2 nd national pilot survey of oaa title iii service recipients: key to planning & improving...

22nd nd National Pilot Survey National Pilot Survey

of OAA Title III of OAA Title III Service Recipients: Service Recipients: Key to Planning & Key to Planning &

Improving PerformanceImproving Performance Nancy Wellman, PhD, RDNancy Wellman, PhD, RD

National Resource Center on Nutrition, Physical National Resource Center on Nutrition, Physical Activity & AgingActivity & Aging

Florida International UniversityFlorida International University

44thth State Units on Aging Nutritionists & Administrators Conference State Units on Aging Nutritionists & Administrators ConferenceAugust 2006August 2006

OutlineOutline 22ndnd National Pilot Survey overview National Pilot Survey overview

How AoA uses this information in its How AoA uses this information in its Performance Plan submitted to OMB Performance Plan submitted to OMB & Congress every year & Congress every year

22ndnd National Pilot Survey findings National Pilot Survey findings

Questions: how can you use this Questions: how can you use this information & data to justify, manage information & data to justify, manage & plan for nutrition services in your & plan for nutrition services in your state state

General PurposeGeneral Purpose

To show that To show that Administration on Aging Programs Administration on Aging Programs

achieve results intended by the achieve results intended by the Older Americans Act, andOlder Americans Act, and

Participants value the services.Participants value the services.

SeeSee: Older Americans Act Program : Older Americans Act Program Results & Program EvaluationResults & Program Evaluation

www.aoa.gov/about/results/index.aspwww.aoa.gov/about/results/index.asp

Target Audiences Target Audiences for Reportfor Report

Federal Government Federal Government Congress – GPRA; AoA performance Congress – GPRA; AoA performance

budget Congressional justificationbudget Congressional justification Office of Management and Budget - PARTOffice of Management and Budget - PART Program evaluationProgram evaluation

State Government State Government Benchmark for state/federal comparisonsBenchmark for state/federal comparisons State legislatureState legislature Tool for improving performanceTool for improving performance Tool for program planningTool for program planning

Target Audiences Target Audiences for Reportfor Report

Local Local Justification for public funders: Justification for public funders:

county/citycounty/city Justification for private funders: Justification for private funders:

United Way, foundations, grantsUnited Way, foundations, grants Benchmark for AAAs & local providersBenchmark for AAAs & local providers Tool for improving performanceTool for improving performance Tool for program planningTool for program planning

Public inquiries, other federal & state Public inquiries, other federal & state agencies, universities, researchers, agencies, universities, researchers, general publicgeneral public

National Pilot SurveysNational Pilot Surveys

Specific Purposes: Specific Purposes: Develop annual performance targetsDevelop annual performance targets Measure progress toward long-term Measure progress toward long-term

performance targets performance targets Develop preliminary national Develop preliminary national

benchmarks for use by SUAs & AAAs benchmarks for use by SUAs & AAAs Develop plans for full-scale nat’l Develop plans for full-scale nat’l

study in 2005—currently in data study in 2005—currently in data collection phasecollection phase

Sample sizes large enough for analysis Sample sizes large enough for analysis by subgroup & geographical region.by subgroup & geographical region.

National Pilot SurveysNational Pilot Surveys

Specific Purposes: Specific Purposes: Explore possibility of substituting Explore possibility of substituting

survey for program reporting survey for program reporting requirements requirements

Plan next phase of POMPPlan next phase of POMP Assess practical utility of various Assess practical utility of various

performance measurement performance measurement instruments.instruments.

AoA Performance PlanAoA Performance Planaoa.gov/about/legbudg/performance/legbudg_performance.asaoa.gov/about/legbudg/performance/legbudg_performance.as

pp

Improve targeting of OAA services:Improve targeting of OAA services:National Survey, NAPIS SPRNational Survey, NAPIS SPR Vulnerable older populationsVulnerable older populations Services provided to people who need themServices provided to people who need them

Improve program efficiency: NAPIS SPRImprove program efficiency: NAPIS SPR Improve client assessments & results: Improve client assessments & results:

National Survey, NAPIS SPRNational Survey, NAPIS SPR Services are of high qualityServices are of high quality Meals improve food & nutrient intakesMeals improve food & nutrient intakes Programs provide opportunities for health Programs provide opportunities for health

promotion/disease preventionpromotion/disease prevention Consumers value program participationConsumers value program participation

National Pilot Survey National Pilot Survey MethodologyMethodology

Westat’s 2-Stage Sample DesignWestat’s 2-Stage Sample Design 11stst Stage Stage

165 AAAs 165 AAAs Budget size, 4 Census Regions Budget size, 4 Census Regions

138 AAAs agreed to participate 138 AAAs agreed to participate 22ndnd Stage Stage

Random sample: 24 recipients per Random sample: 24 recipients per AAA on average, for each service AAA on average, for each service domaindomain

