2. 1 Older Americans Act Orientation JEAN LLOYD, MS, RD US Administration on Aging 4 th State Units on Aging Nutritionists/Administrator Conference August, 2006

3. 2 Overview  Aging Statistics  Older Americans Act  Nutrition Program  Resources  Choices for Independence

4. 3 Aging Statistics

5. 4 Number of Persons 65+ & 85+ 1900–2050 [Numbers in Millions]

6. 5 % of Americans AGE 65 Expected to Live to AGE 90

7. 6 Number of Older Adults   60+ 48.6 M   65+ 35.9 M   85+ 4.6 M 65+   Community 33.4 M (93.5%)   Nursing Homes 1.5 M (4.5%)   Assisted Living 1 M ( 2%)

8. 7 The New Aging Reality OLDER AMERICANS LIVE   Longer   Healthier   More independently   More functionally fit   And in the community.

9. 8 Long Term Care Definition   Range of medical, social & personal care services to meet health & personal needs of functionally impaired people.

10. 9 Older Americans Act

11. 10 Older Americans Act Programs and Services   Established in 1965   Does not have any income requirements, forbids means-testing   Means-testing is the determination of eligibility for services based on a specific level of income   For persons 60+, targeting services to persons in greatest economic and social need, with particular attention to low income minorities and individuals residing in rural areas

12. 11 Mission To help older people retain their dignity and independence and remain in their own homes and communities for as long as possible.

13. 12 Older Americans Act, as amended in 2000 – Overview http://www.aoa.gov/about/legbudg/oaa/legbudg_oaa.asp  Title I –  Title I – Declaration of Objectives; Definitions  Title II –  Title II – Administration on Aging  Title III –  Title III – Grants for State and Community Programs on Aging  Title IV –  Title IV – Training, Research and Discretionary Projects and Programs  Title V –  Title V – Community Service Employment Program for Older Americans  Title VI –  Title VI – Grants for Native Americans  Title VII –  Title VII – Vulnerable Elder Rights Protection Activities

14. 13 Title I – Objectives   Prevention To inform, empower and assist older persons and their families to make choices that improve the quality of life   Independence Opportunities for older people to remain at home and avoid institutional placements   Protection To safeguard older consumers’ physical, mental, emotional and financial well-being

15. 14 Title II - Administration on Aging   Administration on Aging (AoA)   Assistant Secretary for Aging  National Aging Services Network   Tribal Organizations (243)   State Units on Aging (56)   Area Agencies on Aging (645)   Local Service Provider Agencies (29,000)   Nutrition Service Providers (4,400)   Senior Centers (6,045) that receive support under the OAA

16. 15 Title III – Grants for State and Community Programs on Aging   Part A – General Purpose  Part B – Supportive Services and Senior Centers  Part C – Nutrition Services  Part D – Disease Prevention and Health Promotion  Part E – National Family Caregivers Support Program

17. 16 Title III – Grants for State and Community Programs on Aging   Part A – General Purpose   Sec 301 – Purpose & Administration   It is the purpose of this title to encourage and assist State agencies and area agencies on aging to…foster the development and implementation of comprehensive and coordinated systems …”   Sec 302 – Definitions   The term “comprehensive and coordinated system” means a system for providing all necessary supportive services, including nutrition services…”

18. 17 Title III – Grants for State and Community Programs on Aging   Part A – General Purpose   Sec 303 – Authorization of Appropriations, Uses of Funds   Sec 304 – Allotment; Federal Share   Sec 305 – Organization – State Agencies on Aging, designation/de-designation of planning and service areas, single planning and service areas, area plan, funding formula

19. 18 Title III – Grants for State and Community Programs on Aging   Part A – General Purpose   Sec 306 – Area Plans   Sec 307 – State Plans   Sec 308 – Planning, Coordination, Evaluation & Administration of State Plans – State administration costs, transfers, waivers for transfers   Sec 309 – Payments   Section 310 – Disaster Relief Reimbursements

20. 19 Title III – Grants for State and Community Programs on Aging   Part A – General Purpose   Sec 311 – Nutrition Services Incentive Program   Sec 312 – Multipurpose Senior Centers; Recapture of Payments   Sec 313 - Audit   Sec 314 – Rights relating to In-Home Services for Frail Older Individuals   Sec 315 - Consumer Contributions- Cost Sharing and Voluntary Contributions   Sec 316 - Waivers

