2 nd National Pilot Survey of OAA Title III Service Recipients: Key to Planning & Improving Performance Nancy Wellman, PhD, RD National Resource Center on Nutrition, Physical Activity & Aging Florida International University 4 th State Units on Aging Nutritionists & Administrators Conference August 2006

Outline 2 nd National Pilot Survey overview 2 nd National Pilot Survey overview How AoA uses this information in its Performance Plan submitted to OMB & Congress every year How AoA uses this information in its Performance Plan submitted to OMB & Congress every year 2 nd National Pilot Survey findings 2 nd National Pilot Survey findings Questions: how can you use this information & data to justify, manage & plan for nutrition services in your state Questions: how can you use this information & data to justify, manage & plan for nutrition services in your state

General Purpose To show that Administration on Aging Programs achieve results intended by the Older Americans Act, and Administration on Aging Programs achieve results intended by the Older Americans Act, and Participants value the services. Participants value the services. See: Older Americans Act Program Results & Program Evaluation

Target Audiences for Report Federal Government Federal Government Congress – GPRA; AoA performance budget Congressional justification Congress – GPRA; AoA performance budget Congressional justification Office of Management and Budget - PART Office of Management and Budget - PART Program evaluation Program evaluation State Government State Government Benchmark for state/federal comparisons Benchmark for state/federal comparisons State legislature State legislature Tool for improving performance Tool for improving performance Tool for program planning Tool for program planning

Target Audiences for Report Local Local Justification for public funders: county/city Justification for public funders: county/city Justification for private funders: United Way, foundations, grants Justification for private funders: United Way, foundations, grants Benchmark for AAAs & local providers Benchmark for AAAs & local providers Tool for improving performance Tool for improving performance Tool for program planning Tool for program planning Public inquiries, other federal & state agencies, universities, researchers, general public Public inquiries, other federal & state agencies, universities, researchers, general public

National Pilot Surveys Specific Purposes:  Develop annual performance targets  Measure progress toward long-term performance targets  Develop preliminary national benchmarks for use by SUAs & AAAs  Develop plans for full-scale nat’l study in 2005—currently in data collection phase Sample sizes large enough for analysis by subgroup & geographical region. Sample sizes large enough for analysis by subgroup & geographical region.

National Pilot Surveys Specific Purposes:  Explore possibility of substituting survey for program reporting requirements  Plan next phase of POMP  Assess practical utility of various performance measurement instruments.

AoA Performance Plan aoa.gov/about/legbudg/performance/legbudg_performance.asp Improve targeting of OAA services: National Survey, NAPIS SPR Improve targeting of OAA services: National Survey, NAPIS SPR Vulnerable older populations Vulnerable older populations Services provided to people who need them Services provided to people who need them Improve program efficiency: NAPIS SPR Improve program efficiency: NAPIS SPR Improve client assessments & results: National Survey, NAPIS SPR Improve client assessments & results: National Survey, NAPIS SPR Services are of high quality Services are of high quality Meals improve food & nutrient intakes Meals improve food & nutrient intakes Programs provide opportunities for health promotion/disease prevention Programs provide opportunities for health promotion/disease prevention Consumers value program participation Consumers value program participation

National Pilot Survey Methodology Westat’s 2-Stage Sample Design 1 st Stage 1 st 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 2 nd Stage 2 nd Stage Random sample: 24 recipients per AAA on average, for each service domain Random sample: 24 recipients per AAA on average, for each service domain

OAA Title III Service Domains Caregivers Caregivers Case Management Case Management Congregate Nutrition Program Congregate Nutrition Program Information & Assistance Assessment Information & Assistance Assessment Senior Centers Senior Centers Homemaker Service Homemaker Service Home Delivered Nutrition Program Home Delivered Nutrition Program Transportation Service Transportation Service

OAA Title III Participant Characteristics Physical Functioning Physical Functioning ADL Limitations ADL Limitations IADL Limitations IADL Limitations Social Functioning Social Functioning 2nd Longitudinal Study on Aging 2nd Longitudinal Study on Aging Measures of Social Isolation Measures of Social Isolation Emotional Well-being Emotional Well-being Behavioral Risk Factor Surveillance System survey Behavioral Risk Factor Surveillance System survey Demographic Characteristics Demographic Characteristics

