Nancy Wellman, PhD, RD National Resource Center on Nutrition, Physical Activity & Aging

1. 2nd 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 4th State Units on Aging Nutritionists & Administrators Conference August 2006

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

3. General Purpose To show that • Administration on Aging Programs achieve results intended by the Older Americans Act, and • Participants value the services. See: Older Americans Act Program Results & Program Evaluation www.aoa.gov/about/results/index.asp

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

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

6. 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.

7. 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.

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

9. National Pilot Survey Methodology Westat’s 2-Stage Sample Design • 1st Stage • 165 AAAs • Budget size, 4 Census Regions • 138 AAAs agreed to participate • 2nd Stage • Random sample: 24 recipients per AAA on average, for each service domain

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

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

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

13. Home-delivered 73% age 75+ 61% live alone 85% annual family income <$20,000 69% difficulty with 1+ ADLs Congregate 62% age 75+ 52% live alone Services Targeted to Vulnerable Populations

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

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

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

17. Home-delivered FRUIT: 48% ate 2+ servings/day VEGETABLES: 19% ate 3+ servings/day DAIRY: 21% ate 3+ servings/day (milk, cheese, soy) Congregate 54% 45% 1999-00 NHANES 24% 13% 1999-2000 NHANES 20% 10% 1999-2000 NHANES Meals Improve Dietary Intake

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

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

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

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

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

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

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

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

26. 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?

27. How does Nat’l Pilot Survey info help you: • 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?

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

29. How does Nat’l Pilot Survey info help you: • 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? • Are there other risk factors you should be considering with this very vulnerable population? • Who should you be educating about this? • What are the training or technical assistance implications?

30. How does Nat’l Pilot Survey info help you: • 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?  • How could/should this affect your program planning, implementation & evaluation?

31. How does Nat’l Pilot Survey info help you: • 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? • How can this understanding be integrated into outreach, case management practices, access, referrals, caregiver support, etc.

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

33. How does Nat’l Pilot Survey info help you: • Plan services differently for congregate & home delivered participants? • For example, how do you ensure quality? • Are there implications for monitoring? • How do you educate re importance of monitoring to performance outcomes for individuals & programs?

34. How does Nat’l Pilot Survey info help you: • 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?