Performance
Plans
2001 Government Performance and Results Act (GPRA) Annual
Performance Plans and Reports
PDF version 187KB
Table of Contents:
Part I – Agency Context for Performance Measurement
1.1 Agency Mission and Long Term Goals
1.2 Organization, Programs, Operations, Strategies and Resources
1.3 Partnerships and Coordination.
1.4 FY 1999 Performance Report
1.5 Performance Outcomes Measures Project
Part II – Performance Measures
Budget Level and Full-Time Equivalent Chart
Performance Measures by Performance Area
2.1.A Home-Delivered Meals
2.2.A Information and Assistance
2.3.A Long-Term Care Ombudsman
2.4.A State and Local Innovations and Projects of National Significance
-- Mental Health Initiative
Part III -- Appendices
A.1 Approach to Performance Measurement
A.2 Changes and Improvements Over Previous Year
A.3 Linkage to HHS Strategic Plan
Budget Linkage Table
1.1 Agency Mission and Long-Term Goals
The Administration on Aging is the Federal agency whose goal is to improve
the quality of life for all older Americans, primarily by assisting them
to remain independent, actively engaged, and productive. Through the Older
Americans Act, AoA works closely with its nationwide network of state,
tribal and area agencies on aging to plan, coordinate and develop home
and community-based systems of services that meet the unique needs of
older persons and their families. The agency’s mission is reflected in
statute. The Older Americans Act provides a broad organizing set of ten
core national values and objectives for AoA’s programs in language that
articulates a vision as well as transcendent, fundamental aspirations
for America’s older population. The motivation for embracing these values
and honoring the objectives is captured in the President’s statement in
his proclamation for Older Americans Month 1999: This year’s theme “...reminds
us of the profound debt of gratitude we owe to the generations of older
Americans whose hard work, courage, faith, sacrifice and patriotism helped
to make this nation great.
Strategic Goals of the Administration on Aging
- Provide opportunities for better nutrition and improved health;
- Provide access to services people need by reducing barriers; e.g.,
by utilizing culturally competent service delivery approaches and by
increasing their participation and engagement;
- Provide opportunities to live with safety, independence and dignity;
and at the systems level,
- Develop comprehensive and coordinated services systems based on local
needs.
AoA’s mission also relates closely to the strategic objectives of the Department
as published September 30, 1997, and particularly to the following strategic
goals and objectives:
- Goal 1 -- Reduce the Major Threats to Health and Productivity of
All Americans.
- Strategic Objective 1.3: Improve the Diet and Level of Physical
Activity of Americans.
- Goal 2 — Improve the Economic and Social Well-Being of Individuals,
Families and Communities in the United States
- Strategic Objective 2.5: Increase Opportunities for Seniors to
Have an Active and Healthy Aging Experience
- Strategic Objective 2.6: Expand Access to Consumer-Directed Home
and Community-Based Long-Term Care and Health Services
- Goal 3 -- Improve Access to Health Services and Ensure the Integrity
of the Nation’s Health Entitlement and Safety Net Programs
- Strategic Objective 3.5: Enhance the Fiscal Integrity of HCFA
Programs and Ensure the Best Value for Health Care Beneficiaries
- Strategic Objective 3.6: Improve the Health Status of American
Indians and Alaska Natives
- Goal 4 — Improve the Quality of Health Care and Human Services
- Strategic Objective 4.1: Promote the Effective Use of Appropriate
Health Services
- Strategic Objective 4.2: Reduce Disparities in the Receipt of
Quality Health Care Services
- Strategic Objective 4.4: Improve Consumer Protection.
Along with statutory
responsibilities and Departmental objectives, the agency’s mission is
shaped by the agency’s strategic vision. In this regard, the Administration
on Aging has adjusted its overall goals and priorities to respond to the
phenomenon of dramatic longevity, which has become even more evident over
the last decade. Such a reorientation is essential in light of growing
societal recognition that America’s social practices, institutions and
individuals will be required to respond to the fundamental demographic
shift which is occurring because human life expectancy has increased more
during the last century than over the last four millennia.
It is now evident that Americans of all ages must begin to anticipate
and plan for the likelihood that they will live to be 80, 90, and 100.
The opportunity to live a longer life heightens the importance of:
- keeping active and healthy
- earning and saving as much as possible in order to live comfortably
in the ;ater years;
- being involved in work or activities that are satisfying; and
- maintaining rewarding relationships with family and friends.
All of these are components of “lifecourse planning” in the broadest sense
and are reflected in the priorities of the Administration on Aging. In response
to a new biological phenomenon -- longevity -- programs that serve older
Americans must emphasize how we can age productively and successfully by
planning for longer life. 1.2 Organization, Programs, Operations,
Strategies and Resources
The Administration on Aging The Administration on Aging is an
operating division of the Department of Health and Human Services, headquartered
in Washington, D.C., with regional offices across the country. Total staffing
is less than 150. This small size presents several challenges for the
agency, not the least of which is assuring that staff continue to acquire
the skills required to fulfill the agency’s mission. AoA has begun a workforce
planning and implementation process to prepare the agency to meet the
changing demands placed on it by an ever-larger and more diverse older
population, and to strengthen the core competencies and technical skills
of its present workforce to meet those demands. The workforce planning
process identified the essential core competencies and technical skills
which should underpin a functional model of the organization. The agency
is utilizing the plan that was developed as an outcome of the process
to ensure that both human resource development and recruitment activities
result in the targeted generation and acquisition of those competencies
and skills necessary to achieve the agency’s mission, goals, and future
objectives.
Based on these efforts, AoA is requesting funding for several additional
FTEs. These staff are needed to ensure that AoA can effectively lead important
departmental and federal initiatives that respond to and prepare the nation
for the challenges and opportunities which accompany increased longevity.
The Aging Network
AoA awards grants under the authority of the Older Americans Act, which
provides funds for services and for basic administrative support of the
State, tribal and area agencies in the aging network. Many services provided
through the Aging Network are funded by pooling a variety of sources,
including other Federal programs, State programs (often substantial),
local funds and program income received as donations by people who, for
example, receive meals at a congregate nutrition site.
This ability to leverage and use funds for services from sources other
than the Older Americans Act illustrates an essential system outcome
of the Aging Network. The Act was never intended, in and of itself,
to operate a discrete, independent services program. Rather, the Act put
into place a nationwide service delivery system, the Aging Network, which
identifies service needs and necessary service system modifications, offers
state and local plans to remedy needs, coordinates other funding streams,
and then weaves the services funded by these into a comprehensive services
system. Services funded under the Act frequently are used to "fill
gaps" in other programs, for example, by providing services to people
who are ineligible for other programs but who still need support. We use
the proportion of "leveraged" funding as a performance indicator
for community-based access services in this plan.
The Aging Network is responsive to the diverse population of older Americans,
meeting a wide range of needs, as determined by state and local agencies
through needs assessment processes. Meals are served in congregate settings
such as senior centers, for example, to people who are poor and socially
isolated. Many older people with mild functional impairments need such
supportive services as transportation. For older people with more severe
limitations, the Aging Network provides home and community-based long
term care services through a system which it began to develop in the 1970’s.
In communities throughout the nation, the home and community-based service
systems led by the Aging Network provide a preferred alternative to nursing
home care, enabling people to live as independently as possible for as
long as possible.
The Older Americans Act
The Older Americans Act is currently being considered for reauthorization
in the Congress, and AoA has attempted, through the Administration’s proposal,
to present a new vision to enable America and its communities and its
people to prepare for the growing longevity of our population. The reauthorization
proposal is designed to offer strong support to the Aging Network of state,
tribal and local entities to enable them to best meet emerging challenges.
To improve and strengthen the flexibility of the OAA programs, the Administration
proposes to streamline the operations of state programs, add flexibility
by eliminating unnecessary Federal requirements, and build a more responsive
customer orientation.
Linkage Between Goals
Consistent with the requirements of the GPRA, AoA has established a linkage
between performance goals and strategic goals. Each performance goal supports
the achievement of one or more of AoA’s strategic goals. The successful
pursuit of AoA activities contributes to the achievement of performance
goals by helping assure excellence in the operation of state and area
agency programs.
Strategic
Goals of HHS |
^ |
Strategic
Goals of AoA |
^ |
Performance
Goals |
Achievement of strategic goals is dependent on the successful achievement
of performance goals.
Fiscal Year 2001 Budget Proposal
The FY 2001 budget request is $1,083,619,000, +$150,771,000 above the FY 2000
appropriation. This amount includes an increase of $140 million for Supportive
Services, an increase of $15 million for the base program and $125 million
to support caregivers of older Americans. $5 million is included to increase
core services for Grants to Native Americans and potentially to bolster
caregiver support activities for caregivers of Native American elders. Also
included is an additional $5 million for a new Mental Health Initiative.
Finally, $1 million has been added for twelve new FTEs to support program
activities.
1.3 Partnerships and Coordination
Collaboration with the Aging Network
AoA works collaboratively with its nationwide network of State and Area
Agencies on Aging and tribes to plan, coordinate, and develop community-based
systems of services for older persons and their caregivers. AoA’s partnerships
with other Federal agencies, national organizations, and representatives
of the private sector help ensure that programs and resources available
to older Americans are coordinated with those of the Aging Network.
Grant programs authorized by the Older Americans Act are administered by
AoA. These programs provide meals and various supportive services to help
vulnerable older persons remain in their own homes. These programs also
offer older Americans opportunities to enhance their health and to be active
contributors to their families, communities, and the nation.
Funding provided by AoA supports in-home and community-based services including
nutrition, transportation, health promotion, nursing home ombudsmen, outreach,
and elder abuse prevention efforts. Fifty-seven State Agencies on Aging
are allocated funds for these services based on a formula that reflects
the number of older residents in their state. Moreover, funds are used to
plan, develop, and coordinate in-home and community-based service systems
in their states. All but nine states are divided into Planning and Service
Areas (PSAs). Each PSA is served by an Area Agency on Aging. The 655 Area
Agencies on Aging (AAAs) receive OAA funds from their State Unit on Aging
(SUA). In turn, AAAs contract with public or private providers for services.