OAA Title III OAA Title III Service DomainsService Domains

CaregiversCaregivers Case Case

Management Management Congregate Congregate

Nutrition Nutrition ProgramProgram

Information & Information & Assistance Assistance AssessmentAssessment

Senior CentersSenior Centers Homemaker Homemaker

ServiceService Home Delivered Home Delivered

Nutrition Nutrition ProgramProgram

Transportation Transportation ServiceService

OAA Title III OAA Title III Participant Participant

CharacteristicsCharacteristics Physical FunctioningPhysical Functioning

ADL LimitationsADL Limitations IADL LimitationsIADL Limitations

Social FunctioningSocial Functioning 2nd Longitudinal Study on Aging2nd Longitudinal Study on Aging Measures of Social IsolationMeasures of Social Isolation

Emotional Well-being Emotional Well-being Behavioral Risk Factor Surveillance System Behavioral Risk Factor Surveillance System

surveysurvey

Demographic CharacteristicsDemographic Characteristics

Services Targeted to Services Targeted to Vulnerable PopulationsVulnerable PopulationsHome-deliveredHome-delivered Older Older At nutritional riskAt nutritional risk Lower income Lower income Less food access Less food access More vulnerableMore vulnerable FrailerFrailer More functionally More functionally

impaired impaired

CongregateCongregate OlderOlder At nutritional At nutritional

riskrisk Lower incomeLower income Less food accessLess food access

Services Targeted to Services Targeted to Vulnerable PopulationsVulnerable PopulationsHome-delivered Home-delivered

73% age 75+73% age 75+ 61% live alone61% live alone

85% annual 85% annual family income family income <$20,000<$20,000

69% difficulty 69% difficulty with 1+ ADLswith 1+ ADLs

CongregateCongregate 62% age 75+62% age 75+ 52% live alone52% live alone

Services Targeted to Services Targeted to Vulnerable PopulationsVulnerable Populations

Home Delivered Nutrition ProgramHome Delivered Nutrition Program 29% rated health as poor 29% rated health as poor

Vs. 12% National Health Interview Survey Vs. 12% National Health Interview Survey respondents with incomes <$20,000respondents with incomes <$20,000

58% high school graduates58% high school graduates 7% college 7% college Vs. 78% & 23% Current Population SurveyVs. 78% & 23% Current Population Survey

Socially isolatedSocially isolated 46% would like to do more 46% would like to do more

Vs. 24% of National Health Interview Vs. 24% of National Health Interview SurveySurvey

Services Provided to Services Provided to People Who Need People Who Need

ThemThemMeal provides half or more Meal provides half or more of total daily food intakeof total daily food intake

66% Home Delivered66% Home Delivered

62% in 1st Nat’l Pilot Survey62% in 1st Nat’l Pilot Survey

56% Congregate56% Congregate

Services Provided to Services Provided to People Who Need People Who Need

ThemThem

Home DeliveredHome Delivered FRUITFRUIT: 38%: 38%

99% ate fruit served 99% ate fruit served VEGETABLESVEGETABLES: 34%: 34%

94% ate vegetables served 94% ate vegetables served DAIRYDAIRY: 39% : 39%

95% ate products provided 95% ate products provided MEATMEAT: 51% : 51%

96% ate meat served 96% ate meat served GRAINGRAIN: 67% (1-2 servings): 67% (1-2 servings)

91% ate products provided91% ate products provided

CongregateCongregate 35%35%

96%96% 31%31%

95%95% 32%32%

86%86% 46%46%

97%97% 62%62%

93%93%

Provides sole intake from key food groups: Ate only 1 serving/day

Meals Improve Meals Improve Dietary IntakeDietary Intake

Home-delivered Home-delivered FRUITFRUIT: 48% : 48%

ate 2+ servings/dayate 2+ servings/day

VEGETABLESVEGETABLES: 19% : 19% ate 3+ servings/dayate 3+ servings/day

DAIRYDAIRY: 21% : 21% ate 3+ servings/day ate 3+ servings/day (milk, cheese, soy)(milk, cheese, soy)

CongregateCongregate 54% 54%

45% 1999-00 45% 1999-00 NHANESNHANES

24% 24%

13% 1999-2000 13% 1999-2000 NHANESNHANES

20% 20%

10% 1999-2000 10% 1999-2000 NHANESNHANES

Services help Services help maintain individuals maintain individuals

in their homesin their homesHome Delivered Nutrition ProgramHome Delivered Nutrition Program

29% 3+ ADL limitations29% 3+ ADL limitations 39% need assistance w/ 1+ ADLs39% need assistance w/ 1+ ADLs

6% Census Bureau 6% Census Bureau Survey of Income & Program Survey of Income & Program ParticipationParticipation

69% need assistance w/ 1 or more 69% need assistance w/ 1 or more IADLsIADLs 14%14% Survey of Income & Program Participation Survey of Income & Program Participation

