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Overview of n4as Preparing for the Future Project: What We Learned from Title VI Organizations

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Title: Overview of n4as Preparing for the Future Project: What We Learned from Title VI Organizations


1
Overview of n4as Preparing for the Future
Project What We Learned from Title VI
Organizations
  • National Title VI
  • Training Technical Assistance Forum Listening
    Session
  • Baltimore, Maryland
  • May 1, 2007

2
Project Description
  • A multi-component project designed to support the
    aging network in successful planning,
    implementation, and improvement of programs to
    enhance older peoples choices for independence

3
Project Goals
  • 1) Create a self-assessment survey about key
    components of Choices for Independence, including
    streamlined long-term care systems and more
    community-based options
  • 2) Develop training and technical assistance
    for the aging network for moving forward with
    long-term care programming.

4
Why do this survey?
  • Advocacy
  • Information for your tribe, state and national
    organizations
  • Data for grant-writing and fundraising
  • Compare your organization to others
  • Identify best practices and technical assistance
    needs

5
Partner Organizations
  • National Association of Area Agencies on Aging
    (n4a)
  • Scripps Gerontology Center, Miami University,
    Oxford, Ohio

6
National Association of Area Agencies on Aging
(n4a)
  • Represents 650 AAAs and 243 Title VI-Native
    American aging programs.
  • Advocates for older Americans and their
    caregivers providing them access to critical home
    and community-based and long-term care services
    across America.
  • Provides advocacy support, education,
    information, and technical assistance to AAAs and
    Title VI agencies.

7
National Association of Area Agencies on Aging
(n4a)
  • A national voice on aging services, home and
    community-base care, livable communities for all
    ages, senior mobility, emergency readiness and
    preparedness for older adult and answers on
    aging.
  • Assists its members to build their capacity to
    help older persons and persons with disabilities
    live with dignity and choice in their homes and
    communities for as long as possible.

8
Scripps Gerontology CenterMiami University,
Oxford, Ohio
  • A well established research institution dedicated
    to generating and disseminating information about
    aging.
  • Recent Scripps Projects and Publications
  • Consumer Voice and Choice in Long-Term Care
  • Assessing the Quality of Caregiver Support
    Services
  • Long-Term Care in Ohio A Longitudinal
    Perspective
  • Will They Stay or Will They Go? Predictors of
    Disenrollment From Home and Community-Based
    Services

9
Overview of Choices for Independence
  • 2006 Older Americans Act Amendments
  • To position the aging network for the future,
    improve the quality of life for millions of
    people, and rebalance the current long-term care
    system based on three principles.

10
Choices Principles
  • Enable consumers to remain in their own homes
    through the provision of home and community-based
    long-term care, including the integration of OAA
    programs into long-term care systems
  • Empower consumers to stay active and healthy
    through disease prevention and health promotion
    services and
  • Streamline access to home and community-based
    services

11
Scripps Gerontology Center Project Goals and
Tasks

1) Create a self-assessment survey about key
components of Choices for Independence, including
streamlined long-term care systems and more
community-based options 2) Develop training and
technical assistance for the aging network for
moving forward with long-term care programming.
12
Training and Technical Assistance
  • Business Center
  • workshops on strategic planning for long-term
    care
  • resources for business planning
  • Technical Assistance
  • driven by what we learn from the survey
  • provided by n4a and other resources

13
Survey Development
  • Goals for the survey
  • Information about involvement of Title VIs and
    AAAs in long-term care
  • Questions that capture diversity of experiences
    within the aging network
  • User-friendly useful data well-used data

14
Survey Development
  • Strategies to achieve those goals
  • User-friendly as short as possible and as easy
    to complete as possible
  • Useful quick results, useful reports available
    to Title VIs and AAAs
  • Well-used planning and technical assistance
  • Questions that capture diversity of experiences

15
What we sought to learn
  • Lay of the land
  • Where Title VIs and AAAs are positioned in
    the long-term care system
  • Point of entry services provided funding
    sources interorganizational collaboration
  • Successes and challenges
  • What you want to know about the aging network
    and the work of Title VIs and AAAs
  • Ideas to facilitate survey participation

16
How we sought to learn
17
Listening Sessions(National and Regional)
  • Added to lay-of-the-land understanding
  • Identified themes and issues
  • Background for focus groups

