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