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n4a 2007 n4a 2007 Aging Network Aging Network
SurveySurveyPreliminary Preliminary Title VITitle VI Survey Survey
ResultsResults
March 2008March 2008
BackgroundBackground National Association of Area Agencies on National Association of Area Agencies on
AgingAging ( (n4an4a)) with a grant from with a grant from Administration on AgingAdministration on Aging contracted with contracted with Scripps Gerontology CenterScripps Gerontology Center, ,
Miami University, Oxford, Ohio to:Miami University, Oxford, Ohio to: Create a self-assessment survey for Title VI and
AAA organizations about key components of Choices for Independence; provide timely and useful reports.
Develop training and technical assistance for the aging network for moving forward with long-term care* programming.
* home and community based long-term care
Major components of the Major components of the projectproject
Annual web-based self-assessment survey Annual web-based self-assessment survey and mini-surveysand mini-surveys
Feasibility analysis of a national Feasibility analysis of a national integrated provider data baseintegrated provider data base
Workshops on business planning for Title Workshops on business planning for Title VI and Title III (AAA) directorsVI and Title III (AAA) directors
Web accessible up-to-date and Web accessible up-to-date and comprehensive training materials for AAA comprehensive training materials for AAA board membersboard members
Survey
Web-based survey: designed using SNAP software
Mailed option AAA survey-launched June 25, 2007 Title VI survey-launched August 31,
2007 Average completion time: 30-45 minutes Toll free number available for all
concerns
Survey Development
Goals User-friendly Useful Thorough
Input Listening sessions Focus groups Advisory Council Key Informant and cognitive interviews
Title VI Participation
Scripps Title VI Coordinator Support from National Resource
Center on Native American Aging Ongoing support from Yvonne Jackson
(AoA) Conducted focus group with 5 Title VI
program directors (first phase of Title VI Advisory Group)
Contracted with Cynthia LaCounte as an independent consultant
Different Timelines
AAA and Title VI surveys on different timelines due to: Concerns about timing of survey,
conflicts with other required reporting Feedback from Title VI Directors Feedback from Tribal Consultants
Response Rates
AAA survey launched June 25, 2007AAA survey launched June 25, 2007 81.8% response rate 81.8% response rate
Title VI survey launched August 31, Title VI survey launched August 31, 2007 2007
83% response rate83% response rate
Current EffortsCurrent Efforts
Ended survey completions mid-March, Ended survey completions mid-March, 20082008
Data analysis and meaningful Data analysis and meaningful conceptualizationconceptualization
Report writing and disseminationReport writing and dissemination Continuing work with Title VI and AAA Continuing work with Title VI and AAA
Advisory GroupsAdvisory Groups Develop and launch mini-surveysDevelop and launch mini-surveys
In this session…..In this session…..
We present basic and preliminary We present basic and preliminary findingsfindings
We seek your commentsWe seek your comments We seek a conversationWe seek a conversation
Organizing PrinciplesOrganizing Principles(Choices for Independence)(Choices for Independence)
Enable elders to remain in their own homes Enable elders to remain in their own homes through the provision of through the provision of home and home and community-based long-term carecommunity-based long-term care
Empower consumers to stay active and Empower consumers to stay active and healthy through disease prevention and healthy through disease prevention and health promotion serviceshealth promotion services
Streamline access to home and community-Streamline access to home and community-based services through single point of entry based services through single point of entry and strategic partnershipsand strategic partnerships
Enhance organizational capacity of the aging Enhance organizational capacity of the aging network for the area-wide development and network for the area-wide development and implementation of home and community-implementation of home and community-based long-term care systems.based long-term care systems.
DRAFTDRAFTPreliminary Findings and Preliminary Findings and
IssuesIssues These findings are in draft form and These findings are in draft form and
should not be duplicated or shared.should not be duplicated or shared. These findings are based on an These findings are based on an
earlier, 72% response rate, not the earlier, 72% response rate, not the final 83% response rate.final 83% response rate.
Final analysis will be reported at a Final analysis will be reported at a later date.later date.
Organizational CapacityOrganizational Capacity Average (mean) # of Clients Served:Average (mean) # of Clients Served: 278278
2525thth Percentile: Percentile: 8585 5050thth Percentile: Percentile: 150 (median)150 (median) 7575thth Percentile: Percentile: 374374
Average (mean) # of Employed Staff:Average (mean) # of Employed Staff: Full Time:Full Time: 3.93.9 Part Time:Part Time: 3.23.2
Average Length of Current Director (years):Average Length of Current Director (years): 7.07.0
Average Length of Previous Director (years): Average Length of Previous Director (years): 3.73.7
ServicesServices
Participants were asked to identify Participants were asked to identify which home and community-based which home and community-based services (out of a list of 28) they services (out of a list of 28) they provide and whether those services provide and whether those services were provided with OAA funding were provided with OAA funding and/or other funding.and/or other funding.