Services Are High QualityServices Are High Quality

Home DeliveredHome Delivered 95% rated 95% rated

meals good to meals good to excellentexcellent

92% said meals 92% said meals arrived on timearrived on time

CongregateCongregate 91% rated meals 91% rated meals

good to good to excellent excellent

90% satisfied 90% satisfied with taste of with taste of foodfood

96% recommend 96% recommend program to program to friendsfriends

Consumers Value Consumers Value Program ParticipationProgram Participation

Home DeliveredHome Delivered 86% eat more 86% eat more

balanced mealsbalanced meals 81% better able to 81% better able to

avoid sodium & fatavoid sodium & fat 91% continue to live 91% continue to live

in own homein own home

CongregatCongregatee

79%79%

76% 76%

72% 72%

Provide Opportunities for Provide Opportunities for Health Promotion & Health Promotion & Disease PreventionDisease Prevention

Congregate Nutrition ProgramCongregate Nutrition Program

52% participated in fitness activity52% participated in fitness activity 59% used health screening59% used health screening 57% reported increased social 57% reported increased social

opportunitiesopportunities

SummarySummary

2nd National Pilot Survey 2nd National Pilot Survey showed services were:showed services were:

Targeted to vulnerable populations & Targeted to vulnerable populations & individuals who needed themindividuals who needed them

Highly rated by recipientsHighly rated by recipients Provided assistance to individuals & Provided assistance to individuals &

caregiverscaregivers Helped maintain independence Helped maintain independence Avoided premature nursing home Avoided premature nursing home

placementplacement

How does Nat’l Pilot How does Nat’l Pilot Survey info help you:Survey info help you:

Justify funding for Justify funding for congregate congregate & home delivered meals?& home delivered meals?

Justify Justify increasedincreased funding for funding for one or both?one or both?


Determine how SUAs & AAAs Determine how SUAs & AAAs could/should be doing could/should be doing community needs community needs assessments for nutrition assessments for nutrition services?services?


Think about what nutrition Think about what nutrition services should be in your services should be in your state or area plans? state or area plans?


Develop policies or plan for Develop policies or plan for home & community based home & community based long term care for older long term care for older adults that include nutrition adults that include nutrition services? services?


Plan services differently for Plan services differently for congregate & home delivered congregate & home delivered participants? participants?

For example, are there different For example, are there different health promotion/disease prevention health promotion/disease prevention programs that SUAs, AAAs, or local programs that SUAs, AAAs, or local nutrition service providers should be nutrition service providers should be providing to congregate providing to congregate participants? participants?



For example, are there different For example, are there different social interaction programs & social interaction programs & services needed by home services needed by home delivered participants? delivered participants?


Plan services differently for congregate & home Plan services differently for congregate & home delivered participants? delivered participants?

For example, given that 29% of home For example, given that 29% of home participants have 3+ ADL impairments participants have 3+ ADL impairments (indicator of significant frailty = nursing home (indicator of significant frailty = nursing home level of care), what are implications for program level of care), what are implications for program planning, implementation & evaluation? planning, implementation & evaluation?

Are there other risk factors you should be Are there other risk factors you should be considering with this very vulnerable considering with this very vulnerable population? population?

Who should you be educating about this? Who should you be educating about this? What are the training or technical assistance What are the training or technical assistance

implications? implications?


Plan services differently for congregate Plan services differently for congregate & home delivered participants? & home delivered participants?

For example, since the majority of both For example, since the majority of both congregate & home participants are low congregate & home participants are low income & rely heavily on the meal for income & rely heavily on the meal for their day’s food intake, what are the their day’s food intake, what are the implications for linking with other food implications for linking with other food & nutrition assistance programs? & nutrition assistance programs?

How could/should this affect your How could/should this affect your program planning, implementation & program planning, implementation & evaluation? evaluation?



For example, given ADL/IADL impairment For example, given ADL/IADL impairment levels of home participants, how do you levels of home participants, how do you ensure that other agency staff, AAAs, ensure that other agency staff, AAAs, local nutrition service providers, case local nutrition service providers, case managers, hospitals, etc. understand managers, hospitals, etc. understand relationships between adequate food & relationships between adequate food & nutrient intakes & functionality?nutrient intakes & functionality?

How can this understanding be How can this understanding be integrated into outreach, case integrated into outreach, case management practices, access, referrals, management practices, access, referrals, caregiver support, etc. caregiver support, etc.



For example, should meal content be For example, should meal content be changed in regard to importance ofchanged in regard to importance of customer satisfaction, customer satisfaction, meal to total food & nutrient intakes, meal to total food & nutrient intakes, key food group intakes as well as key food group intakes as well as

limitations of these food group limitations of these food group intakes?intakes?

How important is it to assess the meal How important is it to assess the meal delivery system? delivery system?



For example, how do you ensure quality? For example, how do you ensure quality? Are there implications for monitoring? Are there implications for monitoring? How do you educate re importance of How do you educate re importance of

monitoring to performance outcomes for monitoring to performance outcomes for individuals & programs? individuals & programs?



For example, is there other data For example, is there other data you believe would be useful for you believe would be useful for measuring performance in measuring performance in relationship to individuals, relationship to individuals, programs or systems? programs or systems?

2 nd national pilot survey of oaa title iii service recipients: key to planning & improving...

Documents

national survey

performance tool

state slide

program efficiency

nutrition program home

nutrition services

aoa performance plan

napis spr services