implementation of the decision.

3.5.2.c. Instructions on how to appeal the decision.

W. Va. Code R. § 76-1-4 Request for Bureau of Senior Service Hearing/Appeal

4.1. The Bureau of Senior Services shall provide an opportunity for a hearing to:

4.1.1. Any applicant for designation as a planning and service area under §45CFR1321.39 whose application is denied.

4.1.2. Service providers identified in Section 3.2. whose contract/grant has been suspended, terminated, or non-renewed.

4.1.3. The Bureau of Senior Services shall provide an opportunity to service providers to appeal the decision of the Area Agency on Aging as specified in Section 3.1.

4.2. Request for hearing.

4.2.1. If an entity wants a hearing/appeal, it must file a written request for a hearing with the Bureau of Senior Services within ten (10) working days following the receipt of the notice of adverse action.

4.2.2. A written request for a hearing shall contain the following information:

4.2.2.a. The name, address and telephone number of the complainant.

4.2.2.b. The name, address and telephone number of the respondent.

4.2.2.c. A concise statement of the complaint.

4.2.2.d. A statement of all relevant facts and the grounds on which the complaint is based.

4.2.2.e. The relief being sought.

4.3. Scheduling of the hearing.

4.3.1. Upon receipt of a request for a hearing/appeal, the Bureau of Senior Services will appoint an impartial hearing examiner to conduct the hearing.

4.3.2. The Bureau of Senior Services must complete the hearing process within sixty (60) working days of the date the request for hearing was received by the State Agency.

4.3.3. The hearing examiner shall notify the complainant and respondent, in writing, of the date, time and location of the hearing, allowing for at least ten (10) working days notice to be given to the parties and their representatives.

4.4. Prehearing discovery.

4.4.1. The hearing examiner shall disseminate a copy of the complainant's request for hearing to respondent and all relevant parties to the appeal.

4.4.2. The hearing examiner shall request, from the respondent, written statements in response to complainant's statement.

4.4.3. The hearing examiner shall see that all relevant parties have received written statements from all other relevant parties.

4.5. Conduct of the hearing.

4.5.1. A hearing examiner appointed by the Bureau of Senior Services shall preside at the hearing. Formal rules of evidence shall not apply at such hearing.

4.5.2. The purpose of the hearing shall be:

4.5.2.a. To give both complainant and respondent an opportunity to appear in person and present testimony, witnesses and documentary evidence relevant to the issue in question.

4.5.2.b. To give both complainant and respondent an opportunity to cross-examine the opposing party's witnesses.

4.5.3. The hearing examiner shall have the following responsibilities:

4.5.3.a. To assure that all documents and records presented or referred to during the course of the hearing are made part of the record.

4.5.3.b. To assure that a stenographic and tape recording be made of all proceedings. The tape shall be retained for a period of one (1) year.

4.6. Order of the hearing.

4.6.1. The hearing examiner shall open with a statement of the following:

4.6.1.a. The purpose of the hearing.

4.6.1.b. The procedure the hearing will follow.

4.6.1.c. The way the decision will be transmitted to the parties.

4.6.2. The hearing examiner shall ask each party to state the issue being contested.

4.6.3. The complainant or its representative shall present its case through witnesses or documentary evidence. The respondent shall be offered the opportunity to cross-examine any witness.

4.6.4. The respondent or its representative shall present its case through witnesses or documentary evidence. The complainant shall be offered an opportunity to cross-examine any witness.

4.6.5. At any time the hearing examiner may question any witness in order to clarify the witness' testimony.

4.6.6. The hearing examiner shall give each party an opportunity to make a closing statement before terminating the hearing. Both parties shall have the option of submitting written argument should they so choose.

4.6.7. The hearing may be adjourned and continued to another date at the discretion of the hearing examiner.

4.6.8. The Bureau of Senior Services may terminate formal hearing procedures at any point if the Bureau of Senior Services or the agency or organization that requested the hearing negotiated a written agreement that resolves the issues which led to the hearing.

4.7. The decision.

4.7.1. The hearing examiner shall submit an impartial, written recommendation to the Bureau of Senior Services, setting forth the reasons for and the evidence on which the recommendation is based. The recommendation shall be submitted within ten (10) working days following the conclusion of the hearing; provided, should the parties agree to waive this timeline, the parties, subject to the approval of the hearing examiner, may expand the period for issuance of the decision a reasonable period of time.

4.7.2. The Bureau of Senior Services shall review the recommendation of the hearing examiner and render a decision.

4.7.3. The Bureau of Senior Services shall issue the written decision within five (5) working days following the receipt of the hearing examiner’s recommendations. The decision shall set forth the reasons for the decision and the evidence on which the decision is based, along with any necessary instructions to facilitate the implementation of the decision.

4.7.4. Copies of the decision shall be sent to all parties.

4.8. Final appeal.

4.8.1. The hearing/appeal before the Bureau of Senior Services is final and exhausts all administrative remedies.

W. Va. Code R. § 76-1-5 Due Process Hearings Procedures for Area Agencies on Aging

5.1. The Bureau of Senior Services shall provide due process to Area Agencies on Aging where the Bureau of Senior Services initiates proceedings to:

5.1.1. Revoke or decline to renew the designation of the area agency or agencies.

5.1.2. Designate an additional planning and service area in the State.

5.1.3. Divide the State into different planning and service areas; or

5.1.4. Disapprove the area plan or plan amendment submitted by the Area Agency on Aging as specified in §45CFR1321.39(b); or

5.1.5. Suspend, terminate or non-renew the Area Agency on Aging grant/contract; or

5.1.6. Otherwise affect the boundaries of the planning and service areas of the State.

5.2. When the Bureau of Senior Services initiates proceedings as described in Section 5.1, the Bureau of Senior Services shall:

5.2.1. Notify the area agency or agencies that its decision may be appealed to the Assistant Secretary of the Administration on Aging.

5.3. An appeal by an area agency or agencies, as described in Section 5.1, must be made in 30 days after receipt of the decision by the Bureau of Senior Services to the Assistant Secretary of the Administration on Aging.

5.4. Should the Assistant Secretary of the Administration on Aging reverse or modify the decision of the Bureau of Senior Services, the action of the Bureau of Senior Services shall be nullified or modified.

76CSR1

Series 02 In-Home Care Worker Registry

W. Va. Code R. § 76-2-1 General

1.1. Scope. -- The registry shall provide the public a list of in-home care workers, along with their qualifications, who voluntarily agree to be included and who have completed a criminal background check.

1.2. Authority. -- W. Va. Code §16-5P-1 et. seq.

1.3. Filing Date. -- April 7, 2014.

1.4. Effective Date. -- May 7, 2014.

W. Va. Code R. § 76-2-2 Application

2.1. The Commissioner shall list qualified applicants, who meet the requirements of W. Va. Code §16-5P-1 and this rule, in a central registry.

W. Va. Code R. § 76-2-3 Definitions

3.1. “Applicant” means a person making application to be included on the registry.

3.2. “Commissioner” means the Commissioner of the Bureau of Senior Services or his or her designee.

3.3. “In-home care worker” means an unlicensed person who provides personal care or other services and supports to persons with disabilities or to the elderly in order to enhance their well-being and which involves face-to face direct contact with the person. Functions performed may include but are not limited to assistance and training in activities of daily living, personal care services, and job-related supports.

3.4. “Registry” means a list maintained for the collection of information.

3.5. “Registrant” means an applicant who has passed the application phase and supplied all necessary information.

W. Va. Code R. § 76-2-4 Registry Requirements

4.1. An applicant for listing on the registry of in-home care workers shall be 18 years old or older and shall submit an application to the Commissioner containing the following:

4.1.a. Last name, first name, and middle initial;

4.1.b. Permanent address;

4.1.c. Previous address, if not a West Virginia resident for 12 months or longer from the date the application is submitted to the Commissioner;

4.1.d. Contact information

4.1.e. Birth date;

4.1.f. Valid Driver’s License, if available;

4.1.g. Proof of completed background check;

4.1.h. Proof of Adult Services Abuse Registry check;

4.1.i. Proof of completed CPR and first aid certification;

4.1.j. Proof of education level and certification attained;

4.1.k. West Virginia Business Registration Number, if applicable;

4.1.l. Geographical areas where services could be provided;

4.1.m. Registrant’s availability;

4.1.n. Education/certification;

4.1.o. Proposed fee for hourly services;

4.1.p. Types of services and specialized fields of service, i.e., Dementia, Autism, Alzheimer’s;

4.1.q. Employment preferences such as smoking/non-smoking, male or female, weekdays, evenings, etc.;

4.1.r. Other requirements as may be specified on the application;

4.1.s. Applicable registration fee;

4.2. The Commissioner shall include a note to the applicant concerning privacy issues and the registry with the application.

4.3. Applications may be submitted via a secure internet application.

4.4. The Commissioner shall review the application for completion and post the information to the registry within 15 calendar days. If the application is not complete, the Commissioner shall notify the applicant within 10 calendar days that his or her application is not complete and will not be posted to the registry until the omitted information is provided.

W. Va. Code R. § 76-2-5 Registry

5.1. The Commissioner shall maintain a registry on its website which shall provide the public with the following registrant information:

5.1.a. The last name, first name, and middle initial;

5.1.b. Contact information for employment purposes;

5.1.c. Gender;

5.1.d. Age range;

5.1.e. Indication of completed criminal background check;

5.1.f. Date the criminal background check was completed;

5.1.g. Indication of Abuse Registry Check completion;

5.1.h. West Virginia Business Registration Number, if applicable;

5.1.i. Geographical areas where service could be provided;

5.1.j. Registrant’s availability;

5.1.k. Education/certification;

5.1.l. Indication of a valid driver’s license;

5.1.m. Proposed hourly fee or wage for services;

5.1.n. Types of services and specialized fields of service, i.e., Dementia, Autism, Alzheimer’s;

5.1.o. Employment preferences such as smoking/non-smoking, male or female, weekdays, evenings, etc.;

5.1.p. Other information the Commissioner finds necessary.

W. Va. Code R. § 76-2-6 Renewal

6.1. A registrant shall renew his or her registration annually upon his or her registration acceptance date, and ensure the information on the registry is complete and accurate.

6.2. To renew his or her registration a registrant shall provide proof of completion of OSHA training; HIPAA, Abuse, Neglect and Exploitation and dementia care training.

6.3. A registrant shall be able to update certain designated information through a secure internet application available only to the registrant.

6.4. The Commissioner shall remove a registrant from the registry if a registrant does not renew his or her registration.

W. Va. Code R. § 76-2-7 Fees

7.1. The applicant shall pay an initial registration fee of $10.00.

7.2. The registrant shall pay a fee of $5.00 to renew the registration.

W. Va. Code R. § 76-2-8 Changing, Withdrawing, or Removal From Registry

8.1. A registrant shall update any changes in his or her registration status and any changes in his or her information contained in the registrant’s application within 10 days of the change via a secure internet application.

8.2. To withdraw from the registry, the registrant shall submit a letter or an email via a secure internet application to the Commissioner requesting his or her name and information be removed from the registry. The Commissioner shall remove the registrant within 15 days of notification.

8.3 Upon proof that a registrant’s registration status or information contained in the registrant’s application has changed and the registrant has not updated the changes via the secure internet application within 10 days of the changes, the Commissioner may immediately remove the registrant from the registry.

W. Va. Code R. § 76-2-9 Criminal Background Check

9.1. An applicant shall undergo criminal back ground check by the West Virginia State police. The applicant is solely responsible for undergoing and obtaining the results of the criminal background check.

9.1.a. An applicant shall provide the required information to the West Virginia State police to obtain the criminal background check.

9.1.b. An applicant shall affirm on his or her registry application that he or she has undergone and has received the results.

9.1.c. An applicant who lived outside of this state in the last 5 years shall undergo a state background check from each state in which he or she resided.

9.1.d. The applicant shall provide the required information to the appropriate agency to obtain the criminal background check.

9.2. The Bureau shall place a disclaimer on its website to remind potential employers, they should ask for the potential employee’s results of the criminal record check.

W. Va. Code R. § 76-2-10 Obtaining Information from the Registry

10.1. The WV Registry of In-Home Care Workers can be accessed via the Internet by going to the WV Bureau of Senior Services Website or by phone call to the WV Bureau of Senior Services who will assist in accessing Registry information.

10.1.a. Information on the Registry can be obtained by searching geographical locations, service needs, or by searching the care workers names or agency name.

10.1.b. Individual care workers employed by an in-home care provider agency will be displayed as an employee of the agency and the agency contact information will be displayed.

10.1.c. Independent in-home care workers information will be listed with direct contact information.

76CSR2

Series 03 West Virginia State Plan for Aging Programs - Title V

W. Va. Code R. § 76-3-1 General

1.1. Scope. - - The State Plan for Aging Programs includes all assurances and plans to be conducted by the Bureau of Senior Services under the provisions of the Older Americans Act of 1965, as amended. The Bureau of Senior Services is primarily responsible for the coordination of all the major responsibilities of developing and administering a comprehensive and coordinated system of services and activities for providing a positive impact on the lives of elderly people with the service area.

1.2 Authority. - - W.Va. Code §16-5P-1 et. seq.

1.3 Filing Date. – May 15, 2020.

1.4. Effective Date. – July 01, 2020.

W. Va. Code R. § 76-3-2 Incorporation By Reference

The West Virginia State Plan for Aging Programs is hereby incorporated by reference as an interpretive rule. This document is available from the Secretary of State’s Office or the West Virginia Bureau of Senior Services.

WEST VIRGINIA BUREAU OF SENIOR SERVICES

OLDER AMERICANS ACT

WEST VIRGINA STATE PLAN FOR THE

SENIOR COMMUNITY SERVICE EMPLOYMENT PROGRAM

PROGRAM YEARS JULY 1, 2020 – JUNE 30, 2023

(Stand- Alone)

SECTION 1. Overview of the Senior Community Service Employment Program and Purpose of the State Plan 4

SECTION 2. Economic Projections and Impact 6 Long-term Projections for Jobs in Industries and Occupations 6 Strategic Training Plan for Participants to be placed in Unsubsidized Employment 10 State Current and Projected Employment Opportunities 11 Action and Coordination with Other Programs 18 Long-Term Strategy to Engage Employers to Place Participants in Unsubsidized Employment 20 Long- Term Strategy for Serving Minorities under SCSEP 20 Community Service Needs 22 Long-term Strategy to Improve SCSEP Services 23 Strategy for Continuous Improvement in Entered Employment of Performance 23

SECTION 4. Location and Population Served, Including Equitable Distribution 25 Localities and Populations Most in Need of the Type of Projects Authorized by Title V 25 Equitable Distribution Changes from Prior Year 26 Equitable Distribution Imbalances and Corrective Steps 28 The State’s Long-Term Strategy for Achieving Distribution of SCSEP Positions within the State 28 Ratio of Eligible Individuals in Each County and State Total Eligibility Population 29 Relative Distribution of Eligible individuals 31 Avoid Disruptions 38 APPENDICES 39

Appendix A -West Virginia Area Agencies on Aging 40

Appendix B- Workforce WV Development Board 41

Appendix C- Delegation of Authority State Plan Letter 42

Appendix D- Public Comments 43

Appendix E- Occupational Demand 46

Appendix F- Top 15 Occupations in Demand 47

Appendix G- Population by Age Group 48

Appendix H – Labor Force Participation by Age Group 49

Appendix I- Average Turnover Rate by Age 51 WEST VIRGINIA SENIOR COMMUNITY SERVICE EMPLOYMENT PROGRAM STATE PLAN FOR PROGRAM YEARS JULY 1, 2020 THROUGH JUNE 30, 2023

SECTION 1. Overview of the Senior Community Service Employment Program and Purpose of the State Plan In 2014, President Barack Obama signed the Workforce Innovation and Opportunity Act (WIOA) (P.L. 113-128) into law, formally overhauling and reauthorizing the expired Workforce Investment Act (WIA) of 1998. President Obama signed the WIOA following swift passage and overwhelming bipartisan support for the bill in both the U.S. House of Representatives and the Senate.

The U.S. Department of Labor (USDOL), state workforce agencies, local workforce areas, and other stakeholders continue to implement the changes under WIOA, which became effective July 1, 2015.

The Senior Community Service Employment Program (SCSEP) also known as Title V, is authorized under the Older Americans Act (OAA) as amended in 2006, and administered by the U.S. Department of Labor, Employment and Training Administration (DOLETA). The DOLETA distributes SCSEP funds to nineteen (19) National SCSEP Grantees and fifty-six (56) State and Territorial Grantees. The National Grantees operate across multiple state jurisdictions and receive 78% of SCSEP funds. State and territorial SCSEP Grantees receive the remaining 22% of SCSEP funds.

SCSEP is the only grant program designed specifically to serve low-income older workers, age fifty-five (55) and older, by providing job training through community-based organizations and government agencies. The goals of the program are two-fold, to provide community service and to promote self-sufficiency by placing individuals in unsubsidized employment.

Program-eligible older workers must be residents of West Virginia, fifty-five (55) years of age and older, unemployed, with a total family income that does not exceed 125% of the federal poverty guidelines, currently $15,950 for an individual. Service priority is given to individuals meeting one or more of the following criteria:

Disabled Limited English Proficiency Low Literacy Skills Reside in a Rural Area Veterans or Veterans’ Spouses Low Employment Prospects Failed to Find Employment after using WIOA Services Homeless or at Risk of Homelessness Minority Individuals Poverty Level or Below Eligible individuals receive part-time, subsidized job training through community service assignments (CSA) at non-profit organizations or governmental entities.

The West Virginia Bureau of Senior Services (Bureau) administers the State SCSEP Grantee program, contracting with Preston County Senior Citizens, Inc. to provide SCSEP services to eleven (11) Counties. In addition, the National Grantee, National Council on Aging, provides SCSEP services in West Virginia to the remaining 44 counties.

The SCSEP State Plan outlines a four-year strategy covering Program Year July 1, 2020-June 30, 2023 for the statewide provision of community service employment and other authorized activities for eligible individuals under the SCSEP. The four-year strategy must specifically address the following:

Economic Projections Long-Term Projections for Jobs in Industries and Occupations Strategic Training Plan for Participants to Be Placed in Unsubsidized Employment State Current and Projected Employment Opportunities Service Delivery and Coordination Action and Coordination with Other Programs Long-Term Strategy to Engage Employers to Place Participants in Unsubsidized Employment Long-Term Strategy for Servicing Minorities under SCSEP Community Service Needs Long-Term Strategy to Improve SCSEP Services Strategy for Continuous Improvement in Entered Employment of Performance Location and Population Served, Including Equitable Distribution Localities and Populations Most in Need of the Type of Projects Authorized by Title V Equitable Distribution Changes from Prior Year Equitable Distributions Imbalances and Corrective Steps The State’s Long-Term Strategy for Achieving Distribution of SCSEP Positions within the State Ratio of Eligible Individuals in Each Area to the Total Eligible Population in the State Relative Distribution of Eligible Individuals Steps to Avoid Disruptions to Service for Participants During the 2016 reauthorization of the Older Americans Act, changes were made to the performance indicators. This reauthorization changed the follow-up on three of the current Core Performance Measures and added a new Core Measure. Changes were in the following Core Measures, with the new Core Performance Measure being Customer Satisfaction:

Common Measures Entered Employment Common Measures Employment Retention; and Common Measures Average Earnings Strategies for achieving these adjustments will be that both the National and State will continue to follow up with enrollees upon their exit and will now follow-up quarterly to actively capture information as required by the Core Measures. Follow up dates will be updated, and emphasis will be put more in the beginning of the program to ensure that enrollees, host agencies and employers are aware of the culture. Both State and National Grantees will continue to ensure that enrollees are fully equipped with the necessary tools (i.e., functional resumes, computer literate, functional workforce profile etc.) to warrant that, once employed, that employment is sustained. Grantees will continue to adhere to the performance measures that are set forth by the WIOA and will continue to meet the performance goals by the continuance of excellent rapport with Workforce, host agencies and potential employers.

The OAA and federal regulations require the Governor of each state to develop a strategic four-year State Plan in collaboration with the national SCSEP grantees, the aging network, and workforce entities operating within their state. Because the West Virginia Bureau of Senior Services is West Virginia’s State Unit on Aging (SUA), Governor Jim Justice delegated authority to Commissioner Robert Roswall to submit the State Plan on his behalf to USDOL/ETA. (Appendix C)

SECTION 2. Economic Projections and Impact Long-term Projections for Jobs in Industries and Occupations According to the United States Census Bureau, West Virginia’s population totaled 1,852,994 during the last conducted census in 2010. The total number of West Virginians age 55 and older totaled 562,229, comprising 30.4% of the state’s total population. Table 1 illustrates the total population categorized by age ranges.

Table 1 Total Population Categorized by Age Range Age Range Total Percentage 55 to 59 139,368 7.5% 60 to 64 years 125,457 6.8% 65 to 69 years 91,728 5% 70 to 74 years 71,792 3.9% 75 to 79 years 54,725 3% 80 to 84 years 43,238 2.3% 85 years and over 35,921 1.9% (Source: Census Bureau, fact finder, 2010)

Figure 1 shows the age distribution of West Virginia’s working age population in all industries that are broken down into twenty sectors. These sectors include Finance and Insurance; Real Estate; Professional; Scientific, and Technical Services; Management of Companies and Enterprises; Administrative Support; Waste Management and Remediation Services; Educational Services; Health Care and Social Assistance; Arts, Entertainment, and Recreation; Accommodation and Food Services; Other Services; and Public Administration.

Figure 2 narrows down the population results showing only SCSEP’s target audience (55+) in all industries. As depicted in the figures, there is evidence of continuous increase in the representation of (55+) seniors entering the workforce.

Figure 1.

Figure 2 (Source: Figure 1 & 2, QWI Explorer Appendix 97-2018)

According to the Quarterly Workforce Indications (QWI), out of the twenty industries, the industry sectors that represented the largest numbers of employed seniors during 2018 were Health Care and Social Assistance (20%), Education Services (13%), Retail Trade (11%) and Manufacturing (8%). These sectors were the top four employers for older workers 55+ during 2018. Table 2 illustrates the industries during 2018 that had the largest number of older workers.

Table 2 Industry Sector Employment of Older Working West Virginians 55+ in 2018 (Source: Table 2; QWI,NAICS Sectors, 2018)

Information from the QWI was narrowed down to display which of the 20 Industry Sectors had the highest percentage of hiring older workers (55+). Industry Sectors with the largest percent of new hires of older workers during 2018 were Construction (17%), Health Care and Social Assistance (11%) and Retail Trade (10%). Table 3 illustrates the industries during 2018 that had the largest number of 55+ seniors.

Table 3 Industry Sector of New Hires of Older Working West Virginians 55+ 2018 (Source: QWI, NCAICS Sectors, 2018)

From the information gathered in Table 3, the staffing patterns from the top three Industry Sectors of New Hires show employment in Construction (17%), Healthcare and Social Assistance (11%) and Retail Trade (10%). We can forecast that these industries will continue to hire older workers, thus providing employment opportunities in the following Equal Employment Opportunities (EEO) Occupations Groups based off the Industry Sector of New Hires: Transportation, Natural Resources, Contruction & Maintenance Occupations, Sales and Office Occupations, Service Occupations, Education, Legal, Community Service, Arts & Media Occupations, Management, Business & Science. EEO Occupational Groups are categorized into 14 groups and further categorized into nine job categories. Table 4 illustrates the twelve Occupational Groups that were narrowed down from the top three Industries.

Table 4 EEO Tabulation 2006-2010 Occupation Code ( Source: EEO Tabulation 2006-2010 (5yr ACS)

Strategic Training Plan for Participants to be placed in Unsubsidized Employment In order to maximize SCSEP participant placement in unsubsidized employment in high demand jobs, the statewide SCSEP network will focus their on-the-job training opportunities and host agency recruitment efforts on agencies that can provide training for the types of occupations that are listed in Table 4 that are forecasted based on Industry Sector of New Hires 2018 to hire older workers.

Training opportunities will be increased to provide a variety of opportunities that have a higher percentage of developing into unsubsidized employment. Training for computer literacy will continue to be at the forefront, as this is a necessity in a majority of the occupations that forecast continued employment. Computer training opportunities are provided through many entities, such as local American Job Centers (AJC), local Community Colleges, and public libraries. When appropriate, program coordinators and host agencies will encourage participation in specialized computer training opportunities.

Access to training classes offered by the local American Job Center and other non-profit organizations will help increase the skills that enrollees will need to continue to pursue employment.

Another strategy for older workers to be placed into unsubsidized employment would be to look into occupations that require minimum training, as this would help the statewide SCSEP meet the employment goals listed in the core measures that are set forth by DOL.

State Current and Projected Employment Opportunities Per the Workforce West Virginia (WFWV), Labor Market Information (LMI) Ten(10) year projections of the high demand occupations that require minimum education and fit our SCSEP participants’ education and training levels include the following:

Bus Drivers, Transit and Intercity Customer Service Clerks Social and Human Service Assistants Community Health Workers Animal Caretakers Post Secondary School Home Health Aides Rehabilitation Janitors Counter Attendants Some of these occupations require less than a high school education. Others require a high school diploma or some college. Per the data received from SPARQ, the majority of our participants meet the education requirements for the jobs listed above. Hourly wages for the listed occupations start at a minimum of $10.41.

Table 5 Education PY 18 Q4 Final YTD % 8th grade and under 9th grade – 11th grade High school Diploma 1-3 years college Post- Secondary certificate Associate’s Degree Bachelor’s Degree or equivalent Some graduate School Master’s Degree Doctoral Degree ( Source: SPARQ, Quarterly Progress Report Program Year 2018, Quarter 4 Final)

Table 5a provides employment projections based on eight education levels in West Virginia.

Table 5A: Projections by Level of Education (Figure shows employment projections based on eight education levels for the year 2026.)

2016-2026 Occupational Projections by Level of Education Education Level Employment 2016% of Workforce 2026 Projected Employment 2026% of Workforce Less than high school 204,905 27.18% 217,467 27.34% High school diploma or equivalent 321,770 42.68% 330,507 41.55% Some college, no degree 0.12% 1,036 0.13% Postsecondary non- degree award 27,534 3.65% 29,974 3.77% Associate degree 29,988 3.98% 32,412 4.07% Bachelor’s degree 75,584 10.02% 81,073 10.19% Master’s degree 12,755 1.69% 14,523 1.83% Doctoral or professional degree 10,027 1.33% 11,012 1.38% Not applicable 70,476 9.35% 77,496 9.74% Total 753,974 795,500 (Source: Workforce West Virginia, Occupational Employment Statistics (OES)

Table 6 illustrates the required level of education, on-the job training, work experience required, and growth rate of each occupation.

Table 6 ( Source: WV LMI Long term Occupation Projections 2016-2026)

The Workforce West Virginia (WFWV) office divides the state into seven geographic regions that covers all 55 counties shown on the map in Appendix B. As shown below, each region shows their specific region’s greatest growth occupation. Not only does the WFWV consist of seven (7) geographic regions, the seven (7) regions each have at least one comprehensive AJC, at minimum. In total, the seven regions hold Ten (10) comprehensive centers, five (5) satellite centers and seventeen (17) affiliate sites throughout the State. One of the goals of the AJCWV is to offer job seekers and employers ready access to the many workforce development resources available in a local region. The WVWF office offering resources equally across the state as stated above, The SCSEP Network will continue to utilize resources such as transition programs, adult displacement resources, resume enhancement, computer classes, mock interviews and all other events that are offered at the AJCWV.

Within the seven (7) regions that WFWV has divided the state into, each region shows that Host Agency recruitment and enrollee training will have to be individualized to adapt to that particular Region’s occupational demands. The SCSEP Network will maintain working relationships with all WFWV offices to obtain relevant employment and training information that pertains to that Region. Sub-grantees will continue to inform enrollees of their specific region’s occupational projections.

WIOA Region 2 Occupational Employment Projections 2016-2026 Occupational Projects 2016-2026 WIOA 2 Greatest Growth Occupations Greatest Declining Occupations Occupational Therapy Assistants Legal Secretaries Nurse Practitioners Mine Shuttle Car Operators Physician Assistants Switchboard Operations, Including Answering Service Physical Therapist Assistants Executive Secretaries and Executive Administrative Assistants Massage Therapists Labor Relations Specialist WIOA Region 4 Occupational Employment Projections 2016-2026 Occupational Projects 2016-2026 WIOA 4 Greatest Growth Occupations Greatest Declining Occupations Home Health Aides Legal Secretaries Executive Secretaries and Executive Administrative Assistants Nurse Practitioners Medical Transcriptionists Occupational Therapy Assistants Labor Relations Specialist Respiratory Therapists Floral Designers WIOA Region 6 Occupational Projections 2016-2026 Occupational Projects 2016-2026 WIOA 6 Greatest Growth Occupations Greatest Declining Occupations Home Health Aides Data Entry Keyers Legal Secretaries Nurse Practitioners Executive Secretaries and Executive Administrative Assistants Software Developers, Applications Mine Shuttle Car Operators Statisticians Medical Transcriptionists Occupational Projects 2016-2026 WIOA 7 Greatest Growth Occupations Greatest Declining Occupations Nurse Practitioners Legal Secretaries Coating, Painting, and Spraying Machine Setters, Operators, and Tenders Executive Secretaries and Executive Administrative Assistants Assemblers and Fabricators, All Other Healthcare Social Workers Team Assemblers Software Developers, Applications Floral Designers

SECTION 3. Service Delivery and Coordination Action and Coordination with Other Programs West Virginia’s statewide SCSEP network includes the State Grantee and one National Grantee operating in WV. Communication with this network is accomplished through email and teleconference as needed throughout the Program Year. The State Grantee is the West Virginia Bureau of Senior Services, which provides a multitude of services for older Americans in West Virginia under the Older Americans Act (OAA). As the designated State Unit on Aging, the Bureau administers all OAA services throughout the 55 counties that are tailored to Older West Virginians. The Bureau maintains contracts with each of the 55 County Aging Programs, three (3) Statewide Aging & Disability Resource Centers and four (4) Area Agencies on Aging. The Bureau’s mission is to be West Virginia’s premier advocate for the provision of in-home and community-based services for the state’s seniors and others served by our programs and to be a faithful steward of the federal and state monies entrusted to our care for the provision of services throughout West Virginia.

Through a Memorandum of Understanding, the WV Statewide SCSEP network, a mandated partner, partners with the local Workforce Investment Boards operating the American Job Center (AJC)/ One-Stop Centers. The mission and vision between the AJC and WV SCSEP are to empower area employers, individuals and communities to prosper and grow the region’s economy through a workforce development system that is inherently customer-centered, seamless and effective. The mission is to establish a workforce system that provides data-driven and employer-validated talent solutions through the integration of education, workforce and economic development resources across the systems. Its vision is assisting individuals in obtaining employment.

West Virginia’s American Job Centers (AJC’s)/One-Stops are currently located within the local Workforce centers in West Virginia. All SCSEP information is disseminated throughout the AJC for other programs and to the general public. The WV Statewide SCSEP network will continue to work closely with the AJC’s to utilize the partners’ resources that are tailored to SCSEP’s target audience by co-enrolling and by providing SCSEP’s program eligibility requirements, priorities and training slots availability. SCSEP will continue to have a weekly presence at the AJC/One-Stop. The Statewide SCSEP network will continue to require enrollment of SCSEP enrollees into the Local Workforce to ensure that enrollees are abreast of employment opportunities in their areas. The network will also continue to utilize all trainings and job fairs that are offered at the Local AJC’s and will also participate/relay information from other resources outside of the AJC’s One-Stop Partners. The WV Statewide SCSEP network will also encourage enrollees who are approaching their durational limit to enroll in other training programs to ensure a continuous improvement of skills that enrollees receive. As needs become prevalent, the WV Statewide SCSEP network will encourage AJC’s to become Host Agencies and/or consider enrollees for employment opportunities.

One of the barriers with the AJC’s/One-Stop Centers in West Virginia is that they are underutilized. A solution to improve coordination with the One-Stop delivery System would be to coordinate data information sharing with local Workforce West Virginia offices to obtain information on age-eligible persons who visit the AJC.

The Bureau is a member of the Interagency Collaborative Team (ICT), which is comprised of leadership representing workforce target groups. One of the primary goals of this group is to enhance communications, resource sharing and program standardization. Additionally, the Bureau sits on the WV Workforce Development Board, which is comprised of key state players within the workforce arena, including legislators, members of the Governor’s Cabinet, labor leaders and corporate representatives. The main purpose of this group is to approach the system-based issues that require changes in law or formal regulations pertaining to workforce initiatives. As stated, these entities are comprised of private and public key stakeholders. The WV Statewide SCSEP network will continue to maintain relationships and participate in meetings and events to guarantee that SCSEP is considered for program partnership, employment opportunities for enrollees and ultimately remains relevant in discussions regarding barriers to employment. The Bureau will remain an advocate for Older Workers in these groups.

Partnerships will be increased with organizations that provide resources on how to alleviate employment barriers throughout the state, such as transportation, age discrimination, fear of health care being discontinued due to program participation, fear of losing subsidized housing benefits, just to name a few. The Area Agencies on Aging (AAAs) who contract with county aging providers continue to be utilized and researched to determine what additional employment barriers seniors in rural/urban counties might face. Furthermore, the Bureau will take a more active approach with reaching out to AAA’s to also determine additional resources and/or training opportunities that may be available in covered areas.

The WV Statewide SCSEP network will continue to utilize the Labor Market Information (LMI) data that is county specific to ensure that enrollees are receiving the most updated training to warrant eligibility for those high demand occupations in growing industries as discussed in the “Economic Projections” of this report. Ultimate goal for enrollees is that when they leave the program, they will be better off than when they entered. Workforce WV provides quarterly information regarding the job market, as they are the clearing house of employment opportunities for State, Private and non-profit sectors. This information will be researched by the Grantee to ensure that Sub-Grantees are providing enrollees with the essential tools needed to be marketable. Also, resources such as O*net Online will be utilized to determine the necessary skills needed for different occupations that enrollees may be interested in.

Long-Term Strategy to Engage Employers to Place Participants in Unsubsidized Employment West Virginia’s local SCSEP projects will continue to recruit public and non-profit organizations in the communities that are covered. Local Projects will continue to advocate for older workers through presentations, brochure dissemination, poster dissemination, job fair and community events participation and increasing awareness of program vision and mission to community stakeholders. We will also utilize social media as a resource to engage employers by showcasing SCSEP enrollees’ skills.

Local SCSEP projects train participants to help develop the skills and experience necessary to be competitive in the current labor markets. Due to the longevity of organizations that participate as Host Agencies, local SCSEP projects have built a rapport with current Host Agencies and past Host Agencies where they consider enrollees for employment opportunities within their organization. They have established cooperative relationships with the local AJC and public and private employers as well. Coordination and co-location of services at the AJCs help to identify suitable job openings in high demand occupations. Local SCSEP projects will continue to build strong rapport with the communities they are in.

Long- Term Strategy for Serving Minorities under SCSEP West Virginia will continue its recruitment efforts in serving and recruiting eligible minority individuals and other eligible individuals. SCSEP projects will continue to locate offices in culturally and ethnically diverse neighborhoods (i.e., Community Centers). The SCSEP Network will continue to have a presence at events such as the West Virginia Minority Business Expo, Juneteenth Celebration and Herbert Henderson Office of Minority Affairs Listening Tours to target minority audiences throughout the state. Per the United States Census, West Virginia’s 55+ Older American population during 2010 represented 30.4 % of the overall population. Table 7a illustrates West Virginia demographics categorized by age, while 7b illustrates the overall race population in West Virginia.

Table 7 A.

Even with the overall population of minority demographics representing 5.5 % of the entire state, WV Local SCSEP projects are able to capture a high percentage of minority representation. Table 8 illustrates the minority representation currently in the program, captured from the SPARQ database.

Table 8 (Source InfoSPACE, Grantee by Dimension, Race, PY 2018 Final)

Community Service Needs SCSEP has a two-fold approach: helping Older Americans reacclimate themselves back into the workforce with the skills and training needed to be more marketable in the workforce and helping the communities that the program is in. The participant training hours support social services and other services provided in communities throughout the State.

West Virginia’s top occupations per the West Virginia Workforce, Labor Market Information (LMI) 10-year projections of high demand occupations that require minimum education that fit our SCSEP participants’ education and training levels include the following:

Bus Drivers, Transit and Intercity Customer Service Clerks Social and Human Service Assistants Community Health Workers Animal Caretakers Post-Secondary School Home Health Aides Rehabilitation Janitors Counter Attendants With these projections, Host Agency (H.A.) training site recruitment will focus more on entities that will develop skills for these high demand jobs. Also, to ensure that SCSEP’s two-fold approach is being accomplished, local SCSEP projects will continue to research non-profits and Government agencies in the counties that are covered to asses if there is a need. Recruitment of entities such as the West Virginia Department of Agriculture where they have programs such as Veterans and Warriors to Agriculture and Rural Rehabilitation programs that need participants will be utilized.

Recruiting of Host Agencies (H.A.) is currently accomplished by relationships with past and current H.A., great rapport with the American Job Centers (AJC’S), attending meetings, community events, job fairs, health fairs and presenting on behalf of SCSEP. Other avenues of recruitment include marketing campaigns, where Project Directors market SCSEP services and the skills of job ready participants to organizations. Word of mouth is also utilized to recruit host agencies.

Local SCSEP projects will continue to utilize Senior Centers, Aging & Disability Resource Centers (ADRN), OAA programs, AJC’s, and one-stop partners to determine the need in the counties and will continuously refine the strategy for job development to guide employer outreach and participant readiness.

Long-term Strategy to Improve SCSEP Services The strategy to improve SCSEP services within the State is to do the following:

Marketing Campaign- not only disseminate information regarding SCSEP but also promote the program at key meetings to educate organizations of the Mission and Vision Reach out to hiring entities to discuss SCSEP Exchange information regarding eligible Older Workers with AJCs AJCs become H.A.

Encourage cross training in training opportunities for enrollees Inclusion within the WIOA State Plan Provide more incentives, such as drug screenings, criminal background checks for hiring entities Develop relationship with State DHHR to improve requirements for SCSEP target audience (i.e. Medicaid allotment of income)

Revise goals with DOL to reflect actual program funding Increase funding to provide more trainings for enrollees Increase H.A. recruitment for a variety of training opportunities These recommendations will strengthen the SCSEP program within the State, affording not only potential and current enrollees’ opportunities, but also strengthening the organizations that work with the program.

Regarding the long-term changes in the use of grantee and program operators to better achieve goals, the SCSEP network, with its sub grantees, continuously refines its expertise on the basic elements of job development by staying abreast of the many barriers that eligible enrollees face. By trying to alleviate these barriers, Sub-Grantees are continuously assessing skills of participants, revamping Individual Employment Plans, offering additional resources, preparing for exit, resume revamping through workshops and offering one-on-one interaction with SCSEP Staff. As new barriers arise, grantee staff will adapt and provide resources.

