2nd National Pilot Survey of OAA Title III Service Recipients: Key to Planning

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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

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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

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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

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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

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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

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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 natl study in
  2005currently in data collection phase
• Sample sizes large enough for analysis by
  subgroup geographical region.

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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.

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AoA Performance Planaoa.gov/about/legbudg/perform
ance/legbudg_performance.asp

• Improve targeting of OAA servicesNational
  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

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National Pilot Survey Methodology

• Westats 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

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OAA Title III Service Domains

• Caregivers
• Case Management
• Congregate Nutrition Program
• Information Assistance Assessment

• Senior Centers
• Homemaker Service
• Home Delivered Nutrition Program
• Transportation Service

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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

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Services Targeted to Vulnerable Populations

• 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

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Services Targeted to Vulnerable Populations

• Home-delivered
• 73 age 75
• 61 live alone
• 85 annual family income lt20,000
• 69 difficulty with 1 ADLs

• Congregate
• 62 age 75
• 52 live alone

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Services Targeted to Vulnerable Populations

• Home Delivered Nutrition Program
• 29 rated health as poor
• Vs. 12 National Health Interview Survey
  respondents with incomes lt20,000
• 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

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Services Provided to People Who Need Them

• Meal provides half or more of total daily food
  intake
• 66 Home Delivered
• 62 in 1st Natl Pilot Survey
• 56 Congregate

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Services Provided to People Who Need Them
Provides sole intake from key food groups Ate
only 1 serving/day

• 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

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Meals Improve Dietary Intake

• 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

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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

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Services Are High Quality

• 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

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Consumers Value Program Participation

• 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

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Provide Opportunities for Health Promotion
Disease Prevention

• Congregate Nutrition Program
• 52 participated in fitness activity
• 59 used health screening
• 57 reported increased social opportunities

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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

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How does Natl Pilot Survey info help you

• Justify funding for congregate home delivered
  meals?
• Justify increased funding for one or both?

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How does Natl Pilot Survey info help you

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

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How does Natl Pilot Survey info help you

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

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How does Natl Pilot Survey info help you

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

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How does Natl 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?

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How does Natl 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?

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How does Natl 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?

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How does Natl 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 days food
  intake, what are the implications for linking
  with other food nutrition assistance programs? 
  
• How could/should this affect your program
  planning, implementation evaluation?

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How does Natl 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.

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How does Natl 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?

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How does Natl 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?

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How does Natl 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?