Performance
Plans
2002 Government Performance and Results Act (GPRA) Annual Performance Plans and Reports
PDF version 263KB
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
Part
II: Performance Measures
2.1
Community Based Services
2.2
Ombudsman Services
2.3
Services for Native Americans
2.4
Research and Development
2.5
Senior Medicare Patrols
2.6
Program Management
Part III: Appendices
Approach to Performance Measurement
Changes and Improvements
Linkage to the HHS Strategic Plan
Linkage with the Budget and Other Functions
Introduction
With the Government Performance and Results Act (GPRA),
the Congress has established a management tool that compels Federal
agencies and programs to focus on results. Since the passage of
GPRA in 1993, program managers of the Administration on Aging
(AoA) have accepted GPRA as an opportunity to document each year
the results that are produced through the programs they administer
under the authority of the Older Americans Act (OAA). It is the
intent and commitment of AoA, in concert with State and local
program partners, to use the performance measurement tools of
GPRA to continuously improve OAA programs and services for the
elderly.
AoA is the Federal advocacy agency for the elderly and the lead
Federal partner of the “Aging Network,” which administers
programs established under the OAA to support the well being,
health and independence of older Americans. In addition to program
partners within HHS, AoA works with other Federal Departments
and agencies in support of the elderly, including the Departments
of Agriculture and Labor and the Social Security Administration.
The heart of the Aging Network, however, is the 56 State Units
on Aging, the 661 Area Agencies on Aging, and the approximately
29,000 paid and volunteer service providers, which deliver program
services to older individuals throughout the U.S.
In fact, the documentation of results, which is initially illustrated
for OAA programs with the new “developmental” performance
measures included in this plan and report, indicates that the
“Network” itself is a prime factor in the past success
and the future potential for these support programs for the elderly.
The Aging Network of Federal, State and local program managers
and service providers is effectively reaching out to vulnerable
older Americans and coordinating services from a variety of sources
to ensure that their needs are met.
Through extensive partnerships at the Federal, State and local
levels, the Network is producing the results that the Congress
has sought through the OAA. The Network is targeting services
to the most vulnerable elderly individuals in the country. Very
high proportions of service clients are poor and disabled. Many
are minorities, and a significant proportion resides in rural
areas. The Network improves the lives of people served; the nutritional
status of OAA clients is improved through the meals provided,
and support services allow elderly individuals to stay in their
homes. The Network leverages funds from other sources in amounts
that are higher than the OAA grants provided by AoA; the program
income generated by the Network is one-third of the amount provided
by AoA. Approximately half of the employees, who work for Area
Agencies on Aging to coordinate services for the elderly, are
volunteers. The additional services provided because of funding
leveraged by the Network support personal care and other services
that help the most vulnerable elderly individuals remain independent
in their homes. More than half of the senior centers that serve
elderly individuals in communities are also community “focal
points” responsible for service coordination. Government
entities and volunteers pursue excellence and the protection of
the rights and well being of individuals in nursing homes. Through
the Network, the elderly themselves work to improve the integrity
of the governmental health-care financing programs that support
them. The Network now is focusing on the assessment of quality
through the consumer, where it counts the most, at the community
level.
This presentation of AoA’s GPRA performance plan and report
reflects a significant improvement over previous plans and reports
because of the efforts of the Network to improve the availability
of data from the National Aging Program Information System (NAPIS)
and the Performance Outcome Measures Project (POMP). These two
data initiatives, which rely totally on the contributions of State
and Area Agencies on Aging and service providers, have allowed
AoA to identify far more relevant program performance measures
than were included in previous AoA plans, and provide initial
evidence of the effectiveness of the coordination activity and
programs of the Aging Network. Nevertheless, as this plan will
also demonstrate, significant improvement is needed before we
can achieve a level of data reliability that will best serve to
assess OAA program outcomes. Because of the “distributed”
nature of program service delivery for OAA programs, the Network
often relies on very small entities for the maintenance and reporting
of the data needed to demonstrate the continuous effectiveness
of OAA programs. Many of these entities simply lack the capacity
to manage data in a way that will allow for consistency and reliability
across the Network. The data limitations that AoA and the Network
must address are presented in more detail below and in Appendix
1.
Because of the value of performance information for demonstrating
the Network’s effectiveness, AoA and its program partners
will actively pursue support to modernize information generating
capacity across the Network, to expand performance outcome measurement,
which is now required under the OAA, and to refocus the NAPIS
data series toward a more limited and less burdensome data set
that will generate the type of GPRA program assessment that is
introduced in this plan.
The presentation of this plan and report is organized in accordance
with the standardized presentation format established by and for
the agencies of the Department of Health and Human Services (HHS).
AoA fully supports HHS’s efforts to present performance
measurement data under GPRA in a manner that is meaningful for
Federal executive and legislative branch decision makers. Since
the enactment of GPRA in 1993, the Office of Management and Budget
(OMB), the General Accounting Office (GAO), and HHS have provided
leadership that will allow Federal program components to continue
the development of meaningful, realistic and effective performance
measurement programs. Data Challenges
It is important in the introduction to this performance plan
and report to disclose the significant challenge that AoA and
the Aging Network face in obtaining data to measure performance
for programs of this kind. A more detailed presentation of data
issues is included in Appendix 1. All levels of the Aging Network,
from AoA through the state and area agencies on aging to local
centers and service providers, know well the challenge of producing
client and service counts by critical program and client characteristics
for a program which coordinates service delivery
through approximately 29,000 local providers. For example, many
OAA program services do not require a one-time registration for
service on the part of clients; eligible clients may obtain services
on an ad hoc and irregular basis. This makes the tracking of services
to individuals and the generation of “unduplicated”
counts of clients a very difficult task at the local level, particularly
if local entities lack information technology that simplifies
client and service record-keeping and information management.