While there are approximately 27,000 service provider agencies nationwide,
some AAAs deliver services directly when no local contractor is available.
Federal Partnerships
AoA works closely with many Federal agencies on a wide range of issues.
Our discussion here, however, is limited to several examples of collaboration
related to this year’s budget priorities and collaboration in the achievement
of our performance outcomes.
In the area of nutrition, for example, we work with the U.S. Department
of Agriculture on such issues as food security measurement and dietary guidelines
used as standards for our programs. Within HHS, we work with the Office
of Assistant Secretary for Public Health on Dietary Reference Intakes (DRIs),
formerly known as Recommended Daily Allowances and on nutrition performance
measures related to the Healthy People 2010 initiative. AoA is also represented
on such bodies as the HHS Nutrition Policy Board; the HHS Dietary Guidance
Committee; the HHS/USDA Food Security committee; the HHS/USDA Nutrition
and Welfare committee; and the HHS Dietary Reference Intake Working Group.
In the achievement of our transportation performance outcomes, we work closely
with officials of our Department and the U.S. Department of Transportation
on the Coordinating Council on Access and Mobility – which works to reduce
barriers by coordinating approaches to specialized and human services transportation.
Our fiscal year 2001 budget proposal features a new partnership with the
Substance Abuse and Mental Health Administration for our mental health initiative.
The Health Care Financing Administration and the Administration on Aging
are partners in the provision of information and assistance services to
older Americans about the health care options available to Medicare beneficiaries.
Through a cooperative agreement, HCFA transferred to AoA $1.9 million in
fiscal year 1999 to support the efforts of the national aging network to
educate older people about Medicare+Choice.
In addition, together we developed a training manual for information and
assistance programs, so they could explain options and know where and when
to refer beneficiaries for expert help. We are also cooperating with HCFA
on several demonstration projects to develop new models for assuring quality
of care in nursing homes.
In the area of health care anti-fraud activities, we work extensively with
HCFA, the Department’s Office of Inspector General, the U.S. Department
of Justice, state Medicaid agencies, state survey and certification agencies,
Medicare contractors, State and Area Agencies on Aging, and other members
of AoA's National Aging Network. Our fiscal year 1999 performance report
highlights the significant successes of these partnerships. The Centers
for Disease Control and Prevention is a federal partner on the Administration
on Aging’s Performance Outcome Measurement Project. Recognizing the efficiency
of using existing national survey mechanisms to gather outcomes data and
to serve as a general population baseline, AoA will utilize the CDC’s annual
Behavioral Risk Factors Surveillance System, which is conducted in each
state by state health departments. AoA has agreed to provide support for
the BRFSS in exchange for the inclusion, in the fiscal year 2000 survey,
of questions of interest to our programs. They include a question about
whether an individual has recently provided care for an elderly parent,
relative or friend; and a question about whom one would contact to arrange
care for an elderly parent or relative who is no longer able to care for
themselves. For persons receiving help with personal needs, questions will
be posed about the source and adequacy of that help.
Technical assistance will also be provided by CDC on the development of
measures for “social functioning;” for example, by the number of contacts
a person has outside his or her home. We believe people who participate
in OAA programs have more social contacts than people in similar circumstances
who are not participants.
AoA is also working collaboratively with the National Institute on Aging
and the Assistant Secretary for Planning and Evaluation to support the caregiver
supplement to the National Long Term Care Survey and follow-up surveys,
which is essential to establishing baselines for caregiver support activities.
Further information about partnerships that advance specific program goals
is available in the sections of this report that describe those program
activities.
1.4 FY 1999 Performance Report Summary
The GPRA Performance Plan submitted with the fiscal year 1999 budget proposal
relied upon AoA’s basic administrative data system: the State Program Report.
This was, at the time, a new data collection system in the first year of
a three-year implementation period. The State Program Report provides profile
data on the number and characteristics of the people we serve, the services
they receive, the funds used to pay for those services, and the agencies
that deliver services.
Because the State Program Report is a new administrative data system, the
ongoing process of data verification and validation is time-consuming, but
has been effective. Appendix 1 provides further information about data verification
and validation.
Verification of data from fiscal year 1997 was completed recently. Currently,
FY1998 data is being processed and is expected to become available in September,
2000. Data from FY1999 will be available in September, 2001. The current
plan and report provides information about aging services and programs during
fiscal year 1997 because that is the most recent year for which NAPIS /
SPR information is available. AoA is now developing computer software that
will allow States to validate and verify NAPIS / SPR information before
submitting the information to AoA. As this is completed and as the system
matures, we expect to reduce significantly the time lag in reporting data
and to improve our ability to comply with GPRA requirements.
Thus, this performance report relies upon information drawn from data for
FY1997, the most recent available. Fiscal year 1997 data on client characteristics
are also presented. Fiscal year 1997 is the first year for which detailed
data are available on client characteristics such as race and ethnicity,
poverty status, and level of disability. This information is available for
program participants who receive certain core services, although not all
states are currently able to report this data.
1.4.A Client Characteristics
Older Americans Act services reach a significant percentage of all the
people 60 years of age or over in the country. The aging network targets
scarce resources to people in the greatest social and economic need. Our
programs serve members of minority groups, the poor and people with disabilities
at a rate greater than their proportion in the general population.
AoA employs Census Bureau estimates for 1993 as these estimates correlate
data for people 60 years of age and older by race or Hispanic origin,
and by poverty. The number of people in the country 60 years of age and
older was 41,399,000. The number who received services under the Older
Americans Act in 1997 was 7,045,360, or 17 percent of the total population
age 60 and over, and 6,891,416, or 16.6 percent in 1996.
The number of African American individuals 60 and above in the country
was 3,704,000, or 8.9 percent of the population. The number of African
American individuals who participated in our programs in 1997 was 738,519,
or 10.7 percent of all participants. The number in 1996 was 703,076, or
10 percent.
The number of individuals of Hispanic origin 60 and above was 1,776,000,
or 4.2 percent of the population. The number of individuals of Hispanic
origin who participated in our programs in 1997 was 525,304, or 7.6 percent
of all participants. The number in 1996 was 444,430, or 6.3 percent.
The number of people in poverty age 60 and over was 3,376,000, which was
a percentage of 10.5. The number of people in poverty who participated
in our programs in 1997 was 2,681,008, or 38.9 percent of all participants.
The number in 1996 was 2,671,772, or 37.9 percent.
Disability figures from the Census Bureau’s Survey of Income and Program
Participation show that in 1994 and 1995 14,679,000 people, or 47 percent
of those age 65 and over, reported difficulty with one or more functional
activities. Some 5 million people, or 16 percent, reported that they needed
personal assistance with one or more of the instrumental activities of
daily living or the activities of daily living.
Preliminary data from 16 states for 1997 show that people with limitations
in the instrumental activities of daily living (IADLs) represent between
62.6 and 84.7 percent of all recipients of a group of “registered” services
that includes personal care, chore, and homemaker services, home-delivered
meals, adult day care and case management. People with limitations in
the Activities of Daily Living (ADLs) represent between 57.6 and 77 percent
of all recipients of registered services. Some of the people represented
in the ADL chart also have IADL limitations, although this is not shown
in the data.
1.4.B Performance Measures
Strategic Goal 1: Provide Opportunities for Better Nutrition and Improved
Health
Home-Delivered Meals |
Actual Performance |
For fiscal year 1999, maintain the number
of meals served at the 1995 baseline,
119,000,000 meals. |
FY99: 9/01
FY98: 9/00
FY97: 123,455,000
FY96: 119,110,318
FY95: 119,000,000 |
Congregate Meals |
Actual Performance |
For fiscal year 1999, maintain the number
of meals served at the 1995 baseline, 123,400,000 meals. |
FY99: 9/01
FY98: 9/00
FY97: 113,147,407
FY96: 118,632,573
FY95: 123,400,000 |
Our performance goal in this area was to maintain the provision
of services with level funding. We expect to have data for fiscal
year 1999 by September, 2000. The trend, however, between fiscal
years 1995 and 1997, was that home-delivered meals increased while
congregate meals decreased, which is consistent with the pattern
of states transferring funding from the congregate and general
services programs to the home-delivered meals program.
Grants for Native Americans |
Actual Performance |
For fiscal year 1999, improve health
and well-being, and reduce social isolation, among older American
Indians, Alaska Natives and Native Hawaiians through the provision
of community-based services by maintaining the level of service provision
at the 1995 level:
Home-Delivered Meals: 1,455,911
Congregate Meals: 1,321,728
Transportation: 763,287
Information and Referral 632,462
In-Home Services 741,859
Other 511,646 |
Home-Delivered Meals
FY99: 9/01
FY98: 9/00
FY97 1,632,536
FY96 1,394,093
FY95 (corrected) 1,453,733
Congregate Meals
FY99: 9/01
FY98: 9/00
FY97 1,438,908
FY96 1,273,584
FY95 (corrected) 1,285,447
Transportation
FY99: 9/01
FY98: 9/00
FY97 665,063
FY96 701,969
FY95 (corrected) 740,262
Information and Referra
lFY99: 9/01
FY98: 9/00
FY97 678,979
FY96 698,258
FY95 (corrected) 630,950
In-home Services
FY99: 9/01
FY98: 9/00
FY97 866,194
FY96 788,003
FY95 (corrected) 698,015
Other Services
FY99: 9/01
FY98: 9/00
FY97 590,723
FY96 598,896
FY95 (corrected) 583,746
|
For the most part, Native American programs maintained the level
of services, adjusted for inflation, in the face of level funding.
The baseline reported in the fiscal year 1999 performance plan, i.e.,
the level of service provision in 1995, has been updated in our data-collection
system. Those figures, and those for 1996 and 1997, appear above. The
data-collection system for the Native Americans program collects data
on an April-through-March basis, rather than the October-through-September
(Federal fiscal year) basis for the State Program Report.
