Aging and Long-Term Support Strategic Goals

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The Power of Choice

A guide to Aging and Long-Term Support Administration's strategic plan for the 2023-2025 planning cycle. 

From high-quality in-home care providers to safe and protected facility settings, the power of choice for elders and people with disabilities in Washington state is bright.

 

the couple Read and download ALTSA's 2023-2025 Strategic eBook here>

 

 

ALTSA's 2023 - 2025 Strategic Plan 

In the strategic planning process, we identify three key components.

  1. The Strategic Objective: Sets the goal that we are striving to achieve.
  2. The Action Plan: Our action steps to get there.
  3. The Success Measure: The outcome that would let us know we have achieved that goal by 2025.

Read in detail below about all of the components of ALTSA's strategic plan. To read about ALTSA's Strategic Plan Metrics, read the full report here. 

 

Strategic plan index: Jump to a section of the plan by clicking the Strategic Objective (SO)

  1. SO #1: Serve individuals in their homes or in community-based settings of their choice.
  2. SO #2: Develop and expand approaches to serve adults who are older, Medicaid recipients and caregivers.
  3. SO #3: WA Cares Fund – Conduct planning and outreach activities for implementation of the Long-Term Services and Supports Trust Act, which will deliver benefits to eligible individuals.
  4. SO #4: Build long-term care workforce to meet the needs of clients while creating resources to retain current high-quality, long-term care workforce. 
  5. SO #5: Support people to transition from acute care hospitals to services in their homes or communities.
  6. SO #6: Mental Health Transformation – Provide long-term services and supports for individuals transitioning or diverting from state psychiatric hospitals.
  7. SO #7: Support people to transition from nursing homes to care in their homes or communities.
  8. SO #8: Process financial applications, complete new Comprehensive Assessment Reporting Evaluation assessments and reassessments and develop service plans in a timely way so that individuals can be supported in the setting of their choice.
  9. SO #9: Provide education and training to DSHS staff and providers to better serve residents and clients who are deaf, deafblind, deaf plus, hard of hearing, late deafened and speech disabled. 
  10. SO #10: Expand case management services for specialized populations.
  11. SO #11: Provide assistive communication technology services.
  12. SO #12: Complete abuse and neglect investigations timely and thoroughly.
  13. SO #13: Investigate complaints regarding facilities in a timely manner.
  14. SO #14: Conduct timely oversight and compliance activities in facilities and agencies providing residential care and supports.
  15. SO #15: Timely abuse and neglect investigations.
  16. SO #16: Tribal Affairs – Continue to build strong relationships with, and expand contract opportunities for, tribes/tribal organizations to increase access to culturally attuned long-term services and supports for American Indians/Alaska Natives to age in their homes or community-based settings of their choice.
  17. SO #17: Conduct timely oversight and compliance activities in facilities and agencies providing residential care and supports.
  18. SO #18: Create and foster organizational culture that promotes employee engagement. 
  19. SO #19: Develop tools to support staff’s core work and the service delivery system, including updates to technology and improvements in applications and data analysis. 
  20. SO #20: Address risks and plans for emergencies.
  21. SO #21: Promote equity, diversity access and inclusion (EDAI) practices.

 

Strategic Objective #1: Serve individuals in their homes or in community-based settings of their choice. 

The Action Plan:

  • ALTSA will work with clients and their families to assist individuals moving into a setting of their choice with long-term services and supports that fit their unique needs. 
  • ALTSA will create new services for specialized populations and individuals with multiple needs and inform community providers of these services.  
  • ALTSA will work with Tribal governments and regional Area Agency on Aging leadership teams to plan and simplify processes, review and improve access to services and develop resources to help staff support the changing needs of clients.

Success Measure:

Maintain the percentage of Long-Term Services and Supports clients served in home and community-based settings at or above 89% by June 2025. 

Strategic Objective #2: Develop and expand approaches to serve adults who are older, Medicaid recipients and caregivers.