They were also asked to identify if They were also asked to identify if select services were provided with a select services were provided with a consumer directed option.consumer directed option.
ServicesServices Assistive devicesAssistive devices Case Case
managementmanagement ChoreChore Native American Native American
Family Caregiver Family Caregiver Support ProgramSupport Program
Home delivered Home delivered mealsmeals
Home healthHome health HomemakerHomemaker Home Home
modificationmodification Home repair and Home repair and
maintenancemaintenance
Official eligibility Official eligibility determinations determinations for public for public programsprograms
Congregate Congregate mealsmeals
Food pantryFood pantry Information and Information and
referral/assistancreferral/assistancee
Legal assistanceLegal assistance OutreachOutreach OmbudsmanOmbudsman Paperwork and Paperwork and
money money managementmanagement
Translator/Translator/interpreter interpreter assistanceassistance
Medication Medication ManagementManagement
Personal CarePersonal Care Respite CareRespite Care Transportation Transportation Adult day Adult day
serviceservice Adult Protective Adult Protective
ServicesServices Assessment for Assessment for
care planningcare planning Assessment for Assessment for
long-term care long-term care service eligibilityservice eligibility
Benefits Benefits counselingcounseling
ServicesServices(Proportion of programs who offer select (Proportion of programs who offer select
services)services)
61.5
61.5
63.8
64.4
73.6
74.7
87.9
88.5
92.5
93.1
95.4
0 20 40 60 80 100
Benefits counseling
Chore
Assistive devices
Home repair and maintenance
NAFCSP
Respite
Transportation
Outreach
Information and referral/ assistance
Home delivered meals
Congregate meals
ServicesServices(Proportion of programs who offer selected (Proportion of programs who offer selected
services with OAA funding and with funding other services with OAA funding and with funding other than OAA)than OAA)
OAA FundingOAA Funding Congregate Meals Congregate Meals
95.4%95.4% Home delivered Home delivered
meals meals 90.8%90.8% IR/A IR/A 88.4%88.4% Outreach Outreach 82.1%82.1% NAFCSP NAFCSP 71.7%71.7% Transportation Transportation 71.7%71.7%
Other FundingOther Funding Home repair and Home repair and
maintenance maintenance 66.7%66.7% Transportation Transportation 66.7%66.7% Assistive devices Assistive devices 60.5%60.5% Home modification Home modification 59.3%59.3% Medication management Medication management
55.6%55.6% Home health Home health 49.4%49.4% IR/A IR/A 49.4%49.4% Benefits Counseling Benefits Counseling 49.4%49.4%
Consumer Directed Consumer Directed ServicesServices
Analysis issue: How did respondents interpret Analysis issue: How did respondents interpret “consumer directed services?“consumer directed services?
22.5%22.5% of programs stated that their of programs stated that their program provides consumer/self-program provides consumer/self-directed services.directed services.
Most common consumer directed Most common consumer directed services include:services include: Respite care Respite care 82.1%82.1%
NAFCSP NAFCSP 30.8%30.8%
Chore Chore 30.8%30.8%
Personal care Personal care 23.1%23.1%
Funding SourcesFunding Sources
Medicare Medicare 5.65.6 Medicaid Medicaid 12.512.5 Medicaid waiver Medicaid waiver 16.316.3 Indian Health Service Indian Health Service 70.670.6 American Indian Relief Council American Indian Relief Council 4.44.4 Revenue from gaming Revenue from gaming 20.620.6 Other tribal fundingOther tribal funding 73.1 73.1 Title III funding Title III funding 41.341.3 Other state funding Other state funding 28.828.8 SSBG SSBG 13.113.1 Grant funds Grant funds 15.615.6 Private pay clients Private pay clients 3.13.1 Other Other 16.916.9
Percent of respondents providing home and community-based services with funds other than OAA funds:
Funding SourcesFunding SourcesPercent of programs that use at least some Percent of programs that use at least some
funding funding from each of the following sources.from each of the following sources.73.1 70.6
41.3
28.8
20.616.9 16.3 15.6 13.1 12.5
5.6 4.4 3.1
0
10
20
30
40
50
60
70
80
Per
cent
Disease Prevention and Disease Prevention and Health Promotion Services Health Promotion Services or Programs or Programs (proportion of programs that (proportion of programs that
provide disease prevention and health promotion services or provide disease prevention and health promotion services or programs-regardless of funding source)programs-regardless of funding source)
12.6
16.7
76.4
81.6
90.2
92.5
0 10 20 30 40 50 60 70 80 90 100
Other
Evidence-basedprograms
Home injury prevention
Routine healthscreenings
Nutritional counselingand education
General healthpromotion activities
Percent
Funding Sources Funding Sources (Disease Prevention and Health (Disease Prevention and Health
Promotion)Promotion)
Medicare Medicare 3.83.8 Medicaid Medicaid 9.69.6 Medicaid waiver Medicaid waiver 9.09.0 Indian Health Service Indian Health Service 78.878.8 American Indian Relief Council American Indian Relief Council 3.83.8 Revenue from gaming Revenue from gaming 10.310.3 Other tribal fundingOther tribal funding 49.4 49.4 Title III funding Title III funding 28.828.8 Other state funding Other state funding 15.415.4 SSBG SSBG 5.15.1 Grant funds Grant funds 15.415.4 Private pay clients Private pay clients 2.62.6 Other Other 10.310.3
Percent of respondents providing disease prevention and health promotion services and programs with funds other than OAA funds, from the following sources:
Involvement in Key Involvement in Key ProgramsPrograms
ADRC: How did respondents define ADRC: How did respondents define ADRCs?ADRCs?