Services Targeted to Vulnerable Populations Home-delivered Older Older At nutritional risk At nutritional risk Lower income Lower income Less food access Less food access More vulnerable More vulnerable Frailer Frailer More functionally impaired More functionally impairedCongregate Older Older At nutritional risk At nutritional risk Lower income Lower income Less food access Less food access

Services Targeted to Vulnerable Populations Home-delivered 73% age % age % live alone 61% live alone 85% annual family income <$20,000 85% annual family income <$20,000 69% difficulty with 1+ ADLs 69% difficulty with 1+ ADLsCongregate 62% age % age % live alone 52% live alone

Services Targeted to Vulnerable Populations Home Delivered Nutrition Program 29% rated health as poor 29% rated health as poor Vs. 12% National Health Interview Survey respondents with incomes <$20,000 Vs. 12% National Health Interview Survey respondents with incomes <$20,000 58% high school graduates 7% college 58% high school graduates 7% college Vs. 78% & 23% Current Population Survey Vs. 78% & 23% Current Population Survey Socially isolated Socially isolated 46% would like to do more 46% would like to do more Vs. 24% of National Health Interview Survey Vs. 24% of National Health Interview Survey

Services Provided to People Who Need Them Meal provides half or more of total daily food intake 66% Home Delivered 66% Home Delivered 62% in 1st Nat’l Pilot Survey 62% in 1st Nat’l Pilot Survey 56% Congregate 56% Congregate

Services Provided to People Who Need Them Home Delivered FRUIT: 38% FRUIT: 38% 99% ate fruit served 99% ate fruit served VEGETABLES: 34% VEGETABLES: 34% 94% ate vegetables served 94% ate vegetables served DAIRY: 39% 95% ate products provided DAIRY: 39% 95% ate products provided MEAT: 51% 96% ate meat served MEAT: 51% 96% ate meat served GRAIN: 67% (1-2 servings) GRAIN: 67% (1-2 servings) 91% ate products provided 91% ate products providedCongregate 35% 96% 35% 96% 31% 95% 31% 95% 32% 86% 32% 86% 46% 97% 46% 97% 62% 93% 62% 93% Provides sole intake from key food groups: Ate only 1 serving/day

Meals Improve Dietary Intake Home-delivered FRUIT: 48% ate 2+ servings/day FRUIT: 48% ate 2+ servings/day VEGETABLES: 19% ate 3+ servings/day VEGETABLES: 19% ate 3+ servings/day DAIRY: 21% ate 3+ servings/day (milk, cheese, soy) DAIRY: 21% ate 3+ servings/day (milk, cheese, soy)Congregate 54% 54% 45% NHANES 24% 24% 13% NHANES 20% 20% 10% NHANES

Services help maintain individuals in their homes Home Delivered Nutrition Program 29% 3+ ADL limitations 29% 3+ ADL limitations 39% need assistance w/ 1+ ADLs 39% need assistance w/ 1+ ADLs 6% Census Bureau Survey of Income & Program Participation 6% Census Bureau Survey of Income & Program Participation 69% need assistance w/ 1 or more IADLs 69% need assistance w/ 1 or more IADLs 14% Survey of Income & Program Participation 14% Survey of Income & Program Participation

Services Are High Quality Home Delivered 95% rated meals good to excellent 95% rated meals good to excellent 92% said meals arrived on time 92% said meals arrived on timeCongregate 91% rated meals good to excellent 91% rated meals good to excellent 90% satisfied with taste of food 90% satisfied with taste of food 96% recommend program to friends 96% recommend program to friends

Consumers Value Program Participation Home Delivered 86% eat more balanced meals 86% eat more balanced meals 81% better able to avoid sodium & fat 81% better able to avoid sodium & fat 91% continue to live in own home 91% continue to live in own homeCongregate 79% 79% 76% 76% 72% 72%

Provide Opportunities for Health Promotion & Disease Prevention Congregate Nutrition Program 52% participated in fitness activity 52% participated in fitness activity 59% used health screening 59% used health screening 57% reported increased social opportunities 57% reported increased social opportunities

Summary 2nd National Pilot Survey showed services were: Targeted to vulnerable populations & individuals who needed them Targeted to vulnerable populations & individuals who needed them Highly rated by recipients Highly rated by recipients Provided assistance to individuals & caregivers Provided assistance to individuals & caregivers Helped maintain independence Helped maintain independence Avoided premature nursing home placement Avoided premature nursing home placement

How does Nat’l Pilot Survey info help you: Justify funding for congregate & home delivered meals? Justify funding for congregate & home delivered meals? Justify increased funding for one or both? Justify increased funding for one or both?