The Action Plan:

  • ALTSA will partner with Area Agencies on Aging to develop system and policy enhancements, person-centered planning, staff and provider training and data analysis. 
  • ALTSA will increase outreach, enrollment and support of dyads to counteract the higher churn (shorter length of stay) experienced by dyads. 
  • ALTSA will develop a sustainability plan for legislative consideration that shows results and cost effectiveness of supporting care recipients and caregivers.

Success Measure:

To divert or delay individuals' need for more intensive Medicaid Long-Term Services and Supports, emphasizing support of family care givers, increase the proportion of dyads to individuals enrolled by 5% by December 2025.

Strategic Objective #3: WA Cares Fund – Conduct planning and outreach activities for implementation of the Long-Term Services and Supports Trust Act, which will deliver benefits to eligible individuals.  

The Action Plan:

  • ALTSA will work with the Long-Term Services and Supports Trust Commission to develop and implement outreach and community relations strategies. 
  • ALTSA will work with the Employment Security Department, Health Care Authority and the Office of the State Actuary to define the business needs and design the IT and programmatic components for the WA Cares Fund implementation.  
  • ALTSA will work with the Long-Term Services and Supports Trust Commission to draft and finalize annual reports.

Success Measure:

Develop policy, define business needs, design and develop IT systems, initiate public outreach, and create staffing and network development plans for implementing the WA Cares Fund by January 2025. 

Strategic Objective #4: Build long-term care workforce to meet the needs of clients while creating resources to retain current high-quality, long-term care workforce.  

The Action Plan:

  • ALTSA will provide technical assistance to the Office of Superintendent of Public Instruction, Office of Native Education, DSHS Tribal Initiative Project Manager and tribes to implement home care aide training in high schools and skills centers. 
  • ALTSA will recruit summer programs, community programs and community colleges to provide home care aide training to program participants or students. 
  • ALTSA will develop and deploy recruitment marketing materials intended for various streaming services.

Success Measure:

Increase the number of high schools, skills centers, tribal and compact schools delivering home care aide certification training to students, summer programs, community programs and community colleges by June 2025. 

The Action Plan:

  • ALTSA will retain a long-term care workforce by creating a retention toolkit for employers that supports them in recruiting, hiring, training and retention of long-term care staff. 
  • ALTSA will develop a process for sharing the retention toolkit and tracking participants' access to and use of the toolkit.
  • ALTSA will evaluate the retention toolkit for accessibility and efficacy in addressing  turnover and make recommendations to leadership on improvements.  

Success Measure:

Design and deploy resources that increase retention of the direct care workforce by June 2025. 

The Action Plan:

  • ALTSA will develop and deploy materials for presentations to state and national workforce boards, workforce development professionals and health care provider organizations to educate and elevate understanding of the value and contributions of the direct care workforce.   
  • ALTSA will serve as a member of Governor Inslee’s Washington Recovery Group to amplify the importance of direct care careers to garner support for new projects that train more direct care workers.   
  • ALTSA will serve on steering committees and workgroups convened by long-term care and workforce development organizations to create entry points into the direct care workforce.

Success Measure:

Increase the visibility of direct care workforce by educating workforce boards, centers and health care providers about competencies and values of the work by June 2025. 

Strategic Objective #5: Support people to transition from acute care hospitals to services in their homes or communities.

The Action Plan:

  • ALTSA will hold weekly statewide meetings to review cases of individuals with complex needs to increase care coordination efforts.
  • ALTSA will hold weekly statewide acute care hospital meetings with regional staff to share communication and problem solving strategies, medical records, policy changes and best practices that improve discharge planning activities.
  • ALTSA will carry out quality assurance actions and give reports to staff about acute hospital referrals and discharges to help manage transitions, analyze trends and identify barriers and use of resources. 

Success Measures:

  • Maintain the quarterly average percentage of clients whose hospital stay is 100 days or more from the date of referral to HCS not to exceed 5% through June 2025. 
  • Achieve a quarterly percentage of clients transitioned from acute care hospitals in less than 30 days from the date of referral to HCS consistently at 75% through June 2025. 