Evidence-Based Programming: How Evidence-Based Programming: How did respondents define ADRCs?did respondents define ADRCs?
Transition Programming: How did Transition Programming: How did respondents define transitioning respondents define transitioning elders from nursing home back to elders from nursing home back to community?community?
Targeting: How did respondents Targeting: How did respondents define targeting?define targeting?
Single Point of EntrySingle Point of Entry
How did respondents define single How did respondents define single point of entry?point of entry?
PartnershipsPartnerships
Participants were asked to identify Participants were asked to identify which partnerships (out of a list of which partnerships (out of a list of 20) they maintain with federal, state 20) they maintain with federal, state and local organization or affiliations.and local organization or affiliations.
They were also asked to identify if They were also asked to identify if the partnership was formal the partnership was formal (formalized with a contract, compact (formalized with a contract, compact or memorandum of agreement) or or memorandum of agreement) or informal (non-contractual)informal (non-contractual)
PartnershipsPartnerships Federal agenciesFederal agencies MedicaidMedicaid Indian Health ServiceIndian Health Service Tribal organization or Tribal organization or
consortiumconsortium Department of HealthDepartment of Health MR/DD organizationsMR/DD organizations Disability service orgs.Disability service orgs. Mental/Behavioral Mental/Behavioral
healthhealth Adult Protective Adult Protective
ServicesServices Public housing Public housing
authority or other authority or other housing programshousing programs
Health care providers Health care providers and maintenanceand maintenance
Managed care/HMO Managed care/HMO networknetwork
BusinessesBusinesses Advocacy organizationsAdvocacy organizations Charitable organizationsCharitable organizations Educational institutionsEducational institutions Research institutionsResearch institutions Religious organizationsReligious organizations Other social service Other social service
orgs.orgs. OtherOther
Partnerships-Formal and Partnerships-Formal and InformalInformal
(5 most common and 5 least common partnerships)(5 most common and 5 least common partnerships)89.1
84.5
74.7 74.7 73.0
23.6
13.8 11.5 8.06.3
0102030405060708090
PartnershipsPartnerships(Most common formal and informal)(Most common formal and informal)
Formal PartnershipsFormal Partnerships Tribal organization Tribal organization
or consortium or consortium 44.4%44.4% Indian Health Indian Health
Service Service 42.6%42.6% Health care Health care
providers providers 38.0%38.0% Federal agencies Federal agencies
27.8%27.8% Department of Department of
Health Health 25.9%25.9%
Informal PartnershipsInformal Partnerships Health care providers Health care providers
83.7%83.7% Indian Health Service Indian Health Service
80.7%80.7% Public housing Public housing
authority or other authority or other housing programs housing programs 74.7%74.7%
Adult Protective Adult Protective Services Services 71.7%71.7%
Department of Health Department of Health 70.5%70.5%
Progress QuestionsProgress Questions
Sets of questions related to Choices Sets of questions related to Choices principlesprinciples
Response Options:Response Options: Do not plan to work on this.Do not plan to work on this. Would like to work on this but cannot.Would like to work on this but cannot. Plan to work on this but have not Plan to work on this but have not
begun.begun. Have made progress.Have made progress. Have this in place.Have this in place.
Helping Elders to Remain in their Own Helping Elders to Remain in their Own Homes: Homes: MostMost progress progress
Asking elders about their service Asking elders about their service preferences.preferences.
Assessing elder satisfaction with their Assessing elder satisfaction with their services.services.