Extensive and repeated Federal and State efforts to provide technical
assistance and to isolate and correct common data problems have
been helpful for local areas in the majority of States and for
most data elements required by the OAA through National Aging
Program Information System (NAPIS). Nevertheless, much remains
to be done to ensure that local service providers and area agencies
have the capacity to reliably provide important data without excessive
burden.
Because of the data challenge that the Network is addressing,
the FY 1999 data cited in this report must be classified as “preliminary”
data. This means that AoA and the States are still reviewing a
significant number of individual data items, which were generated
from data reported by local components, for accuracy and validity.
Agencies in two small States have not yet been able to generate
program data for FY 1999, and so we have used FY 1998 data for
those States to allow us to provide preliminary national estimates
for this performance report. It should be noted that potential
error for all national data elements caused by the use of FY 1998
data for these two States is less than one tenth of one percent,
so it is not a significant limitation. Still, it reflects that
the data are not complete. In the body of this plan and report,
we cite data limitations in instances where we believe that known
data errors may have affected the totals shown for selected performance
measures. While AoA and the Network must confront this data challenge,
this expanded performance plan and report clearly indicates that
data on client and service characteristics are very valuable to
AoA and the Aging Network in the context of GPRA. Over time, the
data that are collected will continuously document the value and
effectiveness of OAA programs and the Network that coordinates
services to elderly Americans. So, it is AoA’s intention
to fix the data problems that exist.
The Administration on Aging is committed to using the tools offered
by the Government Performance and Results Act to improve its service
to the Aging Network and improve the service of AoA and the Network
to elderly Americans. AoA is equally committed to accelerating
progress toward the development of a rich and comprehensive set
of measures that will inform program decision-making in the years
to come.
Part I Agency Context for Performance Measurement
1.1 Agency Mission and Long-Term Goals
The Administration on Aging (AoA) was established in 1965 through
the enactment of the Older Americans Act, in response to the growing
number of elders and their diverse needs, in particular those
at risk of losing their independence, especially older women,
and low-income minority and rural elders. AoA seeks continuously
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 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. Since 1965, the Older Americans
Act has been re-authorized six times. The latest was in November
2000 when the Older Americans Act Amendments of 2000 were signed
as Public Law 106 – 501, which extends the Act’s programs
through FY 2005.
Since the Older Americans Act was first enacted over 35 years
ago, it has enabled AoA to be the federal focal point for older
persons, their many contributions and their concerns. AoA has
the Congressionally mandated role of providing essential home
and community-based programs in communities all across the country
which keep America’s rapidly growing older population healthy,
secure and independent.
Strategic Goals of the Administration on Aging
The Older Americans Act (OAA) is also effective in defining for
AoA and the Aging Network a compelling set of long-term goals
focused on the quality of life of elderly individuals throughout
the Nation. For AoA, these are prominent among the strategic goals
of the Agency and the Network. The following are OAA and agency-generated
goals and objectives, which provide the foundation for the activities
and performance objectives of AoA and the Aging Network.
- Provide a comprehensive array of community-based, long-term
care adequate to appropriately sustain older people in their
communities and in their homes, including support to family
members and other persons providing voluntary care to older
individuals needing long-term care services.
- Support efficient community services, including access to
low-cost transportation, which provide a choice in supported
emphasis living arrangements and social assistance in a coordinated
manner and which are readily available when needed, with emphasis
on maintaining a continuum of care for vulnerable older individuals.
- Support freedom, independence, and the free exercise of individual
initiative in planning and managing their own lives, full participation
in the planning and operation of community-based services and
programs provided for their benefit, and protection against
abuse, neglect, and exploitation.
- Provide opportunities for better nutrition and improved health.
- Develop comprehensive and coordinated service systems based
on local needs.
- Provide the best possible physical and mental health services
which science can make available without regard to economic
status.
- Support activities which foster the participation of elders
in the widest range of civic, cultural, educational and training
and recreational opportunities.
- Provide opportunities for immediate benefit from proven research
knowledge, which can sustain and improve heath and happiness.