Strategic Objective #6: Mental Health Transformation – Provide long-term services and supports for individuals transitioning or diverting from state psychiatric hospitals.

The Action Plan:

  • ALTSA will work with providers to improve their skills and their capacity to serve specialized populations. 
  • ALTSA will coordinate across systems to successfully transition individuals with complex needs by using a person-centered approach and providing intensive care coordination in order to achieve and maintain community stability. 
  • ALTSA staff will implement a monitoring plan for specialty contracts. 

Success Measures:

  • Achieve a quarterly average of 80 state psychiatric hospital-to-community setting transitions from June 2023 through June 2025. 
  • Achieve a quarterly average of 72 clients diverting from psychiatric hospital to community setting by June 2024.

Strategic Objective #7: Support people to transition from nursing homes to care in their homes or communities.

The Action Plan:

  • ALTSA will support community living by offering temporary or long-term community services and will provide staff and contracted providers with ongoing technical assistance, education, tools and resources that help with the changing needs of clients.
  • ALTSA will collaborate with nursing facilities, providers, residents and families as well as expand resources, services and strategies to support residents transitioning to their preferred community setting. 
  • ALTSA will implement the rental subsidies funded by the Legislature to support individuals transitioning from nursing facilities to independent housing with the support of long-term community services.

Success Measures:

  • Maintain the quarterly average of nursing facility-to-community settings transitions at 976 by June 2025.  
  • Maintain the average length of time an individual remains in the community after transition (in months) at or above 10.75 through June 2025. 
  • Maintain the quarterly percentage of clients without re-institutionalization within the first 30 days of discharge at or above 94% through June 2025. 

Strategic Objective #8: Process financial applications, complete new Comprehensive Assessment Reporting Evaluation assessments and reassessments and develop service plans in a timely way so that individuals can be supported in the setting of their choice.

The Action Plan:

  • ALTSA will work with the Centers for Medicare and Medicaid Services to expand the use of presumptive eligibility for long-term services and supports. 
  • ALTSA staff will coordinate training tools and policy for case management and nursing staff.     
  • ALTSA will hold quarterly statewide and regional performance metrics reviews to identify best practices, accurate reason coding and barriers to determine action steps.  

Success Measures:

  • Maintain the percentage of timely financial eligibility determinations at 96% through June 2025. 
  • Maintain the percentage of initial functional assessments completed within 45 days of creation to 98% through June 2025.
  • Achieve the annual percentage of timely functional reassessments at 98% through June 2025. 
  • Maintain the percentage of financial applications processed within 20 days at or above 35% by June 2025. 

Strategic Objective #9: Provide education and training to DSHS staff and providers to better serve residents and clients who are deaf, deafblind, deaf plus, hard of hearing, late deafened and speech disabled. 

The Action Plan:

  • ALTSA will monitor the caseload and contract performance at the Regional Service Centers and implement corrective actions when necessary. 
  • ALTSA will increase opportunities for virtual and in-person case management services in rural and diverse areas. 
  • ALTSA will increase the number of clients who receive virtual or in-person services by improving outreach and public relations strategies. 

Success Measure:

Fulfill at least 50 requests for service provider education and training requests in communication access modalities (communication methods for people who are deaf, deafblind, deaf plus, hard of hearing, late deafened and speech disabled) per year through June 2025.

Strategic Objective #10: Expand case management services for specialized populations.

The Action Plan:

  • ALTSA will monitor the caseload and contract performance at the Regional Service Centers and implement corrective actions when necessary. 
  • ALTSA will increase opportunities for virtual and in-person case management services in rural and diverse areas. 
  • ALTSA will increase the number of clients who receive virtual or in-person services by improving outreach and public relations strategies. 

Success Measure:

Increase the number of clients served by the Regional Service Centers of the deaf, deafblind, deaf plus, hard of hearing, late deafened and speech disabled to at least 700 through June 2025.