Assisting elders in planning in advance for Assisting elders in planning in advance for long-term care.long-term care.(Discuss)(Discuss)
Helping Elders to Remain in their Own Helping Elders to Remain in their Own Homes: Homes: LeastLeast progress progress
Providing vouchers or cash to elders so they may Providing vouchers or cash to elders so they may purchase services.purchase services.
Providing services to elders who pay for their own Providing services to elders who pay for their own services.services.
Building billing systems for private pay elders.Building billing systems for private pay elders.
Developing policies and procedures to serve private Developing policies and procedures to serve private pay/insurance elders.pay/insurance elders.
Developing policies and procedures for elders who Developing policies and procedures for elders who pay for a part of their services.pay for a part of their services.
Helping Elders Get Home and Helping Elders Get Home and Community-Based Services: Community-Based Services:
MostMost progress progress
Developing collaborations with our local Developing collaborations with our local Area Agency on Aging (Title III)Area Agency on Aging (Title III)
Improving our Information and Improving our Information and Referral/Assistance System.Referral/Assistance System.
Helping Elders Get Home and Helping Elders Get Home and Community-Based Services: Community-Based Services:
LeastLeast progress progress
Electronically maintaining a billing system.Electronically maintaining a billing system.
Developing innovative technology to improve Developing innovative technology to improve elder access.elder access.
Helping Elders Get Home and Helping Elders Get Home and Community-Based Services: Community-Based Services:
MixedMixed progress progress Positioning our organization as the single point of Positioning our organization as the single point of
entry for long-term care in our area.entry for long-term care in our area.
Coordinating a single assessment and eligibility Coordinating a single assessment and eligibility determination process.determination process.
Electronically maintaining information about elders Electronically maintaining information about elders and their services.and their services.
Electronically maintaining health information about Electronically maintaining health information about elders (ADLs, IADLs, diagnoses).elders (ADLs, IADLs, diagnoses).
Electronically maintaining provider information.Electronically maintaining provider information.
Building Home and Community-Building Home and Community-Based Based
Long-Term Care Systems:Long-Term Care Systems:
MostMost progress progress Developing a system to provide home and Developing a system to provide home and community-based services to older adults.community-based services to older adults.
Acquiring board/governance support for Acquiring board/governance support for home and community-based service provision. home and community-based service provision. (Discuss: Did respondents mean tribal government (Discuss: Did respondents mean tribal government
support as opposed to organization board?)support as opposed to organization board?)
Acquiring Tribal Council support for Acquiring Tribal Council support for providing home and community-based providing home and community-based services.services.
Having culturally competent staff.Having culturally competent staff.
Building Home and Community-Building Home and Community-Based Long-Term Care Systems:Based Long-Term Care Systems:
LeastLeast progress progress
Developing a system to provide home and Developing a system to provide home and community-based services to persons community-based services to persons of all of all agesages..
Building a tribal nursing home.Building a tribal nursing home.
Building Home and Community-Building Home and Community-Based Long-Term Care Systems:Based Long-Term Care Systems:
MixedMixed progress progress
Having enough staff to move forward with new programs.Having enough staff to move forward with new programs. Case managing long-term care services.Case managing long-term care services. Having financial resources to move forward with new Having financial resources to move forward with new
programs.programs. Seeking grants for programs.Seeking grants for programs. Obtaining grants for programs.Obtaining grants for programs. Fund-raising and development.Fund-raising and development. Developing relationships with universities or research Developing relationships with universities or research
centers to evaluate our programs and activities. (Discuss)centers to evaluate our programs and activities. (Discuss) Marketing to attract elders to our services.Marketing to attract elders to our services. Building a tribal assisted living facility.Building a tribal assisted living facility. Expanding the types of services we offer.Expanding the types of services we offer.
Training and TA NeedsTraining and TA Needs
Understanding the LTC system Understanding the LTC system 69.369.3 Resource development Resource development 60.860.8 Strategic planning Strategic planning 60.860.8 Learning more about Medicare Learning more about Medicare 46.446.4 Learning more about Medicaid Learning more about Medicaid 44.644.6 Strategic alliances Strategic alliances 27.127.1 Choices for Independence as a Choices for Independence as a
strategic framework strategic framework 26.526.5
Percent of respondents who identified the following training and technical assistance needs as most useful to their organization:
In memory ofIn memory of
Alan Allery
And in honor of his important contribution to this effort.
For further information:For further information:
linscoae@muohio.edulinscoae@muohio.edu mcgrewkb@muohio.edumcgrewkb@muohio.edu kunkels@muohio.edukunkels@muohio.edu Scripps Gerontology CenterScripps Gerontology Center
Miami UniversityMiami University
Oxford, OH 45056Oxford, OH 45056
513-529-2914513-529-2914