Linkage with the HHS Strategic Plan
AoA participated actively in the development of the revised strategic
goals and objectives of the Department of Health and Human Services
(HHS), as published September 30, 2000. AoA program activities
and strategies will continue to support HHS in the achievement
of HHS goals and objectives, and AoA program performance measurement
efforts will support HHS in its efforts to assess the progress
of the Department in achieving the goals and objectives of the
new HHS Strategic Plan. AoA will work with the HHS Office of the
Assistant Secretary for Management and Budget (ASMB) to ensure
continued presentation of AoA program strategies and performance
measures that support HHS goals in the HHS Annual Performance
Plan and Performance Report Summary. AoA programs, activities
and performance measures will be particularly relevant to HHS
efforts to meet the following HHS strategic goals and objectives:
- Goal 1 -- Reduce the Major Threats to the 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 the Proportion of Older Americans
Who Stay Active and Healthy
Strategic Objective 2.6: Increase the Independence and Quality
of Life of Persons with Long-term Care Needs
- 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 Purchase 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: Enhance the Appropriate Use of Effective
Health Services
Strategic Objective 4.4: Develop Knowledge That Improves the
Quality and Effectiveness of Human Services Practices
Along with statutory responsibilities and HHS objectives, the
agency’s mission is shaped by the agency’s strategic
vision. The Administration on Aging’s goals and priorities
respond to the phenomenon of dramatic longevity, which has become
ever more evident over the last decade. America’s social
practices, institutions and individuals will be required to respond
to a fundamental demographic shift because human life expectancy
has increased more during the last century than over the last
four millennia.
We value the knowledge we have gained from previous generations
of older Americans. AoA will build on this base of knowledge to
address pressing issues arising as a result of the longevity revolution.
We expect that advances in science, ubiquitous technology, and
a heightened demand for accountability will be significant factors
that will also shape new policy and program directions in the
coming years.
1.2 Organization, Programs, Operations, Strategies
and Resources
The Administration on Aging
The Administration on Aging provides leadership, coordination
and support to the Aging Network on behalf of older Americans.
AoA works to heighten awareness among other Federal agencies,
organizations, groups, and the public about the valuable contributions
that older Americans make to the Nation and alerts them to the
needs of vulnerable older people.
AoA provides Federal administration of community-services programs
that are mandated under the Older Americans Act. Primarily, these
programs seek to ensure the coordination and enhancement of services
that help vulnerable older persons to remain in their own homes.
The programs provide meals and various supportive services to
help vulnerable older persons remain in their own homes. They
also offer older Americans opportunities to enhance their health
and to be active contributors to their families, communities,
and the nation. Funding by AoA supports in-home and community-based
services including nutrition, transportation, health promotion,
nursing home ombudsmen, outreach, and elder abuse prevention efforts.
Also under the authority of the Older Americans Act, AoA awards
funds to support research, demonstration, and training programs.
Research projects collect information about the status and needs
of subgroups of the elderly, which is used to plan services and
identify opportunities that will assist them. Demonstration projects
test new program initiatives that better serve the elderly, especially
those who are vulnerable.
The Aging Network
Just as AoA coordinates federal activity to ensure the well-being
of older Americans, State and area agencies on aging ensure State
and local coordination and enhancement of services that help vulnerable
older persons to remain in their own homes. Fifty-six State agencies
on aging are allocated funds for support services based on a formula
that reflects the number of older residents in their State. 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 661 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. The State, local and tribal entities to which AoA awards
grants under the authority of the Older Americans Act, and the
service providers they support, comprise the Aging Network.
The Act was never intended, in and of itself, to establish a
discrete, independent services program. Rather, the Act put into
place a nationwide advocacy and 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 program
gaps,” for example, by providing services to people in need
who are ineligible for help through other programs.
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,
mostly to people who are poor and socially isolated. Many older
people with mild functional impairments also 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.
1.3 Partnerships and Coordination
In addition to the fundamental partnership with State and local
agencies, which comprises the basic operating structure of the
Aging Network, AoA works closely with many Federal agencies on
a wide range of issues.
In the area of nutrition, AoA works with the U.S. Department
of Agriculture (USDA) on such issues as food security measurement
and dietary guidelines used as standards for our programs. This
is in addition to USDA’s participation as a partial funding
agent for meals provided through the Aging Network. HHS work with
USDA supports and enhances AoA and HHS objectives to improve the
nutritional status of program participants and the elderly as
a whole. Within HHS, we work with the Office of Public Health
and Science on Dietary Reference Intakes (DRIs), formerly known
as Recommended Dietary Allowances and on nutrition performance
measures related to the Healthy People 2010 Initiative. We also
are a participant in the Federal Food Safety Coalition chaired
by the Center for Food Safety and Applied Nutrition within the
Food and Drug Administration. AoA is also represented on such
bodies as the HHS Nutrition Policy Board; the HHS Dietary Guidance
committee; the HHS/USDA Food Security committee; and the HHS Dietary
Reference Intake Working Group.
In the pursuit of improved transportation services provided through
the Aging Network, 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.
AoA is working with the Centers for Disease Control and Prevention
(CDC) to expand CDC’s Racial and Ethnic Approaches to Community
Health (REACH 2010) to four additional communities that develop
science-based, community demonstration projects for elderly populations.
The purpose of these projects is to eliminate health disparities
among older racial and ethnic minority populations, including
African-American, Asian American and Pacific Islander, Hispanic
American and American Indian or Alaskan native populations. The
initiative will target disparities in cardiovascular disease,
diabetes, and immunizations among older racial and ethnic minority
populations.
In the area of consumer protection and elder abuse, AoA and the
Department of Justice (DOJ) are disseminating information on promising
Federal, State and local approaches that empower older people
to live healthy and safe lives. Featured approaches also address
the coordination of public safety, health and social services
that provide effective prevention and intervention strategies
and reduce victimization. Specific areas of emphasis by AoA and
DOJ include: (1) domestic elder abuse; (2) institutional elder
abuse; and (3) fraud and exploitation, including consumer fraud
issues such as telemarketing. Our shared objective is to foster
enhanced collaboration between the justice, health, aging and
human services networks.