Strategic Goal 2: Provide access to services people need by reducing
barriers, bringing cultural competence to services, and providing opportunities
for social engagement.
Information and Assistance |
Actual Performance |
For fiscal year 1999, maintain the number
of information and assistance contacts at the 1995 baseline, 12,526,537
contacts. |
FY99: 9/01
FY98: 9/00
FY97: 13,985,091
FY96: 13,739,633
FY95: 12,526,537
Contacts |
For fiscal year 1999, increase the level
of leveraged funding over by one percent over the 1995 baseline, from
$38,105,352 plus $381,054 to $38,486,406 |
FY99: 9/01
FY98: 9/00
FY97: $47,293,671
FY96: $42,293,671
FY95: $38,105,352 |
Transportation |
Actual Performance |
For fiscal year 1999, maintain the number
of one-way rides at the 1995 baseline, 39,496,946 one-way rides. |
FY99: 9/01
FY98: 9/00
FY97: 46,578,352
FY96: 36,902,111
FY95: 39,496,946 rides |
For fiscal year 1999, increase by one
percent the amount of leveraged funding over the 1995 baseline, from
$95,349,783 plus $953,497 to $96,403,280. |
FY99: 9/01
FY98: 9/00
FY97: $100,576,352
FY96: 97,634,395
FY95: 95,349,783 |
Case Management |
Actual Performance |
For fiscal year 1999, maintain the number
of hours of case management services at the 1995 baseline, 2,976,149
hours.
(Discontinued in 1999) |
FY99: 9/01
FY98: 9/00
FY97: 2,701,728
FY96: 3,426,542
FY95: 2,976,149 hours |
For fiscal year 1999, increase the level
of leveraged funding by one percent over the 1995 baseline, from $64,622,578
plus $646,226 to $65,268,804. |
FY99: 9/01
FY98: 9/00
FY97: $53,364,889
FY96: $76,879,489
FY95: $64,622,578 |
The Older Americans Act defines the following as “access services:”
information and assistance; transportation; and case management. We chose
to measure the provision of these services as representative of the strategic
goal of providing access to services, and note that the receipt of access
services often implies the receipt of other services.
In the area of information and assistance – often an individual’s first
contact with the aging network – we saw consistent and continued growth,
both in the network’s provision of services and their ability to “leverage”
funding, that is, to obtain funds for the provision of the service from
sources other than the Older Americans Act.
In the area of transportation, states chose to use less of their funding
under Title III of the Older Americans Act for this service between fiscal
years 1995 and 1996, while leveraged funding increased. Title III funding
rebounded, however, between 1996 and 1997, and leveraged funding continued
to increase. The decrease between 1995 and 1996 may be an artifact of
the new data system. We expect some variation over the first three years
of a phased, three-year implementation period for the State Program Report
system. Fiscal year 1999 data will be available in September, 2000.
Case management services increased between fiscal years 1995 and 1996,
both in provision of services and leveraged funding, but declined in 1997
in both areas to below 1995 levels. We believe this reflects practice
in the field, where there is greater emphasis on “consumer directed” services
-- where the individuals have relatively more influence over the services
they receive, and agency-based case managers relatively less. As discussed
in Section 2, we are discontinuing use of this measure based on consultation
with state officials, who have commented that the continued use of this
measure is inappropriate because of changes in the way the program is
administered.
'Strategic Goal 3: Provide opportunities to live with safety, independence
and dignity
Long-Term Care Ombudsman Program
|
Actual Performance |
Maintain the combined resolution/partial
resolution rate of 71.48 percent of complaints in nursing homes. |
FY99: 11/00
FY98: 70.6%
FY97: 72.1%
FY96: 74.0%
FY95: 71.5% |
Our program goal in this area is to assist residents, families,
friends and others to resolve problems related to care and conditions
in nursing homes. Our target for fiscal year 1999 is to resolve
(or partially resolve) 71.48 percent of complaints involving nursing
home care. Performance thus far has been generally consistent
with this goal.
Strategic Goal 4: Develop comprehensive and coordinated services
systems based on local needs.
See section 2.4.A for Accomplishments.
1.5 Performance Outcomes Measures Project
The fiscal year 2001 performance plan continues to rely primarily
on output measures derived from the National Aging Program Information
System (NAPIS). AoA has undertaken a project – the Performance
Outcome Measures Project – to develop and test outcome measures
related to the impact of Older Americans Act services on the lives
of service recipients.
AoA has undertaken the Performance Outcome Measures Project in
partnership with the National Association of State Units on Aging
and the National Association of Area Agencies on Aging. Nineteen
state and area agencies are collaborating on the Project.
Project participants have reached consensus on outcome measures
that are relevant to the performance of the Aging Network that
will be tested during FY2000. These measures emphasize individual
characteristics of the people we serve – including their nutritional
risk, physical functioning, emotional well-being, social functioning,
and satisfaction with the services they receive. Other measures
look at the impact of services that support caregivers and the
degree to which caregivers are satisfied with the services they
receive. In development are measures to assess the performance
of the aging network in reducing barriers to services and in building
the capacity of the aging services system.
AoA has contracted with researchers and academics who are regarded
to have strong expertise in particular substantive areas to help
develop data-collection instruments that proceed from the best
available research. The participating state and local agencies
and the national associations are full partners in the development
of these instruments and will participate in the field-testing
of performance outcome measures over the winter and spring. We
expect to have data from the field tests by this time next year.
Participating agencies include:
Big Sandy Appalachian Development District
-- Prestonburg, Kentucky |
Iowa Department of Elder Affairs – Des
Moines, Iowa |
California Department of Aging -- Sacramento,
California |
Lifestream Services, Inc. – Yorktown,
Indiana |
CICOA, The Access Network – Indianapolis,
Indiana |
Los Angeles City Department of Aging
– Los Angeles, California |
The Council on Aging of the Cincinnati
Area – Cincinnati, Ohio |
New Jersey Division of Senior Affairs
– Trenton, New Jersey |
Connecticut Bureau of Elder Rights and
Community Services – Hartford, Connecticut |
Ohio Department of Aging – Columbus,
Ohio |
Connecticut Association of Area Agencies
on Aging – Hartford, Connecticut |
Area Agency on Aging, Region One – Phoenix,
Arizona |
Florida Department of Elder Affairs –
Tallahassee, Florida |
Area Agency on Aging of Western Arkansas
– Fort Smith, Arkansas |
Georgia Division of Aging Services –
Atlanta, Georgia |
Area Agency on Aging of Hunterdon County,
New Jersey |
Hawaii County Office of Aging – Hilo,
Hawaii |
Hawkeye Valley Area Agency on Aging –
Iowa |
Indiana Bureau of Aging and In-Home Services
– Indianapolis, Indiana |
|
The fiscal year 2001 GPRA performance plan is consistent with
earlier performance plans which relied exclusively on program
output information. Future plans which will rely more on both
outputs (e.g., how many home-delivered meals were served) and
program outcomes now being developed and tested. Both the 2001
performance plan and the 1999 performance report will be available
on AoA’s web site following the release of the President’s fiscal
year 2001 budget.
Part II – Performance Measures
Budget Level and Full-Time Equivalent Chart
Performance Area |
Request |
FTE |
Strategic Goal 1 : Provide opportunities
for better nutrition and improved health |
$560,992 |
58 |
Strategic Goal 2 : Provide access
to services people need by reducing barriers; e.g., by utilizing culturally
competent service delivery approaches and by increasing their participation
and engagement |
$331,052 |
60 |
Strategic Goal 3 : Provide opportunities
to live with safety, independence and dignity |
$149,849 |
33 |
Strategic Goal 4 : Develop comprehensive
and coordinated services systems based on local needs |
$ 26,162 |
16 |
Performance Measures by Performance Area
Strategic Goal 2.1: Provide opportunities
for better nutrition and improved health
Resources, Strategic Goal 2.1 |
FY 1999 Actual |
FY 2000 Appropriation |
FY 2001 Requested |
$520,841 |
$555,992 |
$560,992 |
Performance Goal 2.1.A – Home-Delivered Meals
|
FY Targets |
Actual Performance |
For fiscal year 2000, increase by 32 million meals
above the 1997 baseline, and for 2001, increase by 11 million meals
over the 2000 goal. |
FY01: 166,000,000
FY00: 155,000,000
FY99: 119,000,000 |
FY99: 9/01
FY98: 9/00
FY97: 123,455,000
FY96: 119,110,318
FY95: 119,000,000 |
Performance Goal 2.1.B – Congregate Meals |
FY Targets |
Actual Performance |
Maintain the number of meals served at the 1997
baseline. |
FY01: 113,147,407
FY00: 113,147,407
FY99: 123,400,000 |
FY99: 9/01
FY98: 9/00
FY97: 113,147,407
FY96: 118,632,573
FY95: 123,400,000 |
Introduction
AoA provides congregate and home-delivered nutrition services to older adults
at risk of poor nutrition, poor health, social isolation and loss of independence.
Although these services often include nutrition assessment, education, and
counseling, the primary service provided is meals. The purpose of both nutrition
services programs is to improve the dietary intake of participants, offer
them opportunities for social participation and engagement and for the development
and maintenance of informal support networks, and to link participants to
other health and social services, as needed and as appropriate. Nutrition
services improve nutritional status, decrease the risk of disease and disease-related
disability, help maintain cognitive and physical functioning and decrease
food insecurity. Scientific evidence supports the relationship between good
nutrition, health, and functionality. Four of the ten leading causes of
death and disability (heart disease, cancer, stroke, and diabetes) among
older adults are tied to poor nutrition. A decline in cognitive functioning
and a reduction of the risk of coronary artery disease are linked to adequate
intake of vitamins B6, B12, and folic acid. The prevention and treatment
of osteoporosis and the maintenance of mobility are tied to the consumption
of adequate amounts of calcium and vitamin D. Evidence indicates that the
development of blindness due to cataracts or age-related macular degeneration
may be retarded if there are adequate amounts of the antioxidants -- vitamin
E, beta-carotene and other carotenoids, and ascorbic acid -- in diets. Research
has also found that antioxidants may play a role in the prevention of central
nervous system disorders such as Alzheimer’s, Parkinson’s Disease, and atherosclerosis.
