The Community Care for Disabled Adults (CCDA) program operated by Gulf Coast Community Care, a division of Gulf Coast Jewish Family Services, Inc., was expanded to a special demonstration project in Pinellas and Pasco Counties in FY 1994-1995. The CCDA program assists catastrophically disabled adults ages 18 to 59 who are assessed to be at risk of placement in a nursing home, assisted living facility or other institution. The program enables clients to remain in their households through provision of supportive services, which can include home-makers and chore services, personal care, home-delivered meals, respite care, counseling, transportation and other similar services.

The 1997 Florida Legislature through proviso language required an evaluation of the demonstration project. The evaluation was conducted by the Department of Aging and Mental Health of the Louis de la Parte Florida Mental Health Institute, University of South Florida. Using data collected by CCDA case managers, the goals for the evaluation were to:

• Summarize the characteristics of individuals served in the CCDA demonstration project, to ensure that those served are, in fact, at risk of becoming institutionalized
• Determine whether clients are receiving services appropriate to their disabilities
• Determine the effectiveness of the program to ensure that their risk for institutionalization is being held in check
• Offer recommendations for further expansion of the program

The results showed that:

• The demonstration appears to be effective, meeting the needs of clients and fulfilling legislative intent
• The program leveraged state funding resulting in an additional $350,978 in federal revenue, permitting an additional 220 clients to be served
• Clients are low income, middle-aged, disabled adults
• Program costs averaged $200 per month per person
• As clients age, they are more likely to live alone
• 94.5% of all clients needed assistance with at least one basic self-care deficit such as dressing, bathing or grooming
• 82% needed assistance with two or more basic self-care skills
• Almost all (98.3%) needed assistance to remain at home in areas such as meal preparation, laundry, housework, transportation, or assisting in special health care (e.g.,helping with tubes and catheters, ostomy bags, etc., or having someone available to assist)
• Among the most frequent illnesses and disabilities were multiple sclerosis, arthritis, congenital defects, diabetes, stroke, quadriplegia
• Based on assessments of various function areas, 99.6% of all clients were judged as moderate to high risk for institutionalization
• Some improvements over annual evaluations were noted in Cognitive Functioning (orientation to time, place, personal information) and Health Assessment (case manager's assessment of the client's health, use of medication, etc.)
• Impairments in Living Skills (preparing meals, doing the laundry, housekeeping, going outside of the home, or traveling to appointments), Client Support (services received for both personal care needs and skills necessary to live at home), and Environment (safety of the home and neighborhood, access to shopping and transportation, telephone access) actually increased over annual evaluations. This is likely related to the chronic, often progressive diseases experienced by the clients
• Case managers almost always recommended that the client remain at home with services, rather than alternative placements such as an ALF, nursing home, or other special facility. Clients and family overwhelmingly agree with the recommendations.

The findings support the fact that the CCDA demonstration program is serving seriously disabled adults and providing services appropriate to clients' disabilities and needs. The program is effective in that the clients remain within their homes and remain stable with respect to quality of life. Further expansion of the program will enable a larger population of adults with disabilities to be served.