AoA is developing a partnership with HRSA’s (Health Resources
and Services Administration) Bureau of Health Professions, Division
of Nursing, to initiate a demonstration program to train nurses
specifically to work with, educate and mentor caregivers. Although
nurses are well trained in acute care for older persons, there
is little or no preparatory training for follow-up care and continuing
care of chronic conditions.
During FY 2000, AoA and HCFA joined forces to improve the quality
of care in Nursing Homes. Funding was provided to the National
Long-Term Care Ombudsman Resource Center, the National Center
on Elder Abuse, the National Policy and Resource Center on Nutrition
and Aging and the National Association of Area Agencies on Aging.
The activities of these grantees have resulted in the identification,
development, and demonstration of effective methods to assure
that nursing home staff, residents, family members and communities
at-large understand the types and causes of malnutrition, dehydration
and abuse as well as actions they can take to prevent them.
1.4 Performance Report Summary
Because of the availability of preliminary data for FY 1999 for
the performance measures included in AoA’s FY 1999 Annual
Performance Plan and for the new measures that AoA will utilize
in the future, this submission constitutes AoA’s first significant
GPRA Annual Performance Report. The following chart illustrates
the status of AoA reporting of performance measures included in
its FY 1999 GPRA performance plan. The time needed for the collection
of data from State and local entities does not allow AoA to report
on the performance measures included in its FY 2000 performance
plan. However, whereas AoA had indicated last year that FY 2000
data would not be available until FY 2003, AoA commits to report
the data in the next GPRA performance report to Congress in February
2002.
Year |
Measures in Plan |
Results Reported |
Results Met |
Unreported |
1999 |
18 |
18 |
14 |
0 |
2000 |
18 |
3 |
3 |
15 |
2001 |
26 |
NA |
NA |
NA |
2002 |
26 |
NA |
NA |
NA |
Even before FY 1999 data were available for reporting against
the FY 1999 performance plan, AoA became aware that the measures
utilized in the original FY 1999 plan would not satisfactorily
reflect the program results produced by the Aging Network. For
example, the four FY 1999 performance targets which AoA did not
meet were related to counts of clients served and selected service
units. In analyzing data from FY 1997 and FY 1998, AoA determined
that not meeting these targets reflected an inability to project
these numbers accurately, and was not a matter of program performance.
In fact, performance overall for all of the output measures reflect
consistent, stable service performance across the service areas.
The major changes in the performance measures AoA has added to
the performance plans for FY 2001 and 2002 correct the serious
limitation that the service output measures alone are not indicative
of the results produced on an ongoing basis through the Aging
Network.
The data for the new performance measures identified throughout
this plan, which were tabulated from the National Aging Program
Information System (NAPIS) for FY 1997, FY 1998 and FY 1999 (preliminary),
present a story of performance by the components of the Aging
Network that indicates that the Network produces the results intended
by the Older Americans Act (OAA). The data for each of the three
years show that the Aging Network successfully identified vulnerable
elderly individuals, including the poor, minorities, and individuals
from rural areas. Each year, the Network leveraged funding from
other sources in amounts that were 50% higher than the funding
provided by AoA. The data presented throughout this plan and report
show that the services financed with the funds leveraged from
other sources are those services which allow vulnerable older
individuals to remain in the community, in their homes. The data
show a Network that fosters extensive participation of volunteers,
even in the local entities that help to administer the OAA programs.
The data reflect that the Aging Network works systematically to
improve service coordination, as demonstrated particularly by
the high percentage of senior centers, which are “focal
points” for community services.
Beginning with this submission, AoA has begun to identify developmental
measures, which better address the results generated each year
by the activities of AoA and the Aging Network. The table above
includes counts of those measures for which we have provided performance
targets for FY 2001 and 2002. As we move forward with fuller implementation
of the Performance Outcomes Measures Project, the count of measures
will be expanded to include targets for all of the 36 measures
identified for FY 2002. Although outcome, client and service measures
must remain the center of AoA’s performance measurement
efforts, other relevant measures such as targeting measures, systems
measures and program management measures are proposed for the
first time, and will be made available each year. AoA will continue
to enhance the coverage of its programs and activities to increase
the body of data available for performance measurement annually.
Part II Program Planning and Assessment
Introduction
The core of GPRA planning and reporting is the presentation of
performance measures that address the results that AoA and Aging
Network produce for the program activities entrusted to them.