21. 20 Title III-B Supportive Services &Senior Centers   Information & Assistance   Case Management   Transportation   Homemaker/Chore   Personal Care   Senior Centers   Health and Nutrition Education   “Any other services necessary for the general welfare of older individuals”

22. 21 Title III-C Elderly Nutrition Program   Congregate Nutrition Services (C-1)   5 or more days a week   Congregate setting, including Adult Day Care   Nutrition Education & Counseling, including caregivers   Home-Delivered Nutrition Services – Homebound (C-2)   Hot, cold, frozen, dried, canned or supplemental meals   Nutrition Education & Counseling, including caregivers

23. 22 Title III-D Disease Prevention/Health Promotion   Information at Senior Centers, Meal Sites & Home- Delivered Meals Programs   Health Screening & Risk Assessments   Hypertension-- Cholesterol   Glaucoma-- Vision   Hearing-- Diabetes   Physical Fitness   Prevention & Reduction of Alcohol, Substance Abuse, Smoking Cessation   Medication Management   Nutrition Counseling, including caregivers

24. 23 Title III-E National Family Caregiver Support Program   Service Categories   Information about Services   Assistance with Access to Services   Individual Counseling, Support Groups, Caregiver Training   Respite Care   Supplemental Services, on a Limited Basis Focus on Caregiver vs. Care Recipient

25. 24 Title IV Training, Research, and Discretionary Projects and Programs   Education   Training   Demonstrations   Innovations   Funding – 2006 - $24,595,000

26. 25 Title V Community Service Employment for Older Americans   Administered by U.S. Department of Labor   Subsidized Employment & Training for Low-Income Seniors 55 Years of Age & Older

27. 26 Title VI Grants for Native Americans   Part A – Indian Program   American Indians   Alaska Natives   Part B – Native Hawaiian Program   Part C – Native American Caregiver Support Program ($5 million included in Title III-E)

28. 27 Title VII Vulnerable Elder Rights Protection   Long-term Care Ombudsman Program   Prevention of Elder Abuse, Neglect & Exploitation   Legal Assistance Development

29. 28 Public Health Service Act – Section 398   Alzheimer’s Disease Demonstration Grants to States Program – Total Funding – 2006- $11,668,000   Outreach   Training   Support Groups   Respite Services   Focused on hard-to-reach populations

30. 29 Older Americans Act, 2006 http://www.aoa.gov/about/legbudg/current_budg/legbudg_current_budg.asp TITLESERVICES FUNDING $ III-B Supportive Transportation Senior Centers 350.6 M III-C Nutrition C-1, C-2, NSIP Meals: congregate, home-delivered 715 M III-D HPDP Screening, med. management 21.4 M III-E NFCSP I&R, Support Groups, Respite 156.1 M VI-Amer Indian Same as III 32.4 M VII-Elder Rights Ombudsman 20.1 M

31. 30 AoA: 2006 Budget  TOTAL Title III Budget  TOTAL Title III Budget = $1.3 B  NUTRITION  NUTRITION = $715 M  NUTRITION  NUTRITION = >½ Budget Consistently NUTRITION SERVICES HCBS CG

32. 31 Older Americans Act Nutrition Program

33. 32 OAA Nutrition Program Purposes   Promote health   Provide nutritious meals   Reduce social isolation   Link to other social & rehabilitative services

34. 33 Purpose of the OAA Nutrition Program   Promote health   Primary prevention: health, wellness & functionality activities   Secondary & tertiary: risk reduction, disease management and treatment, i.e. diabetes self management, diabetes support group, provision of a renal diet   Includes either the provision of or referral to health promotion/disease prevention programs, i.e., physical activity, medication management, etc.   Provide nutritious meals   Meet RDAs and Dietary Guidelines for Americans   Meet special needs: health, racial/ethnic, religious   Meals meet participant preferences, could include choice

35. 34 Purpose of the OAA Nutrition Program   Reduce social isolation   Congregate activities, social, physical, cognitive   Active social engagement, volunteer opportunities   Transition home delivered participants to congregate participation as much as possible   Home delivered, personal interaction, friendly visiting, telephone reassurance   Link to other social, rehabilitative services within HCB LTC   Other food and nutrition assistance services, i.e. the Food Stamp Program, food pantries   HP/DP programs, physical activity, falls prevention, depression screening, medication management, immunization   Other supportive services, i.e., transportation, or in-home services, i.e., personal care