Strategy for Continuous Improvement in Entered Employment of Performance The entered employment performance goal continues to be a challenge. During PY 18, the Core Performance measures were revamped from being measured as Common Measures Entered employment and Common Measure Employment Retention to now Employment Rate 2nd and 4th quarter after exit. This major change came about with the Interim Final Rule (IFR) SCSEP Performance Accountability that was issued by USDOL/ETA on December 1, 2017. The purpose of the New Core Measures appears to be an alignment of SCSEP performance data with Workforce Innovation and Opportunity Act (WIOA) performance data to provide usable data comparisons between the programs. Prior to the adjustment, the rate of meeting the projected goals fluctuated. Table 9 reflects the variance during each PY.

Table 9 (Source: Infospace, Core measures, entered employment Sub-grantee)

After the modification of the goals, it was evident that the employment goal/retention needed much improvement and was a barrier that the program faced. During PY18, the target goal that was set forth by DOL during the 2nd quarter after exit was 41.7% and the 4th quarter after exit goal was 35.6%. Table 10 reflects the performance during the final quarter of PY 18.

Table 10 Measure Goal Rate % of Goal Met Employment Rate 2nd Quarter after Exit 41.7% 14.3% N= 5 D=35 34.3% Employment Rate 4th Quarter after Exit 35.6% 8.0% N=2 D=35 22.5% (Source: Quarterly Progress Report. PY18 Final)

Due to the performance during PY18, our approach moving forward is to ensure that the program, specifically the employment aspect of the program, has continuous improvement. The following strategy must be implemented:

Ensure that Sub-Grantees are aware of the LMI high-demand positions Provide adequate training for enrollees Increase accountability of job search log of enrollee Continue and increase partnerships with hiring entities to ensure that enrollees are being considered Increase H.A. sites to provide a variety of training opportunities Collaborate with other employment programs Increase program outreach and program resources Revamp individual employment plan (I.E.P) of individuals to ensure job search complies with employment plan Another barrier that was identified is the majority of SCSEP’s target audience have supplemental insurance, reside in subsidized housing, and/ or receive Social Security Benefits, and because of this factor, the likelihood of them obtaining employment at the completion of the program is very slim. This is due to the fear that benefits will be lost and adjusted. Another strategy would be educating enrollees regarding employment and their current benefits. Eligible seniors want to work but are apprehensive.

SECTION 4. Location and Population Served, Including Equitable Distribution Localities and Populations Most in Need of the Type of Projects Authorized by Title V Most recent West Virginia U.S. Census data shows the 2010 total population for the state of WV at 1,852,994. The population of individuals who are the SCSEP target audience, 55+, shows 562,229, which is 30.4 % of the total population. Of this population, an estimate of 27.7% are at poverty rates for families and people for whom poverty status is determined.

WV partners with a plethora of State and non- profit organizations that play the role of Host Agencies (H.A.). Majority of our H.A. are unable to hire additional help within their organizations due to the limit in funding, but they express that help is needed. H.A. range from local municipalities to State agencies to a local YMCA. All H.A. are essential to the overall success of the program, as they provide the hands-on training that is needed and vital to the program.

Within the SCSEP, priority of service is offered to the following individuals: o Veteran or a Spouse of a Veteran o 65 Years or Older o Has a Disability o Has Limited English Proficiency o Low Literacy Skills o Resides in Rural Area o Low Employment Prospects o Homeless or At Risk of Homelessness o Failed to Find Employment After Utilizing Services Provided Under Title I o Severely Low Employment Prospects and Living in an Area of Persistent Unemployment Equitable Distribution Changes from Prior Year Within West Virginia, there were two SCSEP providers covering 451 authorized positions during PY18. Modified positions during PY18 were 367 statewide. Currently, West Virginia has one National Grantee, National Council on Aging, and one State Grantee, West Virginia Bureau of Senior Services, that comprise the Statewide SCSEP Network. These grantees are experienced SCSEP administrators and are respected, capable partners. The Sub Grantee has created well-established relationships with host training sites, employers, supportive service resources and training providers.

Among these providers, they cover all 55 counties in WV. The distribution of authorizations is based on the Equitable Distribution as provided by U.S. DOL, which identifies each county’s percentage of the state’s program-eligible population.

In 2016, SCSEP held a national competition, which resulted in one National Grantee being eliminated. Due to the elimination of the National Grantee, slot allocations changed, and the National Grantee, NCOA inherited all allocated slots of the eliminated National Grantee. Table 11 represents the Authorized Positions that each grantee had for the past four Program Years. Table 12 goes more in-depth, showing how the counties are distributed among the 55 counties that are covered in West Virginia.

Table 11 Grantee 2016 Q4 Authorized Positions (AP) 2016 Q4 Modified Positions (MP)

2017 Q4

AP 2017 Q4

MP 2018 Q4

AP 2018 Q4

MP AP

MP NCOA

N/P STATE

(Source-Information obtained from SCSEPed.org Authorized and Modified Positions by State Q4) *N/P- Not provided Table 12 Equitable Distribution Imbalances and Corrective Steps Equitable distribution imbalance is caused by many factors, as shown below, that cause a variance in the slots in the Statewide SCSEP Network. The main variance factor in West Virginia is minimum wage. Due to the rising minimum wage and funding, the number of participants who can be assisted are affected by this factor, and slots must be adjusted. In order to achieve the Modified Positions goal with the factors at hand, the SCSEP Network would have to minimize participant hours to accommodate more participants.

Another cause for imbalance/variance is the State’s layout. Majority of our counties are categorized as rural counties and because of this, there are many barriers such as:

Transportation Limited training site opportunities Limited hiring entities Over income seniors Small applicant pool Unaware of program As a State, we want to ensure that we are fully enrolled and want to minimize any variance in SCSEP’s equitable distribution enrollee count. How we will attain this goal is by continuing partnership with local WorkForce offices, continue and increase outreach in areas that are under enrolled while curtailing areas that are over enrolled and begin the discussion of interchanging information among National and State Grantees to fulfill the equitable distribution of all urban and rural counties that are under enrolled.

The State’s Long-Term Strategy for Achieving Distribution of SCSEP Positions within the State West Virginia is divided into 55 counties. The State and National Grantee covers 13 urban counties collectively, with the remaining counties being consider rural. Based on the 2016-2018 Persistent Unemployment data, 36 of the 55 counties in West Virginia are considered having persistent unemployment. Of the 42 rural Counties, 31 show as having persistent unemployment. As stated previously, rural communities face a multitude of barriers. To alleviate the imbalances, the SCSEP Network will continue and increase outreach (i.e., brochures, posters, partnerships and presentations) efforts in the rural counties to ensure that non-profits and government entities are aware of the program.

The State of West Virginia SCSEP Grantee has no authority to move national grantee positions within the state; however, constant contact is maintained with the National. Conversations and recommendations to alleviate variances will continue to be discussed within the statewide SCSEP Network.

Program regulations require SCSEP Grantees to give priority service to individuals with one or more of the following characteristics:

Veteran or a Spouse of a Veteran 65 Years or Older Has a Disability Has Limited English Proficiency Low Literacy Skills Resides in Rural Area Low Employment Prospects Homeless or At Risk of Homelessness Failed to Find Employment After Utilizing Services Provided Under Title I Severely Low Employment Prospects and Living in an Area of Persistent Unemployment The statewide SCSEP Network employs the following tactics to ensure that individuals who meet the criteria above are targeted:

Outreach Materials (brochures and posters) are strategically placed at locations that target our priority of service audience (i.e. Veteran’s Hospitals, shelters, library, rehab disability office etc.)

Locates offices in culturally and ethnically diverse neighborhoods Targets AJC’s Presents and collaborates with entities that target low income populations Collaborates with National on successful tactics utilized Ratio of Eligible Individuals in Each County and State Total Eligibility Population Tables 13 depicts the ratio by percentage of eligible individuals in each service area to West Virginia’s total SCSEP eligible population.

Relative Distribution of Eligible individuals West Virginia continuously utilizes resources to ensure relative distribution is provided to specific individuals throughout the state. Tables 14-18 illustrates the variation of characteristics that are barriers to employment throughout the state, such as rural locations, greatest economic (income) and social need (75+, language barrier, live alone), limited English proficiency and minority rate in West Virginia. The SCSEP Network will continue its efforts in recruiting these individuals who are most in need of SCSEP benefits and priority of service. The SCSEP network’s main goal is to ensure that adequate training is provided to current and past enrollees by providing substantial training opportunities to those most in need to ultimately have the enrollees leave the program more equipped than when they started.

Avoid Disruptions In the event new providers are entered into the state, be it National Grantee or State Grantee, we will utilize the Equitable Distribution to ensure that slots are distributed to all grantees. To avoid disruptions to current participants, a conversation with all affected Grantees in the state will be required. Counties with continuous variances will be considered. For a seamless transition, enrollees will be transferred in the SPARQ database, which will allow the avoidance of disruption in service. Per Topic 81 of the SCSEP Data Collection Handbook, all records moved from the “old grantee” to the new are subject to data validation. During the transfer, we will ensure that all supporting documentation is sent via trackable delivery to the “new” grantee.

APPENDICES

Appendix A -West Virginia Area Agencies on Aging West Virginia's four Area Agencies on Aging (AAAs) are part of a nationwide network of organizations created by the Older Americans Act for the purpose of developing a comprehensive and coordinated plan that assures seniors have access to needed services and programs. The AAAs contract with county aging providers (senior centers) for the provision of meals, transportation, and other services. They also monitor the providers for programmatic and fiscal compliance.

Region I Northwestern AAA- Lynn Williams Dipasquale, Executive Director Counties Served: Brooke, Calhoun, Doddridge, Gilmer, Hancock, Harrison, Marion, Marshall, Monongalia, Ohio, Pleasants, Ritchie, Tyler, Wetzel, Wirt, Wood Region II Metro AAA – Brenda Landers, Executive Director Counties Served: Boone, Cabell, Jackson, Kanawha, Lincoln, Logan, Mason, Mingo, Putnam, Roane, Wayne Region III Upper Potomac AAA – Scott Gossard, Executive Director Counties Served: Barbour, Berkeley, Grant, Hampshire, Hardy, Jefferson, Lewis, Mineral, Morgan, Pendleton, Preston, Randolph, Taylor, Tucker, Upshur Region IV Appalachian AAA – Ramona McNeely-Stanley, Executive Director Counties Served: Braxton, Clay, Fayette, Greenbrier, McDowell, Mercer, Monroe, Nicholas, Pocahontas, Raleigh, Summers, Webster, Wyoming

Appendix B- Workforce WV Development Board

Appendix C- Delegation of Authority State Plan Letter

Appendix D- Public Comments Public Notification:

The West Virginia Bureau of Senior Services sent the attached email to the following West Virginia organizations/ agencies to request comments on the draft West Virginia SCSEP Four Year State Plan- PY 2020-2023.

The Bureau’s four Area on Aging (AAA), ADRN Sub -Grantee Preston County West Virginia’s Workforce Development Board West Virginia’s Interagency Collaborative Team National Grantee -National Council on Aging (NCOA)

West Virginia Bureau of Senior Services Providers Older American’s Act Program Medicaid Program Lighthouse Alzheimer’s SHIP/SMP State Long-Term Care Ombudsman West Virginia’s 55 county providers AARP State Director West Virginia Bureau of Senior Services’ Website Email requesting public comment:

The West Virginia Bureau of Senior Services (The Bureau) completed the draft of the West Virginia Senior Community Service Employment Program (SCSEP) State Plan – PY 2020-2023. SCSEP is the only federally funded training program for low-income older workers who are 55 years of age or older.

The Bureau invites you to comment and provide suggestions for the West Virginia SCSEP State Plan - PY 2020-2023.

The closing date for public comment is April 8, 2020. However, comments received after the closing date will be considered if the plan is revised in the future.

The Bureau encourages you to share this plan with your stakeholders, board members, and workforce partners. The Bureau welcomes suggestions from our local workforce partners.

The plan is located on the Bureaus’ website (http://www.wvseniorservices.gov/). To review the plan, please use the following link: https://apps.sos.wv.gov/adlaw/csr/readfile.aspx?DocId=53023&Format=PDF Instructions for submitting comments:

Thank you for your consideration, Myisha Robinson Myisha R. Robinson Director, Title V Senior Community Service Employment Program (SCSEP)

WV Bureau of Senior Services 1900 Kanawha Blvd, East Charleston, WV 25305 304-558-3317 Summary of Comments

Appendix E- Occupational Demand

Appendix F- Top 15 Occupations in Demand

Appendix G- Population by Age Group

Appendix H – Labor Force Participation by Age Group

Appendix I- Average Turnover Rate by Age Table of Contents The top five occupations with the greatest projected annual growth rate within WIOA Region 1 are all healthcare related. These include Home Health Aides; Occupational Therapy Assistants, Nurse Practitioners, Physician Assistants, and Personal Care Aides.

Occupations with the greatest rate of annual decline in the region include Photographers; Data Entry Keyers; Switchboard Operators, Including Answering; Legal Secretaries; and Executive Secretaries and Executive Administrative Assistants.

All of the top five occupations with the greatest projected annual growth rate within WIOA Region 2 are healthcare related. The top five consists of Occupational Therapy Assistants; Nurse Practitioners; Physician Assistants; Physical Therapy Assistants; and Massage Therapists.

The five occupations with the greatest annual rate of decline include Legal Secretaries; Mine Shuttle Car Operators; Switchboard Operators, Including Answering Service; Executive Secretaries and Executive Administrative Assistants; and Labor Relation Specialists.

Healthcare Occupations lead the pack in the list of occupations with the greatest projected annual growth rate in WIOA Region 3. This group contains Personal Care Aides; Occupational Therapy Assistants; Nurse Practitioners; Physician Assistants; and Operations Research Analysts.

Occupations Leading declines in WIOA Region 3 include Computer Operations; Legal Secretaries; Medical Transcriptionists; Data Entry Keyers; and Switchboard Operators, Including Answering Service.

WIOA Region 4 Occupational Employment Projections 2016-2026 Healthcare Occupations lead the pack in the list of occupations with the greatest projected annual growth rate in WIOA Region 3. This group contains Personal Care Aides; Occupational Therapy Assistants; Nurse Practitioners; Physician Assistants; and Operations Research Analysts.

Occupations Leading declines in WIOA Region 3 include Computer Operations; Legal Secretaries; Medical Transcriptionists; Data Entry Keyers; and Switchboard Operators, Including Answering Service.

WIOA Region 4 Occupational Employment Projections 2016-2026 Occupations with the most projected annual growth in WIOA Region 4 include Home Health Aides; Personal Care Aides: Nurse Practitioners; Occupational Therapy Assistants; and Respiratory Therapists.

The greatest annual rate of decline will be seen among Legal Secretaries; Executive Secretaries and Executive Administrative Assistants; Medical Transcriptionists; Labor Relations Specialists; and Floral Designers.

Occupations with the greatest projected annual growth rate within WIOA Region 5 include Home Health Aides; Personal Care Aides: Nurse Practitioners; Physician Assistants; and Software Developers, Applications.

Occupations with the greatest declines in the annual growth rate include Data Entry Keyers; Legal Secretaries; Mine Shuttle Car Operators; Mail Clerks and Mail Machine Operators, Except Postal Service; and Labor Relations Specialists.

Occupations with the greatest projected annual growth rate in WIOA Region 6 include Home Health Aides; Personal Care Aides; Nurse Practitioners; Software Developers, Applications; and Statisticians.

Occupations with the greatest declines in the growth rate include Data Entry Keyers; Legal Secretaries; Executive Secretaries and Executive Administrative Assistants; Mine Shuttle Car Operators; and Medical Transcriptionists The top five occupations with the greatest projected annual growth rate in WIOA Region 7 include Nurse Practitioner; Coating, Painting, and Spraying Machine Setters, Operators, and Tenders; Personal Care Aides; Healthcare Social Workers; and Software Developers, Applications.

Occupations with the greatest declines in annual growth in the regions include Legal Secretaries; Executive Secretaries and Executive Administrative Assistants; Assemblers and Fabricators, All Other; Team Assemblers; and Floral Designers.

The top five occupations with the greatest projected annual growth rate in WIOA Region 7 include Nurse Practitioner; Coating, Painting, and Spraying Machine Setters, Operators, and Tenders; Personal Care Aides; Healthcare Social Workers; and Software Developers, Applications.

(Source: 2010 United States Census, https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_DP_DPDP1&prodType=table)

(Source: SCSEPED.org, WV, PY 19)

(Source: https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_17_5YR_B17024&prodType=table AGE BY RATIO OF INCOME TO POVERTY LEVEL IN THE PAST 12 MONTHS)

Table 13-Ratio as a Percentage of Eligible Individuals in Each Service Area (Source: https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_17_5YR_B17024&prodType=table AGE BY RATIO OF INCOME TO POVERTY LEVEL IN THE PAST 12 MONTHS)

(Source: Census Bureau, AFF, B01001A-I, ACS 5 yr. est. 2013-2017)

Table 14- depicts 55+ Races in all West Virginia Counties (Source: U.S. Census Bureau: ACS B01001A-E, I 5yr Est. 2017)

(Source: Census Bureau P2 urban/rural, P1 Total population 2010, Table DP02 ACS 5yr disability & living alone, Table B01001 ACS 75+)

Table 15- Greatest Social and Economic Need all Counties (Source: Census Bureau ACS S2301 Table 16 Unemployment Rate 55+ all Counties Table 17: Limited English Proficiency all Counties (Source: B16004: AGE BY LANGUAGE SPOKEN AT HOME BY ABILITY TO SPEAK ENGLISH FOR THE POPULATION 5 YEARS AND OVER - Universe: Population 5 years and over) ******for this instance, only 65+ data (except the Total column) was used to better represent our target audience * Estimates are unreliable due to confidence intervals wider than 20% or relative standard error greater than 30%.

Percentages are calculated with unknowns removed.

Table 18 A- Selected Health Outcomes & Demographics Among West Virginia Residents 55+ by County 2014-2018 (Source Table 18A-B West Virginia Health Statistics Center, Behavioral Risk Factor Surveillance System)

Table 18B Figure 8: Pie Chart of Top 10 Occupational Groups 2018-2020 (Pie Chare is divided into ten sections and contains employment numbers for these largest occupational groups.)

The top job openings by occupational group reported by Workforce West Virginia in 2018 include Office and Administrative Support Occupations, Transportation and Material Moving Occupations, Construction and Extraction Occupations, Production Occupations, and Building and Grounds Cleaning and Maintenance Occupations. West Virginia employers were seeking workers to fill such positions as Customer Service Representatives, Stock Clerks, Tellers, Medical Secretaries, Drivers/ Sales Workers, Heavy and Tractor-trailer Truck Drivers, Construction Laborers, Team Assemblers, Maids and Housekeeping Cleaners, Landscaping and Groundskeeping Workers, and Janitors and Cleaners.

(Source ACS 2013-2017)

The U.S. Census Bureau's 2017 5-year estimates American Community Survey (ACS) lists West Virginia's population 16 years of age and older at 1,503,051. Approximately 53.6% of this total is in the labor force. The employment to population ratio is 49.7%, while the unemployment rate for this population is 7.2%.

West Virginians age 16 to 19 are estimated to number 88,215, 34.2% in the labor force. The employment of population ratio for this group is 26.3%, and the unemployment rate is 23.0%, the highest unemployment rate among all ages. Many teenagers have difficulty finding or keeping employment because of lack of work experience, and because some employers are unwilling to hire teens due to labor laws and inconvenience of scheduling around school functions and extracurricular activities. According to Workforce West Virginia, in 2016 the number of unemployed in this age group who exhausted their unemployment benefits was 31. This number fell to 18 in 2017.

The group containing those 20 to 24 years of age is estimated at 121,171. Of these, 68.5% are in the labor force. The employment to population ratio for this group is 59.3%, while the unemployment rate is 13.4%. In 2016, 937 unemployed in this age group exhausted their unemployment benefits. In 2017, the number fell to 508.

The group containing residents 25 to 29 years old is estimated at 109, 573. The labor force participation rate is 75.7%, tied with the 35 to 44 years age group for the highest among the established aged groups. The employment to population ratio is 67.8%, while the unemployment rate for this group is 10.2%. In 2016, the number of unemployed in this age group who exhausted their unemployment benefits was 1,690. This number fell to 991 in 2017.

(Source: AMS 2013-2017)

West Virginians age 30 to 34 years are estimated at 107,256. The labor force participation rate is 75.3%, and the employment to population ratio is 69.3%. The unemployment rate is 7.6%. The number of unemployed in this age group who exhausted their unemployment benefits in 2016 was 1,791. This number fell to 1,141 in 2017.

The age group of those 35 to 44 years old contains 225,425 residents. The labor force participation rate is 75.7%. The employment to population ratio is 71.0%, the highest among the established age groups. The unemployment rate is 6.1%. The number of unemployment in this age group who exhausted their unemployment benefits and 2016 was 3,844. The number declined to 2,497 in 2017 but remained the highest among all age groups.

The group containing those ages 45 to 54 years in is estimated at 247,043. The labor force participation rate is 70.5%, and the employment to population ratio is 67.1%. The unemployment rate for this age group is 4.7%. The number of unemployed in this age group who exhausted their unemployment benefits in 2016 was 3,617. This number fell to 2,479 in 2017.

The group containing residents ages 55 to 59 is estimated at 135,068. The labor force participation rate is 60.6% and the employment to population ratio is 58.3%. The unemployment rate is 3.8%. The number of unemployed in this age bracket who exhausted their unemployment benefits in 2016 was 1,677. This number fell to 1,169 and 2017.

West Virginians aged 60 to 64 years numbered 132,974, with a labor force participation rate of 43.3%. The employment to population ratio is 41.8%, with an unemployment rate of 3.5%. The number of unemployed in this age group who exhausted their unemployment benefits in 2016 was 1,260. This number fell to 871 in 2017.

The group containing those ages 65 to 74 years of age is estimated at 196, 401, with a labor force participation rate of 19%. The employment to population ratio is 18.4%, and unemployment rate is 3.1%, the lowest among all the age groups. The number of unemployed in this age group who exhausted their unemployment benefits in 2016 was 692. This number fell to 545 in 2017.

The number of West Virginian residents aged 75 and over is estimated at 139,925. The labor force participation rate is 5.1%, and the employment to population ratio is 4.9%. The unemployment rate is 3.2%. The number of unemployed in this age group who exhausted their unemployment benefits in 2016 was 83. This number rose to 93 in 2017, the only age group to see an increase.

Turnover Rates were the highest among the age group of 14-18 years of age (29.0%) and lowest for the age group of 55-64 years of age (4.8%). Also, higher levels of education correspond with lower rates of job turnover, where in 2017, the average turnover rate of those with less than a high school diploma was 9.2% compared with 6.4% for those with a bachelor’s degree or higher.

Series 04 West Virginia State Plan for Aging Programs

W. Va. Code R. § 76-4-1 General

1.1. Scope. - The State Plan for Aging Programs includes all assurances and plans to be conducted by the Bureau of Senior Services under the provisions of the Older Americans Act of 1965, as amended. The Bureau of Senior Services is primarily responsible for the coordination of all the major responsibilities of developing and administering a comprehensive and coordinated system of services and activities for providing a positive impact on the lives of elderly people within the service area.

1.2. Authority. - W. Va. Code §16-5P-1 et. seq.

1.3. Filing Date. - June 23, 2025

1.4. Effective Date. - October 1, 2025

W. Va. Code R. § 76-4-2 Incorporation By Reference

The West Virginia State Plan for Aging Programs is hereby incorporated by reference as an interpretive rule. This document is available from the Secretary of State's Office or the West Virginia Bureau of Senior Services.

STATE OF WEST VIRG

X MONTANI SEMPER LIG

LIGERI

West Virginia Bureau of Senior Services State Plan on Aging October 1, 2025 - September 30, 2029 Aging Well in West Virginia Contents I. Verification of Intent Il. State Plan Narrative 1. Commissioner Graves Executive Summary 2. Context: Setting the Stage in West Virginia 3.

Stewardship and Oversight 4. Older Americans Act Core Services, State Supported Programs, Discretionary Grants and other Initiatives 5. Goals, Objectives, Strategies and Outcomes · Goal 1: Providing Effective and Quality Older Americans Act Core Programs · Goal 2: Targeting Services to Greatest Economic Need and Greatest Social Need · Goal 3: Expanding Access to Home and Community-Based Services · Goal 4: Improving Services and Supports for Caregivers ® Goal 5: Preparedness, Response, and Recovery III. Attachments A. State Plan Assurances and Required Activities B. Information Requirements C. Intrastate Funding Formula (IFF)

D. Geographic Boundaries- AAA/PSA E. Public Comment and Input F. Needs Assessment Report VERIFICATION OF INTENT The Older Americans Act State Plan for Aging Programs is hereby submitted by the West Virginia Bureau of Senior Services (the Bureau) for the period of October 1, 2025, through September 30, 2029. This document includes all assurances and plans to be conducted by the Bureau under provisions of the Older Americans Act, as amended (the Act), during the period identified. The West Virginia Bureau of Senior Services has been given the authority to develop and administer the Older Americans Act State Plan for Aging Programs in accordance with all requirements of the Act and is primarily responsible for the coordination of all State activities related to the purposes of the Act. The Bureau will assume full authority to develop and administer the Older Americans Act State Plan in accordance with all requirements of the Act and related State policies, procedures, and regulations. In accepting this authority, the Bureau assumes the major responsibility to develop and administer a comprehensive and coordinated system of services and activities for providing a positive impact on the lives of older people within the service area.

By submitting this Older Americans Act State Plan to the United States Administration on Community Living (ACL) for approval, the Bureau and its provider agencies agree to comply with all requirements identified in the Older Americans Act.

"I hereby execute this Verification of Intent on behalf of the Bureau. I also hereby approve this Older Americans Act State Plan for Aging Programs as the Authorized Designee of the Honorable Patrick J. Morrisey, Governor of the State of West Virginia, and submit it to the U.S. Department of Health & Human Services Assistant Secretary for Aging for approval." 6-19-2025 Commissioner Date West Virginia Bureau of Senior Services EXECUTIVE SUMMARY The West Virginia Bureau of Senior Services has been given the authority to develop and administer the Older Americans Act State Plan for Aging Programs and this State Plan details our responsibility and intended actions to carry out our duties to the seniors of West Virginia over the next four years.

West Virginia is blessed to have a provider network consisting of 55 county-based senior centers who strive to meet the needs of area senior citizens. These senior centers are generally independent, 501(c)(3) entities that operate under boards of directors who seek to better the lives of the seniors they serve. The Bureau considers its primary mission to do all within our power to get services and information to seniors who can benefit from and who need that outreach. The senior centers are the lifeblood that delivers these services to West Virginia's seniors, and the Bureau supports their efforts with information, funding, and oversight where applicable.

West Virginia senior citizens are part of an extremely rural state as well as being the fourth most elderly state in the nation. Our population is heavily at risk for needing services to allow individual seniors to stay safely in their homes if they so choose. These services may be to deal with the activities of daily living, housekeeping, shopping, cooking, and delivery of meals among many others. The Bureau aims to protect seniors by providing these services to those in need.

Part of our mission is to deliver information -- when seniors do not know what services are available, they are less able to make informed decisions about important matters that could affect their quality of life, their longevity and their contribution to society. The Bureau will re-design its website to make it more user friendly, to make available in a usable format the knowledge seniors need to make important care decisions. We will continue to promote resources for seniors such as the Long-Term Care Ombudsman Program and the Aged and Disabled Waiver Program, and we will connect seniors to important partners such as the AARP, West Virginia University, Marshall University, West Virginia State University (home of the free Healthy Grandfamilies program), and the West Virginia Attorney General's Office Elder Abuse Litigation and Prevention Unit, among others.

The Bureau believes this State Plan helps to address many of the needs of an aging population and make services available in a cost-effective manner. We will administer it to the best of our ability and conscientiously work to fulfill our mission to help West Virginian seniors.

Context: Setting the Stage in West Virginia Needs Assessment Summary and Plan Development A Needs Assessment was conducted by the Center for Business and Economic Research at Marshall University on behalf of the WV Bureau of Senior Services. This project used multiple surveys and various methods of data collection. To gather data swiftly and efficiently, three versions of the Senior Needs Survey were deployed throughout the state. Distribution methods included in person surveys (during group meals and activities), mail-in surveys, and online surveys using SurveyMonkey. Each of the three surveys almed to gather information from a different audience (Seniors, Unpaid Caregivers, Senior Center Staff) with the intent to garner information regarding the unmet needs of seniors throughout the state. This process resulted in the collection of 725 completed senior surveys, 166 completed caregiver surveys, and 124 completed senior center staff surveys. Each survey was comprised of a different set of questions geared toward the target audience. Survey results were tabulated and analyzed and can be found in completion in the appendix of this report. Survey results were distributed to Area Agencies on Aging and the State Plan development team which consists of providers from each Area Agency on Aging region in the state, and all county aging providers. State plan developers with the Bureau, each of the four Area Agency on Aging Directors and the State Plan Development Team work cohesively on plan required components and identification of the needs of seniors in West Virginia. Identified survey outcomes including obesity, mental health, suicide, social isolation, malnutrition and poverty were utilized for incorporation into objectives and strategies in both Area Plans and the State Plan Population Characteristics Looking at population growth for seniors residing in West Virginia, we see that in 2023 the US Census reported that there were 497,318 seniors (aged 60 and older) residing in the state1.

Seniors make up approximately 30.00% of West Virginia's population2. An age breakdown of these seniors can be found below.

WV Seniors Number of Seniors Percentage of Seniors (within total population)

Percentage of Seniors (within Senior population) 60-74 350,996 19.70% 70.57% 75+ 146,322 8.20% 29.42% 85+ 37,416 2.10% 7.52% Total 497,318 30.00% 1 U.S. Census Bureau, U.S. Department of Commerce. "Age and Sex." American Community Survey, ACS 5-Year Estimates Subject Tables, Table S0101, 2023, https://data.census.gov/table/ACSST5Y2023.S0101?t=Age and Sex&g=040XX00US54. Accessed on February 3, 2025. 2 U.S. Census Bureau, U.S. Department of Commerce. "Sex by Age (Two or More Races)." American Community Survey, ACS 1-Year Estimates Detailed Tables, Table B01001G, 2023, https://data.census.gov/table/ACSDT1Y2023.B01001G?t=Race and Ethnicity&g=040XX00US54, Accessed 2025.

The following tables depict WV Seniors (65 and older) by Gender.

Gender (60+)

Number of Seniors Percentage of Seniors 231,858 46.62% 265,460 53.38% Overall Health Status Looking at health outcomes for seniors in the state, we see that 59% of those ages 65-74 residing in WV in 2022 reported having three or more chronic conditions3. There were 2,526 preventable hospitalizations for seniors in 2022. Many lifestyle factors can contribute to chronic health conditions. When analyzing and comparing certain lifestyle choices of seniors we see that 35.8% of seniors are suffering from obesity. 40.4% reported that they are physically inactive. 4.9% admitted to excessive drinking and 12.9% reported that they smoke daily. Many seniors report that in addition to physical health complications they also suffer from mental health issues. 11.2% of seniors reported that their mental health was not good 14 or more days in the past month4. In addition to this, from the years 2020-2022, 24.3 seniors (aged 65+) residing in the state of WV intentionally took their own lives5. Many factors are known to be conducive to poor mental health in seniors, one of the biggest being isolation. In the Index of Social Isolation Risk Factors, seniors residing in WV received a score of 84 out of 100 with 100 equaling the greater risk. Risk factors are identified as "living alone; being divorced, separated or widowed; having never married; having a disability; and having an independent living difficulty6." When looking further at preventable death; in 2022, it was reported that 2,180 seniors in West Virgina suffered from an "early or premature death" which can also be defined as not reaching their 75th birthday. Many seniors residing in the state deal with comorbidities.

Coupling this with poverty and malnutrition leaves many seniors struggling to manage their health.

Population Growth The West Virginia Center on Budget and Policy projects that the number of seniors in West Virginia will grow at a much faster rate than any other population. They report that at this current growth rate, by 2035, the senior population will have grown by at least 150,0007. The senior population is already increasing at a drastic rate. The CDC Wonder population estimates show that West Virginia's senior population was approximately 16% in 2010. Estimates for 2023 show 3America's Health Rankings analysis of U.S. HHS, Centers for Medicare & Medicaid Services, Office of Minority Health, Mapping Medicare Disparities Tool, United Health Foundation, AmericasHealthRankings.org, accessed 2025. 4America's Health Rankings analysis of CDC, Behavioral Risk Factor Surveillance System, United Health Foundation, AmericasHealthRankings.org, accessed 2025.

"America's Health Rankings analysis of CDC WONDER, Multiple Cause of Death Files, United Health Foundation, AmericasHealthRankings.org, accessed 2025. & America's Health Rankings analysis of U.S. Census Bureau, American Community Survey, United Health Foundation, AmericasHealthRankings.org, accessed 2025. 7 https://wvpolicy.org/wp-content/uploads/2018/5/PEL_Report_7.11.12.pdf that the number is now closer to 21.5%. The image below shows senior population growth for West Virginia and the United Statesa. 230% Percentage of population Data Year Greatest Economic Need and Greatest Social Need The Bureau defines greatest economic need in policy as a need resulting from an income level at or below the federal established poverty line. Greatest social need is defined as a need caused by non-economic factors, which include: a) chronic conditions b) housing instability, food insecurity, lack of access to reliable and clean water supply, lack of transportation, utility assistance needs; c) interpersonal safety concerns d) rural location and e) any other status that restricts the ability of an individual to perform normal or routine daily tasks; or threatens the capacity of the individual to live independently.

Approximately 44,449/12.00% of West Virginia Seniors are living below the poverty level. The current state poverty level is 16.7%. Poverty increased 30% for WV seniors 65+ between 2019- 2022.

The following are a few key disparity metrics for aged 60 and older population in West Virginia9:

· 19.3% of WV Seniors 65+ are suffering from food insecurity ® 18.5% of WV Seniors 60+ are having severe housing problems # CDC WONDER, Single-Race Population Estimates 9 CDC, Behavioral Risk Factor Surveillance System ® 56.6% of WV Seniors 65+ are rural « Drug deaths for WV 65+ seniors increased 82% from 2019-2022 · The drug death rate was 5.5 times higher among black WV seniors than white WV seniors The number of 65+ minorities in West Virginia is approximately 22,301/4.17%. The table below shows a breakdown of minorities residing in West Virginia.

Race/Ethnicity Number of Seniors Percentage of Seniors White/Caucasian 357,766 94.11% Black/African American 8,605 2.26% American Indian/Alaska Native 0.04% 1,025 0.27% Native Hawaiian 0.02% 1,520 0.40% Two or More Races 11,003 2.89% Hispanic/Latino(a) 3,601 0.09% Stewardship and Oversight The West Virginia Bureau of Senior Services stewardship and oversight processes consist of internal quality measures, county aging provider network monitoring, plans of correction, data collection, analysis and reporting. These processes serve as the basis for qualitative and quantitative performance assessments and continuous improvement of services, organizational capabilities, targeting services and populations, ensuring efficient programming and quality management.

WV Bureau of Senior Services Internal Quality Measures The WV Bureau of Senior Services has established internal quality measures and a foundation for performance management utilizing Employee Performance Appraisals from the WV Division of Personnel. Employee appraisals include employee responsibilities, performance goals and standards, performance improvement strategies, measures, expectations and objectives to be accomplished. Meetings are held at specific time periods throughout the year with employee supervisors to discuss, evaluate and address work performance.

County Aging Provider Network Monitoring and Plans of Correction The West Virginia Bureau of Senior Services utilizes Area Agencies on Aging, State Program Directors and a registered dietician to conduct annual county aging provider monitoring of aging programs and services. Provider monitoring is conducted on site and/or via desktop review for each program/service provided by each county aging provider. Monitors utilize WV Bureau of Senior Services monitoring tools that evaluate and assess key requirements for aging service programs, interviews with service recipients and interviews with agency staff. Based on findings, monitoring reports are developed and provided to county aging providers and their boards of directors. Findings of non-compliance with policy and requirements call for the county agency provider to submit a Plan of Correction for review and approval. Non-compliance with policy and requirements may also result in additional monitoring, repayment of reimbursed funds, the addition of special conditions and/or involuntary closure. Area Agencies on Aging also monitor financial operations components during annual reviews. They monitor policies and processes related to accounting procedures, travel, purchasing, payroll, cost allocation, invoices for NSIP compliance, invoices and SAMS, indirect cost allocation, conflict of interest, audits, internal checks and balances on banking processes and signatures, grant management, budget revisions, agency by-laws and board minutes. They also utilize a Risk Evaluation Matrix tool to assess risk level. The matrix has indicators to assess low risk, moderate risk and high risk related to staff qualifications, staff turnover, program deliverables, fiscal reporting, funding utilization, audit findings, contracts and commercial relationships, and internal controls.

Area Agencies on Aging also provide onboarding training for all new executive agency staff. The Bureau provides ongoing training via provider communication and various virtual and in-person meetings.

Data Collection, Analysis and Reporting The West Virginia Bureau of Senior Services utilizes WellSky's Social Assistance Management System (SAMS) to meet U.S. Administration on Aging State Program reporting requirements.

The Bureau administers numerous state and federal programs, and reporting requirements for these programs are met through the use of applications from WellSky (SAMS). The WV Bureau of Senior Services functions as the administrator of the state-wide SAMS database and provides ongoing technical support and training to area agencies and county aging providers. Users access SAMS through the internet and web browser. The Bureau utilizes and maintains a single statewide database to prevent duplication of data and effort. The benefits of this system include the capacity to track multiple service programs and consumers who receive services from multiple programs. Area agencies and providers throughout West Virginia can access provider and consumer data for care coordination, planning, contract oversight and reporting. The Bureau utilizes SAMS data to identify trends, gaps, targeted population provider/county issues and systemic issues which may result in quality improvement projects and remediation plans.

Older Americans Act Core Services, State Supported Programs, Discretionary Grants and other Initiatives The Bureau, the designated State Unit on Aging (SUA), offers seniors and those with disabilities a vast array of services and supports through coordinated efforts between four regional AAA offices, three (3) regional ADRCs, fifty-seven (57) county aging providers in fifty-five (55) counties, and a multitude of other partner agencies. The following are summaries of the Bureau's current programs and services.