How does Nat’l Pilot Survey info help you: Determine how SUAs & AAAs could/should be doing community needs assessments for nutrition services? Determine how SUAs & AAAs could/should be doing community needs assessments for nutrition services?

How does Nat’l Pilot Survey info help you: Think about what nutrition services should be in your state or area plans? Think about what nutrition services should be in your state or area plans?

How does Nat’l Pilot Survey info help you: Develop policies or plan for home & community based long term care for older adults that include nutrition services? Develop policies or plan for home & community based long term care for older adults that include nutrition services?

How does Nat’l Pilot Survey info help you: Plan services differently for congregate & home delivered participants? Plan services differently for congregate & home delivered participants? For example, are there different health promotion/disease prevention programs that SUAs, AAAs, or local nutrition service providers should be providing to congregate participants? For example, are there different health promotion/disease prevention programs that SUAs, AAAs, or local nutrition service providers should be providing to congregate participants?

How does Nat’l Pilot Survey info help you: Plan services differently for congregate & home delivered participants? Plan services differently for congregate & home delivered participants? For example, are there different social interaction programs & services needed by home delivered participants? For example, are there different social interaction programs & services needed by home delivered participants?

How does Nat’l Pilot Survey info help you: Plan services differently for congregate & home delivered participants? Plan services differently for congregate & home delivered participants? For example, given that 29% of home participants have 3+ ADL impairments (indicator of significant frailty = nursing home level of care), what are implications for program planning, implementation & evaluation? For example, given that 29% of home participants have 3+ ADL impairments (indicator of significant frailty = nursing home level of care), what are implications for program planning, implementation & evaluation? Are there other risk factors you should be considering with this very vulnerable population? Are there other risk factors you should be considering with this very vulnerable population? Who should you be educating about this? Who should you be educating about this? What are the training or technical assistance implications? What are the training or technical assistance implications?

How does Nat’l Pilot Survey info help you: Plan services differently for congregate & home delivered participants? Plan services differently for congregate & home delivered participants? For example, since the majority of both congregate & home participants are low income & rely heavily on the meal for their day’s food intake, what are the implications for linking with other food & nutrition assistance programs? For example, since the majority of both congregate & home participants are low income & rely heavily on the meal for their day’s food intake, what are the implications for linking with other food & nutrition assistance programs? How could/should this affect your program planning, implementation & evaluation? How could/should this affect your program planning, implementation & evaluation?

How does Nat’l Pilot Survey info help you: Plan services differently for congregate & home delivered participants? Plan services differently for congregate & home delivered participants? For example, given ADL/IADL impairment levels of home participants, how do you ensure that other agency staff, AAAs, local nutrition service providers, case managers, hospitals, etc. understand relationships between adequate food & nutrient intakes & functionality? For example, given ADL/IADL impairment levels of home participants, how do you ensure that other agency staff, AAAs, local nutrition service providers, case managers, hospitals, etc. understand relationships between adequate food & nutrient intakes & functionality? How can this understanding be integrated into outreach, case management practices, access, referrals, caregiver support, etc. How can this understanding be integrated into outreach, case management practices, access, referrals, caregiver support, etc.

How does Nat’l Pilot Survey info help you: Plan services differently for congregate & home delivered participants? Plan services differently for congregate & home delivered participants? For example, should meal content be changed in regard to importance of For example, should meal content be changed 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 limitations of these food group intakes? key food group intakes as well as limitations of these food group intakes? How important is it to assess the meal delivery system? How important is it to assess the meal delivery system?

How does Nat’l Pilot Survey info help you: Plan services differently for congregate & home delivered participants? Plan services differently for congregate & home delivered participants? 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 monitoring to performance outcomes for individuals & programs? How do you educate re importance of monitoring to performance outcomes for individuals & programs?

How does Nat’l Pilot Survey info help you: Plan services differently for congregate & home delivered participants? Plan services differently for congregate & home delivered participants? For example, is there other data you believe would be useful for measuring performance in relationship to individuals, programs or systems? For example, is there other data you believe would be useful for measuring performance in relationship to individuals, programs or systems?