This Program Planning and Assessment presentation focuses on the
performance story that emerges from the performance measures AoA
uses for the assessment of each of the program activities included
in the AoA budget. Accordingly, AoA organizes the Annual Performance
Plan and Performance Report to reflect the overall program structure
of the agency. For each major program activity listed below, AoA
presents performance targets and results in the context of program
objectives and strategies. There is a strong and intentional linkage
between the presentation of program activities in this plan and
the presentation of the AoA budget request. The performance results
of the Aging Network reflect the financial support of programs
for the elderly administered under the OAA. Similarly, the strategies
that are supported annually in AoA budget requests will contribute
to the continued success of the Aging Network in producing results
for older Americans. The AoA program categories identified for
GPRA presentation purposes, with the budget line items that comprise
them, are:
- Community-Based Services
Budget line items:
- Supportive Services and Centers
- Congregate Meals
- Home-Delivered Meals
- Preventive Health Services
- Caregivers (NFCSP)
- Vulnerable Older Americans
Budget line item:
- Ombudsman Services
- Prevention of Elder Abuse
- Native American Services
Budget line item:
- Research and Development
Budget line items:
- Research and Development
- Alzheimer’s Disease Demonstration Grants to States
- Aging Network Support Activities
- Senior Medicare Patrols
- Operation Restore Trust (HCFAC)
- Program Management
Budget line item:
2.1 Community-Based Services
Program Description and Context
(numbers in thousands) |
FY 1999 Enacted
|
FY 2000 Enacted
|
FY 2001 Enacted
|
FY 2002 President’s Budget
|
Community Based Services |
$812,616 |
$847,446 |
$1,001,610 |
$1,011,610 |
AoA’s GPRA program category, Community-Based Services,
comprises the agency’s State and Community budget line items
with the exception of the Protection of Vulnerable Americans line,
which we have elected to show separately for GPRA purposes. Beginning
in FY 2001, this line item also includes a new program created
under the OAA: the National Family Caregiver Support Program.
As indicated above in section 1.2, State Agencies on Aging are
allocated funds for State and Community programs based on formulas
that reflect the number of older residents in their State. These
and other Federal funds and funds from other sources are used
by State and area agencies on aging and service providers to coordinate
and to provide services for elderly individuals.
The services provided under this program activity are extensive
and address the multiple needs of elderly individuals. The program
addresses “access” services, which include information
and assistance, outreach, case-management and transportation.
The program covers direct “community” services, which
include congregate meals, senior-center activities, adult day
care, pension counseling, and health promotion and fitness programs.
This program activity also covers “in-home” services,
which include home-delivered meals, chores, home maintenance assistance,
home-health, and personal care. With the reauthorization of the
OAA, this program also includes “caregiver” support,
such as respite services and information and assistance to caregivers
for the coordination of health and social services.
Goal-by-Goal Presentation of Performance
The Community-Based Services Programs cover the vast majority
of the resources, services and activities of AoA and the Aging
Network. To improve our communication of the potential and the
effectiveness of these programs in this performance plan and report,
AoA has developed an expanded and mixed set of performance measures
for its Community-Based Services Programs. This performance plan
commits for the first time to the development of performance measures
associated with targeting services to vulnerable elderly individuals.
The plan retains the important and fundamental service output
measures that have appeared in previous performance plans for
nutrition, transportation, and information services, and includes
measures that track federal and other contributions to the services
provided through the Aging Network. This plan also presents more
prominently the developmental performance outcome measures that
AoA and the Aging Network are testing under the Performance Outcome
Measures Project. Finally, the plan introduces selected developmental
“systems” measures that reflect the importance of
tracking the capacity of the Aging Network to support the service
activities of the program.
For ease of analysis of performance measures and data in this
section of the plan, AoA provides a summary table for each category
of performance measure for its community services programs, followed
by an analysis of the performance measures and data. The performance
measure categories for this program are 1) targeting measures,
2) system measures, 3) the measures for the traditional units-of-service,
and 4) client and program outcome measures. The narrative analysis
of FY 2000 program accomplishments is provided under the “service
measures” section where the major program activities under
community services are addressed.
Performance Measures Summary Table—Targeting Measures
Performance Goals |
Targets |
Actual Performance |
Notes |
Provide OAA Title III services to a significant
percentage of U.S. poor elderly individuals. (Developmental)
|
FY 02: 45%
FY 01: 45%
FY 00: (New in 01) |
FY 02: 02/04
FY 01: 02/03
FY 00: 02/02
FY 99: 48.1%
FY 98: 53.1%
FY 97: 59.8% |
|
A significant percentage of OAA Title III service recipients
are poor. (Developmental) Norm:
Percent of U.S. elderly population who are poor:
|
FY 02: 25%
FY 01: 25%
FY 00: (New in 01) |
FY 02: 02/04
FY 01: 02/03
FY 00: 02/02
FY 99: 29.9%
FY 98: 36.2%
FY 97: 39.1% |
|
A significant percentage of OAA Title III service recipients
are minorities.
(Developmental)
Norm: Percent of U.S. elderly population who are
minorities:
|
FY 02: 17%
FY 01: 17%
FY 00: (New in 01) |
FY 02: 02/04
FY 01: 02/03
FY 00: 02/02
FY 99: 17.7%
FY 98: 19.6%
FY 97: 21.8% |
|
A significant percentage of OAA Title III service recipients
live in rural areas.
(Developmental)
Norm: Percent of U.S. elderly population who live
in rural areas:
|
FY 02: 25%
FY 01: 25%
FY 00: (New in 01) |
FY 02: 02/04
FY 01: 02/03
FY 00: 02/02
FY 99: 30.7%
FY 98: 33.5%
FY 97: 32.6% |
|
Performance Measures Analysis—Targeting Measures
The OAA seeks to ensure and to support the well-being of elderly
Americans, and particularly those who are most vulnerable: the
poor, minorities, disabled, and the elderly in rural areas. AoA
has identified an initial set of targeting measures to track the
effectiveness of AoA and the Network in meeting the intent of
the OAA to serve vulnerable elderly individuals. Because the measures
are new, and AoA and the Network have not had significant opportunity
to analyze trends associated with these measures and, more significantly,
the data on which they are based, we classify these measures as
developmental. Nevertheless, we believe that ongoing analysis
of the targeting of services to vulnerable individuals is a fundamental
requirement for the Network.