OAA Core Programs, Services and Supports Nutrition Program The OAA Title Ill nutrition program provides nutritious meals to address a multitude of issues and is critical to providing seniors with the opportunity and ability to remain in their own homes. As often stated, it is not just a meal. This program addresses issues of malnutrition, food insecurity and hunger and just as importantly, socialization and participation in programs such as evidencebased disease prevention and health promotion. Nutrition programs are in each county of West Virginia, with approximately 136 congregate locations statewide. Hornedelivered meals are provided in each county to individuals who have difficulty for various reasons leaving their home and attending a congregate meal site Home-delivered meal participants are also encouraged to attend congregate meal sites if possible, and doing so is celebrated. This "flexibility" has been in West Virginia Title Ill policy since 2018 Supportive Services Program OAA Title IIIB supportive services programs offer many important services and supports, A critical service in West Virginia that is targeted in State Plan objectives/strategies is transportation. West Virginia is primarily rural, and much of the state lacks access to public transportation systems or transportation network companies such as Uber and Lyft.

There are many liIB services/supports offered throughout the aging network. These include personal care, homemaker, adult day care, chore, assisted transportation, transportation, information & assistance, outreach, public information/education, and other services group client support and individual client support.

Evidence-Based Disease Prevention and Health Promotion National Family Caregiver Support Program West Virginia county aging providers provide a multitude of evidence-based programs lo seniors in their counties to address chronic health conditions and implement self- management strategies. Programs offered include A Matter of Balance, Bingocize, Chronic Disease Self-Management, Drums Alive, Tai Chi for Arthritis for Falls Prevention, Tal JI Quan: Moving for Better Balance and Walk with Ease. The Bureau, AAA's and county aging providers will continue to focus its wellness programs and initiatives on addressing the high rates of chronic diseases prevalent in WV, including diabetes, heart disease, obesity, cancer and COPD The OAA Title IIIE Caregiver Program provides services and supports to caregivers of older adults in West Virginia and older relative caregivers. With West Virginia's aging population, the need for both services continue to grow. West Virginia _formerly offered older relative caregiver services via the Healthy GrandFamilies program. This service is now being offered through the county aging providers. Services offered include information and assistance, public information/education, training, support groups, in-home respite and out-of-home respite. West Virginia county aging providers operate fifty-seven_comprehensive senior centers throughout fifty-five counties statewide, Many of these senior centers have multiple satellite sites within their counties, for a total of over 136 locations that offer OAA services and supports County aging providers offer Title III OAA nutrition, transportation, in-home care outreach, wellness activities, socialization and a variety of other services and supports Many also offer other services such as Medicaid Waiver, Medicaid Personal Care, veterans services, Head Start, weatherization programs, Healthy GrandFamilies, and many others.

Senior Centers Legal Services The legal services program is contracted through West Virginia Senior Legal Aid, Inc., which focuses on serving economically and socially disadvantaged, disabled, and rural seniors. West Virginia Senior Legal Aid employs one staff attorney and an administrative assistant. Legal counsel Long-Term Care Ombudsman (LTCOP) provides legal advice, information and referrals on matters affecting West Virginia seniors, and, in appropriate cases, provides in-court and out-of-court full or limited legal representation for civil matters facing West Virginie seniors. West Virginia Senior Legal Aid serves seniors without imposing income requirements to qualify for such services, thereby enabling West Virginia Senior Legal Aid to serve a senior who may not qualify for legal services from Legal Aid of West Virginia ~ the state's Legal Service's Corporation ([SC) because of the LSC's Income guidelines. West Virginia Senior Legal Aid's toll-free telephone voicemail and its email are accessible 24/7/365 for inquiries and other communications, and its office is open for in-person legal services by appointment West Virginia Senior I egal Aid also publishes informative articles each month on its website and in West Virginia newspapers, and it works cooperatively with other state agencies and service providers to advance and protect the rights and interests of West Virginia seniors The Long-Term Care Ombudsman Program advocates for residents of long-term care facilities -- nursing homes, assisted living residences, legally unlicensed homes, and similar care homes. The mission of the Ombudsman Program is to enhance the quality of life, improve the level of care, protect the individual rights, and promote the dignity of each long-term care resident. This often involves educating residents, their families and/or legal representatives, and providers about residents' rights. The Ombudsman Program operates statewide in nine separate regions, each having a paid regional ombudsman and, in some Instances, one or more volunteers. Program staff also include the state ombudsman, the regional program director/volunteer coordinator, and an attorney. The ombudsmen _investigate complaints made by or on behalf of long-term care residents, work with resident councils, participate in communily educalion sessions, conduct training for facility staff on the topics of resident rights, abuse and abuse reporting, and provides telephone consultations to individuals in the community and for facility staff.

State Programs, Services and Initiatives Family Alzheimer's In-Home Respite (FAIR)

FAIR is a state-funded (WV Lottery) program created by the Bureau in 2006 and available in all fifty-five (55) counties, FAIR provides up to sixteen (16) hours of respite per week for family caregivers of Individuals with Alzheimer's disease or a related dementia, based on need and availability of workers. Direct care workers employed by county aging providers receive required dementia care training before they can provide FAIR services Workers give caregivers a needed break from the responsibilities of caregiving and, at the same time, offer stimulation and socialization to individuals with dementia. FAIR is fee-for-service based on the income of the care receiver (and spouse when there is one), with a minimum fee of $1.50 per hour. In 2024, FAIR provided 169,344 hours of service to 1,176 caregivers and persons with Alzheimer's disease of a related dementia Monitoring FAIR is ongoing to ensure that the program is adhering to program guidelines and effectively serving as many families as possible statewide Lighthouse The Lighthouse Program is a state-funded (WV Lottery) personal care service to assist seniors with functional needs in their homes. It is for seniors who do not qualify for Medicaid in-home care programs, Services are provided by a trained caregiver who is employed by a county aging provider. Service recipients contribute to services based on their monthly income minus medical expenses. A client can receive up to sixty (60) hours of service each month, including personal care, meal preparation, mobility assistance, and environmental tasks. To participate in the program, an individual must be a citizen of West Virginia, be at least sixty (60) years old and meet the functional eligibility criteria established by the Bureau in this seventeenth year (2024) of the Lighthouse Program, 1,699 senlors received 487,495 hours of service. As with FAIR, payment for Lighthouse services is on a sliding fee scale, based on the income of the service recipient (and spouse ) and funds are used to Aging & Disability Resource Centers (ADRC's) Legislative Initiative for the Elderly provide additional hours of service in the county where they are collected. Aging & Disability Resource Centers aim to streamline access to long-term care services and supports by offering_a_centralized resource_for _information, referrals and assistance West Virginia operates three regional ADRC's in four offices across the state. ADRC's provide information to individuals regarding long-term services and supports and many other resources. They employ certified, professionally trained Community Resource Specialists to help individuals with eligibility applications, referrals to programs, and unbiased Information on services and resources to enable individuals to make Informed decisions. Legislative initiatives for the Elderly (LIFE) are funds appropriated by the Legislature through lottery funds that are allocated based on legislative instruction. Funds are distributed equally to Title IIIB program providers each state fiscal year. County aging providers may use Life monies for operational costs (i.e, rent, utilities, facility insurance, repairs, kitchen equipment) or for Title Ill services as well as state funded Lighthouse and FAIR services Funds used for services must adhere to all program/service policies for which they were used and any program Income received must be used to provide additional services for the service for which they were received Mission WV: Relatives as Parents Program Funding provided to Mission WV, a non-profit organization that has developed networks, support groups, trainings and resources (legal, educational, social) for relatives who are raising children for other family members. Special projects through this project have funded a Legal Guide and Resource Guide for kinship care providers. Mission WV also staffs a toll-free line that offers resource information and support by a licensed social worker Seniors Farmers Market Nutrition Program This program is administered through the WV Department of Agriculture (DOA) through a federally funded grant. The Bureau has a Memorandum of Understanding (MOU) to work with DOA and county aging providers to provide low-income seniors with access to locally grown fruits, vegetables, honey and Person-Centered & Trauma Informed Care herbs, and to increase the_domestic consumption of agricultural commodities through farmers markets and roadside stands Person-centered care has been an initiative within aging services for many years. County aging providers are knowledgeable and strive to focus on the individual, their preferences, values and needs. It has been a core component of guidance and required training component within policy Trauma care has also been incorporated as an initiative into policy and county aging provider training requirements Discretionary, Competitive and Congressional Directed Spending (CDS) Grants, and Governor Initiatives West Virginia State Health Insurance Assistance Program (SHIP)

West Virginia SHIP is administered by the Bureau through a grant from the Administration for Community Living and serves West Virginians receiving Medicare. The program provides free assistance from trained counselors_to_beneficiaries_by providing one-on-one in-person and/or telephone counseling. SHIP staff also provides educational group presentations and uses media resources __ for _outreach Information is provided to beneficiaries, their families, and caregivers on a variety of Medicare topics, including assistance with prescription medications, preventative services, Medigap policies, Long-Term Care insurance plans, and Medicare Savings Programs. SHIP counselors also help in applying for low-income programs to help with Medicare premiums and drug costs The SHIP statewide toll-free number is answered by trained counselors located throughout the stale, Counselors are located in County Aging Program locations, Aging and Disability Resource Centers, and the Bureau of Senior Services.

West Virginia Senior Medicare Patrol (WV SMP)

West Virginia Senior Medicare Patrol (WV SMP), through a grant from the Administration for Community Living, empowers and assists Medicare beneficiaries, their families, and caregivers lo prevent, detect and report health care fraud, errors, and abuse through outreach counseling, and education, WV Medicare for Patients and Providers (MIPPA) Senior Community Service Employment Program (SCSEP)

SMP conducts outreach and education through group presentations, exhibits at events, and works one-on-one with Medicare beneficiaries. WV SMP uses volunteers, in kind team members, and paid staff to help carry out the mission and goals of the SMP program WV SMP receives beneficiary complaints about fraud, errors, and abuse and helps to refer suspected fraud or abuse to appropriate stale and federal agencies for further investigation All three MIPPA grant funding priorities from the Administration for Community Living are overseen by the WV Bureau of Senior Services with the State SHIP director serving as the lead contact. MIPPA funding helps provide outreach and assistance to Medicare beneficiaries with limited Income and assets. MIPPA trained counselors help educate beneficiaries about the Low-Income Subsidy (LIS) program for Medicare Part D, Medicare Savings Programs (MSPs), and Medicare Preventive Services. They also provide one on one application assistance to eligible Medicare beneficiaries to help them apply for these programs The SCSEP is a training program that provides older West Virginians with the skills needed to obtain employment. Targeting those aged fifty-five (55) and older who live at or below 125% of poverty, the SCSEP places seniors al non-profit organizations and state agencies for up to forty-eight (48) months, where they acquire on-the-job skills that will enable them to find gainful employment. The Bureau administers the SCSEP via a contract with the U.S. Department of Labor, For federal program year 24, the Bureau contracted with Preston County Senior Citizens, Inc., in Kingwood, WV, which worked directly with seniors in eleven (11) counties across the state. Remaining counties participate in the SCSEP through the National Council on Aging During program year 2023, Preston County Senior Citizens, Inc , provided support to one hundred eighteen (118) people, By Quarter 2, five (5) individuals achieved unsubsidized employment after exit and by Quarter 4, nine (9) Individuals achieved unsubsidized employment. During enrollees Take Me Home: Money Follows the Person Grant (MFP) on-the-job training, they provided 47,959 hours lo general community service groups. In state FY25 (beginning July 1, 2024), the Bureau is contracting with the Human Resource Development Foundation, Inc. (HRDF) to provide the SCSEP program in the eleven (11) counties that Preston County Senior Citizens, Inc., previously served West Virginia was awarded a Money Follows the Person (MFP) Demonstration grant by the Centers for Medicare and Medicaid Services (CMS) in 2011. West Virginia's MFP program, which is administered by the West Virginia Bureau for Medical Services (BMS), is called Take Me Home West Virginia (TMH). The purpose of MFP is to support state Medicaid programs in providing people with long-term care needs a greater choice of where to live and receive needed long-term services and support. Each state MFP program consists of two parts: (1) A transition program to identify Medicaid members living in long term care facilities (such as nursing homes) who wish to live in the community and help them do so; and (2) A rebalancing program through which states make system-wide changes to their state long-term care systems to enhance home and community-based service options for Medicald beneficiaries. BMS operates the TMH Transition program via contract with the Metro Area Agency on Aging (AAA), Metro AAA provides TMH central office staff and field staff to do outreach and education to likely eligible individuals, hospital and nursing home staff, and property managers The field stalf are regional teams consisting of a Transition Coordinator, Community Liaison Specialist, and a Housing Specialist. Each team is placed throughout the state to provide state-wide coverage for those likely eligible individuals who want to explore the opportunity to live in the community.

No Wrong Door One of the rebalancing programs that TMH funds is the No Wrong Door (NWD) Initiative BMS provides MFP dollars via a contract with the WV Bureau of Senior Services to administer the NWD initiative. The Bureau utilizes Metro AAA to operate WV's NWD initiative called Bridging Resources West Virginia (BRWV), Bridging Resources WV supports older adults, caregivers, individuals with disabilities, veterans, and families by (1) Raising visibility of the full range of available long-term service options (2) Providing objective information, advice, and assistance (3) Empowering people to make Informed decisions about the supports and services needed to live well in their communities and. (4) Helping people access public and private services and support programs.

WV Governor's Office Funding Initiative In FY23, the Governor Office provided $4.267,000 in funding to be awarded to fifty-seven county aging providers Projects and initiatives were completed in FY24 and included approximately $1,400,000 for the purchase of vehicles, $1,500,000 for building renovation and additions, $644,000 equipment, $57 1,000 for nutrition services and $132,000 for transportation services.

Congressionally Directed Spending (CDS) - Aging Well "Safe at Home"

CDSFY23. Congressionally Directed spending funds received for a project to assist WV seniors aged 60 and older to obtain needed home modifications to assist them with remaining in their own homes and communities. The Bureau received $500,000 and an additional $200,000 in state funding utilized to sustain projects through FY25. Project and funding to be re-evaluated for FY26 CDS - Open, Active and Accessible Seniors CDSFY24. Congressionally Directed Spending funds received to provide funding to county aging providers for facility maintenance projects, facility renovations to meet ADA requirement's multi-purpose _passenger vehicles or hot/cold meal delivery vehicles, and equipment purchase and/or repairs.

CDS - WV Senior Health and Wellness Initiative CDSFY25. Congressionally Directed Spending funds received to provide funding to county aging providers for services and programming to support healthy lifestyles. Examples of funding utilization are lending libraries of wellness equipment for homebound older adults, development of senior center gardens, equipment, materials and training costs for various wellness and fall prevention programs and healthy cooking and nutrition classes Medicaid: Bureau Operating Agency Aged & Disabled Waiver The Bureau of Senior Services is the program operating agency under contract with the Bureau for Medical Services (BMS) for the Medicaid Aged & Disabled Waiver Program In FY24, 8,551 individuals were served on the program The Medicaid Aged & Disabled Waiver Program provides services in the home or in the workplace to members who are certified by a physician as requiring these services, Individuals must have five deficits in Activities of Daily Living (dressing, grooming, bathing, etc ) to be medically eligible for the program. Bureau focus includes provider training continuing certification of providers, annual monitoring of provider agencies, managing the incident management system and reporting, and facilitating provider and public work groups. The Bureau does not write or develop policy because that is ultimately the responsibility of BMS, however, the Bureau works closely with BMS when policies and processes are being developed Aged & Disabled Waiver Personal Options Program Personal Options offers participants an additional service model to choose from (i.e. participants can choose to be served by a traditional service provider agency, or they can elect to hire their workers directly), Enrollment for the program, entitled Personal Options, began in May 2007 Bureau staff members enroll participants into Personal Options and provide full-time program monitoring to assure quality services and to meet state and federal regulations, as well as provider training and technical support Medicaid Personal Care Program The Bureau of Senior Services is the program operating agency under contract with the Bureau for Medical Services for the Medicaid Personal Care Program. In FY24, 5,546 individuals were served on the program, The Medicald Personal Care Program provides services in the home or in the workplace to members who are certified by a physician as requiring these services. Individuals must have three deficits in Activities of Daily Living (dressing, grooming, bathing, etc.) to be medically eligible for the program.

Personal Care members are provided with in-home, hands-on, medically necessary activities, such as dressing, personal hygiene, feeding, assistance with self-administration of medications, and meal preparation. Other services include support and assistance outside the home to help obtain/retain competitive employment of at least 40 hours per month. Bureau staff provides full-time program monitoring to ensure quality services and to meet state and federal regulations as well as provider training and technical support.

Events Robert W. Jackson Senior Summit The annual Robert W. Jackson Senior Summit is held annually in May at the Cedar Lakes Conference Center in Ripley, West Virginia Seniors participate in a variety of workshops and health and recreational activities Senior Olympics Held annually by Mineral County Senior Center in Keyser, West Virginia. Hundreds of senior athletes representing many West Virginia counties participate in various events such as the long jump, ladder ball, pickleball, basketball and bocce ball. Each event awards gold, silver and bronze medals for men and women for their age group.

Older Americans Act Month Elder Abuse Awareness Day The Bureau and county aging providers statewide hold vanous events during the month of May to celebrate Older Americans Act Month The Bureau is a partner with the West Virginia Department of Human Services and Adult Protective Services hosting an elder abuse awareness education event for county aging providers and various other providers and interested parties statewide. The conference provides continuing education credit for social workers, nurses, nursing home administrators and attorneys.

GOAL 1 - Providing Effective and Quality Older Americans Act (OAA) Core Programs:

Provide effective and quality OAA core programs to enable and empower older adults and caregivers to make informed decisions, easily access programs and improve quality of life and services.

OBJECTIVE 1.1: Organize Title III and V services to enable older adults to live independently at home and stay connected in their communities, STRATEGY PROJECTED OUTCOME IIIB 1. Utilize monitoring tools and processes to annually monitor the delivery of 3B services. 2. Require all county aging provider directors to receive OAA Title Ill Policy Manual training from the AAA upon employment. 3. Require all staff with direct contact with service recipients to receive mandated competency-based training including person-centered care and trauma-Informed care and annual training on abuse, neglect, and exploitation. 4. Increase outreach and public information/education activities for WV Senior Legal Aid services. 5. The Northwestern Area Agency on Aging (NWAAA) will monitor Senior Legal Aid on a quarterly basis to ensure target populations, legal service categories, and fiscal compliance. 6. Communicate with county aging providers and provide education and technical assistance to expand outreach services and public information/education. 7. Evaluate potential methods to recruit and sustain direct care workforce staff through methods such as: increased wages, enhanced career pathways, and enhanced recruitment efforts. 8. Establish workgroup with providers and identified WV transportation service entities to evaluate current senior transportation needs and barriers in each county.

Improved accountability and quality management. Improved quality of services. 2. Improved knowledge of OAA policy and requirements, and Increased service quality. 3. Increased staff competency, quality of care/services, and increased ability to Identify and report abuse, neglect, and exploitation. 4. Increase senior legal aid service units and services to seniors. 5. Improved accountability and quality management of legal services provided to West Virginia seniors. 6. Increased awareness and knowledge of services, support, and senior related topics. 7. Increased direct care workforce to provide Title IlIB services, 8. Identification of current needs/barriers and development of resources and solutions.

NIC 1. Area Agency on Aging's will utilize monitoring tools and processes to annually monitor the delivery of IIIC services.

Improved accountability and quality management. 2. Compliance with nutritional requirements and ensure seniors are STRATEGY PROJECTED OUTCOME 2. State registered dietician will annually monitor county aging providers to ensure compliance with OAA nutritional requirements utilizing food pattern modeling or nutritional analysis methodologies. receiving necessary calories and nutrients. 3. Increased knowledge about nutrition and improved health outcomes for seniors. 3, State Registered Dietician will provide nutrition counseling during county aging provider onsite visits 4. Continue to require county aging providers to offer and encourage home- delivered meal participants to participate in congregate meals and other senior center services and activities, as feasible, utilizing person- centered approaches as required by policy established by the Bureau. 5. Educate senior centers on common therapeutic and medically tailored meals and how to customize meals to support seniors' health needs. 6. Use the Service Assessment Evaluation Form (SAEF) assessment and prioritization tool to ensure nutrition services are delivered to high-risk clients, prioritizing those with greatest economicisocial need. 7. The Bureau and AAA will continue to educate county aging providers regarding the waitlist policy and AAA's will monitor compliance. 8. Continue nutrition counseling requirements for individuals identified on the Determine Your Nutritional Health Assessment for individuals who indicate a risk of malnutrition, food insecurity, and/or other nutritional concerns. 9. Ensure health and safety check systems, education and policies for individuals identified as socially isolated and/or those with physical and mental health conditions that indicate a health and/or safety risk.
Increased socialization, wellness and health outcomes for home-delivered meal participants. 5. Increased knowledge about therapeutic and medically- tailored meals and Improved health outcomes. 6. Ensure that meals are provided to the highest need clients. 7. Monitor need for additional meals/funding and ensure prioritization of high need Individuals on the waitlist when able to be served. 8. Improved senior health benefits, quality of life, and the reduction of malnutrition and food insecurity through informed dietary choices. 9. Decrease social isolation and improve health status through communication and education.

STRATEGY

PROJECTED OUTCOME

IID 1. Coordinate collaborative efforts with AAA's and county aging providers to expand the impact and effectiveness of evidence-based health promotion programs. 2. Area Agency on Aging's will utilize monitoring tools and processes to annually monitor the delivery of IIID services. 3. Educate county aging providers on additional evidence-based programs that address obesity, diabetes, mental health, and other chronic issues as Identified in survey outcomes. 4. Continue to work with county aging providers that target fall prevention.

Best practices by AAA's and county aging providers and increased participation of seniors in evidence-based programs. 2. Improved accountability and quality management. Improved quality of services 3. Implementation of additional programs to address identified chronic issues. 4. Increase fall prevention programs and decrease older adult falls.

Title V SCSEP 1. Ensure SCSEP participants undergo screening through the ADRC to access and apply for eligible home and community-based services. 2. Explore and develop new partnerships with companies and individuals in the private sector to increase the job experience opportunities. 3. Disseminate SCSEP marketing tools and information to potential host agencies.

Providing additional needed services to increase independence in their community. 2. Opportunities for participants in higher paying jobs. 3. Educate and increase host agencies.

Objective 1.2 Strengthening our State Long-Term Care Ombudsman program.

Title VII Long-Term Ombudsman 1. Provide training regarding the LTCOP through training of service providers, residents, family members, public officials, state and local agencies, and other interested community partners and stakeholders.

Increase awareness of the services provided by the LTCOP.

Program (LTCOP)

Ensure nursing home residents are 2. Continue partnership with Take Me Home WV, and Money Follows the Person. informed about these programs and their rights to receive services in the least 3. The State Long-Term Care Ombudsman will coordinate, restrictive environment. collaborate, and participate with the Financial Exploitation Taskforce. 4. Collaborate and participate in WV Elder Abuse Awareness Day events and activities. 5. Collaborate and participate along with the SMP Director and Medicaid unit on the Committee for Quality Improvement headed by Adult Protective Services. 6. Work collaboratively with the Office of 3, Increase awareness and prevention of financial exploitation. 4. increased knowledge of abuse, neglect, and exploitation, and how to recognize and report.
Increased knowledge and quality Health Facility, Licensure and Certification (OHFLAC), to address complaints and concerns regarding residents in long term care by receiving notifications from surveyors when they enter and exit long term care facilities.

Improvement in Adult Protective Service Programs. 6. Address and resolve complaints and concerns of long- term care residents.

Objective 1.3: Provide quality non-formula-based services and integrate with OAA core programs.

ADRC

Work with ADRC's to develop a public awareness campaign and increase awareness of their services.
Increase awareness of services offered by the ADRC to Increase seniors' ability to access resources and assistance. 2. Increase awareness of ADRC services to seniors. 3. Via expanded partnerships, Increase reach to target populations. 4. Increase knowledge of person-centered and trauma-informed services. 5. Raise visibility of Bridging Resources services and supports. 6. Increase knowledge of suicide prevention/referral and decrease suicide in older adults.
Provide ADRC outreach materials to all OAA senior centers and nutrition sites, 3. Develop partnerships with organizations who work with rural, low income, chronic conditions, mental health, suicide prevention (988), and other high-risk individuals to reach these target population groups. 4. Strengthen collaboration with OAA and Medicald programs to explore new person-centered and trauma- informed training materials for ADRC counselors statewide. 5. Continued development of statewide marketing campaign for West Virginia's No Wrong Door initiative Bridging Resources WV. 6. Collaborate with comprehensive behavioral health centers to educate ADRC's on older population suicide prevention and referral processes.

SHIP / MIPPA/SMP

Conduct training presentations in-person and /or virtually with professional partners on SHIP, MIPAA and SMP. 2. Provide SHIP and ADRC joint brochure to each applicant of the Aged & Disabled Walver Program. 3. Partner with local food banks to share information about Medicare programs, including low-income assistance programs that may allow an individual to have access to funds for food.
Increase knowledge of Medicare programs with partners. 2. Provide information, knowledge and resources to over 5000 current Aged & Disabled Waiver participants. 3. Provide Medicare information, knowledge and target low-income individuals eligible for assistance.
Integrate SHIP, MIPPA/SMP outreach services the various Title III programs to distribute Medicare enrollment and Medicare cost-savings benefit information.
Expand outreach through collaboration with Title Ill programs. 5. Develop an updated user-friendly website to 5. In partnership with Title III, Title V, Title VII, ADRC, WV Assistive Technology System, Medicaid ADW and Personal Care programs, update websites to include the most recent fraud scams, news, calendar of events, resources, etc. increase knowledge of services and programs.

Objective 1.4: Increase Alzheimer's and Dementia awareness, education and services.

Alzheimer's and Dementia 1. Require respite workers to receive dementia care training The Person Comes First: A Practical Approach to Alzheimer's Care, Prior to Providing Care.

Increase staff competency and understanding of Alzheimer's and Dementia care. 2. Implement Initiatives that have been demonstrated to decrease stress and agitation.
Explore Alzheimer's / Dementia doll and pet therapy.
Provide dementia friendly practices training for SHIP and Senior Medicare Patrol team members and the WV No Wrong Door Advisory Group.
Increase knowledge of dementia best practices to be utilized practice and the provision of services and I&A.
Work with members of the Alzheimer's State Plan Task Force to convene a statewide dementia care summit.
Increase understanding of dementia and the needs of those who provide unpaid care.
Educate legislators on the difficulties facing individuals with dementia and family (unpaid) caregivers. 6. Work with the WV Lottery (FAIR funder) to do PSAs that promote the need for in-home direct care workers. 7. Explore methods to increase the number of congregate respite centers in the state.
Increase resources and service options for individuals with dementia and/or their family caregivers. 6. Increase in the number of families receiving services. 7. Increase respite opportunities for caregivers.

GOAL 2 - Targeting Greatest Economic Need (GEN) and Greatest Social Need (GSN): To target services and supports to older adults and family caregivers with the greatest economic need and greatest social need.

Objective 2.1: Target those with GEN and GSN in OAA and other grant programs.

Continued requirement for county aging providers and AAA's to annually attest Assurances and Grant Conditions which include GEN and GSN. 2. Utilize the SAEF scoring system to target individuals with the GEN and GSN. 3. Implement training and resource opportunities for county aging providers, other program staff, and partners to help them recognize and address the needs of vulnerable populations. 4. . Create targeted public Information/education strategies to reach vulnerable/targeted populations, Including mental health populations and HIV/AIDS populations, by partnering with community organizations, 1. Acknowledgment/agreement to Assurance and Grant Conditions. 2. To provide services to those with GEN and GSN.
Increase knowledge of the needs of vulnerable populations and target GEN and GSN.
Increase knowledge of the needs of vulnerable populations and target GEN and GSN such as low income, mental health and HIV/AIDS populations and rural, faith-based groups, and local agencies in targeted populations.
Increase knowledge, outreach and public 5. The Bureau will communicate with the Appalachian American Indians of West Virginia, Inc., and the Native American Indian Federation, Inc., and share information with AAA's and county aging providers for outreach and public information/education. information/education to additional populations. 6. Through analysis, Implement needed strategies to Improve service provisions to targeted populations.
The Bureau, AAA's, and West Virginia Senior Legal Ald will monitor, review, and analyze SPR data for targeted populations. 7. Title V will annually review and analyze Census SPARQ data elements for targeted populations. 8. Discretionary grant programs (SCSEP, SMP, MIPPA, ADRC) will provide outreach materials to all county aging providers for distribution to service recipients and other interested parties. 9. Utilization of Risk Indicator Assessment within the SAEF that identifies individuals with many GSN (I.e. chronic conditions, food insecurity, utility issues, lack of transportation).
Through analysis, implement needed strategies to improve service provisions to targeted populations. 8. Increase knowledge of seniors and vulnerable populations to assist with targeting GEN and GSN. 9. . Targeting services to high risk/high need older individuals.

Objective 2.2: Ensure program participants receive person-centered services and address Social Determinants of Health (SDoH), 1. Continue required OAA county aging provider staff, SHIP, SMP, MIPPA, ADRC, and SCSEP staff receive training on person-centered planning and trauma-informed care. 2. AAA's annually monitor the provision of person-centered training and 1. Collaborative planning development based on an older Individual's strengths and preferences. 2. Ensuring that staff are knowledgeable of person-centered care and trauma-informed care training. trauma-informed care.

Develop new SDoH training module for county aging providers, AAA's, and other partners/stakeholders. 4. Utilization of Risk Indicator Assessment within the SAEF to Identify individuals with the core elements of SDoH (Transportation, Utilities, Housing, Food, Personal Safety). 5. Provide person-centered planning training for SHIP/MIPPA/SMP counselors.
Delivery of knowledge and skills to understand and address the non-medical factors that influence health outcomes such as age, support systems and access to transportation and healthcare. 4. Identification of individuals and targeting of services to high risk/high need older individuals. 5. Ensure counselors are utilizing person-centered practices.

GOAL 3: Expanding Access to Home and Community-Based Services; Enable, support, and empower older adults to maintain a high quality of life in the least restrictive environment through the provision of OAA and other home and community-based services and supports.

Objective 3.1: Explore additional Title IIIB services and increase service provision of current services.

Explore re-implementation of Wellness Checks conducted during the pandemic with appropriate policy parameters. 2.

Work with AAA's and county aging providers and rate setting experts to evaluate implementation of transportation reimbursement rates.

Research and analyze best practices in other states. 4.

Evaluate outreach and marketing strategies for West Virginia Senior Legal Aid. 1.

Increase identification of health and safety issues and decreased social isolation. 2.

Implementation of a methodology that would result in cost savings to be used to increase services. 3.

Utilize successful, best practices in other states to emulate and expand services and programming.

To increase legal services to West Virginia older adults.

Objective 3.2: Explore additional Title IIIC services and increase service provision of current services.

Work with AAA's and other identified partners to evaluate group food and disposables purchasing.
Increase purchasing power and reduce costs. Increase ability to provide more meals and fiscal responsibility.
Research and analyze best practices in other states.
Utilize successful, best practices in other states to emulate and expand services and programming.
Research other states with high congregate program attendance for best practices.
To incorporate new initiatives to increase participation.

Objective 3.3: Explore additional Title IIID services and increase service provision of current services.

Based on West Virginia Needs Assessment, evaluate methodologies such as, partnerships between providers.
Through collaborations and other methodologies, increase services and programming with current funding allocations.
Develop Title IIID work group to evaluate and seek grants and other 2. To obtain additional funding to receive services and programs. funding sources to increase services and programs.
Utilize successful, best practices in other states to emulate and expand 3. Research and analyze best practices in other states. services and programming Objective 3.4: Provide information and seek other resources to increase older adult independence, health and safety.
Collaborate with ADRC's to ensure older individuals receive information on all available HCBS services, including Medicaid.
Individuals receive information to make informed decisions regarding waiver services in addition to all other available HCBS.
Provide training opportunities for assistive technology (AT) and durable medical equipment (DME) for county aging providers.
Increase staff knowledge to better assist older adults in accessing AT and DME for increased independence. 3. To positively impact the need for accessible and affordable housing for West Virginia's older population.
Develop further collaboration with housing entities such as West Virginia Housing Agency.
Collaborate with the West Virginia Department of Economic Development, Office of Broadband, to expand broadband to West Virginia communities that lack access to affordable broadband internet 4. Allow seniors to stay connected to family and friends, access health services, and the tools needed to make full use of the internet. manage finances, participate în educational opportunities, combat social isolation, and stay engaged in local communities, 5. To provide suicide prevention and education to decrease suicide in older adults.
Collaborate with SAMHSA, the West Virginia Bureau of Behavioral Health, comprehensive behavioral health centers, and 988 partners on the development of the suicide prevention policy plan.

GOAL 4: Improving Services and Support for Caregivers; Educate, support, and enhance services to caregivers.

Objective 4.1: Organize Title IIIE services to enable older adults to live at home and stay connected in their communities.

Utilize monitoring tools and processes to annually monitor the delivery of Title IIIE services.
Continue additional training requirements for Title IIIE staff in the areas of communication, psycho-social needs, role of the respite worker, and service recipient rights.
Work with partners evaluating recruitment of direct care workforce methods for Title IIIE respite programs.
Support county aging providers involved with Healthy Grandfamilles program to support grandparents raising grandchildren.
Addition of IIIE older relative caregivers' services in Title Ill policy manual for county aging providers. 1.

Improved accountability and quality management 2.

Increase staff competency and quality of care/services. 3.

Increased respite workforce to provide Title IIIE services and state-funded respite services. 4.

The provision of education and resources tools to assist grandparents in their roles. 5.

To increase services to West Virginia older relative caregivers.

Objective 4.2: Implement the RAISE Family Caregiver Advisory Council, the National Strategy to Support Family Caregivers and the National Technical Assistance Center on Grandfamilies and Kinship Family recommendations, as feasible, to better address caregiver needs.

Requirement for all Title IIIE staff to receive person-centered care training.
The delivery of services based on an individual's needs and preferences.
Continue to provide education on training opportunities to county aging providers.
Conduct outreach and public information/education to targeted populations 2. Increase staff knowledge for the provision of quality services. to inform caregivers of the supports, services, and resources available.
Increase awareness and knowledge of services and resources available to caregivers. 4. To increase caregiver awareness through efforts such as proclamations and media coverage. 5. Increase staff knowledge of unique behavioral needs and deliver services person-centered.
Reach out to various government officials and community leaders to request efforts to recognize and support caregivers. 5, Provide educational materials on how to recognize behavioral signs that a family caregiver or care recipient may have unique needs such as sensitivity to noise, memory loss, etc.
Develop resources specific to kinship care for distribution to county aging providers, community partners, and other entities.
Increased knowledge and awareness of services and programs available to kinship caregivers. 7. Improve ability for caregivers to locate resources and programs. 8. Increased opportunities to support family caregivers. 9. Expand outreach to family caregivers regarding services and resources.
Compile a statewide inventory of existing resources and programs for caregivers of older adults and older relative caregivers. 8. . Explore opportunities for collaboration with various organizations such as: hospitals, employers, philanthropies, and faith-based entities that may have a role in supporting family caregivers.
Explore partnerships with county school districts to distribute information about older relative caregiver programs and kinship families. 10. Explore developing initiatives to promote church-based volunteer networks as well as collegiate level volunteer / community service with university students.
To Increase the workforce through volunteerism. 11. To increase quality direct care workforce.
Explore direct care workforce recruitment and retention initiatives including quality incentive payments and quality licensing designation for providers.
Caregiver friendly workplaces that offer benefits such as flexible working hours, support services, 12. Advocate for the implementation of caregiver-friendly workplaces. telecommuting, paid/unpaid leave and financial assistance, etc.

GOAL 5: Preparedness, Response, and Recovery: To plan and prepare for emergencies, implement appropriate and necessary responses, and be knowledgeable of recovery processes and resources and implement initiatives to promote independence.

Objective 5.1: Strengthen Emergency Service Contingency Operation Plans (ESCOP).

Develop partnerships with local county emergency personnel to provide emergency preparedness, response, and recovery training for each county provider agency. 1, Every county aging provider will receive emergency event training directly from their local emergency personnel.
Continued development of standardized emergency planning, response, recovery template to be utilized by each county aging provider. 3. Implement continuity of operations planning (COOP) within development of emergency plans.
Utilization of standardized emergency plans with consistent requirements and components for all county aging providers. 3. Strengthen the continuation of operations and services during emergencies.

Objective 5.2: Implement initiatives to protect older adults at risk.

Implementation of requirement for annual completion of risk and all-hazards emergency assessment tool. 2. Utilization of Risk Indicators within the 1. Inclusion of Identified risk/hazards in county aging provider emergency plans that are applicable to their county.

SAEF assessment to identify older adults at risk.

Identification of individuals and targeting of services to high risk/high need older individuals. 3. Improved emergency response to high-risk individuals during emergency events. 3, Implementation of required referral process of identified high risk individuals to local emergency service agencies.
Explore grant and other funding 4. Provide capability to serve as opportunities to acquire generators for county aging providers during emergencies. emergency county focal points during emergencies.

Objective 5.3: Implement initiatives to promote independence and decrease social isolation.

Implementation of a referral system for individuals in need of assistive technology to West Virginia Assistive Technology System (WVATS). 2. Continuing partnership with WVATS to provide education and training opportunities to county aging providers.
Improve the lives and independence of older individuals through assistive technology. 2. Increase knowledge of Assistive Technology to promote independence for older individuals. 3. Improved Identification of Individuals experiencing social isolation and Implementation of strategies to decrease isolation.
Evaluate social isolation assessment tools for implementation in HCBS programs.

III. ATTACHMENTS

Attachment A STATE PLAN ASSURANCES AND REQUIRED ACTIVITIES By signing this document, the authorized official commits the State Agency on Aging to performing all listed assurances and activities as stipulated in the Older Americans Act, as amended in 2020.

Sec. 305, ORGANIZATION (a) In order for a State to be eligible to participate in programs of grants to States from allotments under this title ----.

(2) The State agency shall -- (A) except as provided in subsection (b)(5), designate for each such area after consideration of the views offered by the unit or units of general purpose local government in such area, a public or private nonprofit agency or organization as the area agency on aging for such area;

(B) provide assurances, satisfactory to the Assistant Secretary, that the State agency will take into account, in connection with matters of general policy arising in the development and administration of the State plan for any fiscal year, the views of recipients of supportive services or nutrition services, or individuals using multipurpose senior centers provided under such plan; . ..

(E) provide assurance that preference will be given to providing services to older individuals with greatest economic need and older individuals with greatest social need (with particular attention to low-income older individuals, including low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas), and include proposed methods of carrying out the preference in the State plan;

(F) provide assurances that the State agency will require use of outreach efforts described in section 307(a)(16); and (G)(i) set specific objectives, in consultation with area agencies on aging, for each planning and service area for providing services funded under this title to low-income minority older individuals and older individuals residing in rural areas;

(ii) provide an assurance that the State agency will undertake specific program development, advocacy, and outreach efforts focused on the needs of low-income minority older individuals;

(iii) provide a description of the efforts described in clause (il) that will be undertaken by the State agency;

(C) An area agency on aging designated under subsection (a) shall be --- (5) in the case of a State specified in subsection (b)(5), the State agency; and shall provide assurance, determined adequate by the State agency, that the area agency on aging will have the ability to develop an area plan and to carry out, directly or through contractual or other arrangements, a program in accordance with the plan within the planning and service area. In designating an area agency on aging within the planning and service area or within any unit of general purpose local government designated as a planning and service area the State shall give preference to an established office on aging, unless the State agency finds that no such office within the planning and service area will have the capacity to carry out the area plan.