Obesity caused by the interaction of poor nutrition and lack of physical
activity decreases mobility, increases the risk of chronic diseases and
disability and ultimately decreases the life span.
OAA funded nutrition services are targeted to those in greatest
economic and social need, with particular attention given to low-income
minorities. Compared to the general U.S. population, meal program
participants are older, poorer, more likely to live alone; are
more often minorities; are at higher nutritional, and health risk;
and experience greater functional impairment. These programs are
often the primary, daily food source for many participants, who
are typically economically disadvantaged. The meals provided to
program participants generally supply a significant proportion
of their daily nutrients -- 40 to 50 percent – which they need
to maintain health and functionality. As a result of this, the
level of meal service provided is used to indicate the impact
of the nutrition program.
Fiscal Year 1999 Accomplishments
National Nutrition Standards The Older Americans Act prescribes
National Nutrition Standards that must be met in meals for older
adults. These standards require that the meals served through the Elderly
Nutrition Program (ENP) promote health, are culturally appropriate, and
meet the special health needs of older adults. Each meal must contain
1/3 of the Recommended Dietary Allowances (RDAs) as established by the
Food and Nutrition Board, Institute of Medicine, National Academy of Sciences.
Also, each meal must meet the Dietary Guidelines for Americans from the
Department of Health and Human Services (HHS) and the United States Department
of Agriculture (USDA). Moreover, the standards require that meals programs
comply with state, tribal, and local food service laws to ensure meals
served are safe to eat.
AoA’s monitoring of nutrition service providers’ compliance with the National
Nutrition Standards and other service activities, provides assurance that
the meals delivered through the ENP contribute to improved nutritional
intake and promote the improved health of recipients.
Partnerships to Help Ensure the Needs of Older Adults Are Met
AoA officials have participated on the following interagency committees
that addressed issues related to nutrition and health issues:
- the Nutrition Objective Sub-committee for the HHS Healthy People 2000
- Healthy People 2010 National Health Objectives
- HHS Nutrition Policy Board
- HHS Dietary Guidance Committee
- HHS/USDA Food Security committee
- HHS/USDA Nutrition and Welfare committee
- HHS Dietary Reference Intake Working Group to insure the needs and
special concerns of the older population are addressed.
Efforts to Target Specific Recipient Groups During FY 1999, AoA
issued specific requirements to grantees for reporting on the delivery
of specific nutrition services. This was conducted as an initiative to
determine target groups for nutrition services. SUAs were asked to collect
and report data related to “nutrition risk” for program participants.
The SUAs were requested to use check-listed criteria from the National
Screening Initiative (NSI) to identify older adults who are at risk of
becoming malnourished or who are in need of other nutrition-related services
to maintain a healthy life-style. The information collected by the SUAs
and reported to AoA was used by AoA to assist the National Aging Service
Network to target ENP nutrition services such as congregate and home-delivered
meals, nutritional counseling, and case management services to older adults
with the greatest need.
Promotion of Service Needs Awareness
In order to encourage collaborative planning and service activities which
can produce the most beneficial outcomes, AoA has identified opportunities
and resources for the Network through which greater awareness of the service
needs of older Americans can be realized.
During FY 1999, AoA participated in HHS Healthy People 2000 and 2010,
a national prevention initiative that has established national health
targets and that calls for community collaboration in their achievement.
In order to expedite efforts to promote health and prevent illnesses among
older persons, AoA has encouraged the national Aging Network to participate
in the Healthy People initiative and to strive to meet national health
targets.
AoA is also actively engaged in the deliberations of the HHS Dietary Reference
Intake (DRI) Working Group to determine the areas of the Recommended Daily
Allowance (RDAs), now known as the Dietary Reference Intakes (DRIs), that
require revision. The DRI Working Group provides funding and direction
to the Food and Nutrition Board of the Institute of Medicine in developing
new approaches to DRIs. It also recommends experts for discussion panels
and provides assurance that the informational needs of the federal government
and other recipients are met.
Finally, AoA is an active participant on a federal interagency working
group for food security measurement that resulted in the first-ever questionnaire
to measure food security in America. This questionnaire is used in both
HHS and USDA food and health surveys to determine food security and is
used annually as part of the Current Population Survey conducted by the
Census Bureau.
Direct Technical Assistance
AoA personnel provide direct technical assistance via telephone; on-site
assistance; presentations at national, regional, state, and tribal conferences;
and through professional meetings. During FY 1999, AoA personnel provided
more than 20 presentations on nutrition at national meetings. Two of AoA’s
regional offices held meetings on nutrition services that were attended
by a total of 80 Indian tribes.
Technical assistance was directly provided to at least 30 Indian tribes
on-site in conjunction with on-going program monitoring activities. Guidance
has been provided to tribes via telephone technical assistance on issues
such as: how to purchase blast freezing equipment; the implications of
food service laws; constructing client and program outcome measures; interpretations
of the OAA; the nutrient content of meals; and the nutrient needs of older
adults.
As part of its information dissemination function, AoA supports a Nutrition
Resource Center website that includes bibliographies on 45 topics related
to nutrition and aging. The site is connected electronically to actual
publication abstracts. The bibliographies include a wide range of topics
including articles on service provision, innovations, minority issues,
caregiver issues, and others. On a quarterly basis, the Center publishes
an article in the general nutrition Newsletter which is read by approximately
2,500 nutritionists who work with programs that serve older adults. During
the course of a year, Center personnel provide at least 20 presentations
to various groups.
Performance Goal 2.1.C – Programs for American
Indians, Alaskan Natives and Native Hawaiians |
FY Targets |
Actual Performance |
Improve the health and well-being, and reduce social
isolation, among older American Indians, Alaska Natives and Native
Hawaiians through the provision of community-based services.
|
FY01: Increase service provision by ten percent
over FY97 levels
FY00: Maintain service provision at FY97 levels
FY99: N/A
Home-Delivered Meals
FY01: 1,795,200
FY00: 1,632,000
FY99: 1,455,911
Congregate Meals
FY01: 1,582,790
FY00: 1,438,908
FY99: 1,321,728
Transportation
FY01: 731,569
FY00: 665,063
FY99: 763,287
Information and Referral
FY01: 746,900
FY00: 678,979
FY99: 632,462
In-Home Services
FY01: 952,600
FY00: 866,194
FY99: 741,859
Other Services
FY01: 649,710
FY00: 590,723
FY99: 511,646 |
Home-Delivered Meals
FY99: 9/01
FY98: 9/00
FY97 1,632,536
FY96 1,394,093
FY95 (corrected) 1,453,733
Congregate Meals
FY99: 9/01
FY98: 9/00
FY97 1,438,908
FY96 1,273,584
FY95 (corrected) 1,285,447
Transportation
FY99: 9/01
FY98: 9/00
FY97 665,063
FY96 701,969
FY95 (corrected) 740,262
Information and Referral
FY99: 9/01
FY98: 9/00
FY97 678,979
FY96 698,258
FY95 (corrected) 630,950
In-home Services
FY99: 9/01
FY98: 9/00
FY97 866,194
FY96 788,003
FY95 (corrected) 698,015
Other Services
FY99: 9/01
FY98: 9/00
FY97 590,723
FY96 598,896
FY95 (corrected) 583,746 |
Introduction
The 1990 Census counted almost 166,000 American Indians and Alaskan Natives
over the age of 60. Although older adults represent only about eight percent
of the total American Indian and Alaskan Native population, their numbers
are increasing rapidly. This increase is due to better health and living
conditions. Today, older American Indians, Alaskan Natives and Native
Hawaiians can expect to live well into their eighties and nineties. This
recent, but welcome trend will place even greater demands on home and
community-based service delivery systems.
AoA’s American Indian, Alaskan Native, and Native Hawaiian Program--Title
VI of the OAA — is responsible for serving as the federal advocate on
behalf of older Native Americans, coordinating activities with other federal
departments and agencies, administering grants to Native Americans, and
collecting and disseminating information related to the problems of older
Native Americans.
Under Title VI of the OAA, AoA annually awards grants to provide supportive
and nutrition services for American Indian, Alaskan Native and Native
Hawaiian older adults living in the Title VI service area. In 1997, grants
were awarded to 221 American Indian and Alaskan Native tribal organizations
representing 300 tribes, and one organization serving Native Hawaiian
older adults.
In addition to nutrition services, the Title VI program funds supportive
services such as information and assistance, transportation, chore services,
homemaker services, health aide services, outreach, family support, and
legal assistance. Training and technical assistance in these areas is
made available to Title VI grantees in a variety of ways, including on-site,
telephone and written consultation, national meetings, newsletters, and
electronically, by AoA staff and the Native American Resource Centers.
Training and technical assistance are designed to further the development
and strengthen the capacity of Title VI program directors and staff to
manage comprehensive and coordinated systems of nutritional and supportive
services for American Indian, Alaskan Native and Native Hawaiian older
adults.
Fiscal Year 1999 Accomplishments
Providing Outreach, Training, and Expansion of Awareness of the Aging
Process
With funding from AoA’s program for State and Local Innovations and Projects
of National Significance, the University of Colorado and the University
of North Dakota National Resource Centers on Native American Aging have
provided outreach, training and heightened public awareness of the aging
process as it relates to American Indians.
The University of Colorado disseminates information through a successful
website. The University of North Dakota offered more than 12 Geriatric
Leadership Seminars nationally in FY 1999, focusing on the empowerment
of older Native Indian adults through enhanced services.