Performance Results for Targeting Measures
Even though the targeting measures are new and developmental,
the data associated with these measures for FY 1997 and FY 1998,
as well as preliminary data for FY 1999, reflect that the AoA
and the Aging Network have produced results by targeting services
to vulnerable elderly individuals. The new AoA targeting measures
presented above provide evidence that the Aging Network of Federal,
State, and community agencies and providers have developed program
strategies and mechanisms that allow them to identify and provide
services to the individuals who are most vulnerable.
- For all three years, over 30% or more of Aging Network clients
had incomes below the poverty level. As figure 1 indicates,
the percent poor among OAA clients substantially exceeds the
percent poor for all elderly individuals (60 and over) in the
U.S. For the three years, the Aging Network served nearly 50%
of the poor elderly individuals in the nation. Although it appears
in the chart that the poor among service clients are declining,
we have identified likely errors in preliminary FY 1999 data,
which when corrected are likely to demonstrate that the percent
of clients in poverty is stable.
- For minority individuals, the percent minority among OAA clients
in all three years (FY 1997 through FY 1999) was higher than
the percent minority of all elderly individuals. Figure 2 illustrates
this characteristic of the OAA client population for fiscal
years 1997 through 1999. We should note that the percent minority
shown for FY 1999 is preliminary and is likely to be understated.
We have identified likely reporting errors which are likely
to have understated elderly minorities for FY 1999.
- Nearly one-third of OAA program participants in FY 1999 lived
in rural areas, compared to less than one-quarter for the total
population age 60 and above for 1998, the most recent year for
which national estimates are available.
As the performance targets for FY 2001 and 2002 reflect, AoA
will not attempt to “force” annual changes in these
indicators; the stability of program funding argues against predicting
annual changes in such broad indicators. We have selected conservative
“developmental” targets based on past performance
to allow the Network to observe changes over time and to determine
how best to establish ongoing performance targets.
It is AoA’s intention to use these measures for planning
purposes as they mature. AoA believes that failure to maintain
defined target levels would necessarily generate greater scrutiny
and corrective action. For now, we believe that the target levels
selected are indicative of effective performance by the Aging
Network, and it is AoA’s objective to support the Network
to ensure that this performance is maintained. For example, the
data above indicate that the percent of OAA clients who are minorities
is not significantly higher than the percent of all individuals
65 and over who are minorities, even though the preliminary data
for FY 1999 are subject to known errors. This indicator warrants
that AoA conduct a more thorough evaluation of the data on which
the indicator is based to determine whether the circumstance is
true.
AoA will seek to add additional targeting measures to this set.
At the present time, available data on the “disability”
characteristics of the OAA service population are not adequate
for analysis on a national basis. As improvements in administrative
data systems are implemented, AoA will develop performance measures
and targets related to the levels of disability of the client
population.
Performance Measures Summary Table—System Measures (Part
1)
Performance Goals |
Targets |
Actual Performance |
Reference |
Maintain a high ratio of leveraged funds to AoA
funds. (Developmental) |
FY 02: $1.50 to $1.00
FY 01: $1.50 to $1.00
FY 00: (New in 01) |
FY 02: 02/04
FY 01: 02/03
FY 00: 02/02
FY 99: $1.90 to $1.00
FY 98: $1.90 to $1.00
FY 97: $1.80 to $1.00 |
|
Maintain a high ratio
of Network program income
to AoA funding. (Developmental) |
FY 02: $.30 to $1.00
FY 01: $.30 to $1.00
(New in 01) |
FY 02: 02/04
FY 01: 02/03
FY 00: 02/02
FY 99: $.33 to $1.00
FY 98: $.37 to $1.00
FY 97: $.37 to $1.00 |
|
A high percentage of
funding for the following
services will come from leveraged
funds:
- Personal Care
- Home-Delivered Meals
- Adult Day Care
(Developmental) |
FY 02: 70%
FY 01: 70%
FY 00: (New in 01) |
FY 02: 02/04
FY 01: 02/03
FY 00: 04/02
FY 99: 75%
FY 98: 75%
FY 97: 74% |
|
Maintain high percentage
of senior centers that are
community focal points. (Developmental) |
FY 02: 50%
FY 01: 50%
FY 00: (New in 01) |
FY 02: 02/04
FY 01: 02/03
FY 00: 02/02
FY 99: 59.8%
FY 98: 58.8%
FY 97: 57.9% |
|
Maintain high presence
(pct.) of volunteer staff among
area agencies on aging. (Developmental) |
FY 02: 40%
FY 01: 40%
FY 00: (New in 01) |
FY 02: 02/04
FY 01: 02/03
FY 00: 02/02
FY 99: 45.8%
FY 98: 43.8%
FY 97: 50.7% |
|
Increase internet connectivity
for area agencies
on aging (Developmental) |
FY 02:
FY 01: (New in 02)
FY 00: |
FY 02: 02/04
FY 01: 02/03
FY 00: 02/02 |
|
Performance Measures Summary Table—System Measures
(Part 2)
Performance Goals
(measures replaced) |
Targets
(dollars in millions) |
Actual Performance
(dollars in millions) |
Reference |
Increase the amount of funds leveraged for transportation
services. |
FY00: $97.3
FY99: $96.4 |
FY00: 02/02
FY99: $97.0√
FY95: $95.3 |
|
Increase the amount of funds leveraged for information
and assistance services. |
FY00: $38.9
FY99: $38.5 |
FY00: 02/02
FY99: $59.8√
FY95: $38.1 |
|
Increase the amount of funds leveraged for case management
services.
|
FY00: Discontinued
FY99: $65.3 |
FY00: N.A.