(d) The publication for review and comment required by paragraph (2)(C) of subsection (a) shall include -- (1) a descriptive statement of the formula's assumptions and goals, and the application of the definitions of greatest economic or social need, (2) a numerical statement of the actual funding formula to be used, (3) a listing of the population, economic, and social data to be used for each planning and service area in the State, and (4) a demonstration of the allocation of funds, pursuant to the funding formula, to each planning and service area in the State.

Note: STATES MUST ENSURE THAT THE FOLLOWING ASSURANCES (SECTION 306)

WILL BE MET BY ITS DESIGNATED AREA AGENCIES ON AGENCIES, OR BY THE STATE

IN THE CASE OF SINGLE PLANNING AND SERVICE AREA STATES.

Sec. 306, AREA PLANS (a) Each area agency on aging designated under section 305(a)(2)(A) shall, in order to be approved by the State agency, prepare and develop an area plan for a planning and service area for a two-, three-, or four-year period determined by the State agency, with such annual adjustments as may be necessary. Each such plan shall be based upon a uniform format for area plans within the State prepared in accordance with section 307(a)(1). Each such plan shall- (1) provide, through a comprehensive and coordinated system, for supportive services, nutrition services, and, where appropriate, for the establishment, maintenance, modernization, or construction of multipurpose senior centers (including a plan to use the skills and services of older individuals in paid and unpaid work, including multigenerational and older individual to older individual work), within the planning and service area covered by the plan, including determining the extent of need for supportive services, nutrition services, and multipurpose senior centers in such area (taking into consideration, among other things, the number of older individuals with low incomes residing in such area, the number of older individuals who have greatest economic need (with particular attention to low-income older individuals, including lowincome minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas) residing in such area, the number of older individuals who have greatest social need (with particular attention to low-income older individuals, including low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas) residing in such area, the number of older individuals at risk for institutional placement residing in such area, and the number of older individuals who are Indians residing in such area, and the efforts of voluntary organizations in the community), evaluating the effectiveness of the use of resources in meeting such need, and entering into agreements with providers of supportive services, nutrition services, or multipurpose senior centers in such area, for the provision of such services or centers to meet such need;

(2) provide assurances that an adequate proportion, as required under section 307(a)(2), of the amount allotted for part B to the planning and service area will be expended for the delivery of each of the following categories of services --- (A) services associated with access to services (transportation, health services (including mental and behavioral health services), outreach, information and assistance (which may include information and assistance to consumers on availability of services under part B and how to receive benefits under and participate in publicly supported programs for which the consumer may be eligible) and case management services);

(B) in-home services, including supportive services for families of older individuals with Alzheimer's disease and related disorders with neurological and organic brain dysfunction; and (C) legal assistance; and assurances that the area agency on aging will report annually to the State agency in detail the amount of funds expended for each such category during the fiscal year most recently concluded;

(3)

(A) designate, where feasible, a focal point for comprehensive service delivery in each community, giving special consideration to designating multipurpose senior centers (including multipurpose senior centers operated by organizations referred to in paragraph (6)(C)) as such focal point; and (B) specify, in grants, contracts, and agreements implementing the plan, the identity of each focal point so designated;

(4)

(A)(I)(I) provide assurances that the area agency on aging will --- (aa) set specific objectives, consistent with State policy, for providing services to older individuals with greatest economic need, older individuals with greatest social need, and older individuals at risk for institutional placement;

(bb) include specific objectives for providing services to low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas; and (Il) include proposed methods to achieve the objectives described in items (aa) and (bb) of sub-clause (1);

(ii) provide assurances that the area agency on aging will include in each agreement made with a provider of any service under this title, a requirement that such provider will- (!) specify how the provider intends to satisfy the service needs of low-income minority individuals, older individuals with limited English proficiency, and older Individuals residing in rural areas in the area served by the provider;

(II) to the maximum extent feasible, provide services to low-income minority individuals, older individuals with limited English proficiency, and older individuals residing in rural areas in accordance with their need for such services; and (III) meet specific objectives established by the area agency on aging, for providing services to low-income minority individuals, older individuals with limited English proficiency, and older individuals residing in rural areas within the planning and service area; and (ili) with respect to the fiscal year preceding the fiscal year for which such plan is prepared - (1) identify the number of low-income minority older individuals in the planning and service area;

(II) describe the methods used to satisfy the service needs of such minority older individuals; and (III) provide information on the extent to which the area agency on aging met the objectives described in clause (i).

(B) provide assurances that the area agency on aging will use outreach efforts that will- (i) identify individuals eligible for assistance under this Act, with special emphasis On --- (I) older individuals residing in rural areas;

(II) older individuals with greatest economic need (with particular attention to lowincome minority individuals and older individuals residing in rural areas);

(III) older individuals with greatest social need (with particular attention to lowincome minority individuals and older individuals residing in rural areas);

(IV) older individuals with severe disabilities;

(V) older individuals with limited English proficiency;

(VI) older individuals with Alzheimer's disease and related disorders with neurological and organic brain dysfunction (and the caretakers of such individuals); and (VII) older individuals at risk for institutional placement, specifically including survivors of the Holocaust; and (il) inform the older individuals referred to in sub-clauses (I) through (VII) of clause (i), and the caretakers of such individuals, of the availability of such assistance; and (C) contain an assurance that the area agency on aging will ensure that each activity undertaken by the agency, including planning, advocacy, and systems development, will include a focus on the needs of low-income minority older individuals and older individuals residing in rural areas.

(5) provide assurances that the area agency on aging will coordinate planning, identification, assessment of needs, and provision of services for older individuals with disabilities, with particular attention to individuals with severe disabilities, and individuals at risk for institutional placement, with agencies that develop or provide services for individuals with disabilities;

(6) provide that the area agency on aging will --- (A) take into account in connection with matters of general policy arising in the development and administration of the area plan, the views of recipients of services under such plan;

(B) serve as the advocate and focal point for older individuals within the community by (in cooperation with agencies, organizations, and individuals participating in activities under the plan) monitoring, evaluating, and commenting upon all policies, programs, hearings, levies, and community actions which will affect older individuals;

(C)(i) where possible, enter into arrangements with organizations providing day care services for children, assistance to older individuals caring for relatives who are children, and respite for families, so as to provide opportunities for older individuals to aid or assist on a voluntary basis in the delivery of such services to children, adults, and families;

(ii) if possible regarding the provision of services under this title, enter into arrangements and coordinate with organizations that have a proven record of providing services to older individuals, that --- (I) were officially designated as community action agencies or community action programs under section 210 of the Economic Opportunity Act of 1964 (42U.S.C.

for fiscal year 1981, and did not lose the designation as a result of failure to comply with such Act; or (II) came into existence during fiscal year 1982 as direct successors in interest to such community action agencies or community action programs; and that meet the requirements under section 676B of the Community Services Block Grant Act; and (iii) make use of trained volunteers in providing direct services delivered to older individuals and individuals with disabilities needing such services and, if possible, work in coordination with organizations that have experience in providing training, placement, and stipends for volunteers or participants (such as organizations carrying out Federal service programs administered by the Corporation for National and Community Service), in community service settings;

(D) establish an advisory council consisting of older individuals (including minority individuals and older individuals residing in rural areas) who are participants or who are eligible to participate in programs assisted under this Act, family caregivers of such Individuals, representatives of older individuals, service providers, representatives of the business community, local elected officials, providers of veterans' health care (if appropriate), and the general public, to advise continuously the area agency on aging on all matters relating to the development of the area plan, the administration of the plan and operations conducted under the plan;

(E) establish effective and efficient procedures for coordination of --- (i) entities conducting programs that receive assistance under this Act within the planning and service area served by the agency; and (ii) entities conducting other Federal programs for older individuals at the local level, with particular emphasis on entities conducting programs described in section 203(b), within the area;

(F) in coordination with the State agency and with the State agency responsible for mental and behavioral health services, increase public awareness of mental health disorders, remove barriers to diagnosis and treatment, and coordinate mental and behavioral health services (including mental health screenings) provided with funds expended by the area agency on aging with mental and behavioral health services provided by community health centers and by other public agencies and nonprofit private organizations;

(G) if there is a significant population of older individuals who are Indians in the planning and service area of the area agency on aging, the area agency on aging shall conduct outreach activities to identify such individuals in such area and shall inform such Individuals of the availability of assistance under this Act;

(H) in coordination with the State agency and with the State agency responsible for elder abuse prevention services, increase public awareness of elder abuse, neglect, and exploitation, and remove barriers to education, prevention, investigation, and treatment of elder abuse, neglect, and exploitation, as appropriate; and (!) to the extent feasible, coordinate with the State agency to disseminate information about the State assistive technology entity and access to assistive technology options for serving older individuals;

(7) provide that the area agency on aging shall, consistent with this section, facilitate the areawide development and implementation of a comprehensive, coordinated system for providing long-term care in home and community-based settings, in a manner responsive to the needs and preferences of older individuals and their family caregivers, by- (A) collaborating, coordinating activities, and consulting with other local public and private agencies and organizations responsible for administering programs, benefits, and services related to providing long-term care;

(B) conducting analyses and making recommendations with respect to strategies for modifying the local system of long-term care to better ---- (i) respond to the needs and preferences of older individuals and family caregivers;

(il) facilitate the provision, by service providers, of long-term care in home and community-based settings; and (iii) target services to older individuals at risk for institutional placement, to permit such individuals to remain in home and community-based settings;

(C) implementing, through the agency or service providers, evidence-based programs to assist older individuals and their family caregivers in learning about and making behavioral changes intended to reduce the risk of injury, disease, and disability among older individuals; and (D) providing for the availability and distribution (through public education campaigns, Aging and Disability Resource Centers, the area agency on aging itself, and other appropriate means) of information relating to- (i) the need to plan in advance for long-term care; and (ii) the full range of available public and private long-term care (including integrated long-term care) programs, options, service providers, and resources;

(8) provide that case management services provided under this title through the area agency on aging will- (A) not duplicate case management services provided through other Federal and State programs;

(B) be coordinated with services described in subparagraph (A); and (C) be provided by a public agency or a nonprofit private agency that ---- (i) gives each older individual seeking services under this title a list of agencies that provide similar services within the jurisdiction of the area agency on aging;

(il) gives each individual described in clause (I) a statement specifying that the individual has a right to make an independent choice of service providers and documents receipt by such individual of such statement;

(iii) has case managers acting as agents for the individuals receiving the services and not as promoters for the agency providing such services; or (iv) is located in a rural area and obtains a waiver of the requirements described in clauses (1) through (iii);

(9)

(A) provide assurances that the area agency on aging, in carrying out the State Long-Term Care Ombudsman program under section 307(a)(9), will expend not less than the total amount of funds appropriated under this Act and expended by the agency in fiscal year 2019 in carrying out such a program under this title;

(B) funds made available to the area agency on aging pursuant to section 712 shall be used to supplement and not supplant other Federal, State, and local funds expended to support activities described in section 712;

(10) provide a grievance procedure for older individuals who are dissatisfied with or denied services under this title;

(11) provide information and assurances concerning services to older individuals who are Native Americans (referred to in this paragraph as "older Native Americans"), including ---- (A) information concerning whether there is a significant population of older Native Americans in the planning and service area and if so, an assurance that the area agency on aging will pursue activities, including outreach, to increase access of those older Native Americans to programs and benefits provided under this title;

(B) an assurance that the area agency on aging will, to the maximum extent practicable, coordinate the services the agency provides under this title with services provided under title VI; and (C) an assurance that the area agency on aging will make services under the area plan available, to the same extent as such services are available to older individuals within the planning and service area, to older Native Americans;

(12) provide that the area agency on aging will establish procedures for coordination of services with entities conducting other Federal or federally assisted programs for older individuals at the local level, with particular emphasis on entities conducting programs described in section 203(b) within the planning and service area.

(13) provide assurances that the area agency on aging will -- (A) maintain the integrity and public purpose of services provided, and service providers, under this title in all contractual and commercial relationships;

(B) disclose to the Assistant Secretary and the State agency- (i) the identity of each nongovernmental entity with which such agency has a contract or commercial relationship relating to providing any service to older individuals; and (ii) the nature of such contract or such relationship;

(C) demonstrate that a loss or diminution in the quantity or quality of the services provided, or to be provided, under this title by such agency has not resulted and will not result from such contract or such relationship;

(D) demonstrate that the quantity or quality of the services to be provided under this title by such agency will be enhanced as a result of such contract or such relationship; and (E) on the request of the Assistant Secretary or the State, for the purpose of monitoring compliance with this Act (including conducting an audit), disclose all sources and expenditures of funds such agency receives or expends to provide services to older individuals;

(14) provide assurances that preference in receiving services under this title will not be given by the area agency on aging to particular older individuals as a result of a contract or commercial relationship that is not carried out to implement this title;

(15) provide assurances that funds received under this title will be used- (A) to provide benefits and services to older individuals, giving priority to older individuals identified in paragraph (4)(A)(I); and (B) in compliance with the assurances specified in paragraph (13) and the limitations specified in section 212;

(16) provide, to the extent feasible, for the furnishing of services under this Act, consistent with self-directed care;

(17) include information detailing how the area agency on aging will coordinate activities, and develop long-range emergency preparedness plans, with local and State emergency response agencies, relief organizations, local and State governments, and any other institutions that have responsibility for disaster relief service delivery;

(18) provide assurances that the area agency on aging will collect data to determine -- (A) the services that are needed by older individuals whose needs were the focus of all centers funded under title IV in fiscal year 2019; and (B) the effectiveness of the programs, policies, and services provided by such area agency on aging in assisting such individuals; and (19) provide assurances that the area agency on aging will use outreach efforts that will identify individuals eligible for assistance under this Act, with special emphasis on those individuals whose needs were the focus of all centers funded under title IV in fiscal year 2019.

(b)(1) An area agency on aging may include in the area plan an assessment of how prepared the area agency on aging and service providers in the planning and service area are for any anticipated change in the number of older individuals during the 10-year period following the fiscal year for which the plan is submitted.

(2)

Such assessment may include- (A) the projected change in the number of older individuals in the planning and service area;

(B) an analysis of how such change may affect such individuals, including individuals with low incomes, individuals with greatest economic need, minority older individuals, older individuals residing in rural areas, and older individuals with limited English proficiency;

(C) an analysis of how the programs, policies, and services provided by such area agency can be improved, and how resource levels can be adjusted to meet the needs of the changing population of older Individuals in the planning and service area; and (D) an analysis of how the change in the number of individuals age 85 and older in the planning and service area is expected to affect the need for supportive services.

(3) An area agency on aging, in cooperation with government officials, State agencies, tribal organizations, or local entities, may make recommendations to government officials in the planning and service area and the State, on actions determined by the area agency to build the capacity in the planning and service area to meet the needs of older individuals for- (A) health and human services;

(B) land use;

(D) transportation;

(E) public safety;

(F) workforce and economic development;

(G) recreation;

(H) education;

(1) civic engagement;

(J) emergency preparedness;

(K) protection from elder abuse, neglect, and exploitation;

(L) assistive technology devices and services; and (M) any other service as determined by such agency.

(c) Each State, in approving area agency on aging plans under this section, shall waive the requirement described in paragraph (2) of subsection (a) for any category of services described in such paragraph if the area agency on aging demonstrates to the State agency that services being furnished for such category in the area are sufficient to meet the need for such services in such area and had conducted a timely public hearing upon request.

(d)(1) Subject to regulations prescribed by the Assistant Secretary, an area agency on aging designated under section 305(a)(2)(A) or, in areas of a State where no such agency has been designated, the State agency, may enter into agreement with agencies administering programs under the Rehabilitation Act of 1973, and titles XIX and XX of the Social Security Act for the

purpose of developing and implementing plans for meeting the common need for transportation services of individuals receiving benefits under such Acts and older individuals participating in programs authorized by this title.

(2) In accordance with an agreement entered into under paragraph (1), funds appropriated under this title may be used to purchase transportation services for older individuals and may be pooled with funds made available for the provision of transportation services under the Rehabilitation Act of 1973, and titles XIX and XX of the Social Security Act.

(e) An area agency on aging may not require any provider of legal assistance under this title to reveal any information that is protected by the attorney-client privilege.

(f)(1) If the head of a State agency finds that an area agency on aging has failed to comply with Federal or State laws, including the area plan requirements of this section, regulations, or policies, the State may withhold a portion of the funds to the area agency on aging available under this title, (2)

(A) The head of a State agency shall not make a final determination withholding funds under paragraph (1) without first affording the area agency on aging due process in accordance with procedures established by the State agency.

(B) At a minimum, such procedures shall include procedures for- (i) providing notice of an action to withhold funds;

(i) providing documentation of the need for such action; and (iii) at the request of the area agency on aging, conducting a public hearing concerning the action.

(3)

(A) If a State agency withholds the funds, the State agency may use the funds withheld to directly administer programs under this title in the planning and service area served by the area agency on aging for a period not to exceed 180 days, except as provided in subparagraph (B).

(B) If the State agency determines that the area agency on aging has not taken corrective action, or if the State agency does not approve the corrective action, during the 180day period described in subparagraph (A), the State agency may extend the period for not more than 90 days.

(g)

Nothing in this Act shall restrict an area agency on aging from providing services not provided or authorized by this Act, including through- (1) contracts with health care payers;

(2) consumer private pay programs; or (3) other arrangements with entities or individuals that increase the availability of home and community-based services and supports.

Sec. 307, STATE PLANS (a) Except as provided in the succeeding sentence and section 309(a), each State, in order to be eligible for grants from its allotment under this title for any fiscal year, shall submit to the Assistant Secretary a State plan for a two, three, or four-year period determined by the State agency, with such annual revisions as are necessary, which meets such criteria as the Assistant Secretary may by regulation prescribe. If the Assistant Secretary determines, in the discretion of the Assistant Secretary, that a State failed in 2 successive years to comply with the requirements under this title, then the State shall submit to the Assistant Secretary a State plan for a 1-year period that meets such criteria, for subsequent years until the Assistant Secretary determines that the State is in compliance with such requirements. Each such plan shall comply with all of the following requirements:

(1) The plan shall- (A) require each area agency on aging designated under section 305(a)(2)(A) to develop and submit to the State agency for approval, in accordance with a uniform format developed by the State agency, an area plan meeting the requirements of section 306; and (B) be based on such area plans.

(2) The plan shall provide that the State agency will ---- (A) evaluate, using uniform procedures described in section 202(a)(26), the need for supportive services (including legal assistance pursuant to 307(a)(11), information and assistance, and transportation services), nutrition services, and multipurpose senior centers within the State;

(B) develop a standardized process to determine the extent to which public or private programs and resources (including volunteers and programs and services of voluntary organizations) that have the capacity and actually meet such need; and (C) specify a minimum proportion of the funds received by each area agency on aging in the State to carry out part B that will be expended (in the absence of a waiver under section 306(c) or 316) by such area agency on aging to provide each of the categories of services specified in section 306(a)(2).

(3) The plan shall- (A) include (and may not be approved unless the Assistant Secretary approves) the statement and demonstration required by paragraphs (2) and (4) of section 305(d)

(concerning intrastate distribution of funds); and (B) with respect to services for older individuals residing in rural areas -- (i) provide assurances that the State agency will spend for each fiscal year, not less than the amount expended for such services for fiscal year 2000 ...

(il) identify, for each fiscal year to which the plan applies, the projected costs of providing such services (including the cost of providing access to such services); and (iii) describe the methods used to meet the needs for such services in the fiscal year preceding the first year to which such plan applies.

(4) The plan shall provide that the State agency will conduct periodic evaluations of, and public hearings on, activities and projects carried out in the State under this title and title VII, including evaluations of the effectiveness of services provided to individuals with greatest economic need, greatest social need, or disabilities (with particular attention to low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas).

(5)

The plan shall provide that the State agency will ---- (A) afford an opportunity for a hearing upon request, in accordance with published procedures, to any area agency on aging submitting a plan under this title, to any provider of (or applicant to provide) services;

(B) issue guidelines applicable to grievance procedures required by section 306(a)(10); and (C) afford an opportunity for a public hearing, upon request, by any area agency on aging, by any provider of (or applicant to provide) services, or by any recipient of services under this title regarding any waiver request, including those under section 316.

(6) The plan shall provide that the State agency will make such reports, in such form, and containing such information, as the Assistant Secretary may require, and comply with such requirements as the Assistant Secretary may impose to insure the correctness of such reports.

(7)

(A) The plan shall provide satisfactory assurance that such fiscal control and fund accounting procedures will be adopted as may be necessary to assure proper disbursement of, and accounting for, Federal funds paid under this title to the State, including any such funds paid to the recipients of a grant or contract.

(B) The plan shall provide assurances that- (i) no individual (appointed or otherwise) involved in the designation of the State agency or an area agency on aging, or in the designation of the head of any subdivision of the State agency or of an area agency on aging, is subject to a conflict of interest prohibited under this Act;

(ii) no officer, employee, or other representative of the State agency or an area agency on aging is subject to a conflict of interest prohibited under this Act; and (iii) mechanisms are in place to identify and remove conflicts of interest prohibited under this Act.

(8) ) (A) The plan shall provide that no supportive services, nutrition services, or in-home services will be directly provided by the State agency or an area agency on aging in the State, unless, in the judgment of the State agency- (i) provision of such services by the State agency or the area agency on aging is necessary to assure an adequate supply of such services;

(ii) such services are directly related to such State agency's or area agency on aging's administrative functions; or (ili) such services can be provided more economically, and with comparable quality, by such State agency or area agency on aging.

(B) Regarding case management services, if the State agency or area agency on aging is already providing case management services (as of the date of submission of the plan) under a State program, the plan may specify that such agency is allowed to continue to provide case management services.

(C) The plan may specify that an area agency on aging is allowed to directly provide information and assistance services and outreach.

(9) The plan shall provide assurances that --- (A) the State agency will carry out, through the Ofice of the State Long-Term Care Ombudsman, a State Long-Term Care Ombudsman program in accordance with section 712 and this title, and will expend for such purpose an amount that is not less than an amount expended by the State agency with funds received under this title for fiscal year 2019, and an amount that is not less than the amount expended by the State agency with funds received under title VII for fiscal year 2019; and (B) funds made available to the State agency pursuant to section 712 shall be used to supplement and not supplant other Federal, State, and local funds expended to support activities described in section 712.

(10) The plan shall provide assurances that the special needs of older individuals residing in rural areas will be taken into consideration and shall describe how those needs have been met and describe how funds have been allocated to meet those needs.

(11) The plan shall provide that with respect to legal assistance -- (A) the plan contains assurances that area agencies on aging will (i) enter into contracts with providers of legal assistance which can demonstrate the experience or capacity to deliver legal assistance; (il) include in any such contract provisions to assure that any recipient of funds under division (i) will be subject to specific restrictions and regulations promulgated under the Legal Services Corporation Act (other than restrictions and regulations governing eligibility for legal assistance under such Act and governing membership of local governing boards) as determined appropriate by the Assistant Secretary; and (ill) attempt to involve the private bar in legal assistance activities authorized under this title, including groups within the private bar furnishing services to older individuals on a pro bono and reduced fee basis;

(B) the plan contains assurances that no legal assistance will be furnished unless the grantee administers a program designed to provide legal assistance to older individuals with social or economic need and has agreed, if the grantee is not a Legal Services Corporation project grantee, to coordinate its services with existing Legal Services Corporation projects in the planning and service area in order to concentrate the use of funds provided under this title on individuals with the greatest such need; and the area agency on aging makes a finding, after assessment, pursuant to standards for service promulgated by the Assistant Secretary, that any grantee selected is the entity best able to provide the particular services.

(C) the State agency will provide for the coordination of the furnishing of legal assistance to older individuals within the State, and provide advice and technical assistance in the provision of legal assistance to older individuals within the State and support the furnishing of training and technical assistance for legal assistance for older individuals;

(D) the plan contains assurances, to the extent practicable, that legal assistance furnished under the plan will be in addition to any legal assistance for older individuals being furnished with funds from sources other than this Act and that reasonable efforts will be made to maintain existing levels of legal assistance for older individuals; and (E) the plan contains assurances that area agencies on aging will give priority to legal assistance related to income, health care, long-term care, nutrition, housing, utilities, protective services, defense of guardianship, abuse, neglect, and age discrimination.

(12) The plan shall provide, whenever the State desires to provide for a fiscal year for services for the prevention of abuse of older individuals ---- (A) the plan contains assurances that any area agency on aging carrying out such services will conduct a program consistent with relevant State law and coordinated with existing State adult protective service activities for -- (i) public education to identify and prevent abuse of older individuals;

(ii) receipt of reports of abuse of older individuals;

(iii) active participation of older individuals participating in programs under this Act through outreach, conferences, and referral of such individuals to other social service agencies or sources of assistance where appropriate and consented to by the parties to be referred; and (iv) referral of complaints to law enforcement or public protective service agencies where appropriate;

(B) the State will not permit involuntary or coerced participation in the program of services described in this paragraph by alleged victims, abusers, or their households; and (C) all information gathered in the course of receiving reports and making referrals shall remain confidential unless all parties to the complaint consent in writing to the release of such information, except that such information may be released to a law enforcement or public protective service agency.

(13) The plan shall provide assurances that each State will assign personnel (one of whom shall be known as a legal assistance developer) to provide State leadership in developing legal assistance programs for older individuals throughout the State.

(14) The plan shall, with respect to the fiscal year preceding the fiscal year for which such plan is prepared- (A) identify the number of low-income minority older individuals in the State, including the number of low-income minority older Individuals with limited English proficiency; and (B) describe the methods used to satisfy the service needs of the low-income minority older individuals described in subparagraph (A), including the plan to meet the needs of lowincome minority older individuals with limited English proficiency.

(15) The plan shall provide assurances that, if a substantial number of the older individuals residing in any planning and service area in the State are of limited English-speaking ability, then the State will require the area agency on aging for each such planning and service area ---- (A) to utilize in the delivery of outreach services under section 306(a)(2)(A), the services of workers who are fluent in the language spoken by a predominant number of such older individuals who are of limited English-speaking ability; and (B) to designate an individual employed by the area agency on aging, or available to such area agency on aging on a full-time basis, whose responsibilities will include --- (I) taking such action as may be appropriate to assure that counseling assistance is made available to such older individuals who are of limited English-speaking ability in order to assist such older individuals in participating in programs and receiving assistance under this Act; and (ii) providing guidance to individuals engaged in the delivery of supportive services under the area plan involved to enable such individuals to be aware of cultural sensitivities and to take into account effectively linguistic and cultural differences.

(16) The plan shall provide assurances that the State agency will require outreach efforts that will- (A) identify individuals eligible for assistance under this Act, with special emphasis on --- (i) older individuals residing in rural areas;

(ii) older individuals with greatest economic need (with particular attention to low-income older individuals, including low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas);

(ili) older individuals with greatest social need (with particular attention to low-income older individuals, including low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas);

(iv) older individuals with severe disabilities;

(v) older individuals with limited English-speaking ability; and (vi) older individuals with Alzheimer's disease and related disorders with neurological and organic brain dysfunction (and the caretakers of such individuals); and (B) inform the older individuals referred to in clauses (i) through (vi) of subparagraph (A), and the caretakers of such individuals, of the availability of such assistance.

(17) The plan shall provide, with respect to the needs of older individuals with severe disabilities, assurances that the State will coordinate planning, identification, assessment of needs, and service for older individuals with disabilities with particular attention to individuals with severe disabilities with the State agencies with primary responsibility for individuals with disabilities, including severe disabilities, to enhance services and develop collaborative programs, where appropriate, to meet the needs of older individuals with disabilities.

(18) The plan shall provide assurances that area agencies on aging will conduct efforts to facilitate the coordination of community-based, long-term care services, pursuant to section 306(a)(7), for older individuals who --- (A) reside at home and are at risk of institutionalization because of limitations on their ability to function independently;

(B) are patients in hospitals and are at risk of prolonged institutionalization; or (C) are patients in long-term care facilities, but who can return to their homes if community-based services are provided to them.

(19) The plan shall include the assurances and description required by section 705(a).

(20) The plan shall provide assurances that special efforts will be made to provide technical assistance to minority providers of services.

(21) The plan shall --- (A) provide an assurance that the State agency will coordinate programs under this title and programs under title VI, if applicable; and (B) provide an assurance that the State agency will pursue activities to increase access by older individuals who are Native Americans to all aging programs and benefits provided by the agency, including programs and benefits provided under this title, if applicable, and specify the ways in which the State agency intends to implement the activities.

(22) If case management services are offered to provide access to supportive services, the plan shall provide that the State agency shall ensure compliance with the requirements specified in section 306(a)(8).

(23) The plan shall provide assurances that demonstrable efforts will be made ---- (A) to coordinate services provided under this Act with other State services that benefit older individuals; and (B) to provide multigenerational activities, such as opportunities for older individuals to serve as mentors or advisers in child care, youth day care, educational assistance, at-risk youth intervention, juvenile delinquency treatment, and family support programs.

(24) The plan shall provide assurances that the State will coordinate public services within the State to assist older individuals to obtain transportation services associated with access to services provided under this title, to services under title VI, to comprehensive counseling services, and to legal assistance.

(25) The plan shall include assurances that the State has in effect a mechanism to provide for quality in the provision of in-home services under this title.

(26) The plan shall provide assurances that area agencies on aging will provide, to the extent feasible, for the furnishing of services under this Act, consistent with self-directed care.

(27) (A) The plan shall include, at the election of the State, an assessment of how prepared the State is, under the State's statewide service delivery model, for any anticipated change in the number of older individuals during the 10-year period following the fiscal year for which the plan is submitted.

(B) Such assessment may include ---- (i) the projected change in the number of older individuals in the State;

(ii) an analysis of how such change may affect such individuals, including individuals with low incomes, individuals with greatest economic need, minority older individuals, older individuals residing in rural areas, and older individuals with limited English proficiency;

(28) The plan shall include information detailing how the State will coordinate activities, and develop long-range emergency preparedness plans, with area agencies on aging, local emergency response agencies, relief organizations, local governments, State agencies responsible for emergency preparedness, and any other institutions that have responsibility for disaster relief service delivery.

(29) The plan shall include information describing the involvement of the head of the State agency in the development, revision, and implementation of emergency preparedness plans, including the State Public Health Emergency Preparedness and Response Plan.

(30) The plan shall contain an assurance that the State shall prepare and submit to the Assistant Secretary annual reports that describe ---- (A) data collected to determine the services that are needed by older individuals whose needs were the focus of all centers funded under title IV in fiscal year 2019;

(B) data collected to determine the effectiveness of the programs, policies, and services provided by area agencies on aging in assisting such individuals; and (C) outreach efforts and other activities carried out to satisfy the assurances described in paragraphs (18) and (19) of section 306(a).

Sec. 308, PLANNING, COORDINATION, EVALUATION, AND ADMINISTRATION OF STATE PLANS (b)(3)(E) No application by a State under subparagraph (A) shall be approved unless it contains assurances that no amounts received by the State under this paragraph will be used to hire any individual to fill a job opening created by the action of the State in laying off or terminating the employment of any regular employee not supported under this Act in anticipation of filling the vacancy so created by hiring an employee to be supported through use of amounts received under this paragraph.

Sec. 705, ADDITIONAL STATE PLAN REQUIREMENTS (a) ELIGIBILITY .- In order to be eligible to receive an allotment under this subtitle, a State shall include in the state plan submitted under section 307 ---- (1) an assurance that the State, in carrying out any chapter of this subtitle for which the State receives funding under this subtitle, will establish programs in accordance with the requirements of the chapter and this chapter; .

(2) an assurance that the State will hold public hearings, and use other means, to obtain the views of older individuals, area agencies on aging, recipients of grants under title VI, and other interested persons and entities regarding programs carried out under this subtitle;

(3) an assurance that the State, in consultation with area agencies on aging, will identify and prioritize statewide activities aimed at ensuring that older individuals have access to, and assistance in securing and maintaining, benefits and rights;

(4) an assurance that the State will use funds made available under this subtitle for a chapter in addition to, and will not supplant, any funds that are expended under any Federal or State law in existence on the day before the date of the enactment of this subtitle, to carry out each of the vulnerable elder rights protection activities described in the chapter;

(5) an assurance that the State will place no restrictions, other than the requirements referred to in clauses (i) through (iv) of section 712(a)(5)(C), on the eligibility of entities for designation as local Ombudsman entities under section 712(a)(5).

(6) an assurance that, with respect to programs for the prevention of elder abuse, neglect, and exploitation under chapter 3- (A) in carrying out such programs the State agency will conduct a program of services consistent with relevant State law and coordinated with existing State adult protective service activities for- (i) public education to identify and prevent elder abuse;

(ii) receipt of reports of elder abuse;

(ili) active participation of older individuals participating in programs under this Act through outreach, conferences, and referral of such individuals to other social service agencies or sources of assistance if appropriate and if the Individuals to be referred consent; and (iv) referral of complaints to law enforcement or public protective service agencies if appropriate;

(B) the State will not permit involuntary or coerced participation in the program of services described in subparagraph (A) by alleged victims, abusers, or their households; and (C) all information gathered in the course of receiving reports and making referrals shall remain confidential except ---- (i) if all parties to such complaint consent in writing to the release of such information;

(ii) if the release of such information is to a law enforcement agency, public protective service agency, licensing or certification agency, ombudsman program, or protection or advocacy system; or (iii) upon court order.

Signature and Title of Authorized Official Que Ganas Commissioner Date Attachment B INFORMATION REQUIREMENTS Except as indicated where optional or only applicable to States with multiple planning and service areas, the State Plan must state how the following provision(s) will be met:

Greatest Economic and Greatest Social Need 45 CFR § 1321.27 (d) requires each State Plan must include a description of how greatest economic need and greatest social need are determined and addressed by specifying:

(1)

How the State agency defines greatest economic need and greatest social need, which shall include the populations as set forth in the definitions of greatest economic need and greatest social need, as set forth in 45 CFR § 1321.3; and (2)

The methods the State agency will use to target services to such populations, including how OAA funds may be distributed to serve prioritized populations in accordance with requirements as set forth in 45 CFR § 1321.49 or 45 CFR § 1321.51, as appropriate.

"Greatest economic need" means "the need resulting from an income level at or below the Federal poverty level and as further defined by State and area plans based on local and individual factors, including geography and expenses" (45 CFR § 1321.3).

"Greatest social need" means the need caused by the following noneconomic factors as defined in 45 CFR § 1321.3.

A State agency's response must establish how the State agency will:

(1) identify and consider populations in greatest economic need and greatest social need;

(2) describe how they target the identified the populations for service provision;

(3) establish priorities to serve one or more of the identified target populations, given limited availability of funds and other resources;

(4) establish methods for serving the prioritized populations; and (5) use data to evaluate whether and how the prioritized populations are being served.

All Area Agencies on Aging and county aging providers must adhere to how they will include targeted outreach to greatest economic need (GEN) and greatest social need (GSN) populations, and this requirement is within the assurances in their annual Area Plans and provider plans, it is a requirement in the Title III Older Americans Act Policy Manual, and it is included within grant agreement conditions. Another mechanism used for assuring services are targeted to GEN and GSN populations appropriately is the funding formula utilized to distribute Title III funds. The formula was implemented taking into consideration multiple GEN and GSN factors including age, low-income, and rurality. The Bureau of Senior Services also requires county aging providers to complete the Bureau's Services Assessment and Evaluation Form (SAEF) for services received by West Virginia seniors. This completed assessment and evaluation form scores and prioritizes seniors based on Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) needs and greatest economic and greatest social needs such as, low-income, rural, and limited English proficiency. The required completion of SAEF's is monitored annually by the Area Agencies on Aging. In addition to the SAEF, on October 16, 2024, Risk Indicators were added to the assessment. These indicators address many specific greatest social needs indicators such as individuals who use oxygen, those with chronic conditions, food insecurity, terminal illness, utility issues in the home and lack of transportation. The SAEF has a scoring mechanism that provides prioritization scoring using all these factors of greatest economic need and greatest social need. Monitoring tools also address this assurance by validating that prioritization of services are targeting those with greatest economic and greatest social need.

Federal SPR data reports are utilized to evaluate target and prioritized populations being served.

Native Americans: Greatest Economic and Greatest Social Need 45 CFR § 1321.27 (g):

Demonstration that the determination of greatest economic need and greatest social need specific to Native American persons is identified pursuant to communication among the State agency and Tribes, Tribal organizations, and Native communities, and that the services provided under this part will be coordinated, where applicable, with the services provided under Title VI of the Act and that the State agency shall require area agencies to provide outreach where there are older Native Americans in any planning and service area, including those living outside of reservations and other Tribal lands.

WV does not receive Title VI funding and does not have any federally recognized Tribes, Tribal organizations or Native communities. The Bureau will communicate with the following Native American organizations in West Virginia: the Appalachian American Indians of West Virginia, Inc., and the Native American Indian Federation, Inc. The Bureau will share information with Area Agencies on Aging and county aging providers for outreach and public Information/education to these entities and population of older individuals. The SAEF also provided county aging providers with American Indian demographic identification they can utilize for outreach.

Activities to Increase Access and Coordination for Native American Older Adults OAA Section 307(a)(21): The plan shall - (B) provide an assurance that the State agency will pursue activities to increase access by older individuals who are Native Americans to all aging programs and benefits provided by the agency, including programs and benefits provided under this title, if applicable, and specify the ways in which the State agency intends to implement the activities.

45 CFR § 1321.53:

(a) For States where there are Title VI programs, the State agency's policies and procedures, developed in coordination with the relevant Title VI program director(s), as set forth in § 1322.13(a), must explain how the State's aging network, including area agencies and service providers, will coordinate with Title VI programs to ensure compliance with sections 306(a)(11)(B) (42 U.S.C. 3026(a)(11)(B)) and 307(a)(21)(A) (42 U.S.C. 3027(a)(21)(A)) of the Act. State agencies may meet these requirements through a Tribal consultation policy that includes Title VI programs.

(b) The policies and procedures set forth in (a) of this provision must at a minimum address:

(1) How the State's aging network, including area agencies on aging and service providers, will provide outreach to Tribal elders and family caregivers regarding services for which they may be eligible under Title Ill and/or VII;

(2) ) The communication opportunities the State agency will make available to Title VI programs, to include Title III and other funding opportunities, technical assistance on how to apply for Title III and other funding opportunities, meetings, email distribution lists, presentations, and public hearings;

(3)

The methods for collaboration on and sharing of program information and changes, including coordinating with area agencies and service providers where applicable;

(4) How Title VI programs may refer individuals who are eligible for Title III and/or VII services;

(5)

How services will be provided in a culturally appropriate and trauma-informed manner; and (6)

Opportunities to serve on advisory councils, workgroups, and boards, including area agency advisory councils, as set forth in § 1321.63.