Results
During FY 1999, the University of Colorado website was contacted by 3500
individuals who subsequently accessed available training and outreach
services aimed at improving quality of life in Indian communities. More
than 250 individuals participated in the University of North Dakota’s
Geriatric Leadership Seminars. Information obtained by seminar participants
has enabled them to implement program enhancements in numerous Indian
communities.
Providing Home, Transportation, Information and Assistance Support
Services to Indian Communities
Locally administered home and community-based programs and services are
an important component of the long-term care delivery system necessary
to meet the needs of functionally-impaired older adults. In recent years,
Indian tribes have pursued the development of appropriate home and community-based
long term care services to enable their elders to remain as independent
as possible in community settings of their choice. Through 227 grants
provided by AoA, a variety of in-home support services were provided to
tribes, tribal organizations and Native Hawaiian organizations during
FY 1999:
More than 750,000 older American Indians, Alaska Natives and Native Hawaiians
received a variety of in-home services including personal care services,
homemaker services, health aide services, case management assistance,
and family support.
Over 600,000 rides were provided to older Native American adults to meal
sites, medical appointments, grocery stores and other essential community
services.
More than 600,000 older Native American adults received information and
assistance on issues dealing with social security, food stamps, and other
topics.
Results
In-home services are permitting Native American older adults to remain
in their homes for as long as possible, containing costs associated with
the premature institutionalization of older adults.
Recipients of rides were able to increase their access to programs and
services and maintain greater independence within their communities.
Recipients of information and assistance have increased awareness about
their right to receive social security, food stamps and other services
which is improving their health and standard of living in their communities.
The identification of Home and Community Based Long-Term Care (HCBLTC)
needs in Indian communities and barriers to addressing these needs.
To date, the design and development of strategies for HCBLTC in Indian
communities have proceeded with limited involvement of federal and state
agencies. Historical differences among various tribes in the availability
and use of federal, tribal and state programs have resulted in an erratic
and, in some cases, an essentially nonexistent infrastructure for HCBLTC.
AoA is addressing this in two ways:
1) To better identify HCBLTC needs, AoA and two resource centers funded
by AoA -- the Native Elder Health Care Resource Center at the University
of Colorado and the National Resource Center on Native American Aging
at the University of North Dakota -- surveyed key tribal program administrators
from 108 Federally recognized tribes. During FY 1999, information was
collected about the availability of home and community-based long-term
care programs and resources in American Indian and Alaska Native communities.
Information was also collected about how the programs and services are
funded and about barriers to establishing such programs and services in
Indian communities.
2) Also, through a cooperative agreement, funded by AoA, the National
Resource Center on Native American Aging has developed a “Health and Social
Needs Assessment” for Native Elders for use at the community level. It
is currently being pilot-tested at various sites. Workshops are also being
conducted on its use. Barriers, identified in the survey by tribal officials,
to addressing HCBLTC needs include fragmented and insufficient funds,
minimal appreciation of local need, limited access to decision-makers,
and excessive regulations.
Results
During FY 1999 AoA, the Native Elder Health Care Resource Center, and
the National Resource Center on Native American Aging successfully used
survey information to improve the capacity of tribes to develop responsive
home and community based programs. Many tribes have since demonstrated
increased understanding of the issues and of potential resources and have
begun to tap into available funding sources and identify and pursue training
opportunities that will help them develop and improve HCBLTC services
in their communities.
AoA intends to work with tribes and use data from needs assessments to
help them plan necessary HCBLTC programs and services in their communities.
Coordinate with Other Federal Agencies and Private Organizations to
Assist Tribes in Overcoming Barriers and Facilitating the Establishment
of Home and Community Based Long-Term Care Programs and Services.
AoA’s American Indian, Alaskan Native, and Native Hawaiian Program, Title
VI of the OAA, is responsible for serving as an advocate on behalf of
older Native Americans, coordinating activities with other federal departments
and agencies, administering grants to Native Americans, and collecting
and disseminating information related to the problems of older Native
Americans.
A permanent Interagency Task Force comprised of representatives of Federal
departments and agencies with "an interest in older Indians and their
welfare" is mandated legislatively for the purpose of improving services
to older Indians. The Director of the Office of American Indian, Alaskan
Native and Native Hawaiian Programs chairs this Task Force. Task Force
members focus on three areas of concern: health, transportation, and data.
Three subcommittees gather and analyze information, offer recommendations
to the Task Force to further interagency collaboration and enhance services
to older Indians, and identify problems that prevent or diminish collaboration.
During FY 1999, as an outgrowth of the discussions of the Interagency
Task Force for Older Indians chaired by AoA, a subcommittee was formed
to address the need for the development of culturally appropriate material
to be disseminated to the tribes. Participating members of the subcommittees
include representatives from the Veterans Administration (VA) and the
Health Care Financing Administration (HCFA).
During FY 1999, meetings were held with HCFA and AARP on home and community-based
waivers (Medicaid 1915C), with an eye toward training family caregivers
to be eligible to receive Medicaid 1915C-waiver reimbursements for providing
home and community based services.
Also during FY 1999, contacts with and meetings involving the Home and
Community-Based Care Office of the VA were held to discuss methods of
reaching and assisting elderly veterans who reside on reservations. As
a result of these meetings, AoA has invited representatives from the VA
to join its ongoing Interagency Task Force on Older Indians.
Results
The FY 1999 Interagency Task Force on Older Indians Subcommittee’s efforts
will lead to the dissemination of culturally appropriate materials to
Indian tribes aimed at heightening their sensitivity to the needs of their
elders and at increasing their understanding of changes in Medicare/Medicaid
services.
Training and certification of family caregivers will empower them to care
for their elderly family members in Indian communities in more culturally
sensitive and acceptable ways.
The AoA-VA partnership has led to increased efforts to reach and assist
elderly Indian veterans and to increase their knowledge of and access
to services.
Strategic Goal 2.3: Provide opportunities
to live with safety, independence and dignity
Resources, Strategic Goal 2.3 |
FY 1999 Actual |
FY 2000 Appropriation |
FY 2001 Requested |
$ 18,581 |
$ 24,631 |
$149,849 |
Performance Goal 2.3.A – Long-Term Care Ombudsman |
FY Targets |
Actual Performance |
Maintain the combined resolution/partial resolution
rate of 70 percent of complaints in nursing homes. |
FY01: 70%
FY00: 70%
FY99: 71.48% |
FY99: 11/00
FY98: 70.6%
FY97: 72.1%
FY96: 74.0%
FY95: 71.5% |
Introduction
Long-term care ombudsmen are necessary advocates for residents of nursing
homes, board and care homes, and adult care facilities. Since the Long-term
Care Ombudsman Program began 25 years ago, thousands of paid and volunteer
ombudsmen working in every state have made a dramatic difference in the
lives of long-term care residents. Long-term Care Ombudsmen advocate on
behalf of individuals and groups of residents as well as work to effect
systems changes on a local, state and national level.
Ombudsman responsibilities outlined in Title VII of the Older Americans
Act include:
- Identifying, investigating and resolving complaints made by or on
behalf of residents;
- Providing information to residents about long-term care services;
- Representing the interests of residents before governmental agencies
and seeking administrative, legal and other remedies to protect residents;
- Analyzing, commenting on and recommending changes in laws and regulations
pertaining to the health, safety, welfare and rights of residents;
- Educating and informing consumers and the general public regarding
issues and concerns related to long-term care and facilitating public
comment on laws, regulations, policies and actions;
- Promoting the development of citizen organizations to participate
in the program; and providing technical support for the development
of resident and family councils to protect the well being and rights
of residents.
A major goal of the Ombudsman Program is to enable residents of long-term
care facilities and their families to be informed “long-term care consumers”
and to facilitate the resolution of problems regarding care and conditions
in long-term care facilities. Our target is to maintain the 70 percent resolution
/ partial resolution rate for complaints involving nursing homes.
Fiscal Year 1999 Accomplishments
AoA provides national leadership to the states in carrying out their ombudsman
programs. AoA funds the National Long-Term Care Ombudsman Resource Center
which provides training and technical assistance to ombudsmen throughout
the country. Located in Washington, D.C., the Center is operated by the
National Citizens' Coalition for Nursing Home Reform in conjunction with
the National Association of State Units on Aging. The Center provides essential
support for the ombudsman network in its efforts to provide assistance to
and empower long-term care residents, their families and other representatives
of residents’ interests. Some of the major Center objectives include:
- generating on-going communication with state and regional (local)
ombudsman programs
- providing training and training materials directed at expanding ombudsman
professional advocacy and management skills
- promoting public awareness of the ombudsman program
Over the last decade and through FY 1999, the Ombudsman Resource Center
has provided information and training to ombudsmen on improper use of physical
and chemical restraints and creative alternatives to the use of restraints.
The marked decrease in the use of restraints in nursing homes, evidenced
by significant reductions in deficiencies given to facilities for inappropriate
use of restraints, has been due in part to the work of ombudsmen in this
area.
Another primary area of focus in recent years and during FY 1999, is the
involuntary discharge of residents from nursing homes. Ombudsmen continue
to receive extensive training in this area and are now better equipped to
assist residents and their families in these matters.
Increases in long-term care residents' complaints on uses of restraints
and involuntary discharge demonstrate that residents and their families
are aware of residents’ rights in these and other areas and turn to the
ombudsman program for help in securing their rights. (Nursing home residents'
rights complaints to the ombudsman program increased by over 9 percent from
46,909 for FY 1996 to 51,385 for FY 1997, a trend that is expected to continue
for FY 1998 and FY 1999.)
Results
Ombudsman training has improved Ombudsmen’s abilities to assist long-term
care residents in resolving complaints about conditions in long-term care
facilities and other areas of concern and is helping to make older adults
better healthcare consumers by improving their awareness of their health
care rights and ensuring a better understanding of recourses available to
them for addressing issues of dissatisfaction.