FY99: $58.7√
FY95: $64.6 |
|
Performance Measures Analysis—System Measures
One of the most significant factors in the effectiveness of the
Aging Network is its capacity to coordinate support, advocacy,
and services from multiple sources for elderly individuals in
communities across the nation. In previous performance plans,
AoA has utilized total dollars leveraged by the Aging Network
as an indicator of performance, and this plan includes the first
results for that indicator. With this plan, however, AoA modifies
and expands the “system” measures that illustrate
the effectiveness of Federal, State and area agencies on aging
and community-service-providers in serving, and advocating for,
vulnerable elderly individuals across the nation.
Performance Results for Leveraged Funding Measures
The data reported above for AoA’s expanded system measures
(Part 1) demonstrate not only that the funds “leveraged”
by the Aging Network are significant in their total, but they
exceed the funding provided by AoA for home and community services
to the elderly. In addition, the measures indicate that the funding
leveraged by the Network supports the vast majority of services
to the most vulnerable individuals, services that allow the weakest
to remain at home, services such as: personal care, home-delivered
meals, and adult day care. Finally, the Network does not rely
solely on funds provided by other sources, but every year generates
a significant amount of revenue, which is put back into the program
for services. The following are financial performance highlights
for fiscal years 1997 through 1999.
- For all three years reported, FY 1997 through FY 1999, funds
leveraged by State and local agencies exceeded funds provided
by AoA by more than 50%.
- In each of the three fiscal years from 1997 to 1999, approximately
three-quarters of the funding that supported personal care,
home-delivered meals, and adult day care combined, came from
sources other than AoA.
- Data for all three fiscal years indicate that revenue generated
by the Aging Network (e.g., voluntary contributions for meals)
is a significant funding source, representing approximately
one-third of the amount provided by AoA each year.
AoA has selected these developmental measures because they are
indicative of the results that the State and local entities of
the Aging Network produce on an annual basis in coordinating services
and financing in support of elderly individuals and in serving
as advocates for the elderly. Service coordination is a fundamental
necessity for programs that serve individuals. It is reflective
of the need to avoid duplication of effort and wasteful spending.
The activities of the Aging Network, including those of Federal,
State and local entities, are represented in these measures. For
example, the vast majority of the funds that are counted under
leveraged funding were generated through the coordination of other
Federal and State programs. The funding covers services supported
by Medicaid waivers, Social Services block grants and USDA funding
for meals. Funds from AoA support services, but they also support
the Network, which is responsible for the coordination that has
enhanced service support for elderly individuals. AoA’s
initial performance targets for these developmental measures reflect
the view that the past performance of the Network that has been
observed for FYs 1997 through 1999, reflects effective systems
performance that should be maintained.
Performance Results for Other New Systems Measures
Other measures that AoA has selected as system measures represent
the strong community orientation of the program. Senior centers
are not only places where elderly individuals receive selected
services. Reflecting the importance of service coordination to
OAA program managers throughout the Network, over half of the
senior centers participating in the program are community “focal
points” for the coordination of a full range of services
to elderly individuals. Also reflecting community responsibility
in the management of the Aging Network are data that show that
almost 50% of the staff that serve area agencies on aging directly
are volunteer staff.
- For all three years, from FY 1997 through FY 1999, over half
of all senior centers participating in the program were community-service
“focal points.”
- The percentage of the staff of area agencies on aging that is
made up of volunteers was between 40 and 50 percent in FYs 1997,
1998 and 1999.
AoA seeks to maintain the level of performance observed for these
two measures to demonstrate on an ongoing basis that OAA programs
are community based and are organized to ensure service coordination.
The “focal point” measure in particular demonstrates
the intent of the Network to coordinate services. The volunteer
staff measure for area agencies on aging demonstrates that these
critical entities of the Network are more than a governmental
presence at the local level. The significant level of volunteer
staff working in area agencies on aging indicates that these entities
are also community organizations committed to the service of individuals
in need.
Consistent with its conviction of the effectiveness of the Network,
AoA is committed to provide infrastructure support to the local
components of the Network. As a measure of AoA support of the
local components of the Network over the coming years, AoA will
establish a performance measure to increase the Internet connectivity
and capacity of area agencies on aging. This measure will serve
not only as a service capacity indicator, but also as an indicator
of improved capability to address the complex data and record-keeping
requirements associated with generating reliable data on the characteristics
of the clients and services of the Aging Network.
Performance Results for Original Systems Measures
AoA has modified its measures related to leveraged funding, but
recognizes the importance of reporting on the performance targets,
which were included in the FY 1999 performance plan. The data
provided in Part 2 of the systems measures table serve that purpose.