WV does not receive Title VI funding and does not have any federally recognized Tribes, Tribal organizations or Native communities. The Bureau will communicate with the following Native American organizations in West Virginia: the Appalachian American Indians of West Virginia, Inc., and the Native American Indian Federation, Inc. The Bureau will share information with Area Agencies on Aging and county aging providers for outreach and public information/education to these entities and population of older individuals. The SAEF also provided county aging providers with American Indian demographic identification they can utilize for outreach.

Low Income Minority Older Adults OAA Section 307(a)(14):

(14) The plan shall, with respect to the fiscal year preceding the fiscal year for which such plan is prepared- (A) identify the number of low-income minority older individuals in the State, including the number of low-income minority older individuals with limited English proficiency; and (B) describe the methods used to satisfy the service needs of the low-income minority older individuais described in subparagraph (A), including the plan to meet the needs of low-Income minority older individuals with limited English proficiency.

(A) The ACS 2023 indicates that 4.17% of West Virginians are minority older individuals. It also indicates 12% are minority older individuals for whom poverty is determined. ACS 5-year estimates data profiles indicate 2.5% of West Virginians speak a language other than English and 0.7% have limited English proficiency. ACS Special Tabulations (latest release 1/30/24) Table S21014B indicates only three-hundred ninety-five (395) individuals over the age of 60 who cannot speak English well and eighty who cannot speak English at all. Table S21056 indicates 95 minority individuals who cannot speak English well and 15 who cannot speak English at all, for a total of 110. Applying the 12% minority persons older individuals for whom poverty is determined, that indicates 13.2% low-income minority older individuals with limited English proficiency.

(B) The Bureau of Senior Services obtains demographic information on all targeted OAA populations on the SAEF. County aging providers also do outreach and public information/education within their counties targeting areas with high populations of older low-income seniors to provide information on services and supports. They provide information to local social service organizations that serve low-income populations as well as community organizations, churches and associations.

The Bureau also tracks registered clients for home-delivered meals, adult day care, chore, homemaker and personal care. Of the 25,838 registered clients served in FY24, 139 were Hispanic or Latino and 1147 or 4.6% were racial minority, which is a higher percentage than West Virginia's 4.17 total minority population. These requirements are also addressed through the assurances within Area Agency on Aging Area Plans and West Virginia's intrastate funding formula.

Rural Areas - Hold Harmless OAA Section 307(a)(3): The Plan shall- (B) with respect to services for older individuals residing in rural areas -- (i) provide assurances the State agency will spend for each fiscal year not less than the amount expended for such services for fiscal year 2000;

(ii) Identify, for each fiscal year to which the plan applies, the projected costs of providing such services (including the cost of providing access to such services); and (iii) describe the methods used to meet the needs for such services in the fiscal year preceding the first year to which such plan applies.

(i) The Bureau of Senior Services annually submits a certified Maintenance of Effort report.

Each county aging provider receives annually as much funding as it received in the year 2000.

(ii) Rural Counties Title Ill Services ONLY FY2024 (and additional State Plan fiscal years).

MIB $1,318,696

NIC $2,967,935

HID $ 95,738

WIE $ 673,844 $5,056,213

Total Title III Services Funding FY2024 (and additional State Plan fiscal years)

Title IIIB $2,220,870 Title IIIC $4,998,420 Title IIID $ 161,237 Title IIIE $1.094,302 Total $8,474,829 As indicated above, West Virginia expends sixty percent (60%) of its Title Ill service funding in rural counties. This calculation doesn't account for the services provided to individuals who live in a rural area of an "urban" county. These budgets will remain the same for each fiscal year of the State Plan unless there is a change in the Intrastate Funding Formula or an increase or decrease in federal funding.

(iii) In FFY24, Title Ill funds totaled $9,689,829. Of this, $8,474,829 (87%) was allocated to fifty-six (56) county aging providers based on the population of older adults residing in rural areas. As described above in the response for 307(a)(2), a minimum of fifty percent (50%) of Title IIIB funds must be spent on access services.

West Virginia has four Planning and Service Areas (PSA's) each with an Area Agency on Aging (AAA). The AAA's contract with fifty-six (56) senior centers across the state, with forty-four of those being in rural counties (80%) where they serve as local focal points to reach seniors in rural areas to provide information and services. The Bureau also works with the Area Agencies on Aging and county aging providers to conduct evaluations, including public input, of activities and projects carried out under the Older Americans Act, including reaching older individuals with the greatest economic need and social needs or disabilities, with particular attention to individuals with low incomes and individuals residing in rural areas. The Bureau solicits the views and experiences of entities and partners knowledgeable about the needs and concerns of the populations served. The Bureau also utilizes other methods, such as website communication, task force workgroups, and statewide conferences/meetings/trainings, to obtain the views of older individuals, area agencies, and others regarding programs carried out under the Older Americans Act.

Rural Areas - Needs and Fund Allocations OAA Section 307(a)(10):

The plan shall provide assurance that the special needs of older individuals residing in rural areas are taken into consideration and shall describe how those needs have been met and describe how funds have been allocated to meet those needs.

West Virginia is a rural state. West Virginia has fifty-five (55) counties, and forty-four (44) of these counties are considered rural. Per AGID, 219,863 persons 60+ live in rural areas. As of 2022, 56.6% of persons 60+ residing in West Virginia live in rural areas (U.S. Census Bureau, American Community Survey). Even with the few urban counties within West Virginia, many areas of those counties are rural. The largest county by population, Kanawha County, is approximately twenty-five (25) percent rural. As Indicated above, West Virginia expends sixty percent (60%) of its Title III service funding in rural counties. The funding formula utilized to distribute Title III funds takes into consideration multiple factors, including a rurality index developed by Mississippi State University. The Bureau of Senior Services obtains rural information on the SAEF, and prioritization for services is given to those residing in rural areas.

The Bureau of Senior Services monitors providers and utilizes monitoring tools to ensure that prioritization is given to those residing in rural areas. In FY24, sixty-nine percent (69%) of clients that received registered services resided in rural areas. This requirement is also addressed through the assurances within Area Agency on Aging Area Plans.

Assistive Technology OAA Section 306(a)(6)(1):

Describe the mechanism(s) for assuring that each Area Plan will include information detailing how the area agency will, to the extent feasible, coordinate with the State agency to disseminate information about the State assistive technology entity and access to assistive technology options for serving older individuals;

The Bureau and Area Agencies work with the Director at the West Virginia University Center for Excellence in Disabilities (WVUCED) and the Assistive Technology Specialists at West Virginia Assistive Technology System (WVATS) to stay informed, collaborate and make referrals to the West Virginia Assistive Technology System and provide information to county aging providers and seniors statewide. WVATS has implemented an online referral system that county aging providers and the Aging and Disability Resource Centers can utilize for assistive technology needs which include demonstrations, training, evaluations, communication access (CAAT), a lending library as well as resources for work incentive planning and assistance and mental health resources. Collaboration and outreach also include written materials regarding WVATS provided to all these entities for dissemination to older individuals and other interested parties.

Minimum Proportion of Funds OAA Section 307(a)(2):

The plan shall provide that the State agency will --...

(c) specify a minimum proportion of the funds received by each area agency on aging in the State to carry out part B that will be expended (in the absence of a waiver under sections 306 or 316) by such area agency on aging to provide each of the categories of services specified in section 306(a)(2). (Note: those categories are access, in-home, and legal assistance. Provide specific minimum proportion determined for each category of service.)

The West Virginia Bureau of Senior Services specifies that county aging providers must utilize a minimum of fifty percent (50%) of Title IIIB funds among each of the following priority services: services associated with access to services, in-home and legal assistance. Within that fifty percent (50%) requirement, the following minimum proportions must be utilized to carry out

part B services:

Access - 80% In-Home - 16% Legal - 4% These requirements are in the Title III OAA Policy Manual, Section 300.18, as well as county aging provider grant agreements. These percentage requirements must also be reflected within their annual provider budgets submitted for review and approval. West Virginia is very rural, and there is a high demand for transportation services with limited resources. West Virginia also provides the opportunity for individuals whose income is above two hundred percent (200%) of the federal poverty level and receiving Title IIIB Personal Care, Homemaker, Chore and/or Adult Day Care to cost share (Chapter 300, Older Americans Act Title III Services Policy Manual,

Section 300.17). The Bureau provides a sliding fee scale for county aging providers to determine the suggested cost share. County aging providers are monitored to ensure compliance with the requirements of the OAA Section 315 regarding cost sharing. Exclusions from cost sharing include congregate meals, home-delivered meals, assisted transportation, information and assistance, legal assistance, transportation, group client support and individual client support. There is no means testing, and services cannot be denied if individuals choose not to cost share.

Assessment of Statewide Service Delivery Model OAA Section 307(a)(27):

(A) The plan shall include, at the election of the State, an assessment of how prepared the State is, under the State's statewide service delivery model, for any anticipated change in the number of older individuals during the 10-year period following the fiscal year for which the plan is submitted.

(B) Such assessment may include --- (i) the projected change in the number of older individuals in the State;

(iii) an analysis of how the programs, policies, and services provided by the State can be improved, including coordinating with area agencies on aging, and how resource levels can be adjusted to meet the needs of the changing population of older individuals in the State; and (iv) an analysis of how the change in the number of individuals age 85 and older in the State is expected to affect the need for supportive services The West Virginia Bureau of Senior Services has elected to not include an assessment for the 10-year period following the fiscal year for which the plan is submitted in the 2025-2029 State Plan on Aging.

Shelf Stable, Pick-Up. Carry-Out. Drive-Through, or Similar Meals Using Title III Congregate Nutrition (C-1) Service Funding (Optional, only for States that elect to pursue this activity) 45 CFR § 1321.87(a)(1)(ii):

Title III C-1 funds may be used for shelf-stable, pick-up, carry-out, drive-through, or similar meals, subject to certain terms and conditions:

(A) Such meals must not exceed 25 percent of the funds expended by the State agency under Title III, part C-1, to be calculated based on the amount of Title III, part C-1 funds available after all transfers as set forth in 45 CFR § 1321.9(c)(2)(ili) are completed;

(B) Such meals must not exceed 25 percent of the funds expended by any area agency on aging under Title Ill, part C-1, to be calculated based on the amount of Title III, part C-1 funds available after all transfers as set forth in 45 CFR § 1321.9(c)(2)(iii) are completed;

(iii) Such meals are to be provided to complement the congregate meal program:

a. During disaster or emergency situations affecting the provision of nutrition services;

b. To older individuals who have an occasional need for such meal; and/or c. To older individuals who have a regular need for such meal, based on an individualized assessment, when targeting services to those in greatest economic need and greatest social need; and 45 CFR § 1321.27 (j);

If the State agency allows for Title III, part C-1 funds to be used as set forth in §1321.87(a)(1)(i), the State agency must include the following:

(1) Evidence, using participation projections based on existing data, that provision of such meals will enhance and not diminish the congregate meals program, and a commitment to monitor the impact on congregate meals program participation;

(2) Description of how provision of such meals will be targeted to reach those populations identified as in greatest economic need and greatest social need;

(3) Description of the eligibility criteria for service provision;

(4) Evidence of consultation with area agencies on aging, nutrition and other direct services providers, other stakeholders, and the general public regarding the provision of such meals; and (5) Description of how provision of such meals will be coordinated with area agencies on aging, nutrition and other direct services providers, and other stakeholders.

West Virginia is not utilizing C1 funds for shelf-stable, pick-up, carry-out, drive-through, or similar meals.

Funding Allocation - Ombudsman Program 45 CFR Part 1324, Subpart A:

How the State agency will coordinate with the State Long-Term Care Ombudsman and allocate and use funds for the Ombudsman program under Title Ill and Vil, as set forth in 45 CFR part 1324, subpart A.

The Chief Fiscal Officer of the West Virginia Bureau of Senior Services will meet quarterly, and more often as needed, with the State Long Term Care Ombudsman (SLTCO) to inform the SLTCO of all sources of funds for the program and requirements for those funds and to assure that the SLTCO approves all allocations of programs resources before they are distributed to determine that such allocations are consistent with laws, policies, and procedures that govern the Ombudsman program.

Funding Allocation - Elder Abuse, Neglect and Exploitation 45 CFR § 1321.27 (k):

How the State agency will allocate and use funds for prevention of elder abuse, neglect, and exploitation as set forth in 45 CFR part 1324, subpart B.

The West Virginia Bureau of Senior Services will continue to partner with the WV Department of Human Services and Adult Protective Services by co-sponsoring an annual elder abuse awareness education event for all Bureau contracted providers, Area Agencies on Aging, and others. This conference offers continuing education credit for social workers, nurses, nursing home administrators, and attorneys.

The West Virginia Bureau of Senior Services will conduct a program of services consistent with relevant state law and coordinates with existing state adult protective service activities for public education to identify and prevent elder abuse; to receive reports of elder abuse; to engage participation of older individuals in programs under this Act through outreach, conferences, and referral of such individuals to other social service agencies or sources of assistance, if appropriate, and if the individuals being referred consent; and to refer complaints to law enforcement or public protective services agencies, if appropriate.

The West Virginia Bureau of Senior Services will support county aging providers to offer abuse, neglect, financial exploitation and/or reporting information and training to county aging providers, older individuals, caregivers and stakeholders.

The West Virginia Bureau of Senior Services will support and collaborate with the State Long-Term Care Ombudsman in the program's educational efforts to identify, report, and prevent abuse, neglect, and financial exploitation of older adults residing in residential long-term care facilities.

Monitoring of Assurances 45 CFR § 1321.27 (m):

Describe how the State agency will conduct monitoring that the assurances (submitted as Attachment A of the State Plan) to which they attest are being met.

The Bureau has established annual monitoring processes to ensure that the assurances are being met and services are being provided per policy. Monitoring tools include OAA requirements and can be located at www.wyseniorservices.gov Assurances are also annually provided and signed by both the Area Agencies on Aging and county aging providers and are included within their annual signed grant agreement conditions. Area Agencies on Aging monitor monthly services provided and invoices to ensure services are provided as required.

The SAEF assessment is utilized to identify and target the greatest social need individuals and greatest economic need individuals. Reports are generated to regularly (most monthly) monitor meals served, in-home care services, evidence-based disease prevention and health promotion services, caregiver services and other services.

State Plans Informed By and Based on Area Plans 45 CFR § 1321.27 (c):

Evidence that the State Plan is informed by and based on area plans, except for single planning and service area States.

The State Plan and Area Plans are developed as a team project with the Bureau staff, the Area Agencies on Aging and county aging providers. The core team consists of Bureau staff including the Commissioner, Deputy Commissioner, Director of the OAA Program and the Chief Financial Officer, the Executive Directors of each of the four AAA's and four county aging provider Executive Directors (Marion County, Lincoln County, Randolph County and McDowell County, one from each region). Information is distributed regularly with all county aging providers for development input throughout the process. The State Plan and Area Plans are developed together via meetings, collaboration and communication utilizing the needs assessments conducted and following the ACL guidance issued regarding content and key topics of OAA core programs, greatest economic and greatest social need, expanding access to home and community-based services and caregiving.

Public Input and Review 45 CFR § 1321.29:

Describe how the State agency considered the views of older individuals, family caregivers, service providers and the public in developing the State Plan, and how the State agency considers such views in administering the State Plan. Describe how the public review and comment period was conducted and how the State agency responded to public input and comments in the development of the State Plan.

Four AAA's and four county provider agency Executive Directors served on State Plan Development/Area Plan team formed in October 2024. Development meetings are held monthly or more frequently. Email communication of all plan development content is shared with team members for input and development. Information is disseminated to all county aging providers for input.

· Statewide needs assessment conducted with older individuals, caregivers, service providers and other interested parties.

· During development, information is shared via sections with AAA's, county aging providers and other interested parties. ® County aging providers disseminated information to seniors in their counties via senior center forums and newsletters.

· Plan posted on Bureau website for public comment and notices placed on county aging provider websites. » 30-day comment period on Secretary of State's website.

Program Development and Coordination Activities (Optional, only for States that elect to pursue this activity) 45 CFR § 1321.27 (h):

Certification that any program development and coordination activities shall meet the following requirements:

(1) The State agency shall not fund program development and coordination activities as a cost of supportive services under area plans until it has first spent 10 percent of the total of its combined allotments under Title III on the administration of area plans;

(2) Program development and coordination activities must only be expended as a cost of State Plan administration, area plan administration, and/or Title III, part B supportive services;

(3) State agencies and area agencies on aging shall, consistent with the area plan and budgeting cycles, submit the details of proposals to pay for program development and coordination as a cost of Title III, part B supportive services to the general public for review and comment; and (4) Expenditure by the State agency and area agency on program development and coordination activities are intended to have a direct and positive impact on the enhancement of services for older persons and family caregivers in the planning and service area.

West Virginia does not elect to pursue this activity.

Legal Assistance Developer 45 CFR § 1321.27 (I):

How the State agency will meet responsibilities for the Legal Assistance Developer, as set forth in part 1324, subpart C.

The West Virginia Bureau of Senior Services LAD will meet at least quarterly, and more often as needed, with the Title IIIB legal services provider (West Virginia Senior Legal Aid) to discuss current legal trends/concerns and communicate Information from partners, including but not limited to, the LSC-funded legal service provider (Legal Aid of West Virginia), the Office of the West Virginia Attorney General, the State Long Term Care Ombudsman and other relevant resources, i.e., National Center on Law and Elder Rights.

The West Virginia Bureau of Senior Services LAD will participate in scheduled senior center events and co-ordinate the dissemination of information and provision of training for senior center providers to help assure that older individuals understand their rights, exercise choices, benefit from services and opportunities, and avoid unnecessary guardianship or conservatorship proceedings.

The West Virginia Bureau of Senior Services will provide the LAD with opportunities to learn from and network with LAD colleagues and state/national legal professionals, including but not limited to attendance at the annual National Aging and Law Conference, to assure that the LAD has the knowledge and resources to carry out the activities required by the OAA and this

regulation.

Emergency Preparedness Plans - Coordination and Development ###### OAA Section 307(a)(28):

The plan shall include information detailing how the State will coordinate activities, and develop long-range emergency preparedness plans, with area agencies on aging, local emergency response agencies, relief organizations, local governments, State agencies responsible for emergency preparedness, and any other institutions that have responsibility for disaster relief service delivery.

The Bureau works with the county aging providers and Area Agencies on Aging on emergency planning and disaster preparedness. County aging providers are required to submit an Emergency Contingency Services Operation Plan (ECSOP) for review and approval that demonstrates their preparedness to meet the needs of seniors in their counties in emergency situations. We also implemented a risk/hazard policy on October 1, 2024. County aging providers must complete this assessment annually as part of the process to develop their ECSOP. Events that have a high probability and/or high severity score must be addressed in emergency plans. The Bureau also implemented risk indicators that were incorporated into the SAEF on October 16, 2024, to identify and maintain lists for individuals at high risk due to indicators such as unable to vacate, uses oxygen, on dialysis, uses wheelchair, terminal illness, bedbound, cognitive deficits, etc. County aging providers partner with local emergency response agencies, relief organizations, local governments and state emergency response agencies. Most serve on their local emergency response agencies teams, and many serve as shelters for disasters in their counties. In recent years, county aging providers have worked with local and state agencies during floods, snowstorms, ice storms, the MCHM water contamination incident and COVID-19. County plans include strategies to implement emergency shelter, meals, wellness check calls and contacts, identification of those with mobility issues, those dependent upon oxygen, etc., to respond to emergent needs during disasters.

The Bureau has a working relationship and partnership with the WV Division of Homeland Security and Emergency Management which manages disaster preparedness, mitigation, response, and recovery efforts throughout the state by coordinating with all responsible local, state and federal agencies. Staff-assigned Bureau staff serve as part of the team to develop the WV Emergency Operations Plan, and the Bureau has a multitude of Emergency Support Functions (ESF) within the Plan, including ESF1 (Transportation), ESF5 (Mass Care), ESF8 (Public Health & Medical Services) and ESF15 (External Affairs). Bureau staff also serve as a member of the WV Department of Health's Center for Threat Preparedness, Access to Functional Needs group. This group specifically works on projects that target individuals with access and/or functional needs during emergent and/or disaster situations. They are currently working on an updated statewide Risk Assessment.

Emergency Preparedness Plans - Involvement of the head of the State agency ###### OAA Section 307(a)(29):

The plan shall include information describing the involvement of the head of the State agency in the development, revision, and implementation of emergency preparedness plans, including the State Public Health Emergency Preparedness and Response Plan.

The Commissioner of the WV Bureau of Senior Services, as well as assigned Bureau staff, work and partner with the West Virginia Division of Homeland Security & Emergency Management in the development of the West Virginia Emergency Operations Plan to deal with disasters and large-scale threats that result from terrorism, enemy attack, sabotage or other hostile action, or from fire, flood, earthquakes or other natural or man-made causes.

Bureau staff also serve as part of the team to develop the WV Emergency Operations Plan, and the Bureau has a multitude of Emergency Support Functions (ESF) within the Plan, including ESF1 (Transportation), ESF5 (Mass Care), ESF8 (Public Health & Medical Services) and ESF15 (External Affairs).

Attachment C West Virginia Intrastate Funding Formula Background The following is a description of the intrastate funding formula used to allocate federal funds and to meet the following federal requirements:

Each State IFF submitted to ACL must demonstrate that the requirements in OAA Sections 305(a)(2)(C) have been met: OAA, Sec. 305(a)(2)(C)

"States shall, (C) in consultation with area agencies, in accordance with guidelines issued by the Assistant Secretary, and using the best available data, develop and publish for review and comment a formula for distribution within the State of funds received under this title that considers (i) the geographical distribution of older individuals in the State; and (ii) the distribution among planning and service areas of older individuals with the greatest economic need and older individuals with greatest social need, with particular attention to lowincome minority older individuals."

Model Development, IFF Input and Public Comment Process West Virginia researched various other States' IFF strategies and formulas and collaborated with the West Virginia AAAs and the county aging providers throughout development of the current IFF. West Virginia Metro AAA contracted with Marshall University Center for Business and Economic Research (MU CBER) to conduct an expansive survey of service providers and research various formula factors. Among other things, the results of the needs survey indicated a need to directly assess the unique needs of West Virginia's rural seniors, a factor that was not accounted for in previous funding formulas. The repeated feedback on the need for more transportation services aligns this aspect of need with rural demographics.

When the IFF was developed, virtual platform meetings were held with Bureau staff, AAAs, and county aging providers. MU CBER also held virtual platform meetings with those parties to explain the research findings and the formula data details.

The Bureau also developed a survey regarding the proposed funding formula. The survey was distributed to AAAs, county aging providers, and Bureau partners/stakeholders. The survey was placed on the Bureau's website and social media platforms. The results received from the survey were supportive of the current IFF weighted factors. West Virginia's IFF model development is aimed at providing funding to ensure quality services to persons aged sixty (60) or over in the demographics required in OAA, Sec. 305(a)(2)(C).

MU CBER developed the original formula for State Plan 2022-2025 utilizing data from the U.S.

Census Bureau's American Community Survey (ACS) 2019 5-Year data and Purdue University's 2010 Index of Relative Rurality (the "IRR"). This data will be used for the IFF for FFY 2023.

The Bureau updates the demographic data used in the IFF periodically (at least every three (3) years), using updated ACS 5-Year data, to lessen the impact of demographic changes that may occur over time. The IRR, which is more fully explained below, uses decennial U.S.

Census rural data (the U.S. Census Bureau updates the rural data every ten years as part of each decennial U.S. Census).

MU CBER updated the formula for the upcoming 2025-2029 State Plan utilizing data from the U.S. Census Bureau's American Community Survey (ACS) 2023 5-Year data and Mississippi State University's Index of Relative Rurality (IRR) 2020.

The data collection methods used by Mississippi State University to establish the 2020 IRR are very similar to that of Purdue University's which was used in the formula for 2022-2025.

Targeted Population Definitions and Weights The funding formula is comprised of five factors. These factors are in keeping with OAA guidelines and were selected to reflect changing demographics and to give preference to target populations. Prior to 2022, the formula was heavily focused on the size of the senior population, with lesser emphasis on the number of seniors living in poverty and minority seniors and contained no rurality metric. The five factors used in the IFF are the following:

Population Aged 60 to 74: This factor the age group that are or are soon to be "young seniors" who are eligible for but do not use services as often as older seniors do. This group is also the "rising 75+" demographic for planning purposes. (10% weight)
Population Aged 75+; This factor addresses the age group most in need of services, including the "oldest old" aged 85+, (30% weight)
Population 65+ in Poverty: This factor focuses on individuals most in need of services due to lack of their own resources to pay for needs in retirement. (30% weight)
Population of Minorities Age 65+: This factor focuses on the seniors with the largest relative need due to higher shares in poverty and lower household incomes. Most minorities also have less generational wealth to draw on to pay for needs in retirement compared to their white counterparts. (10% weight)
Scaled Relative Rurality: This factor is based on Mississippi State University's Index of Relative Rurality (IRR) which aggregates data on population, population density. remoteness, and built-up area by county using GIS analysis. It provides a measure of relative access to services like healthcare and groceries. Since all 55 counties contain rural areas, MU CBER scaled the indices to accentuate differences in rurality and assigned a value of zero to the least rural county (Berkeley) and a value of 1 to the most rural county (Pocahontas). The county IRRs are available at https://zanodo.org/records/7675745 (20%weight).

Table 1: Factor Weights for the Senior Services Funding Formula Factor Pop 60 to 74 Pop 75+ Minority Pop 65+ Pop 65+ in Poverty Rurality % Weight 10% 30% 10% 30% 20% Compared to previous versions of the IFF for West Virginia, this formula triples the emphasis on seniors in poverty and reduces the emphasis on the base population by half. These weights were selected to address the seniors most in need.

Formula Application The IFF is used to determine each AAA's portion of Older Americans Act Title III B, C, D, and E funds: ₹ Title IIIB (Supportive Services) ® Title IIIC1 (Congregate Meals) & Title IIIC2 (Home Delivered Meals) # Title IIID (Health Promotion) ® Title IIIE (Caregiver Services)

The implementation of the IFF allocates Older Americans Act Title III B, C, D, and E funding to the four regional Area Agencies on Aging (AAA). Allocations by the Bureau for State Agency administration and Long-Term Care Ombudsman are deducted first from the available funding, in compliance with, and subject to, all applicable OAA requirements. The remaining funding (the "Available Funding") is allocated to the Area Agencies on Aging pursuant to the IFF, as set forth in the next section below.

The IFF is not used to allocate the Nutrition Services Incentive Program (NSIP) funds. NSIP funds are distributed based on the total number of eligible meals served in each planning and service area to each AAA in proportion to the total number of eligible meals served in the State in the prior federal fiscal year.

IFF Funding Formula Allocations Base Amount for Area Plan Administration Allocation The first step in the formula is the allocation from the Available Funding of a base amount of funding to be awarded to the Area Agencies on Aging (AAAs) for use for Older Americans Act area plan administration. The amount of funding allocated to area plan administration is determined by the Bureau and will not exceed allowable amounts under the OAA and will follow, and subject to, all applicable OAA requirements. The area plan administration funding determined by the Bureau is divided equally among, and allocated equally to, the AAAs. The OAA Title III B, C, D and E funds remaining after deductions from the Available Funding for Area Plan administration is referred to as the "Service Funding." and the Service Funding is allocated to the AAAs, as set forth below.

Service Funding Allocations Demographic Data Calculations Each AAA's percentage share of the following factors:

The share of individuals aged 60 to 74 residing in each county 2. The share of individuals aged 75+ residing in each county 3. The share of individuals aged 65+ in poverty residing in each county 4. The share of minority individuals aged 65+ residing in each county is determined as follows:

First, for each AAA, the applicable data for each county located in the AAA's region is aggregated, using ACS 2023 5-year Data. The following Table 2 shows the AAA-level demographic data for each of the first four factors listed above:

Table 2: Key Demographic Data by AAA AAA Pop 60 to 74 Pop 75+ Pop 65+ Poverty Minority Pop 65+ Region!/Northwestern 93,934 39,935 13,842 3,938 Region II/Metro 104,670 44,421 17,119 5,753 Region III/Potomac 76,666 32,060 12,966 6,196 RegionIViAppalachian 70,953 29,916 14,775 4,269 WV Total 346,223 146,322 58,702 20,156 SOURCE: U.S. Census Bureau, ACS 2023 5-Year Data Next, each AAA's percentage share for each of these four factors is determined by dividing each AAA's demographic data for each factor by the WV Total for that factor:

Demographic data for factor X = AAA percentage share for the factor WV Total for the factor X The following Table 3 shows the calculation of the AAA percentage shares using ACS 2023 5-Year data:

Table 3: Shares of Factor Data by AAA AAA Pop 60 to 74 Pop 75+ Minority Pop 65+ Pop 65+ Poverty Region I/Northwestern 27.13% 27.29% 19.54% 23.58% Region Il/Metro 30.23% 30.36% 28.54% 29.16% Region III/Potomac 22.14% 21.91% 30.74% 22.09% Region IV/Appalachian 20.49% 20.44% 21.18% 25.17% WV Total AAA Scaled Average County Rurality Calculations The incorporation of ruralness in the IFF is important as rural seniors comprise a large portion of the clients served in West Virginia. Every county has residents living in places considered rural.

The majority of the State's counties are more than 50 percent rural, and 13 of 55 counties are 100 percent rural.

MU CBER estimated the number of rural seniors residing in each AAA using Mississippi State University's 2020 IRR.

The IRR is a tool developed by geography researchers at Mississippi State University that accounts for aspects of ruralness in addition to population. 10 It ranks the relative rurality of each county and calculates a value (between 0 and 1) for each county based on 4 steps:

Identifying the dimensions of rurality: population size, density, remoteness, and built-up areas 10 Ayoung Kim, & Brigitte Waldorf. (2023). The Index of Relative Rurality (IRR): US County Data for 2020 (1.0.0) [Data set]. Zenodo. https://doi.org/10.5281/zenodo.7675745 2. Selecting measurable variables to adequately represent each dimension:

· Size: logarithm of population size. » Density: logarithm of population density.

· Remoteness: network distance. The shortest route along the network of roads and highways, using a geospatial database of the U.S. Census Bureau and Federal Highway Administration.

· Built-up area: urban area (per the US Census Bureau) as a percentage of total land area.

Re-scaling the variables onto bounded scales that range from 0 to 1.
Selecting a link function: unweighted average of the four re-scaled variables.

MU CBER adjusted the IRR values by scaling them to create distinction between counties. This process is based on the difference between the most rural (Gilmer and Ritchie in Region I and Barbour in Region III) and the least rural (Kanawha in Region II) counties in West Virginia, and the average county IRR for each AAA. « Maximum County IRR: Gilmer, Ritchie, and Barbour at 0.56 · Minimum County IRR: Kanawha at 0.38 · Difference: 0.56 - 0.38 = 0.18 Each AAA's average county IRR is scaled as follows:

First, the average of the IRRs for the counties in the AAA's region is determined by using county data from the IRR tool. The average is determined by summing all the county IRRs in the region and dividing that sum by the total number of counties in the region:

AAA average county IRR = county 1 IRR + county 2 IRR + county 3 IRR + ... county IRR Total number of counties in the AAA region Next, the minimum IRR for the State (0.38) is deducted from the AAA's average county IRR.

The resulting figure is then divided by the difference between the most rural and least rural counties in the State (0.18).11 This creates a wider range of values between 0 and 1 and provides additional distinction between areas that are rural. This resulting figure is the Scaled IRR for the AAA.

Once the Scaled IRR for a AAA is calculated, the share of rurality for the AAA is calculated. This is done by dividing the AAA's Scaled IRR by the sum of all four AAAs' scaled IRRs. The 12. NOTE: These results are the same as if had scaled all counties in each AAA and averaged those values. resulting number, the AAA's Share of Rurality, is the number used for the IFF (expressed as a percentage - see the column on the right in the table below).

Table 4: Share of Rurality by AAA AAA County Avg IRR Scaled IRR Equation Scaled IRR Share of Rurality Equation Share of Rurality Share of Rurality (%)

Region I/Northwestern

0.4956 (0.4956-0.38) + (0.18)

0.6422 0.6422+2.503

0.2566 25.66% Region II/Metro

0.4700 (0.4700-0.38) + (0.18)

0.5000 0.5000+2.503 0,1998 19.98% Region Il//Potomac

0.5027 (0.5027 - 0.38) + (0.18)

0.6817 0.6817+2.503

0.2723 27.23% Region IV/Appalachian

0.5023 (0.5023 - 0.38) + (0.18)

0.6794 0.6794+2.503

0.2714 27.14% Sum

2.50

1.0000 Demonstration of Allocation of Service Funding through the Intrastate Funding Formula (FF)

Each AAA's percentage share of the Service Funding = (AAA percentage share of Pop 60 to 74 * 0.10) + (AAA percentage share of Pop 75+ * 0.30) + (AAA percentage share of Minority Pop 65+ * 0.10) + (AAA percentage share of Pop 65+ In Poverty * 0.30) + (AAA Relative Rurality percentage share * 0.20)

When applying the factor percentage shares from Tables 3 and 4 above, the formulas for each AAA are the following:

Region ! Total IFF Share: = (27.13% * 0.10) + (27.29% * 0.30) + (19.54% * 0.10) +( 23.58% * 0.30) + (25.66% * 0.20) =

0.2506 Region Il Total IFF Share: = (30.23% * 0.10) + (30.36% * 0.30) + (28.54% * 0.10) + (29.16% * 0.30) + (19.98% * 0.20) =

0.2773 Region Ill Total IFF Share: = (22.14% * 0.10) + (21.91% * 0.30) + (30.74% * 0.10) + (22.09% * 0.30) + (27.23% * 0.20) =

0.2393 Region IV Total IFF Share: = (20.49% * 0.10) + (20.44% * 0.30) + (21.18% * 0.10) + (25.17% * 0.30) + (27.14% * 0.20) =

0.2328 Table 5: Allocation of Funds to AAA's The following table reflects FY2025 Allocations of Federal and State Funds to West Virginia's four Area Agency on Aging and 55 County Aging Service Providers.

ALLOCATION OF FUNDS TO AREA AGENCIES & SERVICES PROVIDERS FOR FY25 PLANNING & SERVICE AREA TITLE HI SERVICE FUNDS (B, C, D, E) & TVI ELDER ABUSE NON-TITLE FUNDS TOTAL AWARD Northwestern Area Agency on Aging $2,199,478 $3,020,777 $5,220,255 Metro Area Agency on Aging $2,456,985 $3,574,641 $6,031,626 Upper Potomac Area Agency on Aging $2,004,627 $2,644,956 $4,649,583 Appalachian Area Agency on Agine $2,109,808 $3,421,379 $5,531,187 Other ** (Unclassified) $27,713,716 $27,713,716 TOTAL $8,770,898 $40,375,469 $49.146,367 ** Other (Unclassified) Funds include Federal NSIP, State funded programs for Nutrition, In-Home Care, Legislative Initiatives for the Elderly (LIFE), Long Term Care Ombudsman, Senior Centers & Medicare Programs Data Sources for Funding Formula · 2023 American Community Survey 5-year Estimates: https://data.census.gov/table?t=Ace%20and%20Sex&g:0400000US54.0500000 040XX 00US5480600000 % Mississippi State University Index of Relative Rurality: https://scholarsjunction.misstels.edu/males-publications/1/ Attachment D Area Agencies on Aging Geographical Boundaries West Virginia's four Area Agencies on Aging (AAAs) are

part of a nationwide network of organizations created by the Older Americans Act for the purpose of developing a comprehensive and coordinated plan that assures seniors have access to needed services and programs. The AAAs contract with county aging providers (senior centers) for the provision of meals, transportation, and other services; they also monitor the providers for programmatic and fiscal compliance.

Region 1 Region II Region IN Region IV Region !

Northwestern AAA PO Box 2086 (105 Bridge Street Plaza)

Wheeling, WV 26003 Telephone: 304-242-1800; 800-924-0088 Fax: 304-242-2437 E-mail: khudak@@belomar.org Website: https://www.belomar.org/aging/ Katie Hudak, Director Counties Served: Brooke, Calhoun, Doddridge, Gilmer, Hancock, Harrison, Marion, Marshall, Monongalia, Ohio, Pleasants, Ritchie, Tyler, Wetzel, Wirt, Wood Region Il Metro AAA 824 Cross Lanes Drive Cross Lanes, WV 25313 Telephone: 304-720-6858 Fax: 304-720-6864 E-mail: LanderBB@metroaaa.com Website: https://www.metroaaa.com/ Brenda Landers, Director Counties Served: Boone, Cabell, Jackson, Kanawha, Lincoln, Logan, Mason, Mingo, Putnam, Roane, Wayne Region III Upper Potomac AAA 131 Providence Lane Petersburg, WV 26847 Telephone: 304-257-1221; 800-296-1221 Fax: 304-257-4958 E-mail: AAnderson@regioneight.org Website: https://www.regioneight.org/upaaa Ashley Anderson, Director Counties Served: Barbour, Berkeley, Grant, Hampshire, Hardy, Jefferson, Lewis, Mineral, Morgan, Pendleton, Preston, Randolph, Taylor, Tucker, Upshur Region IV Appalachian AAA 1460 Main Street, Box 2 Princeton, WV 24740 Telephone: 304-425-1147; 800-473-1207 Fax: 304-487-3767 E-mail: Rebecca.Bivens@appalachiansaa.org Website: https://www.aaapa.org/ Rebecca Bivens, Director Counties Served: Braxton, Clay, Fayette, Greenbrier, McDowell, Mercer, Monroe, Nicholas, Pocahontas, Raleigh, Summers, Webster, Wyoming Attachment E Public Comment and Input 1. Four AAA's and four county provider agency Executive Directors served on State Plan Development/Area Plan team formed in October 2024. Development meetings held monthly or more frequently. Email communication of all plan development content shared with team members for input and development.

Information disseminated to all county aging providers for input.

Statewide needs assessment conducted with older individuals, caregivers, service providers and other interested parties.
During development, information is shared via sections with AAA's, county aging providers and other interested parties. Attachment B also submitted to ACL Regional Administrator for review during development.
County aging providers disseminated information to seniors in their counties.
Plan posted on Bureau website, social media sites for public comment and notices placed on county aging provider websites.
30-day public comment period through Secretary of State's website.