Producing and Disseminating the National Ombudsman Report
AoA compiles the National Long Term Care Ombudsman Report from information
submitted by the states. The information is submitted in response to reporting
requirements, which were developed by AoA in the early 1990's to comply
with the requirements of the OAA and recommendations by the Office of
the Inspector General and the General Accounting Office. The report includes
program highlights, data on cases and complaints made to ombudsmen, information
on program structure and operation; and major long-term care issues identified
by states. The report is a valuable source of information available at
the national level on experiences of long-term care residents and operation
of the state ombudsman programs. Information in this report is used by
legislators, researchers, public policy analysts, state and federal government
officials, and ombudsmen themselves for a variety of purposes, including:
- understanding what is happening to long term care residents,
- addressing emerging and long-standing institutional care issues,
- having knowledge of ombudsman program structure and operation in other
states, and
- targeting training provided to staff and volunteers to address the
most prevalent types of complaints and designing public information
which best meets the public need, as reflected in calls to the ombudsman
program for information.
Because the report provides statewide data by program and per FTE, states
are able to see how their programs and staffing allocations compare with
one another. Where imbalances are noted, cases can be made with state legislatures
for additional funding. For example, the state of Georgia secured an additional
$114,000 in FY 1998 (using information from the report) leading to an updating
of their statewide funding formula for the first time in many years as well
as an anticipated increase in funding for FY 1999. These funds have enabled
them to upgrade their Ombudsman Program and provide more services to their
long term care consumers and their families.
Results
Information from the National Ombudsman Report is facilitating the improvement
of many state and local ombudsman programs by enabling ombudsmen to target
training in areas of need, concentrate volunteers and other resources
in troubled areas, and to leverage statistical information to gain additional
funding for programs from their state legislatures. .
Performance Goal 2.3.B -- Caregiver Support |
FY Targets |
Actual Performance |
Obtain reliable baselines through support of the National Institute
on Aging’s Caregiver Supplement to the National Long Term Care Survey
and follow-on surveys. |
FY01, FY00: Baselines to be established
FY99: N/A. |
NA – New Program |
Introduction
In the fiscal year 2001 budget proposal, AoA proposes to provide funding
for caregiver support activities under the existing authority of Title
III of the Older Americans Act. Help for caregivers is needed now more
than ever. The population age 85 and over will continue to grow faster
than any other age cohort, increasing by 50% from 1996 to 2010. Additionally,
research has shown that caregiving exacts a heavy emotional, physical,
and financial toll.
While the U.S. population is aging, the structure of the American family
continues to evolve. More women are in the workforce, making it more difficult
for them to be available as caregivers; family mobility has increased
thus geographically separating older family members from younger ones;
and family size has decreased resulting in fewer adult children being
available to serve as caregivers. Thus, fewer family members will increasingly
share caregiving responsibilities.
Support provided to informal caregivers can significantly benefit them
while delaying the need of care recipients for nursing home services.
For example, a recent NIH study found that caregiver stress is reduced
when care recipients use adult day care and institutionalization of the
care recipient is delayed.
Performance Goal 2.3.C – Health Care Anti-Fraud
Activities
|
FY Targets |
Actual Performance |
Increase by 30% for fiscal year 2000 and an additional
30% for fiscal year 2001 the number of trainers who conduct activities
to educate Medicare beneficiaries.
Increase by 50% for fiscal year 2000 and an additional 50% for fiscal
year 2001 the number of substantiated complaints generated through
this program’s activities.
Increase by 100% for fiscal year 2000 and another 150% for fiscal
year 2001 the amount of Medicare funds recouped that are attributable
to the project. |
FY 2001: 23,150 additional volunteers trained
FY 2000: 17,810 additional volunteers trained
FY 1999: N/A
FY 2001: 300 complaints
FY 2000: 200 complaints
FY 1999: N/A
FY 2001: $6.75 million
FY 2000: $2.70 million
FY 1999: N/A
|
FY99 Baseline: 13,700 volunteers trained who are
conducting educational sessions for Medicare beneficiaries.
FY99 Baseline: 133 complaints
FY 99 Baseline: $1.34 million |
Introduction
The General Accounting Office (GAO) estimates that billions of Medicare
dollars are lost each year to waste, fraud and abuse. The Department of
Health and Human Services has launched a comprehensive initiative which
focuses on fighting and preventing such wasteful, fraudulent and abusive
practices.
In 1995, the Administration on Aging (AoA) became a partner in a government-led
effort to fight fraud, waste and abuse in the Medicare and Medicaid programs
through the implementation of a ground-breaking demonstration project called
Operation Restore Trust (ORT). ORT’s purpose is to coordinate and target
federal, state, local and private resources on those areas most plagued
by fraud and abuse.
ORT is an outgrowth of a comprehensive anti-fraud initiative that began
in five states -- California, Florida, Illinois, New York and Texas. This
initiative created a partnership in the Department of Health and Human Services
between the Health Care Financing Administration, the Office of Inspector
General, and AoA, which work as a joint-team to carry out ORT. Other critical
partners include the U.S. Department of Justice, state Medicaid agencies,
state survey and certification agencies, Medicare contractors, State and
Area Agencies on Aging, and other members of AoA's National Aging Network,
including long-term care ombudsmen.
The ORT demonstration phase returned $23 for every $1 spent while focusing
on the fastest growing areas of Medicare (including home health care, skilled
nursing facilities, and providers of durable medical equipment).
AoA’s program goal for ORT is to train National Aging Network staff and
retired volunteers on ways to educate Medicaid and Medicare beneficiaries
regarding how to protect themselves against fraudulent, wasteful, and abusive
health care practices. This program goal relates to and supports the AoA
strategic goal: opportunity to live with safety, independence and dignity,
through planning and delivering quality health care services to older Americans.
Fiscal Year 1999 Accomplishments
Delivery of Grant Funded Technical Assistance and Training
AoA is committed to reducing waste, fraud and abuse in the Medicare and
Medicaid programs and has been involved in ORT since its inception, providing
technical assistance to state and local ombudsmen, health insurance counselors,
and others to recognize and report suspected cases of fraud and abuse in
nursing homes. It has since expanded these efforts by providing technical
assistance and training in 18 states to other National Aging Network personnel,
including staff and volunteers of State and Area Agencies on Aging, health
insurance counselors, and other service providers.
One of the key components of AoA’s anti-fraud efforts is the administration
of its cooperative agreement demonstration projects designed to utilize
the skills and expertise of retired professionals in identifying and reporting
health care waste, fraud and abuse. In FY 1997 and 1998, AoA awarded 12
grants for the purpose of providing technical assistance and training in
these and other related areas. During FY 1999, AoA expanded these efforts
by awarding 29 new grants in 24 additional states and the District of Columbia
and Puerto Rico, for a total of 41 grants designed to train retired volunteers
on ways to educate Medicare and Medicaid beneficiaries regarding how to
protect themselves from fraudulent, wasteful and abusive health care practices.
Through input from volunteers, partners and stakeholders, AoA also worked
to develop numerous technical resources. These include:
- best practice recommendations
- a bimonthly newsletter for grantees
- a limited access internet communication system for sharing information
and answering questions
- a web page which includes training manuals, pamphlets and brochures
- bi-regional conferences which bring together experts from the Office
of the Inspector General, HCFA, Medicare carriers and others to develop
and institutionalize strategies for preventing waste, fraud and abuse
in the healthcare systems
- an annual conference for providing technical assistance and information
exchange.
Results
During the initial demonstration stage of ORT, AoA staff trained an estimated
2,500 people in the five ORT states. The combined ORT effort by all of its
partners led to the overall collection of $187 million in fines, recoveries,
settlements, audit disallowance and civil monetary penalties owed to the
federal government.
During FY 1998 and FY 1999, AoA and its grantees trained more than 16,000
volunteers to serve as Medicare and Medicaid educators in their communities.
Working through group and one-on-one sessions, these volunteers educated
over 325,000 beneficiaries on ways of identifying and protecting themselves
against fraudulent, wasteful, and abusive health care practices. During
FY 1999, more than 5,000 cases involving questionable charges for medical
services were referred by the volunteers to health care providers, appropriate
Medicare carriers, or the HHS Inspector General for follow-up and investigation
Delivery of Public Information
AoA has continued to provide a variety of valuable information to the general
public regarding Medicare and Medicaid waste, fraud and abuse. This information
helps to increase public awareness and empowers individuals to take greater
personal responsibility for monitoring their own health care. The information
is also designed to address the seriousness of this problem and to subsequently
provide advice and guidance on preventive techniques and methods that can
help reduce victimization of older Americans through fraudulent health care
practices. Examples of major presentations included: • Information
presented in public forums and other community education sessions, highlighted
by a national “roll-out” event held on February 24, 1999, simultaneously
in 30 sites around the country, which were linked by satellite.
- In FY 1999, AoA’s grantees, developed a brochure in partnership with
doctors, hospitals, and health care providers which is provided to beneficiaries
when they are discharged from the hospital to inform them about the
steps they can take to protect themselves from fraudulent or unscrupulous
practices.
- Also in FY 1999, a series of locally-based training manuals and consumer
education materials were developed, including information on Medicare
and Medicaid and examples of fraudulent health care practices. Training
sessions were delivered through a coordinated effort with other federal,
state and local agencies.
- Another major FY 1999 activity was the creation of a health care journal
for Medicare/Medicaid beneficiaries, which AoA developed in partnership
with its grantees.
- Also in FY 1999, AoA funded 50 public service announcements and 1250
media events to increase public awareness on ways to protect against
health care waste, fraud and abuse.
Results
Since the national “roll-out” event, dissemination of the training materials,
and the informational brochures, calls from hospitals and health care personnel
for additional materials and speakers have been increasing. There have also
been noticeable increases in newspaper articles and a groundswell of invitations
from senior centers for speakers and experts to present information on ways
to combat fraudulent and unscrupulous healthcare practices. These trends
highlight an increasing awareness among these groups to better understand
and develop methods for dealing with this highly important healthcare issue
– a primary goal of the ORT program.
