Rebalancing Long Term Care: The Role of the Older Americans Act Nutrition Program Jean Lloyd Dian Weddle 4 th State Units on Aging Nutritionists & Administrators Conference August 29, 2006

Objectives of Presentation  Introduce the Challenge Brief  Describe the Rebalancing Environment  Present Choices for Independence & Role for OAA Nutrition Program

OAA Nutrition Program  Cost effective service for older adults that: 1)Assists them to engage in society & community life 2)Maintains their health & independence 3)Allows them to remain at home in their communities 4)Supports the OAA vision and 5)Meets performance outcomes & indicators established AoA.

Good Food & Nutrition  Key factors in successful aging  Help reduce disease-related disability  Promote health, support increased mental & physical functioning  Are more important than genetic factors in avoiding decline

Nutrition in Keeping Older Adults Healthy & Independent  Prevention of malnutrition (obesity, undernutrition)  ↓ risk of chronic disease & disease-related disability  Critical in management & treatment of chronic disease  Nutrition therapy is cost effective

Top Nine Chronic Health Conditions  Heart Disease  Hypertension  Stroke  Emphysema  Asthma  Chronic Bronchitis  Cancer  Diabetes  Arthritis All have dietary & nutritional implications affecting independence!

The Changing Long Term Care System  Different Needs: Current population vs. baby boomers  Current System: Costly facility-based LTC  69% of Medicaid spending on LTC  Rebalanced System: More cost effective home & community-based model

Benefits of Rebalancing  Empower older adults & families to select services & providers  Increased consumer satisfaction  Money saved through ↓ use of high cost ER & institutional care

AoA’s Choices for Independence Initiative  Empower consumers to make informed decisions about Choices for LTC  Target high risk, nursing home appropriate, non-Medicaid individuals & delay institutionalization without current OAA service categories or title restrictions  Build prevention into community living through evidence based health promotion & disease prevention programs designed for older adults

Importance of the OAA  Cornerstone for cost effective, comprehensive, coordinated, high quality, long term home & community based services  OAA has the experience, network & programs to serve as model for a rebalanced LTC system  Visible, creditable & trusted

Challenges & Opportunities Lie Ahead  Need philosophical & operational shift… FROM: provider/service driven model TO: empowered consumers making their own decisions

Implications for Nutrition Services  Balance needs of today’s older adults with a more independent, mobile & younger group  Increasing diversity in:  Severity of impairments  Information & referral needs  Mix of therapeutic nutrition  Health & social services  Array of health promotion & disease prevention community programs

Serving Nursing Home Eligible Consumers  Currently targeting & serving increasingly frailer, impaired & more underserved population  Possible implications for risk of malnutrition  30% of those getting home-delivered meals eligible for nursing home placement  Regulations in nursing homes require monitoring, evaluation & care plan development to prevent deterioration EXA: National guidelines for screening, staging, prevention and treatment of pressure ulcers

OAA Aging Network  Nutr Program & RD/ICE dietitians at state AND local levels  First line of defense in monitoring &/or improving nutritional & weight status  Development of state & local area plans should include nutrition expertise & provide for nutritional needs of consumers

OAA Nutrition Program  Promotes Health & Independence in Home & Community-Based LTC  Well integrated into home & community settings through community partners & social service and medical care components  Can serve as model program for implementing AoA’s Choices Initiative

OAA Nutrition Program  Consumer-driven nutrition services/interventions for older adults including:  Meals: tasty & nutritionally dense to enhance food/nutrient intake  Congregate Meal Sites: provide interaction & improves active social engagement  Nutrition Education: empowers behavioral change & provides latest nutritional information  Nutrition Counseling: enhances chronic disease management by consumer & caregiver  Referrals & Coordination: connects consumer & caregiver to community partners

OAA Nutrition Program & Continuous Quality Improvement  Maintains adherence to the latest scientific evidence & highest performance standards  Mechanisms in place for customer & dietary intake assessment as well as adherence to consistency of standards  Provides training & guidance on nutritional aspects to case managers These assure that process provides safe, comprehensive & scientifically accurate services!

Nutrition & Choices  The OAA Nutrition Program provides nutritional choices including:  Congregate sites & restaurant vouchers  Menu & food selection (EXA: culturally appropriate meals)  Home Delivered Meals, hot or frozen, including specialized therapeutic meals (EXA: renal diets)  In-depth individualized nutrition counseling for disease management for consumer & caregiver (EXA: diabetes, cancer)  Educational sessions including caregiver needs, guidance for healthy eating, & tips for physical activity.

Nutrition Care Process  Screen  Assess  Problem ID  Intervention  Follow up

Choices & the OAA Nutrition Program  Older adults are willing to make nutrition-related lifestyle changes when:  Information relevant to their needs is available  They understand how to make changes!

Choices & the OAA Nutrition Program  Choices can:  Provide a seamless, coordinated, comprehensive home & community based system  Close gaps in service (EXA: variations in what federal, state & local agencies offer in regards to consumer eligibility requirements & funding)

Choices & the OAA Nutrition Program  Choices extends OAA Nutrition Program’s health & independent living services to new groups of older adults, families & caregivers  Choices can close current gap in nutrition services. Nutrition often viewed as two separate systems: 1.) social & supportive services system 2.) medical problem-oriented treatment  Nutrition Program uses holistic system addressing nutrition related social and medical issues

Choices & the OAA Nutrition Program  Choices allows for flexibility to provide specific information & referral services, long term living options, & health promotion & disease prevention programs  SUAs, AAAs & OAA Nutrition Program providers can build consumer driven nutrition outreach, messages & services into state & area plans

Choices & the OAA Nutrition Program  Choice models should have quality improvement & assurance processes  RDs provide training to case managers & other assessors to help them understand:  Nutrition related needs  When services might be needed for consumers & their families  Safe & acceptable nutrition practices

Choices & an Integrated OAA Nutrition Program  Empower consumers to make informed Choices for long term living  One-Stop-Shopping to ↓ nutrition risk & promote healthy eating through consumer- tested brochures & offer information on congregate dining sites  Prioritize service referrals to ↓ malnutrition risk by including key ?s re: inadequate nutrition & health on I&R form  ↓ nutrition risk & food insecurity through information & referrals to agencies/programs that ↑ access to food (EXA: Food Stamp Program, Food Banks, Senior Farmers Market Nutrition Program)

Choices & an Integrated OAA Nutrition Program  Target high risk, nursing home appropriate, non-Medicaid individuals  Delay institutionalization through Choices for home & community care to meet their individualized needs & preferences without the current OAA service categories or title restrictions

The Question is… HOW DO WE DO THIS?

Choices & an Integrated OAA Nutrition Program  Train case managers, homemakers & personal assistants to provide safe & acceptable nutrition practices to meet quality measures.  Choices in home delivered meals including specialized therapeutic meals, meals modified for consistency, choice of hot or frozen meals & service daily or weekly  Coordinate discharge planning & nutrition services including meals & individualized nutrition counseling for disease management

Choices & an Integrated OAA Nutrition Program  Build prevention into community living through evidence based health promotion & disease prevention programs designed for older adults  Provide information & referrals for consumers & families about evidence based HPDP programs in area  Build evidence based HPDP components into senior centers & congregate dining sites  Offer Choices among HPDP programs offered to homebound consumers

The Choices Challenge  Improving the health & independence of consumers & caregivers  Quick response  Consumer driven model  Consumer perceived value  Matching need with service array  Integrating into Choices for Independence