Attachment F Needs Assessment for West Virginia Residents Aged 60 and Over & Caregivers Objectives The Center of Business and Economic Research (CBER) at Marshall University conducted this needs assessment on behalf of the West Virginia Bureau of Senior Services to identify the unmet needs of Seniors (defined as those aged sixty and older) in the State of West Virginia.

Primary data collection for this assessment began in October 2024 and ended December 2024.

A total of 725 individuals aged sixty and over, 165 Caregivers, and 123 individuals who work directly with seniors participated in surveys as part of this project, all of whom resided in the State of West Virginia. Specific goals for this project included identifying unmet needs for Seniors in the state, seeking to understand how to better meet these needs, and identifying how services should adapt to meet these needs.

Background Definitions The Code of Regulations set forth by the West Virginia Legislature defines a Senior as an individual who is sixty years of age or older. 12 Demographic Statistics Data from the 2023 American Community Survey 5-Year Estimates Series data indicates that there are approximately 497,318 seniors in West Virginia, 13 equating to approximately

27.9 percent of the total population. Of these Seniors, approximately 46.6 percent are male, and

53.4 percent are female. A significant majority (94.3 percent) identified their race as being "White", with 2.5 percent identified as "Black or African American", 0.1 percent identified as "Native American or Alaskan Native", 0.5 percent reported their race as "Asian", 0.3 percent reported being some other race, 2.3 percent identified as two or more races and 0.8 percent identified as Hispanic. This data is presented graphically in Figures 1-4.

WV Legislature §16-55-3. Chapter 16, Article 55. Meaning of Senior as defined by West Virginia Code. https://code.wvierislature.nov/16-55-3/ 2 U.S. Census Bureau, U.S. Department of Commerce. "ACS Demographic and Housing Estimates." American Community Survey, ACS 5-Year Estimates Dato Profiles, Table DP05, 2023.

Figure 1. Total Population and Seniors in West Virginia 2,000,000 1,800,000 1,600,000 1,400,000 1,200,000 1,000,000 800,000 600,000 400,000 200,000 Total Population Aged 60 and Older Source: 2023 American Community Survey 5-Year Estimates Series Figure 2. West Virginia Seniors as a Percentage of Total Population 60 and older Population 28% Population under 72% Source: 2023 American Community Survey 5-Year Estimates Series Figure 3. West Virginians Aged Sixty and Older by Gender 46.6% 53.4% Total Male Population & Total Female Population Source: 2023 American Community Survey 5-Year Estimates Series Figure 4. West Virginians Aged Sixty and Older by Race/Ethnicity 90% 80% 70% 60% 40% 30% 20% 10% 0% White Native American/ Alaskan Native Hispanic Some Other Race Two or More Races Race/Ethnicity 94% 0.1% 0.8% 0.3% 2.3% Methodology Survey Instrument This project used multiple surveys and various methods of data collection. In order to gather data swiftly and efficiently, three versions of the Senior Needs Survey were deployed throughout the state. Distribution methods included in person surveys (during group meals and activities), mail-in surveys, and online surveys using the online SurveyMonkey™ platform. Each of the three surveys aimed to gather information from a different audience (Seniors, Unpaid Caregivers, Senior Center Staff) with the intent to garner information regarding the unmet needs of seniors throughout the state. This process resulted in the collection of 725 completed senior surveys, 166 completed caregiver surveys, and 124 completed senior center staff surveys. Each survey was comprised of a different set of questions geared toward the target audience. A copy of each survey can be found in the appendix.

Survey Results Survey results are broken down into three categories, each containing two sections. Categories will include Senior Survey Results, Unpaid Caregiver Survey Results, and Senior Staff Survey Results. Each of these categories will contain two sections; the first provides demographic information, while the second details respondent perceived needs.

Senior Survey Results 1. What Age Range Do You Fall In?

The survey began by asking respondents basic demographic questions such as age, race/ethnicity, and gender. The ages surveyed ranged from 60-99, however, most respondents were between the ages of 60-89. Table 1 and Figure 5 show a breakdown of respondent ages.

Table 1. What Age Range Do You Fall In?

What Age Range Do You Fall In?

Age Range 60-69 38.6% 70-79 38.9% 80-89 17.5% 90-99 Figure 5. What Age Range Do You Fall In? 35.0% 30.0% 20.0% 15.0% 10.0% 5,0% 60-69 70-79 80-89 90-99 2. What is your preferred gender?

The majority of respondents who took part in the senior needs survey were female. The complete breakdown of survey participants' gender can be found in Table 2 and Figure 6.

Table 2. What Is Your Preferred Gender?

Response 30.5% 67.9% 1.1% Figure 6. What Is Your Preferred Gender? 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 3. Which of the following do you identify as your race?

This survey question was used to identify the race of survey respondents. The majority of participants (85.1%) identified their race as White/Caucasian. All responses to this question can be found in Table 3 and Figure 7.

Table 3. Which Of the Following Do You Identify as Your Race?

Which Of the Following Do You Identify as Your Race?

Response Number of Responses White or Caucasian 85.1% 10.8% 0.4% Native Hawaiian/Pacific Islander American Indian or Alaska Native 0.7% 0.8% Figure 7. Which Of the Following Do You Identify as Your Race Which of the following do you identify as your race? 85.1% 10.8% 0.4% 0,00% 0.7% White or Caucasian Black or African American Native Hawallan American Indian Prefer not to say or other Pacific or Alaska Native Islander 4. Do you identify as Hispanic or Latino/a?

The majority of participants did not identify as Hispanic or Latino/a. The complete breakdown of this question can be found in Table 4 and Figure 8.

Table 4. Do you identify as Hispanic or Latino/a?

Do you identify as Hispanic or Latino/a? 0.7% 82.8% 16.5% 0.7% Figure 8. Do you identify as Hispanic or Latino/a? Do you identify as Hispanic or Latino/a? 82.8% 5. Which of the following best describes your personal income last year?

Most respondent answers fell between $0-$49,999/year. Only 1.6% of respondents reported their income as being over $150,000/year and approximately 20% of respondents chose not to disclose this information. The income breakdown of respondents can be found in Table 5 and Figure 9.

Table 5.

Which of the Following Best Describes Your Personal Income Last Year? $0-$14,999 16.7% $15,000-$24,999 23.6% $25,000-$49,999 21.1% $50,000-$74,999 8.8% $75,000-99,999 100,000-$149,999 4.0% $150,000 10.6%

9.8 Figure 9. Which of the Following Best Describes Your Personal Income Last Year? Which of the following best describes your personal income last year? 23.6% 21.1% 16.7% 8.8% 10.6% S 4.0% . $0-$14,999 $15,000-$24,999 $25.000-$49,999 $50,000-$74,999 $75,000-$99,999 $100,000-$149,999 $150,000+ 6. What is your current employment status?

A majority of survey participants reported being fully retired or disabled. However, some are still working full-time. The results of this question can be found in Table 6 and Figure 10.

Table 6. What Is Your Current Employment Status? What Is Your Current Employment Status?

Fully Retired 57.4% Retired, but working part-time 7.7% Working full-time 10.2% Working part-time 1.4% Unemployed Unemployed, but looking for work 0.2% Homemaker Disabled Don't Know/Prefer Not to Say 1.1% 4.0% Figure 10. What Is Your Current Employment Status? What is your current employment status? 57.4% 7,7% 10.2% 1.4% 0.2% 1.1% Fully Retired Retired, but working part-time Working full time Working part-time Unemployed Unemployed, but looking for ...

Homemaker Disabled Don't know/Prefer not to say Other (please specify)

This question begins Section 2 of the Senior Needs Survey.

How would you rate your current physical health?

The next few questions focus on perceived health status. Many participants report to be in good or fair physical health. The complete breakdown for this question can be found in Table 7 and Figure 11.

Table 7. How Would You Rate Your Current Physical Health? How Would You Rate Your Current Physical Health?

Very Good 23.6% 33.4% 27.4% 4.8% Figure 11. How Would You Rate Your Current Physical Health?

How would you rate your current physical health? 33.4% 27.4% 23.6% Very good 8. How would you rate your current mental health?

Participants also perceive themselves to be in good mental health with the majority of participants responding that their mental health is "good" or "very good." Responses to this question can be found in Table 8 and Figure 12.

Table 8. How Would You Rate Your Current Mental Health? How Would You Rate Your Current Mental Health?

Very Good 31.7% 33.6% 13.1% Figure 12. How Would You Rate Your Current Mental Health? How would you rate your current mental health? 33.6% 31.7% 13.1% Very good 9. Do you currently have any of the following chronic health conditions?

This question asked participants to select any of the listed chronic health conditions they have been diagnosed with. Arthritis and High Blood Pressure were reported as affecting over half of the survey participants. A full breakdown of chronic disease morbidity can be found in Table 9 and Figure 13.

Table 9. Do You Currently Have Any of the Following Chronic Health Conditions? Do You Currently Have Any of the Following Chronic Health Conditions?

Blindness or Severe Vision Impairment Significant Hearing Loss Physical Handicap/Loss of Limb Heart Disease 9.3% Obesity Diabetes 10.7% High Blood Pressure 24.2% Cancer Stroke 2.3% Arthritis 20.7% Emotional or Mental Illness 3.1% Figure 13. Do You Currently Have Any of the Following Chronic Health Conditions?

Do you currently have any of the following chronic health conditions? (choose all that 24.2% 20.7% 9.3% 10.7% 2.3% 3.1% Blindness or ...

Significant.

Physical ...

Heart Disease Obesity Diabetes High Blood ...

Cancer Stroke Arthritis Emotional or ::

Other (please.

Have you received at least one or more doses of the Covid-19 vaccine?

The majority of respondents (68.4%) reported that they had received at least one dose of the vaccine. Of those who answered "No" when prompted with the answer "why not" the most common response was "They just don't want it." More responses can be found in the

appendix. The full breakdown of results for this question can be found in Table 10 and Figure 14.

Table 10. Have You Received At Least One Or More Doses of the Covid-19 Vaccine? Have You Received At Least One Or More Doses of the Covid-19 Vaccine? 68.4% 18.9% Figure 14. Have You Received At Least One Or More Doses of the Covid-19 Vaccine?

Have you received at least one or more doses of the Covid-19 vaccine? 68.4% 11. In the past few months, have you needed help getting enough food or the right kinds of foods to eat?

This question and the following question were used to gauge food scarcity among participants. The majority of respondents (70.8%) reported that they did not need help with getting food to eat. The results of this question can be found in Table 11 and Figure 15.

Table 11. In The Past Few Months, Have You Needed Help Getting Enough Food or the Right Kinds of Foods to Eat?

In The Past Few Months, Have You Needed Help Getting Enough Food or the Right Kinds of Foods to Eat? 23.4% 70.8% Figure 15. In The Past Few Months, Have You Needed Help Getting Enough Food or the Right Kinds of Foods to Eat?

In the past few months, have you needed help getting enough food or the right kinds of foods to eat? 70.8% 23.4% 12. If you answered "Yes" to the previous question, which of the following has prevented you from obtaining these foods?

This question is a follow-up to the previous question regarding food scarcity. The biggest barrier to obtaining food for respondents was reported as "lack of money." A complete breakdown of these answers can be found in Table 12 and Figure 16.

Table 12. Which of the Following Has Prevented You from Obtaining These Foods?

Which of the Following Has Prevented You from Obtaining These Foods?

Lack of Transportation 26.0% Lack of Money 50.7% Lack of Fresh and Nutritious Food in Your Area 7.5% Figure 16. Which of the Following Has Prevented You from Obtaining These Foods?

If you answered "Yes" to the previous question, which of the following has prevented you from obtaining these foods? (choose all 50.7% 26.0% 7.5% Lack of transportation Lack of money Lack of fresh and nutritious food in your area Other (please specify)

On average, how many days a week do you engage in physical activity?

For this question, examples of physical activity included exercise, gardening, and housework. Levels of physical activity varied amongst respondents with most seniors engaging in some sort of physical activity at least one day a week. A full breakdown of responses can be found in Table 13 and Figure 17.

Table 13. On Average How Many Days A Week Do You Engage in Physical Activity? On Average How Many Days A Week Do You Engage in Physical Activity ?? 15.6%

1-2 Days 23.0%

3-4 Days

5-7 Days 23.2% 13.5% Figure 17. On Average How Many Days A Week Do You Engage in Physical Activity? On average, how many days a week do you engage in physical activity? (exercise class, gardening, housework) 23,0% 23.2% 15.6% 1-2 days 3-4 days 5-7 days 14. If you answered "None" to the previous question, what barriers prevent you from being physically active?

For those who responded that they were not engaging in any physical activity during the week, the three biggest perceived barriers were "lack of motivation," "chronic health conditions," and "fear of injury." A full breakdown of these answers can be found in Table 14 and Figure 18.

Table 14. What Barriers Prevent You from Being Physically Active? What Barriers Prevent You from Being Physically Active?

Lack of Motivation 26.4% Chronic Health Conditions 27.5% Fear of Injury 22.7% Lack of Time 4.1% Lack of Access to Facilities Lack of Social Support 5.6% 6.7% Figure 18. What Barriers Prevent You from Being Physically Active?

If you answered "None" to the previous question, what barriers prevent you from being physically active? (choose all that 26.4% 27.5% 22.7% 6.7% 4.1% 5.6% $ Lack of motivation Chronic health conditions Fear of injury Lack of time Lack of access to facilities Lack of social support 15. How do you travel on a regular basis?

The next few questions were used to identify what areas of need there are regarding transportation for seniors. The majority of respondents reported that they drive themselves (49.4%). A number of seniors also reported never leaving the house because they have no transportation. Table 15 and Figure 19 show the results from this question.

Table 15. How do you Travel on a Regular Basis?

How do you Travel on a Regular Basis?

Drive 49.4% Ride in a Car with a Friend or Relative 25.6% Take a Senior Shuttle or Van Use Public Transportation 4.1% Use Rideshares 2.2% Wałk Never Leave the House Figure 19. How do you Travel on a Regular Basis? How do you travel on a regular basis? (choose all that apply) 49.4% 25.6% 4.1% 2.2% Drive Ride in a car with a friend or relative Take a senior van, shuttle, minibus Use public transportation (bus, van)

Use rideshares such as Uber or Lyft Walk Never leave the house 16. If you have difficulty with transportation, what would you say is the main reason?

Respondents reported that "having to rely on others" was their biggest issue regarding transportation. This was followed by "Disability/health-related issues," and public transportation not being available in their area. A full breakdown of the results from this question can be found in Table 16 and Figure 20.

Table 16. What is the Main Reason you have Difficulty with Transportation?

What is the Main Reason you have Difficulty with Transportation?

Having to rely on others 40.1% Don't know who to call Public transportation isn't available in my community 16.0% Can't afford it 8.1% Disability/Health-Related 20.8% Not Sure 9.7% Figure 20. What is the Main Reason you have Difficulty with Transportation?

If you have difficulty with transportation, what would you say is the main reason? (choose all 40.1% 16.0% 20.8% 8.1% 9.7% Having to rely on others Don't know who to call Public transportation ..

Can't afford it Disability/health-related Not sure 17. How would you describe your current housing situation?

This question was used to gauge the need for housing assistance for seniors. Most participants (66.5%) reported that they own their own home. Table 17 and Figure 21 depict all responses to this question.

Table 17. How Would You Describe Your Current Housing Situation?

How Would You Describe Your Current Housing Situation?

I Own My Home 66.5% I Am Renting a Home/Apartment 14.5% I Reside in a Senior Living Community I Am Living with A Friend or Family Member 4.8% I Receive Government Housing Assistance I Am Unhoused Prefer Not to Say 1.4% 10.1% Figure 21. How Would You Describe Your Current Housing Situation? How would you describe your current housing situation? 66.5% 14.5% 4.89% 1.4% I own my home I am renting a home/apartment I reside in a senior living community I am living with a friend or family member I receive government housing assistance I am unhoused Prefer not to say 18. Do you feel safe in your home?

Approximately 70.5% of participants reported that they feel safe in their home. A complete breakdown of responses can be found in Table 18 and Figure 22.

Table 18. Do You Feel Safe in Your Home?

Do You Feel Safe in Your Home? 70.5% 27.6% Figure 22. Do You Feel Safe in Your Home? Do you feel safe in your home? 70.5% 19. What programs and services do you want or need assistance with?

This question was used to assess what services are most desired by seniors in the state.

The most requested services were Home-Delivered/Congregate Meals followed by Transportation and Recreation. All results for this question can be found in Table 19 and Figure 23.

Table 19. What Programs and Services do you Want or Need Assistance With?

What Programs and Services do you Want or Need Assistance With?

Adult Education Employment and Job Training 1.5% Congregate/Home-Delivered Meals Housing Assistance Emergency Preparedness 6.6% Technology Assistance 7.9% Welfare Benefits 8.9% Wellness Programs 11.7% 8.9% In-Home Care/Support Legal Assistance 4.9% Socialization 11.9% Figure 23. What Programs and Services do you Want or Need Assistance With? What programs and services do you want or need assistance with? (choose all that apply) 11.7% 11.9% 6.6% 7.9% 8.9% 8.9% 4.9% 1.5% Adult Education Employment and job ...

Congregate meals of ...

Housing assistance Emergency ...

Technology assistance Welfare benefits Wellness programs In-home care/support Legal assistance Socialization 20. During the last year, have you had any problems with any of the following? If yes, how would you describe the problem?

Physical health was the most reported problem for respondents. Approximately 23.0% reported that they would describe their physical health as a major problem and 37.1% reported it as a minor problem. A breakdown of results for this question can be found in Table 20 and Figure 24.

Table 20. During the Last Year, have you Had Problems with Any of the Following?

During the Last Year, Have You Had Problems with Any of the Following?

Major Problem Minor Problem No Problem Physical Health 23.0% 2.7% Adequate Housing 2.7% 89.0% 2.3% Adequate Transportation 38 7.9% 12.2% 77.4% Feelings of 9.9% 20.4% 66.9% 2.9% Loneliness or Isolation Affording Utilities 7.7% 74.5% Affording Medication 27 5.6% 14.7% 77.9% Being a Victim of a Crime 2.9% 91.7% Dealing with Legal Issues 16 3.3% 7.5% 85.3% Performing Everyday Activities 9.6% 20.3% 66.3% 3.8% Having Too Few Activities 9,5% 22.5% 65.6% 6.8% 22.2% 67.0% Figure 24. During the Last Year, have you Had Problems with Any of the Following?

During the last year, have you had problems with any of the following? If yes, how would you describe the problem? ¿ Major Problem #Minor Problem # No Problem PHYSICAL HEALTH ADEQUATE HOUSING BEING A VICTIM OF A CRIME DEALING WITH LEGAL ISSUES & *:

V * V :

ADEQUATE TRANSPORTATION

FEELINGS OF LONELINESS AND/OR ISOLATION

AFFORDING UTILITIES

AFFORDING MEDICATION

PERFORMING EVERYDAY ACTIVITIES (WALKING, ...

HAVING TOO FEW ACTIVITIES/BORED

In case of an emergency, do you have the following? (choose all that apply)

This question was used to gauge the extent to which seniors in the state are prepared for an emergency. Most seniors reported having a place to go and/or a family or friend to assist if necessary. Less than half of participants reported that they have carbon monoxide alarms and only 40.04% reported having access to an emergency kit. Responses to this question can be found in Table 21 and Figure 25.

Table 21. In Case of an Emergency, Do You Have the Following?

In Case of an Emergency, Do You Have Access to the Following?

A place to go if necessary 69.9% A family and/or friend to assist you if needed 79.9% An emergency kit A communication plan/list of emergency contacts 32.3% Smoke alarms 75.6% Carbon monoxide alarms 44.8% If oxygen dependent, a backup supply or power source 5.7% Figure 25. In Case of an Emergency, Do You Have the Following?

In case of an emergency, do you have the following? (choose all that apply) 79.9% 69.9% 75.6% 44.8% 32.3% Smoke alarms Carbon monoxide alarms If oxygen dependent, a backup. 5.7% A place to go if necessary A family and/or friend to assist you.

An emergency kit (medication, A communication plan/list of ...

How do individuals in your household receive information during an emergency?

"Cell Phone Call" was the most chosen response for this question followed by "Television" and "Text Message." Several respondents also reported receiving information via Landline Call. All reported responses to this question can be found in Table 22 and Figure 26.

Table 22. How Do Individuals in Your Home Receive Information During an Emergency? How Do Individuals in Your Home Receive Information During an Emergency?

Cell Phone Call 37.0% Text Message 12.0% Email Landline Call AM/FM Radio Online Via Social Media 5.1% 13.9% Figure 26. How Do Individuals in Your Home Receive Information During an Emergency? How do individuals in your household receive information during an emergency? 37.0% 12.0% 5.1% 3,9% Cell phone call Text message Email Landline call AM/FM Radio Online via social media (please describe)

How Do You Get Your Information About Senior Citizens Services? (Choose all that The most chosen response for this question was "Word of Mouth" followed by "Local Senior Center Website." Approximately 16.4% of respondents reported that they don't receive any information. A full breakdown for this response can be found in Table 23 and Figure 27.

Table 23. How Do You Get Your Information About Senior Citizen Services?

How Do You Get Your Information About Senior Citizen Services?

Online 30.8% By Mail 12.6% By Phone Word of Mouth 47.2% Local Senior Center Website 18.9% Local Senior Center Mailings Local Senior Center Social Media 14.6% WV Bureau of Senior Services 4.7% I Don't Receive Any Information 16.4% 6.2% Figure 27. How Do You Get Your Information About Senior Citizen Services? Where do you get your information about senior citizens services? (choose all that apply) 47.2% 30,8% 18.9% 12.6% 14.6% 16,4% 4.7% 6.2% Online By mail By phone Word of mouth Local senior center website Local senior center mailings Local senior center social media WV Bureau of Senior Services i don't receive any information (please This concludes the Senior Survey portion of the needs assessment. All responses to questions including an "Other" option can be found in the appendix.

B. Senior Caregiver Survey Results 1. What is your age?

This question begins the demographic section of the Unpaid Caregiver survey. Most respondents reported that they were between the ages of 50 and 70. A complete breakdown of the results for this question can be found in Table 24 and Figure 28.

Table 24. What Is Your Age?

Age Range 20-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100 Figure 28. What Is Your Age?

What Is Your Age?

B 20-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100

Ages of Respondents *Number of Respondents 2. What is your preferred gender?

Approximately 87.12% of unpaid caregivers who took this survey were female. The results for this question can be found in Table 25 and Figure 29.

Table 25. What Is Your Preferred Gender?

What Is Your Preferred Gender? 87.1% Prefer Not to Say Figure 29. What Is Your Preferred Gender? What is your preferred gender? 87.1% 3. Which of the following do you identify as your race?

Approximately 95% of respondents reported their race as white. All respondent responses can be found in Table 26 and Figure 30.

Table 26. Which Of the Following Do You Identify as Your Race?

Which Of the Following Do You Identify as Your Race?

White or Caucasian 95.0% Native Hawaiian or Pacific Islander American Indian or Alaska Native Prefer Not to Say Figure 30. Which Of the Following Do You Identify as Your Race?

Which of the following do you identify as your race? 95.0% White or Caucasian Black or African American Native Hawalian American Indian Prefer not to say or other Pacific or Alaska Native Islander 4. Do you identify as Hispanic or Latino/a.

Only 1.2% of respondents reported that they identify as Hispanic or Latino/a. All results for this question can be found in Table 27 and Figure 31.

Table 27. Do You Identify as Hispanic or Latino/a?

Do You Identify as Hispanic or Latino/a?

Number of Percentage of 98.8% Figure 31. Do You Identify as Hispanic or Latino/a?

Do you identify as Hispanic or Latino/a. 98.8% This question begins Section 2 of the Unpaid Caregiver Survey.

What is your relation to the senior you are providing care to?

The most reported relation was "Adult Child" followed closely by "Other Relative."

Approximately 13.7% of respondents reported that they were the spouse of the senior to whom they were providing care for and approximately 10% referred to themselves as "Friend." Results for this question can be found in Table 28 and Figure 32.

Table 28. What Is Your Relation to the Senior You are Providing Care To? What is Your Relation to the Senior You Are Providing Care To?

Spouse 13.7% Adult Child Friend 10.0% Neighbor Other Relative 35.0% Figure 32. What Is Your Relation to the Senior You are Providing Care To? What is your relation to the senior you are providing care to? 35.0% 13.7% 10.0% Spouse Adult child Friend Neighbor Other relative 6. Are you a full-time unpaid caregiver? Approximately 58.9% of respondents reported that they were not full-time unpaid caregivers. This question was used to determine whether unpaid caregivers are also employed. Table 29 and Figure 33 show the results for this question.

Table 29. Are You a Full-Time Unpaid Caregiver?

Are You a Full-Time Unpaid Caregiver?

Number of Percentage of 41.1% 58.9% Figure 33. Are You a Full-Time Unpaid Caregiver? Are you a full-time unpaid caregiver? 58.9% 41.1% 7. Do you provide care for more than one family member on a regular basis?

Less than half but more than 20% of respondents reported that they care for more than one family member on a regular basis. A breakdown of results for this question can be found in Table 30 and Figure 34.

Table 30. Do You Provide Care for More Than One Family Member on a Regular Basis?

Do You Provide Care for More Than One Family Member on a Regular Basis?

Number of Percentage of 31.5% 68.5% Figure 34. Do You Provide Care for More Than One Family Member on a Regular Basis?

Do you provide care for more than one family member on a regular basis? 68.5% 31.5% 8. What kind of care do you provide? (choose all that apply)

Most respondents reported that they provide a variety of care for their senior(s). A complete breakdown of responses can be found in Table 31 and Figure 35.

Table 31. What Kind of Care Do You Provide?

What Kind of Care Do You Provide?

Personal Care 72.0% Housekeeping 81.4% Meals 79.5% 81.4% Management of Finances 65.3% Figure 35. What Kind of Care Do You Provide?

What kind of care do you provide? (choose all that apply) 81.4% 79,5% 81.4% 72.0% ¿ 65.3% Personal Care Housekeeping Meals Management of finances ⑆ 9. How often in the past month have you felt financially burdened by your caregiving?

The most reported response to this question was "Sometimes" followed by "Never."

Results for this question can be viewed in Table 32 and Figure 36.

Table 32. How Often in The Past Month Have You Felt Financially Burdened By Your Caregiving?

How Often in the Past Month Have You Felt Financially Burdened by Your Caregiving?

N/A 8.8% 21.8% 39.4% 30.0%

Figure 36. How Often in The Past Month Have You Felt Financially Burdened by Your Caregiving?

How often in the past month have you felt financially burdened by your caregiving? 39.4% 30.0% 21.8% 8.8% N/A 10. How often have you struggled physically due to your caregiving?

Over half of respondents reported that they sometimes struggle physically with their caregiving. A full breakdown of responses to this question can be found in Table 33 and Figure 37.

Table 33. How Often in The Past Month Have You Struggled Physically Due to Your Caregiving?

How Often in the Past Month Have You Struggled Physically Due to Your Caregiving? 25.6% 51.2% 23.1% Figure 37. How Often in The Past Month Have You Struggled Physically Due to Your Caregiving?

How often have you struggled physically due to your caregiving? 51.2% E 25.6% 23.1% 11. When thinking of the senior you care for, please describe their level of need for the following choices:

Based on responses to this question, unpaid caregivers perceive the biggest needs for their seniors to be "assistance with in-home caregiving," "transportation," and "combating feelings of loneliness and isolation." All responses to this question can be found in Table 34 and Figure 38.

Table 34. When Thinking of the Senior You Care For, Please Describe Their Level of Need for the Following Choices:

When Thinking of the Senior You Care For, Please Describe Their Level of Need for the Following Choices:

Housing Assistance 21.7% 16.6% 12.1% 45.2% 4.5% Income Assistance 17.9% 18.6% 18.6% 39.1% Employment and Job Training 82.2% 9.2% Managing Financial Issues 26.9% 24.4% 15.4% 28.2% 5.1% Managing Social Security Benefits 26.4% 14.2% 15.5% Preparing a Wili/Trust 20.6% 14.2% 45.8% Assistance with In- Home Caregiving 46.7% 21.4% 14.9% 13.6% Managing Chronic Diseases 28.4% 30.3% 20.6% 16.8% Combating Feelings of Loneliness and/or Isolation 35.3% 28.8% 19.6% 12.4% Affording Healthy Foods 20.8% 17.5% 35.1% 39.0% 16.2% 15.6% 28.6% Affording Utilities 14.9% 22.7% 18.8% 40.3% Affording Medication 16.6% 16.6% 14.6% 47.7% 4.6% Avoiding Cybercriminals 24.0% 18.2% 16.2% 33.8% 7.8% Emergency Preparedness 18.2% 27.9% 24.0% Maintaining Routine Healthcare 33.8% 22.7% 16.9% Figure 38. Please Describe Their Level of Need for the Following Choices: When thinking of the senior you care for, please describe their level of need for the following choices: 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% Housing assistance Income assistance Employment and job training Managing financial issues Managing social security benefits Preparing a will/trust Assistance with In-Home Caregiving Managing Chronic Diseases Combating feelings of loneliness and/or isolation Affording healthy foods Affording utilities Affording medication Emergency preparedness Avoiding cybercriminals or online scams Maintaining routine healthcare (vaccines, eye ... 0.00%. #High Need &No Need This concludes the Unpaid Caregiver Survey portion of the report. All responses to questions including an "Other" option can be found in the appendix.

C. Senior Center Staff Survey Results This survey does not include a demographic section.

Please estimate the percentage of seniors at your center who are living at or below the poverty level:

Participants reported that many of their seniors were living at or below the poverty level.

Approximately 40.6% of participants reported that 25%-50% of their seniors were at or below the poverty level and approximately 41.5% reported that more than 50% of their seniors were living at or below the poverty level. All data for this question can be found in Table 35 and Figure 39.

Table 35. Please Estimate the Percentage of Seniors at your Center Who Are Living At Or Below the Poverty Level:

Please Estimate the Percentage of Seniors at Your Center Who Are Living At or Below the Poverty Level 13.8% 40.6% >50% 41.5% Figure 39. Please Estimate the Percentage of Seniors at your Center Who Are Living At Or Below the Poverty Level: Please estimate the percentage of seniors at your center who are living at or below the poverty level: 40.6% 41.5% 13.8% 2. Approximately how many of your seniors are rural?

Over half of respondents reported that over 50% of their seniors reside in an area that is considered rural. All response data for this question can be found in Table 36 and Figure 40.

Table 36. Approximately How Many of Your Seniors Are Rural: Approximately How Many of Your Seniors Are Rural 2,4% 13.0% 24.4% >50% 57.7% Figure 40. Approximately How Many of Your Seniors Are Rural Approximately how many of your seniors are rural? 57.7% 24,4% 13.0% 3.

When it comes to income and housing, what do you perceive to be the level of need for your seniors?

Respondents reported that the three biggest needs for their seniors were "Housing Availability," "Income Assistance," and "Transportation." A complete breakdown of these results can be found in Table 37 and Figure 41.

Table 37. When It Comes to Income and Housing, What Do You Perceive to Be the Level of Need for Your Seniors:

When It Comes to Income and Housing, What Do You Perceive to Be the Level of Need for Your Seniors:

Housing Affordability 57.0% 30.6% 7.4% Housing Accessibility 48.8% 32.2% 14.9% Housing Availability 52.5% 29.2% 13.3% Income Assistance 52.9% 49.2% 0.8% Employment and Job Training 6.8% 22.2% 39.3% 15.4% 16.2% Managing Financial Debt 18.5% 34.4% 34.4% 9.2% Managing Social Security Benefits 32.5% 39.2% 20.0% 5.0% Preparing a Will/Trust 38.0% 31.4% 19.0% 9.1% Assistance with In-Home Caregiving 63.3% 30.8% Figure 41. When It Comes to Income and Housing, What Do You Perceive to Be the Level of Need for Your Seniors:

When it comes to income and housing, what do you perceive to be the level of need for your seniors? & High Need #Moderate Need # Slight Need & No Need # Unsure a # MANAGING SOCIAL SECURITY ... "A"

PREPARING A WILL/TRUST

ASSISTANCE WITH IN-HOME. .-

HOUSING AFFORDABILITY

HOUSING ACCESSIBILITY

HOUSING AVAILABILITY

INCOME ASSISTANCE

EMPLOYMENT AND JOB TRAINING

MANAGING FINANCIAL DEBT

Please estimate the percentage of seniors in your center who are dealing with malnutrition:

Approximately 34.8% of respondents reported that 10-25% of their seniors were experiencing malnutrition and approximately 22.6% of respondents reported that 25-50% of their seniors were experiencing malnutrition. All results for this question can be found in Table 38 and Figure 42.

Table 38. Please Estimate the Percentage of Seniors in Your Center Who Are Dealing with Malnutrition:

Please Estimate the Percentage of Seniors in Your Center Who Are Dealing with Malnutrition 21.7% 34.8% 22.6% >50% Figure 42. Please Estimate the Percentage of Seniors in Your Center Who Are Dealing with Malnutrition: Please estimate the percentage of seniors in your center who are dealing with malnutrition: 34.8% 21.7% 22,6%

14.85 5. What do you perceive to be the biggest barrier to obtaining healthy foods for your seniors? (choose all that apply)

Participants responded that "Affordability" was the biggest barrier followed by "lack of transportation to stores." Responses to this question can be found in Table 39 and Figure 43.

Table 39. What Do You Perceive to Be the Biggest Barrier to Obtaining Healthy Foods for Your Seniors?

What Do You Perceive to Be the Biggest Barriers to Obtaining Healthy Foods for Your Seniors?

Affordability 85.5% Lack of Stores That Sell These Foods 17.1% Lack of Transportation to Stores 67.5% Unable to Cook 55.6% Figure 43. What Do You Perceive to Be the Biggest Barrier to Obtaining Healthy Foods for Your Seniors?

What do you perceive to be the biggest barrier to obtaining healthy foods for your seniors? (choose all that apply) 85.5% 67.5% 55.6% 17.1% Affordability Lack of stores that sell Lack of transportation to these foods stores Unable to cook Other (please specify)

Approximately how many of your seniors come for congregate meals?

Respondents reported most frequently that between 10-25% of their seniors come for congregate meals. A complete breakdown of results for this question can be found in Table 40 and Figure 44.

Table 40. Approximately How Many of Your Seniors Come for Congregate Meals? Approximately How Many of Your Seniors Come for Congregate Meals? 37.2% 24.8% 19.5% We Do Not Offer Congregate Meals Figure 44. Approximately How Many of Your Seniors Come for Congregate Meals? Approximately how many of your seniors come for congregate meals? 37.2% 24.8% 19,5% We do not offer congregate meals 7. Approximately how many of your seniors use your home-delivered meal service?

Most respondents reported that at least 10% of their seniors use their home-delivered meal service. Of those who responded only 3.5% reported less than 10% usage and approximately 7.0% responded that they do not offer home-delivered meals. A complete breakdown of results for this question can be found in Table 41 and Figure 45.

Table 41. Approximately How Many of Your Seniors Use Your Home-Delivered Meal Service?

Approximately How Many of Your Seniors Use Your Home-Delivered Meal Service? 20.2% 30.7% 38.6% We Do Not Offer Home-Delivered Meals Figure 45. Approximately How Many of Your Seniors Use Your Home-Delivered Meal Service? Approximately how many of your seniors use your home-delivered meal service? 38.6% 30.7% 20.2% 3,5% We do not offer homedelivered meals 8. Approximately how many of your seniors have a chronic health condition?

Over half of respondents replied that more than 50% of their seniors has a chronic health condition. All results for this question can be found in Table 42 and Figure 46.

Table 42. Approximately How Many of Your Seniors Have a Chronic Health Condition?

Approximately How Many of Your Seniors Have a Chronic Health Condition?

Number of Percentage of 1.7%% 9.5% 30.7% Figure 46. Approximately How Many of Your Seniors Have a Chronic Health Condition? Approximately how many of your seniors have a chronic condition? (heart disease, diabetes, obesity, cancer., etc.)

30.7 9.5% 9. Approximately how many of your seniors have received at least one dose of the Covid-19 Vaccine?

Over half of the respondents reported being unsure about the number of seniors who had been vaccinated for covid. Approximately 22.6% reported that more than 50% of their seniors had been vaccinated. A full breakdown of results for this question can be found in Table 43 and Figure 47.

Table 43. Approximately How Many of Your Seniors Have Received At Least One Dose of the Covid-19 Vaccine?

Approximately How Many of Your Seniors Have Received At Least One Dose of the Covid-19 Vaccine? 20.0% 22.6% 53.0% Figure 47. Approximately How Many of Your Seniors Have Received At Least One Dose of the Covid-19 Vaccine?

Approximately how many of your seniors have received at least one dose of the Covid-19 vaccine? 53.0% 20.0% 22.5% 10. Is access to healthcare an issue for your seniors?

Approximately 37.1% reported that access to proper healthcare is a moderate concern for their seniors, approximately 27.6% reported that it was a slight concern, and approximately 25.9% responded that it was a great concern for their seniors. All responses to this question can be found in Table 44 and Figure 48.

Table 44. Is Access to Healthcare an Issue for Your Seniors?

Is Access to Healthcare an Issue for Your Seniors?

Yes, It Is a Great Concern 25.9% It Is a Moderate Concern It Is a Slight Concern 27.6% No, It Is Not a Problem Figure 48. Is Access to Healthcare an Issue for Your Seniors? Is access to healthcare an issue for your seniors?

25.95 27.6% Yes, it is a great concern It is a moderate concern It is a slight concern No, it is not a problem 11. What Do You Perceive to Be the Biggest Area(s) of Unmet Medical Needs for Your Seniors?

The biggest areas of unmet needs according to respondents were "Preventative Care," followed closely by "Chronic Disease Management," and "Mental Health." All responses to this question can be found in Table 45 and Figure 49.

Table 45. What Do You Perceive to Be the Biggest Areas of Unmet Medical Needs for Your Seniors?

What Do You Perceive to be the Biggest Areas of Unmet needs for Your Seniors?

Preventative Care 28.5% Chronic Disease Management 24.1% Mental Health 18.1% Dental Health 16.4% Substance Abuse They Do Not Have Unmet Needs 6.9% Figure 49. What Do You Perceive to Be the Biggest Areas of Unmet Medical Needs for Your Senior?

What do you perceive to be the biggest area(s) of unmet medical needs for your seniors? 28.5% 24.1% 18.1% 16.4% 6.9% Preventative care Chronic disease Mental health Dental health Substance abuse They do not have unmet medical needs 12. Approximately how many of your seniors are physically active?

Most respondents reported that at least 10% of their seniors are physically active. A complete breakdown of results for this question can be found in Table 46 and Figure 50.

Table 46. Approximately How Many of Your Seniors Are Physically Active?

Approximately How Many of Your Seniors Are Physically Active? 19.0% 44.9% 8.6% Figure 50. Approximately How Many of Your Seniors Are Physically Active? Approximately how many of your seniors are physically active? 44.9% 19.0% 8.6% 13. Approximately How Many of Your Seniors Do Not Have Access to Transportation?