36. 35 Title III-C, OAA Nutrition Program or Elderly Nutrition Program   Congregate Nutrition Services   Congregate settings, including adult day care, intergenerational settings   Does not provide for take out meals   Home Delivered Nutrition Services   Homebound, in home service   Meals: 5 or more days per week   Nutrition Screening, Education and Counseling

37. 36 Section 339 Requirements   Program   Partially federally funded, state administered   “A State that establishes and operates a nutrition project under this chapter shall…”   State must solicit advice of a dietitian or individual of comparable expertise in planning nutritional services and ensuring….   Indicates that meals, other than in-home meals, must be provided in settings close to residences of older individuals

38. 37 Section 339 Requirements   Meals   1/3 RDA; Dietary Guidelines for Americans, 2005; state & local foodservice law   Design meals to meet special dietary needs (cultural/ethnic preferences, health, religious needs)   Design “appealing” meals, i.e. food/menu choice   OAA provides the authority for program implementation to vary state by state

39. 38 Section 339 Requirements   Other Program Requirements   Some states delegate more responsibility to AAAs and local service providers than others   Local nutrition service providers must implement the program with the expertise of a dietitian or individual of comparable expertise as well as the input from meal participants, and other knowledgeable individuals   Provide for nutrition screening, education and counseling

40. 39 Meal Service Trends FY Total Meals C-1C-2% C-2 1975 48.5 M n/a 1977101.0 M 86.2 M 14.8 M15% 1987232.6 M146.7 M 85.9 M37% 1997240.0 M116.5 M123.5 M51% 2004247.9 M105.0 M142.9 M58%

41. 40 Participant Trends FY TOTALC-1C-2% C-2 1995 3,401,2062,412,468988,73829 19973,003,4132,112,924890,48915 19992,644,0101,760,068883,94233 20002,696,3301,743,292953,03835 20042,746,0571,777,995968,06235

42. 41 Congregate Expenditures FY Title III - $Other Sources - $ Total - $% Title IIII 1995 249,687,321272,356,673523,043,99448 1997 244,053,197299,833,168543,886,36545 1999 244,890,396311,390,223556,280,61944 2000 248,518,121313,850,484562,368,60544 2004 251,350,262361,964,947613,315,20941

43. 42 Home Delivered Expenditures FY Title III - $Other Sources - $ Total - $% Title III 1995 134,119,129262,570,482396,689,61134 1997 139,734,714321,158,337460,893,05130 1999 148,249,211351,184,005499,433,21630 2000 164,638,849367,274,096531,912,94531 2004 203,102,209467,217,933670,320,14230

44. 43 Nutrition Program Income as a % of Total Expenditures C-1C-2 FY Total - $ % % 1997$100,861,10418.5 $ 86,482,422 18.8 1999$104,433,07818.7 $ 93,026,909 18.6 2000$107,260,12419.0 $ 94,783,521 17.8 2004$125,238,65120.5$114,390,22317.1

45. 44 Average Cost of Meals Based on Total Expenditures FYC-1C-2 1997$4.70$3.74 1999$4.93$3.72 2000$4.86$3.71 2003$5.87$4.63 2004$5.81$4.68

46. 45 Older Americans Act Congressional Action  House Action - Reauthorization  H.R. 5293, Senior Independence Act of 2006, introduced May 2006  Senate Action - Reauthorization  S. 3570, Older Americans Act Amendments of 2006, introduced June 2006  Appropriation bills have not been passed in either chamber, continuing resolutions are usual

47. 46 Resources

48. 47 Dietary Guidelines for Americans 2005 HHS Toolkit for Health Professionals   Getting Older. Living Healthier. Feeling Better. Consumer Brochure  (8)  Older Adult Health Fact Sheets (8) Specific info re healthy diets & phys activity for health professionals   Nutrition Service Providers Guide Assistance materials for planning meals for older adults in group settings  /  Available July, 2006 www.healthierus.gov/dietaryguidelines/

49. 48 Resources   National Resource Center on Nutrition, Physical Activity & Aging Florida International University http://nutritionandaging.fiu.edu http://nutritionandaging.fiu.edu   Subscribe: NAN Listserve for BiWeekly Highlights   Older Americans Nutrition Program Toolkit   Creative Solutions   Information on DRIs, Dietary Guidelines   Topics A - Z

50. 49 Resources   US Administration on Aging www.aoa.gov www.aoa.gov   Eldercare Locator : access service info www.eldercare.gov www.eldercare.gov