18
Phoenix and Sacramento KAI Cluster Trainings
  • Training topics
  • Questions raised
  • Discussions inside and outside of sessions

19
One Title VI/AAA Focus Group
  • Washington, D.C. n4a advisory group, 12 members
    include two Title VI org directors
  • (Arizona, Florida, Indiana, Iowa, Kentucky,
    Massachusetts, Michigan, North Carolina, Ohio,
    Oregon)

20
Two Title VI Focus Groups
  • Phoenix facilitator Randella Bluehouse, Inter
    Tribal Council of Arizona/ AAA Reg. 8 n7
  • Sacramento facilitator Dee Horn, Inter-Tribal
    Council of Nevada n9
  • (Alaska, Arizona, California, Idaho, Nebraska,
    Nevada, New Mexico, North Dakota, Oklahoma,
    Washington)

21
Two AAA Focus Groups
  • Oxford, OH Regional n9
  • (Ohio, Kentucky, Indiana)
  • Biloxi, MS SE4A n9
  • (Alabama, Florida, Georgia, Kentucky, North
    Carolina, South Carolina, Tennessee)

22
Title VI Focus Group Process
  • Broad participation as questions and issues arose
  • Meg Graves (AoA) in Phoenix
  • Yvonne Jackson (AoA) in Sacramento
  • Cynthia LaCounte (KAI) at each
  • Bob Logan (n4a) at each
  • Kathy McGrew (Scripps Gerontology Center) at each

23
Individual Resources
  • Allen Allery, Director, National Resource Center
    on Native American Aging
  • Yvonne Jackson, Director of the AoA Office for
    American Indian, Alaskan Native, and Native
    Hawaiian Programs

24
So what have we learned?
  • We have been well informed for this stage of
    survey development.
  • Next stage
    Title VI key informants, Title VI
    advisory group

25
Our sources helped us understand
  • Diversity among tribes, Title VI organizations,
    and their political/governmental contexts
  • If you have seen one Title VI organization,
    youve seen one Title VI organization
  • Also true of AAAs

26
Definitions of long term care
  • Tend to associate long term care with nursing
    homes (very few nursing facilities in Indian
    Country)
  • CMS moving away from institutional bias and
    rebalancing toward home and community based
    services (HCBS)
  • The focus of Choices and of the survey is on HCBS

27
Indian Country isleading by necessity and
tradition
  • HCBS emphasis
  • Consumer direction-family members providing care
    to their elders

28
We came into this world with our own food We
came into this world with our own medicine We
came into this world with our own customs and
practices. And we have been disconnected from
that -- a Phoenix focus group participant
29
Policy and Program Challenges
  • You are asked to provide services in a way that
    is often incongruent with customs, traditional
    practices, and some realities not shared by most
    AAAsSquare peg, round hole
  • Regulations and imposed programs are often
    perceived as barriers.
  • Tribes and Title VI organizations do not always
    feel understood, respected, or trusted.

30
Relationship with state is critical
  • Much variability in relationships between
    tribes/Title VIs and states
  • strong, cooperative relationships
  • relationships characterized by tension
  • non-relationships
  • Most significant challenges
  • access to Medicaid HCBS waiver services
  • frustration about not receiving direct funding

31
Title VIs and AAAs Different Paths
  • Title VIs and AAAs walk different paths in
    providing long-term care
  • sources of funding and reporting lines
  • service resources

32
Title III (AAAs) and Title VI coordination
  • Required, but not defined
  • There are models of effective coordination, but
    they are not the norm.
  • All are stretched beyond capacity.
  • All feel under constant threat of losing funding.

33
Access to services/programs
  • Rurality an enormous issue (mirrored in some of
    the rural AAAs)
  • All the reservations and rancherias are located
    so far away from the cities that we cant get to
    those services and the services arent coming out
    to the reservation. When money flows from the
    state, it goes to the cities.

34
Geographic distances a major challenge
  • We use whats available, but theres not much
    out there. Our public health nurse may travel a
    hundred miles to see someone.
  • We have reservations with an hour-and-a-half to
    two-hour emergency response timelet alone
    constant care of any type
  • Phone services We had to go through I dont
    know how many hoops just to get telephone service
    to the clinic it took us about three years to
    get a phone line in.