Respondents reported most frequently that between 10-50% of their seniors do not have access to transportation. Approximately 37.9% reported that 10-25% of their seniors do not have access to transportation and approximately 39.7% reported that 25- 50% do not have access to transportation. All data for this question can be found in table 47 and Figure 51.

Table 47. Approximately How Many of Your Seniors Do Not Have Access to Transportation?

Approximately How Many of Your Seniors Do Not Have Access to Transportation? 37.9% 39.7% 12.9% 3.4% Figure 51. Approximately How Many of Your Seniors Do Not Have Access to Transportation? Approximately how many of your seniors do not have access to transportation? 37.9% 39.7% 12.9% 3.4% 14. What are the biggest barriers to providing transportation services to seniors?

Most respondents reported that "Funding" is their biggest perceived barrier to providing transportation services to seniors. All results for this question can be found in Table 48 and Figure 52.

Table 48. What Are the Biggest Barriers to Providing Transportation Services to Seniors? What Are the Biggest Barriers to Providing Transportation Services to Seniors?

Drivers 48.7% 33.0% 13.0% Funding 75.2% 14.5% Appropriate or Capable Vehicles 31.5% 25.9% 24.1% 12.0% 6.5% County Transit Vehicles 48.4% 25.8% 10.3% 3.1% 12.4% Figure 52. What Are the Biggest Barriers to Providing Transportation Services to Seniors?

What are the biggest barriers to providing transportation services to seniors?

DRIVERS

FUNDING

APPROPRIATE OR

CAPABLE VEHICLES

COUNTY TRANSIT

SERVICES # High Need * Moderate Need * Slight Need & No Need 15. Are seniors in your area aware of services available to them?

Approximately 62.93% of respondents believe their seniors to be "Somewhat Aware" of services offered to them. All responses to this question can be found in Table 49 and Figure 53.

Table 49. Are Seniors in Your Area Aware of Services Available to Them?

Are Seniors in Your Area Aware of Services Available to Them?

Yes, Very Aware Somewhat Aware 62.9% No, Not Very Aware 12.1% Figure 53. Are Seniors in Your Area Aware of Services Available to Them? Are seniors in your area aware of services available to them? 62.9% 12.1% Yes, Very Aware Somewhat Aware No, Not Very Aware 16. What public information/education methods would be most effective? (choose all Most respondents felt that "Direct Mail from Bureau of Senior Services, etc." would be the most effective followed by "Television" and "Outreach Via Community Organizations." All data relating to this question can be found in Table 50 and Figure 53.

Table 50. What Public Information/Education Methods Would Be Most Effective?

What Public Information/Education Methods Would Be Most Effective? 69.8% Telephone 28.4% Radio 39.7% Direct Mail from Bureau of Senior Services, etc. 72.4% Electronic/Social Media 30.2% Outreach via Community Organizations 61.2% Figure 53. What Public Information/Education Methods Would Be Most Effective? What public information/education methods would be most effective? (Choose all that apply) 69.8% 72.4% 61.2% 39,7% 28.4% 30.2% $.2% Telephone Radio Direct mail from Bureau of Senior Services, etc.

Electronic/Social Media Outreach via Community Organizations Other {please 17. Please estimate the need of each of the following services for your senior.

Based on the results of this question, which can be viewed in Table 51 and Figure 54. the biggest areas of need appear to be "In-Home Care" and "Transportation."

Table 51. Please Estimate the Need of Each of The Following Services for Your Seniors: Please Estimate the Need of Each of the Following Services for Your Seniors Respite 36.8% 44.7% 10.5% Legal Assistance 23.2% 50.0% 22.3% 4.5% Emergency Preparedness 34.5% 41.6% 15.9% Technology Assistance 52.6% 31.6% 11.4% 1.8% Wellness Programs 45.1% 38.9% 4.4% 37.7% 42.1% 14.9% 4.4% in-Home Care 73.0% 21.7% 67.0% 27.0% Figure 54. Please Estimate the Need of Each of The Following Services for Your Seniors:

Please estimate the need of each of the following services for your seniors:

RESPITE

LEGAL ASSISTANCE

EMERGENCY PREPAREDNESS

TECHNOLOGY ASSISTANCE

WELLNESS PROGRAMS

RECREATION

IN-HOME CARE

TRANSPORTATION #Moderate Need * Slight Need 18. Please estimate the percentage of seniors who have an emergency preparedness plan in place:

Respondents appear to be mostly usure or do not believe the majority of their seniors have an emergency preparedness plan in place. All results for this question can be found in Table 52 and Figure 55.

Table 52. Please Estimate the Percentage of Seniors Who Have an Emergency Preparedness Plan in Place:

Please Estimate the Percentage of Seniors Who Have an Emergency Preparedness Plan in Place? 33.0% 18.3% 11.3% 28.7% Figure 55. Please Estimate the Percentage of Seniors Who Have an Emergency Preparedness Plan in Place: Please estimate the percentage of your seniors who have an emergency preparedness plan in place 33.0% 28.7% 18.3% 11.3% 19. What are your biggest staffing areas of need?

Respondents report their biggest staffing areas of need to be "In-Home Services," followed by "Drivers," and "Volunteers." All responses to this question can be found in Table 53 and Figure 56.

Table 53. What Are Your Biggest Staffing Areas of Need? What Are Your Biggest Staffing Areas of Need?

In-Home Services 89.6% Drivers 47.7% 32.4% 13.5% 2.7% Community Health Workers/RN's 36.9% 36.0% 16.2% 4.5% 6.3% Volunteers 41.8% 21.8% 21.8% 5.4% 9.1% Social Workers 27.3% 28.2% 19.1% 13.6% 11.8% Cooks/Kitchen Staff 23.4% 37.8% 18.0% 15.3% 5.4% Figure 56. What Are Your Biggest Staffing Areas of Need?

What are your biggest staffing areas of need? # Moderate Need ASlight Need IN-HOME SERVICES [HOMEMAKER, PERSONAL CARE, RESPITE)

DRIVERS

COMMUNITY

HEALTH

WORKERS/RN'S

VOLUNTEERS

SOCIAL WORKERS

COOKS/KITCHEN

STAFF

This concludes the Needs Assessment Survey Section.

A. Appendix Senior Needs Survey Open Ended Question Responses Which of the following do you identify as your race?

English Appalachian American Middle Eastern What is your current employment status?

Short term disability Caregiver Widow's pension Self employed Volunteer If you answered "None" to the previous question, what barriers prevent you from being physically active? (choose all that apply)

COPD

Physical limitations Mobility issues Have you received at least one or more doses of the Covid-19 vaccine? If no, why not?

It's a bio weapon!

Alternative treatment methods are better I am concerned there is not enough research done; people were dying from the effects of taking the vaccine Very little testing, negative results of those with chronic health issues, i.e., heart issues Don't want I didn't trust the government!

Because Pfizer lied and the health czar is all about himself and not West Virginians Don't trust them Personal choice Heart condition Believe it could harm me If you answered "Yes" to the previous question, which of the following has prevented you from obtaining these foods? (choose all that apply)

Physically unable to shop Don't want to go to the store alone Not much appetite Had rare cancer in pallet, unable to get teeth Senior center limitations Hard to walk Mobility issues Do not qualify for SNAP, was turned away from the food bank During the last year, have you had problems with any of the following? If yes, how would you describe the problem?

TBI no energy, get tired easily, need to sleep extended hours Fibromyalgia & Arthritis Needing someone to do minor house repairs concern for when I retire knee replacement and physical therapy Please help all seniors with lowering the costs of utilities; prices of daily living expenses are going up and up and the increase of SS is not keeping up!

Do not use computer & surveys, Information are kept on internet.

A lack of energy need activities to do or groups with Alzheimer's How do individuals in your household receive information during an emergency?

In House alarms N/A Online alerts newspaper Weather app for our county Depends on what kind of emergency Alexa Depends on emergency. Do not have cell service at house. There is landline IF it is working. Do not have TV. Can't text or get text messages because of no cell service.

Would have to be email or landline for house. Radio is only in vehicles.

Where do you get your information about senior citizens services? (choose all In person at center Newsletter from BCSCC Family Unpaid Caregiver Survey Open Ended Question Responses What is your age? 60s When thinking of the senior you care for, please describe their level of need for the following choices Affordable meal delivery Adult daycare services in Putnam County Caregiving assistance Maintaining daily medication transportation The state relies too heavily on providing benefits via the internet I am a senior and they base help on both my husband and mine income, which puts it out of the bracket to get help. He is on oxygen and does pretty well.

Senior Center Staff Survey Open Ended Question Responses When it comes to income and housing, what do you perceive to be the level of need for your seniors?

Housekeeping Transportation for shopping and social Meal delivery made available for a wider area Medical adult day health services, personal care homes, transportation Senior high rise for 60+ no longer exists What do you perceive to be the biggest barrier to obtaining healthy foods for your seniors? (choose all that apply)

Some of our seniors are homeless and only receive cooked meals from our center or at the occasional church event. we need a place all seniors can get fresh fruits and vegetables once a week Poor appetite and isolation reducing desire to eat there is a waiting list What do you perceive to be the biggest area(s) of unmet medical needs for your seniors? specialist care Properly educated medical professionals who understand Alzheimer's and other forms of dementia. In asking a case management team recently if they knew who noted dementia expert Teepa Snow is, not one Case Manager knew who she is. They admitted to not having training. We passed legislation in WV to provide funds for dementia training for first responders, yet they do not get enough training and have cases like in one county where a person with Alzheimer's was arrested for repeatedly calling the police. She had no understanding. Our state is seriously lacking in helping older adults. cleaning and doing chores they are no longer able to perform like grass and weed cutting heavy lifting and small home repairs medical transportation What are the biggest barriers to providing transportation services to seniors?

There is county transportation, but the scheduling seems off. It takes a tremendous amount of time and switching buses to get from certain parts of the main part of town to the other. You have to dedicate a lot of time to go places and return. At times this takes the whole day. appropriate pay unmet needs are evenings and weekends Vehicles used to last 7 - 8 years, now we are lucky if they last 3 years without needing major repairs TRAVEL OUTSIDE OF THE STATE IN COUNTIES BORDERING OTHER STATES What public information/education methods would be most effective? (Choose all that Booths at health fairs, etc.

PARTNERSHIPS WITH OTHER COMMUNITY AGENCIES

Word of mouth Newspapers Direct mail Surveys The Center for Business and Economic Research at Marshall University is conducting a survey on behalf of the West Virginia Bureau of Senior Services to help understand the needs of seniors across the state and how services should adapt to meet those needs.

We are seeking your input as a means of gathering information from a diverse group of citizens.

Section 1: Demographics 1. Area/Zip Code:

A 2. What age range do you fall in? 50-59 60-69 70-79 80-89 90-99 100+ 3. What is your preferred gender?

Which of the following would you identify as your race?

Caucasian Native Hawaiian or Other Pacific Islander American Indian or Alaskan Native 5. Do you identify as Hispanic or Latino/a.

Section 2: Income and Employment 6. Which of the following best describes your personal income last year? $0-$14,999 $15,000-$24,999 $25,000-$49,999 $50,000-$74,999 = $75,000-$99,999 $100,000-$149,999 $150,000+ 7.What is your current employment status?

Fully Retired Retired but working part-time Working full-time Working part-time Unemployed Unemployed, but looking for work Homemaker Disabled Don't know/Prefer not to say

Section 3: Health and Nutrition 8.How would you rate your current physical health?

Very good 9. How would you rate your current mental health? xcellent Very good 10. Do you currently have any of the following chronic health conditions? (choose all that Blindness or severe vision impairment Significant hearing loss Physical handicap/loss of limb Heart Disease Obesity Diabetes High Blood Pressure Cancer Stroke Arthritis Emotional or mental illness 11. Have you received at least one or more doses of the Covid-19 vaccine? If no, why not?

In the past few months, have you needed help getting enough food or the right kinds of foods to eat?

If yes, which of the following has prevented you from obtaining these foods?

Lack of transportation Lack of money Lack of fresh and nutritious food in your area 13. On average, how many days a week do you engage in physical activity? 1-2 days 3-4 days 5-7 days If none, what barriers prevent you from being physically active?

Lack of motivation Chronic health conditions Fear of injury Lack of time Lack of access to facilities Lack of social support

Section 4: Transportation and Housing 14. How do you travel on a regular basis?

Drive Ride in a car with a friend or relative Take a senior van, shuttle, or minibus Use public transportation (bus, van)

Use rideshares such as Uber or Lyft Walk Never leave the house 14. If you have trouble with transportation, what would you say is the main reason?

Having to rely on others Don't know who to call Public transportation isn't available in my community Can't afford it Disability/health-related Not sure 15. How would you describe your current housing situation?

I own my home o I am renting a home/apartment o I reside in a senior living community I am living with a friend or family member c I receive government housing assistance I am unhoused

Section 5: Services 16. What programs and services do you want or need assistance with? (choose all that Adult Education o Employment and job training o Congregate meals or home-delivered meals ☐ ☐ Housing assistance Emergency Preparedness Technology assistance Income assistance Wellness programs Legal Assistance Socialization In-home care/support 17. How often in the past month have you felt financially burdened by your caregiving?

N/A 18. During the last year, have you had problems with any of the following? If yes, how would you describe the problem?

Problems/Concerns Major Problem Minor Problem No Problem Physical Health Adequate Housing Adequate Transportation Feelings of loneliness and/or isolation Affording Utilities Affording Medication Being a victim of a crime Dealing with legal issues Performing everyday activities (walking, bathing, etc.)

Having too few activities/bored 19. Do you have an emergency preparedness plan?

Yes o No 20. How do Individuals In your household receive information during an emergency?

Cell phone call Text message Email Land line call AM/FM Radio Online via social media Text message Email Land line call AM/FM Radio 21.Where do you get your information about senior citizens services?

Online By mail By phone Word of mouth Local senior center WV Bureau of Senior Services I don't receive any information Thank you so much for your participation. Your answers will help form the basis of recommendations for service improvements statewide.

IF YOU HAVE A CAREGIVER, PLEASE REFER THEM TO SECTION 6 BELOW

Section 6: Caregiving 1.What is your age?

What is your gender?
Which of the following would you identify as your race?

Caucasian Native Hawaiian or Other Pacific Islander American Indian or Alaskan Native 4. Do you identify as Hispanic or Latino/a.

Yes o No 5. What is your relation to the senior you are providing care to?

Relative Friend Hired through an agency Assigned by the state 6. Is Caregiving your full-time job?

If not, what is?

Do you provide care for more than one family member on a regular basis? . How often have you struggled financially due to your caregiving?
How often have you struggled physically due to your caregiving?
What kind of care do you provide? (choose all that apply)

Personal Care Housekeeping Meals Management of finances 11. When thinking of the senior you care for, please describe their level of need for the following choices:

Housing assistance Income assistance Employment and job training Managing financial issues Managing Social Security benefits Preparing a will/trust Assistance with In-Home Caregiving Managing chronic diseases Combating feelings of loneliness and/or isolation Affording healthy foods Affording Utilities Affording Medication Avoiding cybercriminals or online scams Emergency preparedness Maintaining routine healthcare (vaccines, eye exams, dental exams)

The Center for Business and Economic Research at Marshall University is conducting a survey on behalf of the West Virginia Bureau of Senior Services to help understand the needs of seniors across the state and how services should adapt to meet those needs.

We are seeking your input as a means of gathering information from a diverse group of providers.

Name (Optional):

Position in center:

Senior Center Name:

County in which senior center is located:

Section 1: Income and Housing 1. Please estimate the percentage of seniors at your center who are living at or below the poverty level: 10% 2. Approximately how many of your seniors are rural?

When it comes to income and housing, what do you perceive to be the level of need for your seniors?

Housing affordability Housing accessibility Housing availability Income assistance Employment and job training Managing financial debt Managing Social Security benefits Preparing a will/trust Assistance with in-home caregiving

Section 2: Health and Nutrition 4. Please estimate the percentage of seniors in your center who are dealing with malnutrition:

What do you perceive to be the biggest barrier to obtaining healthy foods for your seniors? (choose all that apply)

Affordability Lack of stores that sell these foods Lack of transportation to stores Unable to cook 6. Approximately how many of your seniors come for congregate meals or use your home-delivered meal service?

Congregate meals We do not offer congregate meals Home-Delivered Meals We do not offer home-delivered meals 7. Approximately how many of your seniors have a chronic condition? (heart disease, diabetes, obesity, cancer., etc.)

Approximately how many of your seniors have received at least one dose of the Covid- 19 vaccine?
Is access to healthcare an issue for your seniors?

Yes, it is a great concern o It is a moderate concern o It is a slight concern ☐ ☐ ☐ No, it is not a problem 10. What do you perceive to be the biggest area(s) of unmet medical needs for your seniors?

Preventive care Chronic disease Mental health o Dental health Substance abuse They do not have unmet medical needs 11. Approximately how many of your seniors are physically active? 0 ≤ 10% ☒ ☐

Section 3: Transportation 12. Approximately how many of your seniors do not have access to transportation?

What are the biggest barriers to providing transportation services to seniors?

Drivers Funding Appropriate or capable vehicles County Transit Services

Section 4: Services 14. Are seniors in your area aware of services available to them?

Yes, Very Aware Somewhat Aware No, Not Very Aware 15. What public information/education methods would be most effective? (Choose all Telephone Radio Direct mail from county aging provider, etc.

Electronic/ Social Media Outreach via community organizations 16. Please estimate the need of each for the following services for your seniors:

Respite Nutrition services Legal Assistance Emergency preparedness Technology Assistance Wellness programs In home care 17. Please estimate the percentage of your seniors who have an emergency preparedness plan in place:

Section 5: Needs 18. What are your biggest staffing areas of need?

In-home services (homemaker, personal care, respite)

Drivers Community health workers/ RN's Volunteers Social workers Cooks/Kitchen staff Thank you so much for your participation. Your answers will help form the basis of recommendations for service improvements statewide.

Attachment D Area Agencies on Aging West Virginia's four Area Agencies on Aging (AAAs) are

Region !

Region Il Region !!!

Region IV Region I Northwestern AAA PO Box 2086 (105 Bridge Street Plaza)

Wheeling, WV 26003 Telephone: 304-242-1800; 800-924-0088 Fax: 304-242-2437 E-mail: KHudak@belomer.org Website: www.belomer.org/aging Katie Hudak, Director Counties Served: Brooke, Calhoun, Doddridge, Gilmer, Hancock, Harrison, Marion, Marshall, Monongalia, Ohio, Pleasants, Ritchie, Tyler, Wetzel, Wirt, Wood Region II WVSC-Metro AAA 824 Cross Lanes Drive Cross Lanes, WV 25313 Telephone: 304-720-6858 Fax: 304-720-6864 E-mail: LenderBB@metroeaa.com Website: https://www.metrossa.com Brenda Landers, Director Counties Served: Boone, Cabell, Jackson, Kanawha, Lincoln, Logan, Mason, Mingo, Putnam, Roane, Wayne Region III Upper Potomac AAA 131 Providence Lane Petersburg, WV 26847 Telephone: 304-257-1221; 800-296-1221 Fax: 304-257-4958 E-mail: sanderson@regioneight.org Website: https://www.regioneight.org/unaas Ashley Anderson, Director Counties Served: Barbour, Berkeley, Grant, Hampshire, Hardy, Jefferson, Lewis, Mineral, Morgan, Pendleton, Preston, Randolph, Taylor, Tucker, Upshur Region IV Appalachian AAA 1460 Main Street, Box 2 Princeton, WV 24740 Telephone: 304-425-1147; 800-473-1207 Fax: 304-487-3767 E-mail: Rebecca. Bivens@appalachiansss.org Website: Www.22808.019 Rebecca Bivens, Director Counties Served: Braxton, Clay, Fayette, Greenbrier, McDowell, Mercer, Monroe, Nicholas, Pocahontas, Raleigh, Summers, Webster, Wyoming

Series 05 WV Long-Term Care Ombudsman Program

W. Va. Code R. § 76-5-1 General Purpose

1.1. Scope. -- This rule establishes the policies of the office of the long-term care ombudsman program. This program was created to effectively assist residents of long-term care facilities in the assertion of their civil and human rights.

1.2. Authority. -- W. Va. Code '16-5L-21.

1.3. Filing Date. -- June 29, 1995.

1.4. Effective Date. -- July 31, 1995.

W. Va. Code R. § 76-5-2 Application and Enforcement

2.1. Application -- This rule applies to state, regional and volunteer long-term care ombudsman programs.

2.2. Enforcement -- This rule is enforced by the State Commission on Aging.

W. Va. Code R. § 76-5-3 Definitions

3.1. "Case Record" -- means the official files in which the ombudsman records all information relative to the investigation and resolution of the case. Case records are confidential.

3.2. "Client" -- means a resident of a long-term care facility of the applicant for long-term care services. Where appropriate, the term includes a prospective, previous, or deceased resident or recipient.

3.3. "Complainant" -- means any person who files one or more complaints with the ombudsman program. Examples of categories of complainants include residents, relatives, friends, facility staff, or other agency staff.

3.4. "Complaint" -- means a concern brought to, or initiated by, the ombudsman for investigation and action by or on behalf of one or more residents of a long-term care facility relating to health, safety, welfare or rights of a resident.

3.5. "Core Ombudsman Services" -- means investigating complaints; developing resident and family council; monitoring long-term care facilities, providing general information; providing advocacy services; providing public or community education; monitoring the implementation of laws, regulations and policy; providing professional development for representatives of the office; managing a volunteer program; program supervision; and program administration.

3.6. "Facility Monitoring" -- means the establishment of a regular presence in facilities by the ombudsman. Visits should be unannounced. Appointments may be made at the ombudsman's discretion.

3.7. "Family Council Activity" -- means provision of technical assistance, information, training, or support to residents' family members or facilities' staff in forming or maintaining a family council.

3.8. "Follow-up Activities" -- means site visits, phone calls, letters or interviews completed by an ombudsman after the complaint is resolved or referred.

3.9. "General Training" -- means presentations to community groups or to groups of residents or families on long-term care issues, long-term care issues, the long-term care ombudsman program, etc.

3.10. "Government Agency" -- means any department, division, office, bureau, board, commission, council, authority, or any other agency or instrumentality created by the State or political subdivision thereof or to which the State is a party or by any county or municipality which is responsible for the regulation, visitation, inspection, or supervision of long-term care facilities or which provides services to residents or long-term care facilities.

3.11. "Guardian" -- means the person with legal authority to manage the affairs, property and rights of another person who for some peculiarity of status or defect of age, understanding or self control is considered incapable of administering his or her own affairs.

3.12. "Identity Information" -- means information containing the identity of a complainant or resident, or which reasonably could reveal the identity of any complainant or resident.

3.13. "Immediate Family" -- means spouse, children, mother, father, brothers, or sisters.

3.14. "Information and Assistance" -- means providing assistance by telephone or in person on topics such as selecting a nursing home, resident rights, and understanding Medicaid.

3.15. "In-Service Training" -- means presentations by an ombudsman to facility staff on long-term care issues.

3.16. "Legal Representative" -- means a court appointed guardian, conservator, attorney in fact, or an executor or administrator of the estate of a deceased client who can give consent or authorization in the matter.

3.17. "Long-Term Care Facility" -- means nursing home, personal care home, or residential board and care home as defined in W. Va. Code, '16-5C-2; nursing homes operated by the Federal government or the State government; extended care facilities operated in connection with hospitals; and any similar institution, residence or place, or any part or unit thereof, however named, in this State which is advertised, offered, maintained or operated by the ownership or management for consideration, for the express and implied purpose of providing accommodations and care or personal assistance to one or more persons who are ill or otherwise incapacitated or are dependent upon the services of others by reasons of physical or mental impairment and who are not related within the degree of consanguinity of second cousin to the owner or manager of the institution, residence or place.

3.18. "Office of the State Long-Term Care Ombudsman" -- means the Office which includes the state long-term care ombudsman, regional long-term care ombudsmen and volunteer ombudsmen all of whom are representatives of the Office.

3.19. "Official Duties" -- means the work assigned to the Office of the State Long-Term Care Ombudsman authorized by federal or state law and carried out under the auspices and general direction of the state long-term care ombudsman.

3.20. "Pecuniary Interest" -- means pecuniary interest in long-term care which includes, but is not limited to, employment by a home health company, employment by a long-term care facility, or by an association (or affiliate organization of association) for long-term care facilities, or by any organization or corporation that directly or indirectly legislates, owns or operates a long-term care facility.

3.21. "Personal Assistance" -- means any personal services, including, but not limited to: help in walking, bathing, dressing, feeding or getting in or out of bed, or supervision required because of the age or mental impairment of the resident.

3.22. "Providers" -- are the individual facilities that provide long-term care services and, where appropriate, the corporations, part- nerships or persons that operate these types of entities.

3.23. "Record" -- means any medical, social, personal, administrative and financial information maintained by any long-term care facility, or by any state or local agency, pertaining to a resident of a long-term care facility or to the facility.

3.24. "Regional Long-Term Care Ombudsman or Regional Ombudsman" -- means any paid staff of a designated regional long-term care ombudsman program who has obtained appropriate certification from the State Commission on Aging and who meets the qual- ifications set forth in W.Va. Code '16-5L-9.

3.25. "Regional Long-Term Care Program or Regional Program" -- means an entity designated as a regional long-term care ombudsman program by the state long-term care ombudsman.

3.26. "Representative of the Office" or "Representative of the Office of the State Long-Term Care Ombudsman" -- means one of the three categories of ombudsmen.

3.27. "Resident" -- means an individual living in a nursing home, personal care home, a residential board and care home, or any long-term care facility as defined in W. Va. Code, '16-5L-3(b) and this rule or who has lived in such a setting, or who has made application to live in such a setting.

3.28. "Resident Council Development"-- means providing technical assistance, information, training, or support to a facility's residents or staff in forming or maintaining a resident council.

3.29. "State Long-Term Care Ombudsman or State Ombudsman" -- means an individual who meets the qualifications of W. Va. Code '16-5L-5 and this rule and who is employed by the State Commission on Aging to implement the state long-term care ombudsman program.

3.30. "Volunteer Long-Term Care Ombudsman or Volunteer Ombudsman" -- means any uncompensated individual who per- forms the duties enumerated under W. Va. Code '16-5L-8 and this rule: Provided, that the individual has obtained appropriate certification as set forth in W. Va. Code '16-5L-9 and this rule.

3.31. "Volunteer Development -- means the implementing a program to recruit, train and supervise Certified Volunteer Ombudsman from the community.

3.32. "Withdrawn" -- means the complaint was discontinued at the option of the ombudsman or the complaint was withdrawn by the resident and not continued by the ombudsman.

W. Va. Code R. § 76-5-4 Office of the State Long-Term Care Ombudsman

4.1. Office Administration

4.1.1. The Office of the State Long-Term Care Ombudsman is administered by the State Commission on Aging.

4.1.2. No individual involved in the selection of the state long-term care ombudsman may be (1) subject to a conflict of interest; (2) a member or staff personnel of an agency or organization which is (a) responsible for licensing or certifying long-term care ser- vices in West Virginia; (b) an association (or an affiliate organization of such an association) of long-term care facilities; or (c) a member or employee of an agency or organization which is designated as a regional long-term care ombudsman program.

4.2. Office Responsibilities

4.2.1. The responsibilities of the Office of the State Long-Term Care Ombudsman include, but are not limited to providing advocacy, responding to complaints, monitoring the long-term care system and applicable laws and regulations, expanding the ombudsman network, and representing the interests of residents.

W. Va. Code R. § 76-5-5 Designation of Regional Long-Term Care Ombudsman Programs

5.1. General Designation Requirements

5.1.1. The State Commission on Aging has the authority to designate and maintain Regional Long-Term Care Ombudsman Programs encompassing all planning and development areas of the State under the direction of the state long-term care ombudsman.

5.1.2. In order to be designated, a Regional Long-Term Care Ombudsman Program (1) cannot have a pecuniary, licensing, or organizational interest; (2) must maintain a private, nonprofit status or function as a local or regional government agency; (3) must agree to create and be capable of maintaining a regional long-term care ombudsman program; and, (4) must adhere to all requirements set forth under law and rule.

5.1.3. The program must submit a completed designation proposal and budget to the State Commission on Aging each year.

5.1.3.a. The proposal and budget are reviewed by the state long- term care ombudsman and other staff as the executive director of the State Commission on Aging deems necessary.

5.1.4. Upon approval by the State Commission on Aging, the designated Regional Long-Term Care Ombudsman Program is operated as a component of the Office of the State Long-Term Care Ombudsman.

5.1.5. No individual involved in the designation of a Regional Long-Term Care Ombudsman Program may be (1) subject to a conflict of interest; (2) a member or staff personnel of an agency or organization which is (a) responsible for licensing or certifying long-term care services in West Virginia, or (b) an association (or an affiliate organization of such an association) of long-term care facilities; or (c) a member or employee of an agency or organization which is designated as a Regional Long-Term Care Ombudsman Program.

5.1.6. A regional long-term care ombudsman program may not operate in conflict with objectives and policies of the Office of the State Long-Term Care Ombudsman.

5.1.7. Any complaints that the organization or agency designated as the Regional Long-Term Care Ombudsman Program has violated the Older Americans Act, as amended, the Long-Term Care Ombudsman Program Act, or applicable regulations will be reported to the state long-term care ombudsman.

5.2. Initial Designation of Existing Regional Long-Term Care Ombudsman Programs:

5.2.1. No Regional Long-Term Care Ombudsman Program may operate unless it has been designated as such by the State Commission on Aging. Any program serving as a Regional Program on July 1, 1995 will be designated as a Regional Program for a period of one (1) year unless the state long-term care ombudsman determines that the agency does not meet the requirements established under law and rule.

5.2.2. Unless otherwise provided in this rule, no Regional Program may be fully designated unless it has complied with all requirements of governing the Office.

5.2.2.a. The Regional Program must ensure compliance with all program and contract requirements, all relevant federal and state statutes, regulations and policies, and ensure program integrity and stability.

5.2.2.b. No Regional Program nor any member of its staff may hold an un-remedied conflict of interest.

5.2.2.c. The Regional Program must maintain an incoming toll-free telephone line to be answered during normal business hours.

5.2.3. The Regional Program's policies and procedures must address, at a minimum (1)prioritizing, screening and investigating complaints, (2)maintaining confidentiality, (3)recruiting and managing volunteers; (4)screening potential and actual employees for conflicts of interest, (5)identifying information which may be provided by an employee in different situations, (6)handling complaints about employees, (7)participating in inspections and, (8)fiscal management.

5.2.4. The Regional Program must have policies that address personnel issues, evaluations, job descriptions, and wage scales for each job classification. Personnel policies must include hours of work, benefits, promotion and evaluation criteria, personnel records for employees, and a grievance procedure.

5.2.5. The Regional Program must maintain a personnel record for each employee including written job descriptions, applications or resumes, annual performance evaluations, and documentation that the employee has received personnel policies, grievance procedures and wage information pertinent to his or her job.

5.2.6. The Regional Program must have procedures to assure that each complaint received is screened, and if appropriate, assigned to an ombudsman for investigation and back-up procedures for assigning a substitute ombudsman in the absence of the assigned ombudsman.

5.2.7. The Regional Program must establish an advisory group to the program with the responsibility to render advice and support to the staff and sponsoring agency in matters pertaining to the program. The advisory group must be made up of persons concerned about the quality of life in long-term care facilities and in protecting the rights of residents of such facilities and include consumer representation.

5.2.8. The Regional Program must have access to consultants in aging, health care and legal professions to provide technical support and advice to ombudsmen.

5.2.9. The Regional Program must retain all books, records and other documents relevant to the operation of the program for three (3) full years after final payment of the grant award and all other pending matters are closed, unless transfer is authorized in writing from the State Commission on Aging. Federal and/or state auditors and any persons duly authorized by the State Commission on Aging will have full access to and the right to examine any of said material during the said period, or until resolution of all financial matters, unless prohibited by federal or state law and/or regulations.

5.3. Development of Ombudsman Plans by all Regional Programs.

5.3.1. The Regional Program shall develop an ombudsman plan.

5.3.2. The Ombudsman plan must include (1) investigating complaints, (2) promoting awareness of the ombudsman program, (3) educating the public, (4) monitoring laws, regulations and policies, (5) advocating, (6) providing legal counsel, (7) recruiting and managing volunteers and, (8) providing a quality assurance process.

5.3.3. The state long-term care ombudsman may consider each plan based upon (1) goals, (2) action steps, (3) objectives, (4) time lines and, (5) outcome standards.

5.3.4. The state long-term care ombudsman may utilize the following process when designating an organization or agency to serve as a Regional Long-Term Care Ombudsman Program:

5.3.4.a. The State Commission on Aging may issue a request for proposal (RFP) seeking an organization or agency to serve as the Regional Long-Term Care Ombudsman Program or take other appropriate action consistent with agency regulations.

5.3.4.b. The State Commission on Aging, or the state long-term care ombudsman may conduct an on-site visit to each of the agencies responding to the RFP to verify the facts presented in each proposal.

5.3.4.c. The State Commission on Aging will request that all of the responding agencies that meet the requirements develop an ombudsman plan. The responding agencies shall have forty (40) days to respond to this request, unless extensions are granted consistent with agency regulations.

5.3.4.d. The state long-term care ombudsman will review the ombudsman plans and will choose the agency most appropriate to serve as the Regional Long-Term Care Ombudsman Program.

5.3.4.e. The state long-term care ombudsman notifies the responding agencies of his/her decision within forty-five (45) days.

5.3.5. The state long-term care ombudsman may provisionally designate a Regional Program for ninety (90) days if there is cause for doing so. Cause may include, but is not to be limited to, the agency's failure to comply with all of standards set forth in this rule or the existence of a conflict of interest left without remedy on the part of the agency seeking designation or any individual employee by or working for that agency.

5.3.6. A Regional Program that is provisionally designated must report progress and supply supporting program documents on required changes or required corrections in writing to the state long-term care ombudsman on a monthly basis or as otherwise required.

5.3.7. The state long-term care ombudsman may renew the provisional designation of a Regional Program for an additional ninety (90) days if the case upon which the designation is based will reasonably take more than ninety (90) days to correct and the agency is making reasonable progress toward completing that correction.

5.3.8. The state long-term care ombudsman may withdraw the designation of a provisionally Regional Program when the correction necessary to obtain full designation status is not likely to be accomplished within the time permitted.

5.3.9. Any sponsoring agency receiving full or provisional designation as a Regional Long-Term Care Ombudsman Program shall enter into a contract with the State Commission on Aging. At a minimum, the contract must specify the geographical region to be served, the ombudsman services to be provided, a requirement that the Regional Program abide by all rules, policies and laws governing the Office, payment for services, effective date, sub-contracting, termination, and renewal.

5.4. Program Review for Continued Designation.

5.4.1. At least forty-five (45) days prior to the end of each Regional Program's designation year, the state long-term care ombudsman must conduct an annual review to determine whether the Regional Program may continue its designation. In addition to the annual review the state long-term care ombudsman may conduct additional program reviews at any time.

5.4.2. When conducting a program review, the state long-term care ombudsman will make an on-site visit to the Regional Program and to representatives of the Office as he or she deems necessary. The state long-term care ombudsman may consider (1) compliance with all state and federal laws, regulations, policies, procedures and rules, (2) records and documentation, (3) ombudsman pro- gram services, (4) attainment of outcomes and objectives and, (5) plans for ensuing year.

5.4.3. During the on-site visit the state long-term care ombudsman shall have access to administrative and complaint records. Program administrative records include, but are not limited to, advisory board minutes; conflict of interest screening; quality assurance documents; client satisfaction surveys; professional development documents; documentation pertaining to the grandfathering of staff, all general information and activity logs.

5.4.4. When reviewing Regional Programs or representatives of the Office, the state long-term care ombudsman will review cases drawn from a random sampling of cases documented in the ombudsman's monthly re- port. The cases reviewed by the state long-term care ombudsman may include cases which were discontinued, withdrawn, unresolved, referred, unverified, open for longer than sixty (60) days, involved legal intervention or a hearing, or required a high number of hours.

5.4.5. If appropriate, upon the completion of any program review, the state long-term care ombudsman will develop a technical assistance plan for the Regional Long-Term Care Ombudsman Program.

5.4.6. Within thirty (30) days of completing any program review, the state long-term care ombudsman will provide the Regional Program with written notification of the results.

5.5. Provisional Designation of Regional Programs, Involuntary Withdrawal of a Regional Program's Designation, Voluntary Separation of Regional Programs from the Office.

5.5.1. The state long-term care ombudsman may change the designation of a fully designated Regional Program to provisional designation, or he/she may withdraw the designation of a fully or provisionally designated Regional Program for cause. Cause may include, but shall not be limited to:

5.5.1.a. The Regional Program's failure to follow policies, procedures, or state or federal laws;

5.5.1.b. The Regional Program's failure to meet performance standards;

5.5.1.c. The Regional Program's failure to provide services in accordance with state or federal laws, office policies or procedures, the service contract, or the ombudsman plan;

5.5.1.d. The development of a conflict of interest without remedy involving the Regional Program, it's sponsoring agency, or an individual associated with either;

5.5.1.e. The misfeasance, malfeasance, or nonfeasance of a regional or volunteer ombudsman; or,

5.5.1.f. For any other reason wherein the decertifying of a Regional Program is warranted at the discretion of the state long-term care ombudsman.

5.5.2. When provisionally designating a Regional Program, the state long-term care ombudsman will provide notice of the decision. The notice must specify the changes or corrections and define the length of time the Regional Program will be given to come into compliance. Any Regional Program on provisional designation must provide the state long-term care ombudsman with a written re- port of their progress on a monthly basis or as otherwise required and must document that the required changes and corrections have been made.

5.5.3. The state long-term care ombudsman may withdraw the designation of a Regional Program when the scope and severity of the cause is of such a severe nature that corrections are not likely to be successfully implemented or when it appears that correction will not be implemented in appropriate time frames. The state long-term care ombudsman may presume such failure when:

5.5.3.a. The cause is found to involve a flagrant disregard of the Office's policies and procedures, standards, or federal or state law;

5.5.3.b. The pattern of problems are repeated; or,

5.5.3.c. Attempted correction of problems by the Regional Program have not been successful.

5.5.4. The state long-term care ombudsman must give the Regional Program notice of his/her decision to withdraw the Regional Program's designation. The notice must contain an explanation of the state long-term care ombudsman's reason for the withdrawal of the designation.

5.5.5. A Regional Program may voluntarily withdraw its designation as a Regional Long-Term Care Ombudsman Program by providing the state long-term care ombudsman with a written notice of its intent ninety (90) days prior to the date upon which the program expects the withdrawal of designation to take place.