Strategic Objective #11: Provide assistive communication technology services.

The Action Plan:

  • ALTSA will increase the statewide use of assistive listening technology at the Legislature, Area Agency on Aging offices and Home and Community Services and Residential Care Services offices.  
  • ALTSA will offer virtual or in-person training and consultation for staff and Regional Service Centers. 
  • ALTSA will evaluate the use of assistive communication technology by clients and staff. 

Success Measure:

Increase the number of ACT consultation services to meet service objectives involving the public and clients with assistive listening systems from 350 in June 2023 to 500 by June 2025.

Strategic Objective #12: Complete abuse and neglect investigations timely and thoroughly.

The Action Plan:

  • ALTSA will improve onboarding process to retain trained, skilled staff and build in-training units for Social Service Specialists 1 and 2.   
  • ALTSA will work with the Human Resources Division to improve and streamline the recruiting process and work to build core competencies of Adult Protective Services Field staff.                                                                                      
  • ALTSA will increase staff training on investigation and case closure policy and procedures.

Success Measure:

Increase the percentage of investigations of adult abuse and neglect completed within 90 days, or remaining open for “good cause,” to 98% through June 2025.

Strategic Objective #13: Investigate complaints regarding facilities in a timely manner.

The Action Plan:

  • ALTSA will hire staff, increase retention and reduce turnover by cross-training staff for all facility types and hire on-call staff to respond to changing complaint volumes. 
  • ALTSA will conduct trainings to ensure quality and consistency of investigations and modernize the Residential Care Services investigation, documentation and record storage systems.
  • ALTSA will reestablish timely re-inspections, which were delayed by the COVID-19 pandemic.

Success Measure:

Maintain the long-term care facility complaint investigation backlog of non-immediate jeopardy complaints to 50 or fewer through June 2025.

Strategic Objective #14: Conduct timely oversight and compliance activities in facilities and agencies providing residential care and supports.

The Action Plan:

  • ALTSA will cross-train licensors for different settings and improve recruitment and retention strategies. 
  • ALTSA will develop a Residential Care Services workload model for staff using key metrics such as facility type, workload, provider growth and regulatory changes.
  • ALTSA will modernize the Residential Care Services inspection, licensing, documentation and record storage systems.

Success Measure:

Maintain timely re-inspections for nursing homes, assisted living facilities and adult family homes to 90% or higher by June 2025.

The Action Plan:

  • ALTSA will use continuous quality improvement internal controls to track timeliness of oversight and compliance activities. 
  • ALTSA will enhance the Enforcement Communications Center software to improve tracking and timeliness of Statement of Deficiency processing. 
  • ALTSA will reestablish timely Nursing Home Statements of Deficiency processing, which were delayed by the COVID-19 pandemic. 

Success Measure:

Maintain the percentage of Nursing Home Statements of Deficiency sent to the facility within the federal regulatory standard at 90% through June 2025. 

The Action Plan:

  • ALTSA will expand and retain Residential Care Services staffing for Certified Community Residential Services and Supports to allow for program-specific quality recertification and enforcement.
  • ALTSA will modernize the Residential Care Services inspection, licensing, documentation and record storage systems.
  • ALTSA will reestablish timely quality assurance activities, which were delayed by the COVID-19 pandemic.

Success Measure:

Maintain timely recertification at 90% for services provided to people with developmental and intellectual disabilities through June 2025. 

Strategic Objective #15: Timely abuse and neglect investigations.

The Action Plan:

  • ALTSA will conduct quality assurance activities to evaluate areas for improvement and ensure consistent intake decisions and timely assignment of investigations. 
  • ALTSA will assess whether to change current response times for clarity.
  • ALTSA will conduct a root cause analysis on any missed or late responses and create action plans for improvement.

Success Measure:

Increase timely initial response to investigations based on priority to 100% for high-priority investigations and maintain at 99% for medium- and low-priority investigations through June 2025. 

