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Rebalancing Long Term Care: The Role of the Older Americans Act Nutrition Program

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... caregiver needs, guidance for healthy eating, & tips for physical activity. ... to nutrition risk & promote healthy eating through consumer-tested brochures ... – PowerPoint PPT presentation

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Title: Rebalancing Long Term Care: The Role of the Older Americans Act Nutrition Program


1
Rebalancing Long Term Care The Role of the
Older Americans Act Nutrition Program
  • Jean Lloyd Dian Weddle
  • 4th State Units on Aging Nutritionists
    Administrators Conference August 29, 2006

2
Objectives of Presentation
  • Introduce the Challenge Brief
  • Describe the Rebalancing Environment
  • Present Choices for Independence Role for OAA
    Nutrition Program

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

4
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

5
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

6
Top Nine Chronic Health Conditions
  • Heart Disease
  • Hypertension
  • Stroke
  • Emphysema
  • Asthma
  • Chronic Bronchitis
  • Cancer
  • Diabetes
  • Arthritis

All have dietary nutritional implications
affecting independence!
7
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

8
Benefits of Rebalancing
  • Empower older adults families to select
    services providers
  • Increased consumer satisfaction
  • Money saved through ? use of high cost ER
    institutional care

9
AoAs 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

10
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

11
Challenges Opportunities Lie Ahead
  • Need philosophical operational shift…
  • FROM provider/service driven model
  • TO empowered consumers making their own decisions

12
Implications for Nutrition Services
  • Balance needs of todays 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

13
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

14
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

15
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 AoAs
    Choices Initiative

16
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

17
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!

18
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.

19
Nutrition Care Process
  • Screen
  • Assess
  • Problem ID
  • Intervention
  • Follow up

20
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!

21
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)

22
Choices the OAA Nutrition Program
  • Choices extends OAA Nutrition Programs 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

23
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

24
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

25
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 IR 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)

26
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

27
The Question is…
  • HOW DO WE DO THIS?

28
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

29
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

30
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
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