5.6. Notice Rights and Hearing Requirements.

5.6.1. Whenever a party requests a hearing in accordance with this rule, the state long-term care ombudsman sets the date, time, and place for the hearing, and notifies the party thereof within thirty (30) working days of receiving the request for a hearing, unless the parties agree otherwise.

5.6.2. The director of the State Commission of Aging has the authority to designate a hearing officer. Upon completion of the hearing, the hearing officer makes a recommendation and forwards it to the Director of the Commission on Aging. The Director makes the final decision within thirty (30) days after the hearing was held. The Director's decision will be the final administrative form of appeal.

W. Va. Code R. § 76-5-6 Certification and Continuing Education

6.1. General Requirements

6.1.1. The state long-term care ombudsman develops and implements procedures for training and certification of regional and volunteer long-term care ombudsmen.

6.1.1.a. Regional and volunteer long-term care ombudsmen who satisfactorily complete the training requirements may be certified by the State Commission on Aging.

6.1.1.b. Regional and volunteer ombudsman are given identification cards which are presented to the administrator or his or her designee when entering a long-term care facility and to employees, residents and others thereafter.

6.1.1.c. Consistent with the provisions of this rule, certified regional and volunteer long-term ombudsmen are to be representatives of the Office of the State Long-Term Care Ombudsman.

6.1.2. No regional or volunteer ombudsman may perform his or her official duties prior to the completion of certification training except as a supervised portion of that training program.

6.1.3. An individual must attend, at a minimum, twenty-five (25) hours of training to be initially certified as a regional or volunteer ombudsman.

6.1.4. Regional and volunteer long-term care ombudsmen who have completed the minimum training requirements specified in this section of the rule may be given identification cards by the State Commission on Aging valid for one (1) year.

6.1.5. For each year after initial certification, a regional long-term care ombudsman must attend twenty-five (25) hours of documented continuing education on long-term care, federal, state, and local laws, regulations, and policies or subjects related to his or her duties or responsibilities annually in order to obtain a new identification card.

6.1.5.a. The Regional Program will submit requests for staff to the state ombudsman in accordance with section 6.6.

6.1.6. For each year after initial certification, a volunteer long-term care ombudsman must attend at least seven (7) hours of documented continuing education, on subjects related to long-term care, annually in order to obtain a new identification card.

6.2. Approval of Certification and Continuing Education.

6.2.1. All certification training conducted under this rule must be based upon a curriculum approved by the state long-term care ombudsman.

6.2.2. The state long-term care ombudsman may give at his/her discretion full or partial credit of training.

6.2.3. All requests for credit must come from the Regional Program. All requests for credit must include documentation of the training or experience described in the application.

6.2.4. In all cases where the state long-term care ombudsman seeks to decertify a regional or volunteer ombudsman, or to remove a candidate for failure to complete certification training or continuing education in a timely manner, the state long-term care ombudsman will give notice to the Regional Program. Upon receipt of the notice, the Regional Program must ensure that the individual is relieved of all complaint-handling duties that require contact with consumers or providers until such time as all appeals have been exhausted and a final determination has been made. Notice will include reasons for the proposed action, law or rule involved, an explanation or extenuating circumstances may be provided in writing, date for which his or her identification care must be returned, and a statement regarding entitlement to an appeal.

6.3. Certification Training Deadlines.

6.3.1. Candidates must complete certification training within six (6) months, if a volunteer ombudsman or two (2) months if a regional ombudsman.

6.3.2. The state long-term care ombudsman may approve an application where the applicant demonstrates an acceptable reason for extending the time for certification training and the candidate shows probable success for becoming certified. Acceptable reasons may include, but are not limited to, illness in the immediate family, unexpected changes in living circumstances, employment conflicting with the scheduled training and time constraints.

6.4. Failure of a candidate to complete certification training or continuing education.

6.4.1. Failure of a candidate to complete the certification training or continuing education is cause for removal as a regional or volunteer ombudsman.

6.4.2. A candidate may demonstrate extenuating circumstances or give an explanation to the regional ombudsman, for volunteer ombudsman of that program; or to the state long-term care ombudsman, for regional ombudsman. If the explanation or extenuating circumstances are not acceptable to the regional ombudsman or the state long-term care ombudsman, he or she must notify the candidate.

6.4.3. An individual who has been removed as a candidate may be reinstated if the candidate is likely to successfully complete certificate training.

6.5. Central Registry.

6.5.1. The Regional Program must maintain a central registry of regional and volunteer ombudsmen. The registry must include name, address and telephone number; qualifications; classifications; counties the regional ombudsman is assigned; facility the volunteer ombudsman is assigned; position description which contains any prohibitions.

6.5.1.a. Prohibitions may include limitations on duties, limitations on complaint activity investigation, and any limitations due to a conflict of interest.

6.6. Separation of Representatives from the Office.

6.6.1. The separation of a representative from the office may occur through decertification, voluntary resignation, termination, or reduction in force.

6.6.2. No regional of volunteer ombudsman may be recommended for decertification without cause. Cause includes, but is not limited to:

6.6.2.a. Failing to follow policies and procedures that conform to the statute and regulations;

6.6.2.b. Failing to provide services in accordance with the statute, regulations, and policies of the Office, the service contract, and approved ombudsman plan;

6.6.2.c. Performing a function not recognized or sanctioned by the Office;

6.6.2.d. Failing to meet the required qualifications;

6.6.2.e. Failing to complete certification training;

6.6.2.f. Failing to meet the continuing education requirements; or,

6.6.2.g. Intentionally failing to reveal a conflict of interest.

6.6.3. When the state long-term care ombudsman initiates a decertification action, he or she will provide written notification to the Regional Program.

6.6.4. An ombudsman who voluntarily separates from the Office may apply to have his/her certification reinstated when he/she becomes reemployed by or accepted as a volunteer of the Office. Any person seeking recertification must apply in writing to the state long-term care ombudsman. The application must provide the date of separation and a summary of any professional development in or experience with ombudsman skills, long-term care services, problem resolution skills or related skills the applicant may have received since his/her separation from the Office.

6.6.5. The state long-term care ombudsman will review the application of an individual seeking reinstatement and may require the applicant to receive additional professional development, based upon the length of time the applicant has been away from the field, and the experience or professional development the applicant has accumulated in the interim.

6.7. Continuing Education Requirements.

6.7.1. The required hours of continuing education may be prorated for a regional or volunteer ombudsman who has been certified for less than twelve (12) months.

6.7.2. No session will be approved as a source for continuing education credits unless:

6.7.2.a. The individual(s) presenting the session has a recognized expertise in the content area;

6.7.2.b. The session transmits knowledge relevant to the duties of a long-term care ombudsman; and,

6.7.2.c. The session has not been held for the purpose of individual or group supervision.

6.7.3. The Regional Program must submit all requests for credit toward their continuing education requirements to the state long-term care ombudsman. All requests for credit must contain the name of the session, a brief summary of the session's content, and the length of the session.

6.7.4. No regional or volunteer ombudsman may be precluded from meeting continuing education requirements with credits that were also counted toward the continuing education requirements of other professional organizations or boards, as long as content is related to his or her job description.

6.7.5. Each regional and volunteer ombudsman of a Regional Program must apply to his/her Regional Program for review of the continuing education hours he or she has earned. By May first of every year, he or she must produce documentation to substantiate attendance at approved sessions. By June first of every year, the Regional Program must certify to the state long-term care ombudsman that each regional and volunteer ombudsman has fulfilled his or her continuing education requirements.

6.7.6. If a regional or volunteer ombudsman has not fulfilled his/her continuing education requirements by the first day of June then the Regional Program, must certify to the state long-term care ombudsman the number of hours not yet completed, and the probability of completion of the necessary hours by the thirtieth (30) day of June. By July tenth (10) of every year, the Regional Program must submit any remaining information needed to complete the continuing education certification process.

6.7.7. A regional or volunteer ombudsman may demonstrate extenuating circumstances or give an explanation to the Regional Program. If the explanation or extenuating circumstances are not acceptable to the state long-term care ombudsman, the state long-term care ombudsman, will notify the Regional Program.

6.7.8. A regional or volunteer ombudsman not meeting the continuing education requirement will not be certified or if certified may be decertified.

6.8. Training Content.

6.8.1. The training content for all candidates seeking certification for volunteer or regional ombudsman must include instruction in (1)the ombudsman program authority and responsibility, (2)resident rights, (3)an overview of long-term care facilities, (4)review of medical records, (5)applicable laws and regulations, (6)Medicare and Medicaid, (7)confidentiality, (8)aging process, (9)community agencies, (10)effects of institutionalization, (11)ethics, and, (12)any additional topic deemed appropriate by the state ombudsman.

6.8.2. Ombudsman skills will include training in (1)observing and communicating with residents, (2)building relationships with providers, (3)investigating complaints, and, (4)complaint resolution techniques.

6.8.3. The training content for all candidates seeking certification as a regional ombudsman includes the professional development required under section 6 of this rule, and additional in depth professional development, regional ombudsman training will include (1) development of an action plan, (2) legal, administrative, and other remedies, (3) disclosure of information, (4) advance directives, (5) service management, (6) advocacy skills, (7) documentation, (8) mediation and negotiation, (9) reporting system, and, (10) any additional topics deemed appropriate by the state ombudsman.

W. Va. Code R. § 76-5-7 Conflict of Interest

7.1. General.

7.1.1. A conflict of interest, as used in this rule, occurs when:

7.1.1.a. A state, regional or volunteer ombudsman or any member of his or her immediate family has a pecuniary in-terest in long-term care facilities within the state or an association thereof within the last two (2) years.

7.1.1.b. A state, regional or volunteer ombudsman or any member of his or her immediate family has a pecuniary in-terest adverse to long-term care facilities or an association thereof.

7.1.1.c. A state, regional or volunteer ombudsman solicits contributions or seeks employment from a long-term care facility which he or she monitors.

7.2. Disclosure and Review

7.2.1. Potential and existing state, regional or volunteer long-term care ombudsmen are to disclose information regarding himself/herself and his or her immediate family in order to assess a conflict of interest at the time of employment and at least annually.

7.2.1.a. Regional and volunteer long-term care ombudsman information is reviewed by the state long-term care ombudsman at the time of certification and during the annual program review. When completed, the person who conducted the screen and the person screened must acknowledge the completion of the screen in writing. The completed screening instrument must be made a record of the program and must be subject to program review.

7.2.1.b. The state long-term care ombudsman will report potential or apparent conflicts of interest from the review to the executive director of the State Commission on Aging.

7.2.1.c. The executive director of the State Commission on Aging reviews potential or apparent conflicts of interest of the state long-term care ombudsman.

7.2.1.d. The residence of a member of a state, regional or volunteer long-term care ombudsman's immediate family in a long-term care facility is not, in and of itself, construed as a conflict of interest. However, a state, regional or volunteer long-term care ombudsman may not be assigned to a long-term care facility in which an immediate family member is a resident.

7.2.2. No long-term care ombudsman volunteer may perform his or her duties in any specific facility at which, within the proceeding two (2) years, an immediate family member of the volunteer is or has been a resident or an applicant for resident. Placing a name of a family member on a waiting list is not a formal application.

7.2.3. Upon allegation, discovery or disclosure of a conflict of interest the executive director of the State Commission on Aging is required to identify and to remedy a conflict of interest. Failure to abide by the remedy defined by the Director is grounds for termination of certification of a state, regional or volunteer ombudsman and is grounds for termination as a designated Regional Long-Term Care Ombudsman Program.

7.2.4. A report of a potential or actual conflict of interest must be submitted in writing to the Director and reveal the nature, extent and potential impact of the conflict of interest, and will propose a remedy which will neutralize the conflict of interest. Examples of remedies which may be approved include remedies that assure:

7.2.4.a. The independence of the ombudsman to provide unbiased investigations, successful problem resolution, advocacy services, and other ombudsman services;

7.2.4.b. That no employee having a conflict of interest is involved with or influences the operation of the program; and,

7.2.4.c. That no employee having a conflict of interest is involved with or influences any decision to hire or appoint a state, regional or volunteer ombudsman.

7.2.5. Within thirty (30) days of receiving a report, the Director must review the nature, scope and extent of the conflict of interest and determine whether or not to approve the report. While the decision is pending, the Regional Program responsible must assign an individual with a conflict of interest to duties that do not pose a conflict.

7.2.5.a. The Director may grant a waiver of the conflict, approve a remedy or take an action deemed necessary.

7.2.5.b. Any waiver granted will remain in effect for as long as the conflict continues to exist to the same extent as reported and for as long as the remedy continues to work.

7.2.6. Actions prohibited by someone holding a conflict of interest may include, but are not be limited to, actions taken to influence any decision or action which could be characterized as interference with or reprisals against an ombudsman.

7.2.7. A state or regional ombudsman assigned to investigate a complaint must reveal any relationship with the provider, public agency or person involved that may call into question his or her objectivity or effectiveness in investigating the complaint. These types of relationships may include, but are not limited to, having previously worked for or with a current employee of the provider, having a relative, significant other, who works for the provider, or having worked for the public agency involved in the complaint.

7.2.8. No regional ombudsman may investigate a complaint involving a service directly delivered by a sponsoring agency. The resident must be informed of any decision to refer the complaint to the state long-term care ombudsman and must be informed of the reasons for the referral.

7.2.9. A Regional Program which receives a complaint about a service which the sponsoring agency does not directly provide, but for which the sponsoring agency contracts, set standards, reimburses, or brokers, must reveal the relationship and offer options to the resident. The ombudsman must adhere strictly to the resident's confidentiality and proceed in accordance with the resident's directions and consistent with this rule.

7.2.10. Any conflict of interest not waived or remedied, and any prohibition resulting therefrom, must be recorded in the regional or volunteer's position description which is placed on file in the central registry.

W. Va. Code R. § 76-5-8 Investigation of Complaints

8.1. Consent

8.1.1. A state or regional ombudsman may investigate a complaint, reveal the identity of a resident, or resolve a complaint when authorized. Authorization is given by consent. Consent may be given in writing by the resident or orally, when written consent is not practicable. Oral consent must be documented in the case record.

8.1.2. When the resident is unable to give consent due to diminished capacity or death, consent may be given in writing by the legal representative or guardian; or, orally, when written consent from the legal representative is not practicable. Oral consent must be documented in the case record.

8.1.2.a. When there is no legal representative, the legal representative is unknown to the ombudsman or the provider, the legal representative cannot be reached within five (5) days of the date upon which a complaint was received, or when the estate of a deceased client has no executor, the ombudsman may proceed with the investigation.

8.1.2.b. In the event that the legal representative or guardian refuses to authorize an investigation or the ombudsman has reasonable cause to believe the legal representative or guardian is not acting in the best interest of the client, the ombudsman may proceed with the investigation if approved by the state long-term care ombudsman.

8.2. Investigation response time.

8.2.1. In responding to or investigating a complaint, the ombudsman must consider the urgency of the complaint as seen by both the program and the resident. If there is probable physical harm to the resident, the ombudsman must respond appropriately by the end of the next working day after receiving the complaint. In all other cases, the ombudsman must respond as appropriate to the complaint.

8.3. General Investigative Procedures.

8.3.1. The ombudsman initiates the investigation by:

8.3.1.a. Establishing contact with the resident, legal representative or other relevant person;

8.3.1.b. Visiting the site;

8.3.1.c. Obtaining a clear statement of the clients problems and goals;

8.3.1.d. Informing the resident of his or her rights and the ombudsman process;

8.3.1.e. Revealing known conflicts of interest, if any; and,

8.3.1.f. Identifying the participants.

8.3.2. After initiating the investigation, the ombudsman must proceed with the complaint and implement a strategy to resolve the concern until the case is closed. This process may include:

8.3.2.a. Identifying the relevant agencies;

8.3.2.b. Identifying any steps already taken to handle the complaint;

8.3.2.c. Gathering factual information through interviews with persons with potential knowledge;

8.3.2.d. Observing in the facility;

8.3.2.e. Researching regulations and laws;

8.3.2.f. Reviewing relevant resident, provider, or government records;

8.3.2.g. Taking appropriate action pertaining to complaints regarding any government agency; and,

8.3.2.h. Documenting all activities.

8.3.3. The ombudsman may (1) bring issues to the attention of the facility before referring a complaint, (2) immediately refer a complaint to the appropriate regulatory, social service or other agency. Referrals must include pertinent facts and are subject to confidentiality and consent requirements. Confidential information will be documented as confidential when transmitted. The ombudsman may report violations of:

8.3.3.a. Licensing and certification regulations to the Office of Health Facility Licensure and Certification;

8.3.3.b. Professional licensing laws or standard to the appropriate professional board;

8.3.3.c. Suspected abuse and neglect to adult protective services; and,

8.3.3.d. Suspected criminal activity to the appropriate law enforcement agency.

8.3.4. The state or regional long-term care ombudsman need not investigate any complaint if:

8.3.4.a. The complaint is trivial, frivolous, vexatious or not made in good faith;

8.3.4.b. The complaint has been too long delayed to justify present investigation;

8.3.4.c. The resources available, considering the established priorities, are insufficient for an adequate investigation;

8.3.4.d. The matter complained of is not within the investigatory authority of the long-term care ombudsman program; or,

8.3.5. If a determination is made by a regional long-term care ombudsman not to investigate any complaint, then the complaint is to be referred to the state long-term care ombudsman who will make a final decision as to whether the matter warrants further investigation.

8.3.6. A state or regional ombudsman must open a case on those complaints which they intend to pursue, as authorized by the resident or deemed necessary by the ombudsman. All other activities taken on behalf of residents must be recorded as either information and assistance or advocacy activities.

8.3.7. The Ombudsman need not exhaust one principal step before starting another; he/she need use only those necessary principal steps, and need not follow them in the order given in this section.

8.3.8. The resident, if competent, or their legal representative must have the right to participate in planning any course of action to be taken on his/her behalf by the ombudsman and the resident or their legal representative must have the right to approve or disapprove any proposed action to be taken on his/her behalf by such ombudsman.

8.4. Confidentiality of Information.

8.4.1. Identity information obtained or maintained by a state, regional or volunteer ombudsman in the course of carrying out their official duties pursuant to the long-term care ombudsman program must remain confidential except as provided in this rule.

8.4.1.a. Representatives of the Office must not reveal identifying information about individuals providing information about a complaint without their consent unless ordered to do so by a court.

8.4.1.b. A representative of the Office who receives a subpoena for ombudsman records, to attend a deposition, or to give testimony in court must notify the state long-term care ombudsman immediately.

8.4.2. Complainants can remain anonymous or have their identity remain confidential. When these situations occur, the Regional Program is to advise the complainant about possible limitations in the ability of the program to investigate and resolve the complaint; however, in many instances the program can proceed without disclosing the complainant's or resident's identity, and must do whatever is possible under these circumstances.

8.4.3. Representatives of the Office must maintain records in a confidential manner and address the storage, maintenance, and physical access to all written and electronic complaint records and assure that complaint records are in a secure location so that access to the files is limited to the State Long-Term Care Ombudsman, Director of Commission on Aging or designee.

8.4.4. At the request of the provider, person or parties against whom the complaint has been filed, and subject to restrictions under this section, a state or regional ombudsman may state the verification status of the complaint in question and whether or not the case had been opened or closed.

8.4.5. All other information and files maintained by the ombudsman program are to be disclosed only at the discretion of the regional ombudsman program having authority over the disclosure of such files. Prior to any destruction of the files, the state long-term care ombudsman must receive notice; this notice must be in writing and 30 days prior to the actual destruction of the files.

8.4.6. Except as otherwise provided by the law and rule, persons authorized to review records include the state ombudsman.

8.5. Complaint Intake and Screen.

8.5.1. A representative of the Office may receive a complaint over the telephone, in person or through the mail. A complaint identified or generated by the office itself shall be considered a complaint received.

8.5.2. The Regional Program must assure that all complaints are screened prior to assignment for investigation to identify those complaints which they will decline to investigate, consistent with this rule.

8.5.3. A representative of the Office must gather basic information in response to a complaint received including:

8.5.3.a. The full name, address and telephone number of the person(s) making the complaint, except in those instances when a complainant requests anonymity;

8.5.3.b. The full name, address and telephone number of the resident involved, when necessary;

8.5.3.c. The full name, address and telephone number of the resident's legal representative, if applicable, as well as a brief review of the legal representative's scope of authority;

8.5.3.d. The provider(s), agency(ies), parties or persons involved, if applicable; and,

8.5.3.e. A statement of facts about the complaint, including the date(s) of any alleged occurrence(s), the sequence of events as known to the complainant, and any steps previously taken by the complainant to resolve the complaint.

8.6. Access to Residents.

8.6.1. An Ombudsman is entitled under both federal and state law to have immediate access to a resident to seek consent from that resident or to communicate further.

When exercising this right, the ombudsman must:

8.6.1.a. Respect the privacy and convenience of the resident. The ombudsman should, whenever possible, seek to communicate to residents, at convenient times to the resident;

8.6.1.b. Inform the appropriate staff member of his/her presence upon entering the facility;

8.6.1.c. Announce and identify themselves to the resident; and,

8.6.1.d. Never seek to intimidate, coerce, or deceive the resident into a communication or interview.

8.6.2. An ombudsman must terminate an interview or visit with a resident who has expressly declined services or withdrawn consent for services.

8.6.3. Should an ombudsman be denied immediate access to a resident, the ombudsman is to inquire as to the nature of the denial and determine an appropriate action according to the response.

8.6.3.a. If the explanation appears reasonable to the ombudsman (e.g. the resident is being bathed), the ombudsman should accept the explanation and seek the earliest opportunity to interview the resident.

8.6.3.b. If the explanation does not appear reasonable to the ombudsman, or if access is being denied arbitrarily, the ombudsman should inform the administrator of the facility of their legal right to communicate with the resident.

8.6.4. When a denial of access continues, the ombudsman must notify the state long-term care ombudsman so that appropriate action may be discussed.

8.7. Access to Records.

8.7.1. A state or regional ombudsman must be allowed access to any re-sident's records, including medical records, reasonably necessary to any investigation, however:

8.7.1.a. If the resident is competent and has the ability to write, access may only be obtained by the written consent of the resident;

8.7.1.b. If the resident is competent but unable to write, oral consent may be given in the presence of a third party who must witness the resident's consent in writing;

8.7.1.c. If the resident is under a guardianship or has granted a medical power of attorney, or granted any other power of attorney which is in effect, access may only be obtained by the written consent of the guardian or attorney in fact, unless the existence of guardianship, medical power of attorney or attorney in fact is unknown to the long-term care ombudsman upon investigation and to the long-term care facility, or unless the guardian or attorney in fact cannot be reached through normal communications channels within five (5) working days;

8.7.1.d. If the resident is unable to express written or oral consent and there is no guardian or attorney in fact or the notification of the guardian or attorney in fact is not achieved for the reasons set forth in subsection (c) of this section, or if the resident is deceased, inspection of records may be made;

8.7.1.e. If access to records is necessary to investigate a complaint and (1)the legal representative or guardian refuses to give permission or (2)the ombudsman has reasonable cause to believe the legal representative or guardian is not acting in the best interest of the resident, access may be obtained with approval of the state ombudsman.

8.7.2. The state or regional long-term care ombudsman is allowed access to all records of any long-term care facility that are reasonably necessary for the investigation of a complaint, including, but not limited to, facility incident reports, dietary records, policies and procedures of the facility that the facility is required to maintain under federal or state law, admission agreements, staffing schedules, and any document depicting the actual staffing pattern of the facility and resident council and grievance committee minutes.

8.8. Verification of Complaints.

8.8.1. The validity of each complaint investigated is to be determined according to the classifications listed below and documented by the ombudsman based on the evidence or information obtained during the investigation.

8.8.2. Verified. A complaint shall be considered verified if:

8.8.2.a. Observed by an Ombudsman;

8.8.2.b. Substantiated through interviews, records, inspections, and/or observation;

8.8.2.c. Reported in licensing or survey reports; or,

8.8.2.d. Acknowledged by facility.

8.8.3. Partially Verified. A complaint shall be considered partially verified if a portion of the complaint is verified and/or the complaint is supported by evidence which is contradictory but tends to corroborate the complaint.

8.8.4. Not Verified. The complaint shall be considered not verified if the interviews, records, or observations fail to corroborate the substance of the complaint.

8.8.5. Undetermined. A complaint shall be considered as undetermined when there is not enough information to classify the complaint as either verified, partially verified, or not verified.

8.9. Complaint resolution.

8.9.1. Except as otherwise provided in this section, the ombudsman must attempt to resolve all verified or partially verified complaints.

8.9.2. The ombudsman must advise the resident or legal representative of the options for resolving the complaint and the various strategies that could be used. Where appropriate, the ombudsman will encourage and empower the resident to handle the complaint directly with the agency, provider, or person with whom the resident has the problem.

8.9.3. If a complaint is verified, partially verified, or undetermined, the ombudsman has the responsibility to inform the resident of the legal, administrative, and other remedies available to resolve the complaint. The ombudsman will assist the resident in seeking appropriate remedies in order to resolve the complaint, subject to confidentiality provisions. The ombudsman will attempt, whenever possible, to resolve complaints on an in-house basis (i.e. within the facility or agency where the problem exists).

8.9.4. The resolution status of each complaint must be documented according to the classifications listed below:

8.9.4.a. Resolved or Partially resolved. A complaint will be classified as resolved or partially resolved when the problem reported was corrected or partially corrected to the satisfaction of the complainant and/or the ombudsman, and a satisfactory change occurred; or, the problem reported was referred on to another agency and was corrected or partially corrected to the satisfaction of the resident and/or the ombudsman, and a satisfactory change occurred.

8.9.4.b. Not resolved. A complaint will be classified as not resolved when the ombudsman took steps to correct the problem; however, for whatever reason, the problem was not corrected to the satisfaction of the resident and/or the ombudsman, and no satisfactory change occurred.

8.9.4.c. Withdrawn. A complaint will be classified as withdrawn when the ombudsman, because of lack of cooperation or information, discontinues the investigation or resolution efforts or the complaint was withdrawn by the resident.

8.10. Notice of Complaint Disposition.

8.10.1. During the course of an investigation and resolution process:

8.10.1.a. The ombudsman must inform the resident of actions taken in the course of the investigation and resolution process, upon request.

8.10.1.b. If a complaint has been referred to another investigative agency, the ombudsman will follow-up with the investigating agency at least once every thirty (30) days until the investigation is completed and must immediately report the status of the investigation to the resident.

8.10.1.c. If the complaint has been referred to the Office of Health Facility Licensure and Certification for investigation, the regional ombudsman will request a copy of the investigative report.

8.10.1.d. The Regional Program must notify the Office, whether in writing or by telephone, prior to initiating any legal action in circuit court or pursuing an appeal of an administrative hearing. If the Regional Program's attempt to notify the Office is unsuccessful, the Regional Program may contact the Office within two (2) working days.

8.10.2. Once the resolution of a complaint has been determined to be resolved or partially resolved, not resolved, or referred the ombudsman must, within thirty (30) days, inform the resident as to the outcome of the complaint and the activities undertaken by the Regional Program to resolve the complaint unless the complainant or the resident requested not to be recontacted or their identities are anonymous.

8.11. Closing a case.

8.11.1. A state or regional ombudsman may close a case if:

8.11.1.a. The complaint has been resolved or explained to the resident's satisfaction;

8.11.1.b. The complaint has not been verified upon investigation;

8.11.1.c. The ombudsman is satisfied with the resolution and no further activity will produce further satisfaction for the resident;

8.11.1.d. The complaint is not a complaint the ombudsman should be investigating;

8.11.1.e. The resident has requested that the ombudsman cease his/her activity;

8.11.1.f. It has become apparent that the complaint is frivolous, vexatious or was not made in good faith; or,

8.11.1.g. It is determined that an adequate investigation cannot be conducted because of insufficient funds, insufficient staff, lack of staff expertise, or any other reasonable factor that would result in an inadequate investigation despite a good faith report.

8.12. Referral of Complaints to the State Long-Term Care Ombudsman.

8.12.1. A regional ombudsman must refer to the state long-term care ombudsman any complaints:

8.12.1.a. That pose a conflict of interest to the ombudsman or the Regional Program that cannot be remedied by reassigning the complaint;

8.12.1.b. That the resident has requested the complaint be handled by the state long-term care ombudsman;

8.12.1.c. That are trivial, frivolous, vexatious, or not made in good faith;

8.12.1.d. That were made so long after the actual occurrence that it is no longer reasonable to conduct an investigation; or,

8.12.1.e. For which an adequate investigation cannot be conducted because of insufficient funds, staff, experts, or other factor that could result in an inadequate investigation despite a good faith effort.

8.13. Case Records.

8.13.1. The complaint case record must include only objective observations of items such as the resident's physical condition, behavior, conversations, and other facts that are revealed during the course of the investigation. In addition, all complaint case records must contain:

8.13.1.a. Data required by the statewide uniform reporting system;

8.13.1.b. Resident data: name; address/location; telephone number; sex; age; minority status; source of payment; name of any legal representative (if applicable); scope of authority of legal representative; address and telephone number of any legal representative;

8.13.1.c. Complainant data: name; address; telephone number and, relationship to the resident;

8.13.1.d. Pertinent provider information;

8.13.1.e. A clear, concise statement of the complaint, from both the complainant and resident, if different;

8.13.1.f. Documentation of the resident's consent to handle a complaint;

8.13.1.g. A statement as to the resident's desired outcome;

8.13.1.h. The action plan;

8.13.1.i. A running chronology of the contacts made to gather information regarding the complaint and to effect resolution of the problem, including the type of contact, the date, and who made the contact;

8.13.1.j. Documentation of any deviations from case handling protocol, practice, or policy;

8.13.1.k. Documentation of referrals to other agencies and the state long-term care ombudsman;

8.13.1.l. Copies of all correspondence sent or received regarding the complaint;

8.13.1.m. Copies of all documents gathered as a part of the complaint handling process;

8.13.1.n. Copies of release of information forms used to obtain documents or documentation of how consent was obtained;

8.13.1.o. Documentation of consent to reveal identities of the resident or other individuals involved in the complaint; and,

8.13.1.p. A summary statement of the closed complaint that demonstrates the extent to which the resident's desired outcome was achieved and the reason the case is being closed.

8.13.2. Complaint case records must be retained by the state long-term care ombudsman and Regional Programs for three (3) years.

8.13.3. Complaints must be documented on the statewide reporting system.

W. Va. Code R. § 76-5-9 Ombudsman Program Services

9.1. Facility Monitoring.

9.1.1. The Regional Program will visit long-term care facilities unannounced within its geographic jurisdiction. The Regional Program must develop and implement a written visitation plan which assures that the program has personal contact with residents and employees of facilities within the service area.

9.1.2. Personal contact means visiting residents, consulting with the administrator of the facility, or, if unavailable, another supervisory facility staff person, and the president of the resident's council, or, if unavailable, another member of the resident's council.

9.1.3. The Regional Program will prioritize visits, as defined in this section, to a facility where persons over the age of sixty (60) reside where:

9.1.3.a. Three (3) or more verified or partially verified complaint reports are received by the Regional Program within each calendar quarter. If a complaint report has been received where the nature of the complaint or complaints are not against the facility, the complaint report may not be counted when determining the need for more frequent visits;

9.1.3.b. The Regional Program has been informed that ownership of the facility has changed;

9.1.3.c. The Regional Program has received notice that incidents have occurred in a facility which result in an action or determination by the Office of Health Facility Licensure and Certification such as penalty assessment, admission ban, license revocation, provisional license, inspection monitor, receiver, or decertification proceeding.

9.2. Public Information and Education.

9.2.1. The Regional Program will accept referrals and inquires and provide information to assist residents, or individuals requesting the information on behalf of a resident, concerning the long-term care system, the rights and benefits of residents of long-term care facilities, services available to residents including the activities of the ombudsman program, and concerns of residents of long-term care services to the public.

9.2.1.a. The ombudsman may not reveal confidential information when responding to information requests.

9.2.1.b. Inquires regarding specific facility complaints will include number of complaints, general complaint types, verification and resolution.

9.2.1.c. Complaint data will not be given unless verification and resolution status is also included.

9.2.2. The Regional Program will conduct public education activities including providing public speaking engagements, sponsoring or conducting workshops, promoting the development of community organizations to participate in the ombudsman program, developing and distributing written materials, and participating in media coverage concerning long-term care issues.

9.3. Issue Advocacy.

9.3.1. The Regional Program will assist the Office in monitoring the development and implementation of federal, state, and local laws, regulations and policies that relate to long-term care facilities. This service component includes participation in any Long-Term Care Ombudsman Program advocacy activities concerning legislative and regulatory issues.

W. Va. Code R. § 76-5-10 Legal Issues

10.1. Legal Advice and Consultation to Regional Ombudsmen.

10.1.1. Regional Program staff may contact either the Regional Program's legal counsel or the Office to seek advice or consultation regarding a specific legal issue related to a complaint. The request may be made by telephone, or submitted in writing. The Office or Regional Program's legal counsel may request a brief, concise description of the complaint, the specific legal issue for which legal expertise is sought, and any relevant documentation.

10.1.2. A response will be in writing or telephone within five (5) working days by:

10.1.2.a. Providing the requested legal advice or consultation;

10.1.2.b. Requesting additional information;

10.1.2.c. Providing an update on the progress in obtaining the necessary information and an anticipated time frame; or

10.1.2.d. Indicating that the request is inappropriate and can not be answered.

10.1.3. The Office may follow up in writing to any final responses made by telephone to the Regional Program to assure consistency and accuracy in the information conveyed.

10.2. Notifying the Office.

10.2.1. A Regional Program must notify the Office upon receipt of any complaint, summons, subpoena, lawsuit, injunction, or notice of any other legal action taken against the Regional Program or any Representative of the Office. Such notice must be provided within twenty-four (24) hours, in writing, and is to include a copy of any legal document.

W. Va. Code R. § 76-5-11 Willful Interference

11.1. General Guidelines

11.1.1. Any individual who attempts to intentionally prevent, interfere with, or attempt to impede in any way with an ombudsman in the performance of his or her official duties under either state or federal law relating to the activities of the Office of the State Long-Term Care Ombudsman is in violation of W. Va. Code '16-5L-18.

11.1.2. When an ombudsman believes that willful interference is being attempted or has occurred, the ombudsman should take such steps as are necessary to prevent the interference by warning the perpetrator of the sanctions provided by law, and, if possible, advising the appropriate supervisor or the administrator of the facility of the situation and the sanctions provided by law. All attempts to prevent interference will be recorded in the case record. If the interference continues, the ombudsman must:

11.2.1.a. Attempt to corroborate his or her account of the situation with documentation, witness, photographs, tape recordings, or physical evidence. The prosecution of any willful interference may involve a criminal trial, and, accordingly, any corroborating evidence should be carefully collected, preserved, and safeguarded for delivery to the appropriate law enforcement office.

11.2.1.b. Immediately inform the legal counsel to the ombudsman program that an apparent violation of W. Va. Code '16-5L-18 has occurred.

11.1.2.c. Immediately inform the Office of the State Long-Term Care Ombudsman about the interference and provide supporting documentation concerning the interference for appropriate action.

W. Va. Code R. § 76-5-12 Severability

12.1. The provisions of this rule are declared to be severable. If any provision of this rule is held invalid, the remaining provisions will remain in effect.

76CSR5

Series 06 Shared Table Initiative for Senior Citizens

W. Va. Code R. § 76-6-1 General

1.1. Scope. -- This rule details methods, establishes and affirms the creation of the shared table initiative for senior citizens who suffer from food insecurity. The purpose is to establish a statewide initiative to facilitate shared tables at senior centers and similar facilities where congregate and home delivered meals are provided to seniors in need. Senior citizens may not always want to consume certain food or beverage items included in their meal.

1.2. Authority. -- W. Va. Code §16-5S-9a.

1.3. Filing Date. -- June 9, 2026.

1.4. Effective Date. -- June 9, 2026.

1.5. Sunset Provision. -- This rule shall terminate and have no further force or effect on August 1, 2031.

W. Va. Code R. § 76-6-2 Definitions

2.1. “Apparently fit grocery product” means a grocery product that meets all quality and labeling standards imposed by federal, state and local laws and regulations even though the produce may not be readily marketable due to appearance, age, freshness, grade, size, surplus or other conditions.

2.2. “Apparently wholesome food” means food that meets all quality and labeling standards imposed by federal, state and local laws and regulations even though the food may not be readily marketable due to appearance, age, freshness, grade, size, surplus or other conditions.

2.3. “Donate” means to give without requiring anything of monetary value from the recipient, except that the term includes donations by one nonprofit organization to another nonprofit organization, notwithstanding that the donor organization has charged a nominal fee to the done organization, if the ultimate recipient or user is not required to give anything of monetary value.

2.4. “Gleaner” means a person who harvests a donated agricultural crop for free distribution to the needy or for donation to a nonprofit organization for ultimate distribution to the needy.

2.5. “Good Samaritan Food Donation Act” means a law providing a statutory framework to protect food donators from liability for their good faith efforts (W. Va. Code §55-7D-1).

2.6. “Sharing tables” are tables or stations at senior centers or other locations where congregate meals are provided to senior citizens where senior citizens may return unopened prepackaged items, whole fruit and unopened beverage items they choose not to eat. These food and beverage items are then available to other senior citizens who may need additional nutritional servings.

W. Va. Code R. § 76-6-3 Types of Food That May Be Distributed

3.1. Any unopened pre-packaged items, including, but not limited to pretzels, crackers, bags of fruits and vegetables stored in a cooling bin, wrapped whole fruit, such as apples and bananas and unopened milk which has been stored in a cooling bin maintained at 41 degrees Fahrenheit or below may be distributed at a sharing table. Nutrition providers shall be aware of and comply with all Federal, state, and local laws, rules, regulations, and codes regarding standards for the preparation and distribution of food and beverages.

W. Va. Code R. § 76-6-4 Methods of Distribution to Make Food Available

4.1. Food and beverages which may be distributed under section three of this rule may be distributed at sharing table or to senior citizens who receive home-delivered meals.

W. Va. Code R. § 76-6-5 Methods of Distributing Excess Food to Persons or Organizations Providing Food to Seniors Suffering from Food Insecurity

5.1. Senior citizens may take an additional helping of a food or beverage item from the share table during congregate serving times or the food or beverage item may be provided as an extra serving to home delivered meal recipients. Food or beverage items left on the share table may be served for reimbursement during another meal service time if maintained at the appropriate storage standards.

W. Va. Code R. § 76-6-6 Methods to Otherwise Donate Excess Food to Persons or Organizations Providing Food to Persons or Families Suffering from Food Insecurity

6.1. Senior centers or other locations where congregate meals are provided to senior citizens which receive, prepare, or donate food and beverages to a food bank or other nonprofit charitable organization under this rule, shall comply with and are subject to the Good Samaritan Food Donation Act, W. Va. Code §55-7D-1 et seq.