During FY 1999, the health care journal was used by Medicare/Medicaid
beneficiaries to record the medical care they receive. The journal
facilitated communication and understanding between health care
providers and patients and serves as a record for beneficiaries
to use in reconciling their Medicare statements. The journal was
used by beneficiaries to record such information as the purpose
of health care visits, the date, the health care provider, etc.
This information ultimately helped them to better understand their
legitimate health care financial obligations as well as to recognize
questionable and otherwise fraudulent health care charges. This
increased understanding is, to a degree evidenced in the growing
number of consumer complaints among these consumers.
Strategic Goal 2.4: Develop comprehensive
and coordinated services systems based on local needs.
Resources, Strategic Goal 2.4 |
FY 1999 Actual |
FY 2000 Appropriation |
FY 2001 Requested |
$13,000 |
$21,162 |
$26,162 |
Program Goal 2.4.A -- State and Local Innovations
and Projects of National Significance – Mental Health Initiative
|
FY Targets |
Actual Performance |
Create and distribute culturally-appropriate educational
materials about mental illnesses common among older adults;
Enable aging network professionals to recognize symptoms of mental
illness, use culturally appropriate strategies for promoting good
mental health, and strengthen ties with mental health professionals;
Provide information resources to clinicians who work with older adults
to help them improve diagnostic accuracy, make better use of age-appropriate
treatments, and use community-based aging services as effective psychosocial
treatments. |
FY01: Increase over baseline by an appropriate amount.
FY00: Establish baselines
FY99: N/A |
N/A -- New program |
Introduction
Under its program of State and Local Innovations and Projects of National
Significance, AoA’s discretionary grants have developed, tested and incorporated
innovative programs at the state and local levels. The contributions of
several Title IV program initiatives (e.g., Operation Restore Trust and
the Eldercare Locator) to the accomplishment of AoA’s FY 1999 goals have
been presented in other sections of this report. The focus for the 2001
performance plan is AoA’s proposal to develop a mental health initiative.
Under this initiative, AoA will provide:
- Incentive-based competitive grants to states for the purpose of developing
replicable models of innovations in mental health service delivery to
older people. Preference for these incentive grants will be given to
states that target Preventive Health funds for mental health activities.
- Development and provision of technical assistance and education to
enhance the capacity of both the aging network and the mental health
network to better serve older people. These capacity building efforts
include:
Customer Education – Development of educational materials to de-stigmatize
mental illness among older adults, improve the ability of elders and their
families to recognize the symptoms of mental illness, improve access to
mental health services and treatment, and promote good mental health by
teaching preventative health behaviors. Particular attention will be given
to the special informational requirements which are appropriate for minority
elders and for those with the highest rates of suicide (white males 85+,
Asian women 65+, for example). Capacity for Building Aging Network
Professionals – Development of a nationwide training and technical assistance
effort to enable Aging Network professionals to recognize the symptoms of
mental illness in older adults, to transmit best practices such as culturally
appropriate strategies for promoting mental health in older people, and
to promote appropriate, timely referrals between the aging and mental health
networks. Physician Information -- Provide informational
resources to physicians and other clinicians who work with older adults
to help them improve accuracy of their diagnoses, to utilize age-appropriate
mental health treatment protocols and resources, and to appropriately use
community based aging and mental health services as supportive psychosocial
interventions.
Fiscal Year 1999 Accomplishments
The program goal for AoA’s program of State and Local Innovations and Projects
of National Significance is to establish programs for model demonstrations,
applied research and national resource centers to produce best practices,
useful knowledge, and systems improvements that point policy makers and
program administrators to well-reasoned courses of action in the field of
aging.
This goal supports AoA’s strategic goal of development of comprehensive
and coordinated services system for older individuals.
During the 1980’s, discretionary grants helped several states, including
Colorado, Hawaii, Oregon, and Wisconsin develop cutting edge home and community-based
service systems for frail older adults. Competitive grants have underwritten
the necessary planning and implementation of systems of home and community-based
long term care services.
In FY 1995, AoA created the National Mentors Programs in Aging to encourage
states in learning about and sharing with one another their successes in
developing long term care service systems. States with demonstrated proficiency
in the operation of home and community-based care systems were organized
as a corps of mentors and advised other states on best practices in developing
long-term care systems.
Through its program of State and Local Innovations and Projects of National
Significance, AoA has funded numerous community and regional coalitions
to address the needs of at-risk older adults. By involving churches, businesses
and other organizations, these coalitions have forged new partnerships and
have yielded tangible benefits, such as additional volunteers and expanded
resources for older adults in their communities.
On a national level, this program supports the Eldercare Locator, an effort
to help local and long-distance caregivers find information they need. By
calling a toll-free number, family members are directed to appropriate sources
of information about services for older persons in every locality in the
U.S. Results
In FY 1999, the National Mentors Programs in Aging project produced an updated
“State Long-term Care Profiles Report,” documenting the progress states
have made toward a more balanced long term care system. Developing such
a system will help to offset the current over-reliance on nursing facility
care by promoting greater use of home and community-based care. The report
is being used by states in developing strategies and programs to strengthen
home and community based service systems.
Part III – Appendices A.1
Approach to Performance Measurement
A.1.A Evaluations
Major program evaluations have been used to inform AoA’s GPRA efforts.
For example, national program evaluations of the Elderly Nutrition and
Long-Term Care Ombudsman Programs were completed in 1995 and 1996. These
studies offered compelling evidence of the importance of performance measurement
and the use of current research findings for professionals who manage
and deliver these services. Furthermore, the studies helped to identify
outcomes and areas where ongoing measurement can advance understanding
of the relationship of particular interventions to desired outcomes. We
believe the implementation of a program outcome information collection
system would enable ongoing program evaluation, with basic performance
information suggesting areas for policy inquiries answerable only by such
formal evaluations.
A.1.B Data Verification and Validation
OMB approval to implement the State Program Report – mandated under the
1992 amendments to the Older Americans Act -- was obtained in time to
establish a system which draws upon data from fiscal year 1995. AoA used
a three-year phase-in of the system, with detailed client-registration
data first required for fiscal year 1997.
Data verification has been accomplished through a labor-intensive data
review process involving AoA regional staff, who also contact state officials
to reconcile any inconsistencies. To reduce the amount of time required
by this method, AoA has worked closely with states on implementation issues
and is in the process of automating segments of the process.
Currently, the verification process takes more than a year. Data from
fiscal year 1997 is available now. Preliminary data from fiscal year 1999
will be available in September, 2001.
A.1.C Performance Outcome Measures Project
As noted earlier, AoA is working in partnership with 17 State and Area
Agency partners, which were selected in October 1998, and two national
organizations which represent these components of the Aging Network. Major
milestones completed under the Project include:
- November, 1998: Representatives of the 17 participating agencies
(Partners) met to complete an in-depth review of the Project objectives
and the four phases of work: data collection; determination of a core
set of performance outcome measures; field-testing of the core set of
measures; and dissemination and utilization activities.
- February, 1999: AoA convened an Expert Committee to advise the Project
staff on such issues as the appropriateness of specific measures used
by states and local agencies and their applicability for wider use throughout
the aging network, and use of national data sets as indicators of program
performance. The Expert Committee reviewed proposed outcome measures
developed by the Partners. The Committee also requested that development
of specific products to facilitate their work, including a literature
review and annotated bibliography, as well as information about relevant
data sets available through federal surveys. These products were completed
by April, 1999.
- January through March, 1999: Project staff completed the administration
of a semi-structured interview guide to document performance outcome
measures currently in use or under development by participating agencies.
The detailed results of this data collection are available in a document,
“Performance Outcome Measures Project: Interim Report of Information
Collection Activities.”
- March, 1999: A second meeting of the Partners was held to review
the data collected, and to organize potential outcome measures suitable
for inclusion in a core set around nine areas of concern, such as “access
to services” and “social functioning.” Participants subsequently prioritized
the proposed outcome measures by availability and usefulness.
- May, 1999: The second meeting of the Expert Committee involved the
review and discussion of performance outcome measures suggested by the
Partners, and the documented measures currently used by the Partners’
agencies. The Committee also deliberated over the use of data from national
surveys as indicators of performance for programs for older Americans.
- June, 1999: Drawing from the recommendations received from the Expert
Commmittee on the performance outcome measures suggested by the Partners,
AoA and its contract researchers assembled and proposed a core set of
performance outcome measures. The Project has adapted a theoretical
framework developed by the United Way to guide its work.
- November, 1999: Commitments were secured by Partners to field-test
select measures. Based upon the measures they are testing, the Partners
are participating on a variety of technical support and discussion groups
led by staff and by contract researchers. Final work is now underway
on data-collection instruments. Data collection from the field test
will be completed by September, 2000.
A.2 Changes and Improvements Over Previous
Year
There are four significant improvements to AoA’s previous (FY 2000) Performance
Plan. First, AoA restructured its plan to conform to the new HHS Department-wide
format. HHS developed the standardized format to address GAO and OMB’s
concerns; i.e., plan components were inconsistent and difficult to cross-reference.
The standardized format also allows HHS to meet the requirements of the
FY 2001 Annual Performance Plan, the FY 2000 Revised Final Performance
Plan, and the FY 1999 Performance Report in one document. AoA chose to
organize this document around four strategic goals.
Second, AoA has clarified several of its objectives to provide a single,
concise statement of its program activities. Third, AoA has progressed
on several of its developmental goals. While targets have not been identified
for all of these goals, both baselines and objectives have been refined.
Finally, AoA dropped the case management goal, as the measure is no longer
appropriate, and adjusted several FY 2000 targets consistent with appropriations
levels.