Strategic Objective #16: Tribal Affairs – Continue to build strong relationships with, and expand contract opportunities for, tribes/tribal organizations to increase access to culturally attuned long-term services and supports for American Indians/Alaska Natives to age in their homes or community-based settings of their choice.

The Action Plan:

  • ALTSA will engage tribes and tribal organizations to expand information and identify opportunities for the delivery of long-term services and supports to American Indians and Alaska Natives.
  • ALTSA will build state agency partnerships to identify complementary funding resources and opportunities for tribal contracting that support elders and individuals with disabilities and provide comprehensive, evolving long-term services and supports. 
  • ALTSA will build strong relationships with long-term service providers to increase statewide capacity to serve American Indian and Alaska Native older adults and individuals with disabilities during the COVID-19 pandemic and throughout the recovery period.

Success Measure:

We will facilitate contracting with tribes, tribal organizations and tribal businesses to expand Long-Term Services and Supports to tribal communities by three new contracts per year to benefit AI/AN elders, veterans and adults with disabilities by June 2025.

The Action Plan:

  • ALTSA will engage tribes to identify long-term services and supports that meet the requirements for increased federal financial participation. 
  • ALTSA will help tribal social and health service departments bill for Medicaid-reimbursed long-term services and supports by sharing federal requirements for updating Indian Health Service contracts.
  • ALTSA, in coordination with the Health Care Authority, will develop and implement billing guidelines and systems for Medicaid-reimbursed long-term services and supports provided by tribal governments/enterprises.

Success Measure:

Identify and implement increased federal financial participation for a minimum of one long-term services and supports contract provided by June 2025. 

Strategic Objective #17: Conduct quality assurance activities and comply with federal, state and program requirements.

The Action Plan:

  • ALTSA will conduct quality assurance reviews to help Residential Care Services identify barriers and develop solutions through proficiency improvement plans.
  • ALTSA will provide consultation and technical assistance for Residential Care Services proficiency improvement plans.  

Success Measure:

Maintain 100% completion of Residential Care Services Division quality assurance process reviews through June 2025.

The Action Plan: 

  • ALTSA will complete annual risk assessments and build a monitoring schedule to ensure program and fiscal contract compliance.
  • ALTSA will create and distribute monitoring tools for use by Area Agencies on Aging. 

Success Measure:

Maintain 100% completion of scheduled AAA monitoring visits and timely completion of draft and final monitoring reports through June 2025. 

Strategic Objective #18: Create and foster organizational culture that promotes employee engagement.

The Action Plan:

  • ALTSA will encourage participation in Connection Cafés; specifically Mental Health Matters; Resiliency Moment; Equity, Diversity, Access and Inclusion; and ALTSA THRIVES. 
  • ALTSA will share monthly Wellness Note and ALTSA Update articles providing education, links to Employee Assistance Program, SmartHealth and other health and safety resources. 
  • ALTSA will ensure that wellbeing best practices including Critical Incident Stress Management and burnout prevention are woven into leadership and staff development workshops.  

Success Measure:

To measure our success in supporting employee’s well-being, increase the number of positive ALTSA responses to the DSHS survey question, "My agency supports employee well-being" from 65% to 67% by June 2025. 

The Action Plan:

  • ALTSA will encourage staff participation in quality improvement efforts.
  • ALTSA will provide staff with the Lean Six Sigma Green Belt certification program.  
  • ALTSA will expand Lean learning opportunities in partnership with the DSHS Office of Innovation, Strategy and Visual Communications. 

Success Measure:

To measure our success in creating a culture of innovation, increase the positive ALTSA responses to the DSHS survey question, “I am encouraged to come up with better ways to do things” from 54% to 57% by June 2025. 

The Action Plan:

  • ALTSA will launch and leverage information from the “Why Do You Stay?” and “New Employee Satisfaction” surveys.
  • ALTSA will support person-centered thinking, trauma-informed leadership, telework and flexibility through messaging and workshops.  
  • ALTSA will collaborate with the communications team and others in support of engagement in strategic planning, employee surveys, New Employee Orientation, Combined Fund Drive, Wellness, Lean, Infants at Work, Employee Appreciation, and Equity, Diversity, Access and Inclusion events and efforts. 