51. 50 Modernizing the OAA for the 21 st Century: Choice for Independence

52. 51 Empowering Individuals to Make Informed Choices Through “one-stop shop” resource centers and public education campaigns Builds on   Own Your Future Campaign   Aging & Disability Resource Centers

53. 52 Offering More Choices for High-Risk Individuals Through Flexible Service Dollars And Consumer-Directed Approaches Helping Moderate and Low-Income Individuals at High Risk of Nursing Home Placement Builds on The Cash & Counseling Demo

54. 53 Building Prevention Into Community Living Evidence-based programs, such as:  Chronic Disease Self- Management  Falls Prevention  Nutrition  Physical Activity Delivered Through Aging Services Providers Builds on Builds on AoA’s Evidence-Based Initiative

55. 54 Contact Information JEAN L. LLOYD, MS, RD National Nutritionist US Department of Health & Human Services Administration on Aging Washington, DC 20001 202-357-3582 jean.lloyd@aoa.hhs.gov

56. 55

57. Older Americans Act Frequently Asked Questions Floristene Johnson, MS, RD, LD Region VI Joseph M. Carlin, MS, RD Region I

58. How can I get my questions answered?

59. Does the State need to have a nutrition policy and procedure manual?

60. Is the nutrition program required to provide services in an adult day care?

61. Who may participate in the OAA Nutrition Program?

62. Are family caregivers eligible for home delivered meals?

63. Who may not participate in the OAA Nutrition Program?

64. If an older individual is accompanied by a younger person who is seeking Title III-C nutrition services under the spousal eligibility provision of Section 339 (2)(I) and the two individuals self-identify as “husband” and “wife” for the purposes of meeting the Federal definition, what provisions exist within the Act authorizing the State Agency to inquire further about age, marital status and gender of such persons?

65. What are the eligibility criteria for meals to be served in OAA Nutrition Programs?

66. Can meals served to recipients of Medicaid waiver meals who are 60 years or over, or disabled under 60 years be reported as eligible Title III-C meals?

67. How are contributions to be used?

68. Does AoA have a written response that has been officially released to States, regarding sending "bills" for home delivered meals?

69. Should we deny meals to potential clients/participants based on citizenship or national origin?

70. Are participants required to sign in?

71. What is the guidance on waiting lists?

72. Does a Title III meal have to be the noon meal? Can the daily meal be an early evening meal everyday?

73. Can a meal be counted as an eligible meal if the client does not eat everything served?

74. If a client asks for a part of a meal after eating a complete meal, can the second helping be considered an eligible meal?

75. Are “Carry-out”/”Take- Out” meals considered eligible meals?

76. What should SUAs be doing with Title VI?

77. Does the OAA (or AoA) require an SUA to use a menu pattern?

78. Could you please clarify the requirement for home delivered meals to provide milk if the client does not drink milk? Is there a recommendation for record-keeping purposes that the client refuses a portion of the meal and then not send the milk?

79. Is there any expectation that we collect and include in reporting the NSI risk scores for recipients of meals from the "other"/non-contractual funding sources?

80. Do we have to use the NSI checklist for our State Program Report (SPR)?

81. Can NSIP money be used to buy frozen meals that meet 1/3 RDA for home delivered meal recipients?

82. Can a 60 year old caregiver (family, volunteer, paid or not) receive a home-delivered meal along with the 60+ client receiving HD meals and have it counted as an NSIP HDM which means it would be paid for with T-III C2 funds?

83. Can a congregate meal provider provide an evening or weekend meal at a congregate site to an eligible meal participant who is identified as a high nutritional risk and can that meal be funded by Title III C1 funds? If the meal is funded with local dollars, is the meal eligible for NSIP? Can a congregate meal provider provide an evening or weekend meal at a congregate site to an eligible meal participant who is identified as a high nutritional risk and can that meal be funded by Title III C1 funds? If the meal is funded with local dollars, is the meal eligible for NSIP?

84. When is a waiver of the 5-day a week requirement needed?

85. What about holidays? May nutrition sites close for major holidays and still meet the 5-day a week rule?

86. How many cans of a liquid supplement can be counted as a meal?

87. If an eligible client meets the criteria for a home- delivered meal is not "at home", can they still have the meal delivered?

88. Can the client's meal be delivered to her child’s workplace which is not the client's, "place of residence" as described in NAPIS?