Original FY 2000 |
Revised FY 2000 |
Rationale for Change |
Performance Goal 2.2.C : Secure
and maintain access to aging-related services and opportunities for
older individuals and their families through the provision of case
management services through the Older Americans Act and other funding
sources. |
Performance Goal 2.2.C : Dropped.
|
AoA determined that this is not an appropriate measure
because “consumer directed care” is becoming increasingly popular.
|
Performance Goal 2.1.A – Home Delivered
Meals: Increase the number of home-delivered meals served to 146 million
meals. |
Performance Goal 2.1.A – Home Delivered
Meals: Increase the number of home-delivered meals served to 155 million
meals. |
Increased Congressional appropriation. |
Performance Goal 2.1.B – Congregate
meals: Maintain the level of service provision at the FY 1995 level
of 123.4 million meals. |
Performance Goal 2.1.B – Congregate
meals: Maintain the number of meals served at the 1997 baseline of
113,147,407. |
Updated performance data; lack of increase in Congressional
appropriation; and pattern by States of transfer of funds from congregate
to home-delivered meals programs. |
Performance Goal 2.1.C – Programs
for American Indians, Alaskan Natives and Native Hawaiians: Service
delivery at FY95 levels:
Home-Delivered Meals: 1,455,911
Congregate Meals: 1,321,728
Transportation: 763,287
Info & Referral: 632,462
In-Home Services: 741,859
Other: 511,646 |
Performance Goal 2.1.C – Programs
for American Indians, Alaskan Natives and Native Hawaiians: Service
delivery at FY97 levels:
Home-Delivered Meals: 1,632,000
Congregate Meals: 1,438,908
Transportation: 665,063
Info & Referral 678,979
In-Home Services: 866,194
Other: 590,723 |
Updated performance information: new targets reflect
service provision at FY97, rather than FY95 levels. |
Performance Goal 2.2.A – Information
and Assistance: Maintain level of service provision at FY95 level
of 12,526,526 contacts. |
Performance Goal 2.2.A – Information
and Assistance: Maintain level of service provision at FY97 level
of 13,985,091 contacts. |
Updated performance information: new targets reflect
service provision at FY97, rather than FY95 levels |
Performance Goal 2.2.B – Transportation:
Maintain level of service provision at FY95 level of 39,496,946 one-way
rides |
Performance Goal 2.2.B – Transportation:
Maintain level of service provision at FY97 level of 46,578,352 one-way
rides |
Updated performance information: new
targets reflect service provision at FY97, rather than FY95 levels
|
Performance Goal 2.3.A – Long-Term
Care Ombudsman: Maintain the combined resolution / partial resolution
rate of 71.48 percent of complaints in nursing homes. |
Performance Goal 2.3.A – Long-Term
Care Ombudsman: Maintain the combined resolution / partial resolution
rate of 70 percent of complaints in nursing homes. |
Fluctuations in reported performance
levels have occurred as new data system is implemented; agency decided
on 70 percent resolution / partial resolution rate as appropriate
target. |
Performance Goal 2.3.C – Health Care
Anti-Fraud Activities: No numeric targets |
Performance Goal 2.3.C – Health Care
Anti-Fraud Activities:
Increase number of trainers – 17,810 additional volunteers trained.
Increase substantiated complaints – 200 additional complaints
Increase Medicare funds recouped – additional $2.7 million |
Number targets established for the first
time. |
A.3 Linkage to HHS Strategic Plan
HHS Strategic Goal 1: Reduce the Major Threats
to Health and Productivity of All Americans |
HHS Strategic Objective 1.3: Improve the Diet
and Level of Physical Activity of Americans |
AoA Programs -- Objectives |
Nutrition Services
- Home Delivered Meals
- Prevent decline and/or improve nutritional intake of home-delivered
meal recipients.
- Congregate Meals
- Prevent decline and/or improve nutritional intake of congregate
meal program participants.
|
Programs for American Indians, Alaska Natives, and
Native Hawaiians
- Improve the health and well-being, and reduce social isolation
among older American Indians, Alaska Natives, and native Hawaiians
through the provision of community-based services, such as those
directed at improving the diet and physical activity of these
groups.
|
HHS Strategic Goal 2: Improve the Economic and
Social Well-Being of Individuals, Families and Communities in the
United States |
HHS Strategic Objective 2.5: Increase Opportunities
for Seniors to Have an Active and Healthy Aging Experience |
AoA Programs -- Objectives |
Nutrition Services
- Improving or maintaining the nutritional intake of meal program
participants.
|
Community-Based Services
Information and Assistance
- Provide older Americans with accurate, timely information so
they may make informed choices, and, if appropriate, obtain available
services and supports.
Transportation Services
- Provide transportation services that help older Americans perform
activities essential to their continued health and well-being.
|
Programs for American Indians, Alaska Natives and
Native Hawaiians
- Providing community-based services to improve the health and
well-being, and reduce social isolation among American Indians,
Alaska Natives and Native Hawaiians.
|
Alzheimer’s Disease Demonstration Grants
- Demonstrate effective ways to provide people with Alzheimer’s
and related disorders and their families with the services they
need.
|
State and Local Innovations and Projects of National
Significance—Mental Health Initiative
- Address the mental health issues affecting older Americans.
|
HHS Strategic Objective 2.6: Expand Access to
Consumer-Directed Home and Community-Based Long Term-Care and Health
Services
|
AoA Programs -- Objectives |
Long-Term Care Ombudsman
- Assist residents, families, friends and others to resolve problems
related to care and conditions in long-term care facilities.
|
Alzheimer’s Disease Demonstration Grants
- Demonstrate ways to provide people with Alzheimer’s Disease
and related disorders and their families with the home and community-based
long-term care and health services they need.
|
HHS Strategic Goal 3: Improve Access to Health
Services and Ensure the Integrity of the Nation’s Health Entitlement
and Safety Net Programs |
HHS Strategic Objective 3.5: Enhance the Fiscal
Integrity of HCFA Programs and Ensure the Best Value for Health
Care Beneficiaries |
Operation Restore Trust
- Conduct activities to educate Medicare beneficiaries.
- Increase number of complaints about instances of possible fraud
and abuse.
- Increase amount of Medicare funds recouped throughinvestigation
and prosecution of fraud and abuse.
|
HHS Strategic Objective 3.6: Improve the Health
Status of American Indians and Alaska Natives |
AoA Program -- Objective |
Programs for American Indians, Alaska Natives and
Native Hawaiians
- Improve the health and well-being, and reducing social isolation
among older American Indians, Alaska Natives, and native Hawaiians
through the provision of community-based services.
|
HHS Strategic Goal 4: Improve the Quality
of Health Care and Human Services |
HHS Strategic Objective 4.1: Promote the Appropriate
use of Effective Health Services |
AoA Programs -- Objectives |
State and Local Innovations and Projects of National
Significance—Mental Health Initiative
- Promote the appropriate use of effective health services to
address the mental health issues affecting older Americans.
|
Alzheimer’s Disease Demonstration Grants
- Promote the appropriate use of effective health services to
provide people with Alzheimer’s Disease and related disorders
and their families with the services they need.
|
HHS Strategic Objective 4.2: Reduce Disparities
in the Receipt of Quality Health Care Services |
AoA Program -- Objectives |
State and Local Innovations and Projects of National
Significance—Mental Health Initiative
- Address the mental health issues affecting older Americans
by reducing disparities in the quality of health care received
by sufferers of physical and mental disorders.
|
Programs for American Indians, Alaska Natives and
Native Hawaiians
- Improve the health and well-being, and reduce social isolation
of Native Americans, Alaska Natives and Native Hawaiians by reducing
disparities in the receipt of quality health care among these
groups.
|
HHS Strategic Objective 4.4: Improve Consumer Protection |
AoA Program -- Objectives |
Long-Term Care Ombudsman
- Improve consumer protection by assisting residents, families,
friends and others to resolve problems related to care and conditions
in long-term care facilities.
|
Budget Linkage Table
($ Amounts in 000’s)
AoA FY 2001 Performance Plan Programs |
Program/Budget Line Items |
FY 1999 Appropriation |
FY 2000 President’s Budget |
FY 2001 Proposed |
Strategic Goal 1
2.1.A Home-Delivered Meals
2.1.B Congregate Meals
2.1.C Grants to Indian Tribes
Preventive Health Services |
Home-Delivered Meals
Congregate Meals
Grants to Indian Tribes
Preventive Health Services |
$ 112,000
$ 374,261
$ 18,457
$ 16,123 |
$ 147,000
$ 374,412
$ 18,457
$ 16,123 |
$ 147,000
$ 374,412
$ 23,457
$ 16,123 |
|
Strategic Goal 1 (Total) |
$ 520,841 |
$ 555,992 |
$ 560,992 |
Strategic Goal 2
2.2.A Information and Assistance
2.2.B Transportation
2.2.C Case Management
2.2.D Alzheimer’s Disease |
Supportive Services and Centers
Alzheimer’s Disease |
$ 309,957
$ 5,970 |
$ 310,082
$ 5,970 |
$ 325,082
$ 5,970 |
|
Strategic Goal 2 (Total) |
$ 315,927 |
$ 316,052 |
$ 331,052 |
Strategic Goal 3
2.3.A Long Term Care Ombudsman
2.3.B Caregiver Support
2.3.C Health Care Anti-Fraud
Activities |
Vulnerable Older Americans
Supportive Services and Centers
State & Local Innovations-Projects of Nat’l Significance; HCFAC
|
$ 12,181
$ --
$ 6,400 |
$ 13,181
$ --
$ 11,450 |
$ 13,181
$ 125,000
$ 11,668 |
|
Strategic Goal 3 (Total) |
$ 18,581 |
$ 24,631 |
$ 149,849 |
Strategic Goal 4
2.4.A State and Local Innovations and Projects of National Significance
– Mental Health Initiative |
State and Local Innovations and Projects of National
Significance |
$ 13,000 |
$21,162 |
$ 26,162 |
|
Strategic Goal 4 (Total) |
$ 13,000 |
$ 21,162 |
$26,162 |
|
Total Budget |
$868,349 |
$917,837 |
$1,068,055 |
|