35
Wide Variability
  • Size/scope of programs (staff, services,
    population served)
  • Position of Title VI organizations in tribal
    long-term care

36
Perspectives about expanding programs
  • Often seen as beyond capacity/role of
    organization
  • Open to identifying ways to expand programs by
    positioning the organization and expanding
    capacity

37
Survey Participation Challenges
  • Seeing the value
  • Time/ease
  • Tribal agreement
  • Trusting the process

38
Sample Questions
39
Enabling Consumers to Remain in their Own Homes
  • Please check which of the following home and
    community-based services your organization
    provides, either directly or through contract.
    Indicate if the service is provided with OAA
    funding or with sources OTHER than OAA funding.
    Where applicable, please check whether the
    service is consumer/self-directed. Check all
    that apply.
  • Service OAA Other Consumer/Self
    Funding Funding Directed
  • Assistive devices ? ? ?
  • Case management ? ? ?
  • Chore ? ? ?
  • Home delivered meals ? ? ?
  • Homemaker ? ? ?
  • Home Modification ? ? ?
  • Home repair and maintenance ? ?
    ?
  • Personal Care ? ? ?
  • Transportation ? ? ?
  • Family Caregiver Support Program ? ?
    ?
  • Native American Family Caregiver ? ?
    ?
  • Support Program

DRAFT
40
Enabling Consumers to Remain in their Own Homes
  • How do you rate your organizations progress, if
    any, on each of the areas below?

DRAFT
Have made some progress
Have taken preliminary steps
Have made significant progress
Do not plan to work on this
Plan to work on this but have not begun
Have completed task or have a program in place
41
Streamlining Access to Home and Community-Based
Services
  • How do you rate your organizations progress, if
    any, on each of the areas below?

DRAFT
Have made some progress
Have taken preliminary steps
Have made significant progress
Do not plan to work on this
Plan to work on this but have not begun
Have completed task or have a program in place
42
Enhancing Organizational Capacity for Home and
Community-Based Long-Term Care Systems
  • How do you rate your organizations progress, if
    any, on each of the areas below?

DRAFT
Have made some progress
Have taken preliminary steps
Have made significant progress
Do not plan to work on this
Plan to work on this but have not begun
Have completed task or have a program in place
43
Enhancing Organizational Capacity for Home and
Community-Based Long-Term Care Systems
  • To what extent do you agree or disagree with each
    of the following statements?

DRAFT
Strongly Disagree
Strongly Agree
Agree
Disagree
44
Organizational Capacity to Develop and Implement
Home and Community-Based Long-Term Care Systems
  • Is the area served by your organization
  • __ Predominantly urban
  • __ Predominantly suburban
  • __ Predominantly rural
  • Which of the following structures best describes
    your organization?
  • __ An independent agency
  • __ A part of city government
  • __ A part of county government
  • __ Division of tribal government
  • __ Division of an Inter-Tribal Council
  • __ Part of a council of governments or regional
    planning and development agency
  • __ Other. Please describe________________________
    ___

DRAFT
45
Organizational Capacity to Develop and Implement
Home and Community-Based Long-Term Care Systems
DRAFT
  • How long has the current director of this
    organization held this position?
  • _____years _____months
  • What is the total number of full-time and
    part-time staff employed by your organization?
  • _____full-time _____part-time
  • What is the total number of unduplicated people
    served by your organization in 2006?
  • ______________

46
Mock Survey Report
General Description
  • Staff Employed (average)
  • Full-Time X
  • Part-Time X
  • Clients served (average) XXX
  • Length of employment
  • of current director
  • (average years) X

47
Mock Survey Report
Percentage of Title VI Organizations who provide
home delivered meals, personal care, and chore
services, by funding source.
48
Mock Survey Report
Percentage of Title VI organizations who agree or
disagree that decisions at their state and/or
tribal level limit what they can do.
49
Mock Survey Report
Progress made by Title VI organizations (who
serve more than 200 elders) in developing
collaborations with their local AAA.
50
Mock Survey Report
Percentage of Title VI Organizations who agree or
disagree with the following statement We are not
looking for new opportunities because we can
barely do what we are doing now, by size of
staff.
Fewer than 5 employees
5 or more employees
51
Next steps
  • Feedback from you
  • Interviews with key informants
  • Review by advisory committees
  • Pilot-testing
  • Final revisions, refinements
  • Launching the survey!

52
Contact
  • National Association of Area Agencies on Aging
    (n4a)
  • www.n4a.org
  • Scripps Gerontology Center
  • www.scrippsaging.org
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