Success Measure:

To measure our success in being an employer of choice, increase the positive ALTSA responses to DSHS survey question, “I would recommend my agency as a great place to work” from 67% to 69% by June 2025. 

The Action Plan:

  • ALTSA will provide staff and leadership development through Focal Point, Lessons in Leadership, The ALTSA Way, New Employee Orientation, Highlighting and Building Excellence in Teams and Connection Cafés.
  • ALTSA will maximize Washington State Learning Center capabilities.  
  • ALTSA will expand individual and group leadership coaching, mentoring and development workshops.   

Success Measure:

To measure our success in supporting people development, increase positive ALTSA responses to the DSHS survey question, “I have opportunities to learn and grow” to measure supporting people development from 71% to 73% by June 2025.  

Strategic Objective #19: Develop tools to support staff’s core work and the service delivery system, including updates to technology and improvements in applications and data analysis. 

The Action Plan:

  • ALTSA will collaboratively update Secure Tracking and Reporting System with the Facility Management System and the Records Management System.
  • ALTSA will improve the efficiency and effectiveness of current data and documentation systems.
  • ALTSA will develop an integrated document management system in alignment with DSHS enterprise IT strategies. 

Success Measure:

To reduce paper-based processes while improving electronic based systems, ALTSA will continue to implement paperless documentation systems across ALTSA divisions by December 2025. 

Strategic Objective #20: Address risks and plans for emergencies.

The Action Plan:

  • ALTSA will annually review and update the Continuity of Operations Plan, train staff and test the plan through exercise or real world incidents. 
  • ALTSA will support a Long-Term Care Incident Management Team by providing ongoing training  to members and continued participation in the Washington Incident Management Team Coalition.
  • ALTSA will annually review and update the Emergency Preparedness Plan to effectively and efficiently respond to future public health emergencies. 

Success Measure:

Foster a safe and secure environment by ensuring that ALTSA is prepared to transition into incident management quickly to address emergencies by completing the Action Plan by June 2025. 

The Action Plan:

  • ALTSA will maintain a risk register, perform quarterly updates and make recommendations to ALTSA leadership to avoid or minimize future risks. 
  • ALTSA will maintain a risk program that is integrated with other risk elements such as tort claims, safety reports, incident reports and public disclosure requests.  

Success Measure:

Foster a safe and secure environment by ensuring that ALTSA maintains vigilance and action plans to work towards mitigating and eliminating identified risks by completing the Action Plan by June 2025. 

Strategic Objective #21: Promote equity, diversity access and inclusion (EDAI) practices.

The Action Plan:

  • ALTSA will continue to train management and staff about Equity, Diversity, Access and Inclusion principles. 
  • ALTSA will expand quality assurance policies and procedures to measure EDAI success. 
  • ALTSA will expand on Certified Diversity Executive/Certified Diversity Professional learning. 

Success Measure:

Provide fundamentals of EDAI, to include anti-racism training to ALTSA management and staff by December 2025. 

The Action Plan:

  • ALTSA will continue to meet or exceed the Culturally and Linguistically Appropriate Services Standards by supporting a diverse workforce, creating and supporting programs to retain staff, removing any potential biases identified within policies and procedures and working with tribes to identify barriers and unintended consequences of hidden bias in current practices.
  • ALTSA will continue to provide opportunities for staff and leadership to acquire shared language and practices on equity through diversity workshops, discussion opportunities and resource sharing on Equity, Diversity and Inclusion topics.
  • ALTSA will continue to use art, videos, storytelling and employee recognition to generate sustained personal dialogue and enterprise-wide appreciation for transformational systemic change. 

Success Measure:

Operationalize EDAI principles throughout the organization, as measured by completion of ALTSA’s identified goals in the DSHS Truth, Social Justice and Dismantling Racism Action Plan by December 2025. 
 

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