The level of leveraged funds for these community-based service
programs is significant, and the funds taken as a whole enhance
the total level of services that the Aging Network is able to
provide to elderly Americans. The variations in the data from
year to year reflect the developmental nature of performance measurement,
and demonstrate that the “absolute value” of dollars
leveraged was not indicative of program effectiveness. In our
view the data illustrate the limitation of the measure itself.
Absolute dollars of leveraged funds do not reflect a story of
performance that is relevant for the Network. As explained above,
AoA will utilize the measures presented in Part 1 of the systems
table and discontinue those in Part 2.
Performance Measures Summary Table—Service Measures
Performance Goals |
Targets
(numbers in millions) |
Actual Performance
(numbers in millions) |
Ref. |
Nutrition
Maintain the number of home-delivered meals provided. |
FY02: 183.0
FY01: 176.0
FY00: 155.0
FY99: 119.0 |
FY02: 02/04
FY01: 02/03
FY00: 02/02
FY99: 132.1√
FY98: 129.7
FY97: 123.4
FY96: 119.1
FY95: 119.0 |
|
Maintain the number of congregate meals provided.
|
FY02: 115.2
FY01: 115.2
FY00: 113.1
FY99: 123.4 |
FY02: 02/04
FY01: 02/03
FY00: 02/02
FY99: 113.3√
FY98: 114.1
FY97: 113.1
FY96: 118.6
FY95: 123.4 |
|
TransportationMaintain the number of
units of service provided. |
FY02: 50.7
FY01: 50.7
FY00: 46.6
FY99: 39.5 |
FY02: 02/04
FY01: 02/03
FY00: 02/02
FY99: 42.9√
FY98: 45.7
FY97: 46.6
FY96: 36.9
FY95: 39.5 |
|
Information and Assistance
Maintain the number of units of service provided. |
FY02: 15.2
FY01: 15.2
FY00: 14.0
FY99: 12.5 |
FY02: 02/04
FY01: 02/03
FY00: 02/02
FY99: 12.2 √
FY98: 13.1
FY97: 14.0
FY96: 13.7
FY95: 12.5 Contacts |
|
Case Management
Maintain the number of units of service. (Discontinued in
’00) |
FY00: Discontinued in 00
FY99: 3.0 |
FY99: 3.4√
FY98: 2.9
FY97: 2.7
FY96: 3.4 |
|
Performance Measures Analysis—Service Measures
For this plan, AoA has retained the same service measures that
it has employed in performance plans for previous years. The measures
in this section of the plan are output measures that reflect the
intention of the agency to meet the requirements of GPRA to provide
a mix of performance measures that are relevant to program results.
These measures also provide a basis for the fundamental tracking
of the level of services that we provide. Rather than encumber
the plan with extensive counts for a variety of services, AoA
will continue to report on major service categories identified
in the table above, with the view that they are representative
of AoA funded activity. The following descriptions of these service
activities provide important context to this set of measures and
to the nature of the basic services the Aging Network provides.
It is followed by an analysis of the data, particularly for FY
1999, and by an explanation of planned performance for FY 2002.
Nutrition Services
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. Prevention of 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 arteriosclerosis.
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 the daily nutrients -- 40 to 50 percent – needed 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.
Transportation Services
As America’s population ages and experiences longevity
in record numbers, the issue of mobility rises in importance.
Since 1900, the percentage of Americans age 65 and older has more
than tripled. By 2030, there will be about 70 million older persons,
more than twice their number in 1997. According to a 1997 study,
one-fourth of the 75-and-older age group does not drive. This
number is expected to increase as our population ages, creating
an even greater need for alternative transportation services,
including public transportation systems or specialized transportation
services.
AoA supports the development of more options for access to transportation
by:
- providing grants to States and territories to maintain service
levels and, where possible, to leverage funding to increase
these services;
- advocating for the coordination of transportation services;
- offering technical advice and guidance; and,
- funding demonstrations of promising alternatives.
Formula grants to 57 States and territories maintain service
provision levels for supportive services assessed as needed and
deemed most appropriate within each community. Supportive services
include transportation services which offer older persons access
to senior centers, adult day care, doctor’s offices, hospitals,
clinics, grocery stores, congregate meal sites, and other programs
and destinations. Besides helping older persons to meet the obligations
and responsibilities which are part of daily life, transportation
services make possible social engagement and participation, important
components of quality of life. National studies show that, for
older persons, the greatest problem caused by the lack of transportation
is a sense of loneliness and uselessness. A person overcome with
these feelings is more likely to be a candidate for depression,
declines in physical health, and early institutionalization, a
costly and preventable fate.
The Supportive Services funds allocated to the 57 State and territories
are distributed, following a needs assessment based State plan,
to 655 area agencies on aging, that in turn award grants or contracts
to local service providers in keeping with a comparable area plan.
Services are targeted to persons 60 years of age and over, with
a focus upon those individuals with the greatest economic and
social needs. Particular attention is given to low-income minorities.
Information and Assistance Services
Social and demographic trends are making the need for information
services increasingly important to the average American family.
Today, older Americans and caregivers face a complicated array
of choices and decisions about services and programs available
to assist them. Many need support and assistance to navigate the
complex environment of public and private sector benefits and
services. Information and Assistance (I&A), established by
the 1973 Amendments to the OAA, is a federally required service
intended to inform, guide, and link older adults to available,
appropriate, and acceptable services to meet their needs. Currently,
there are I&A programs operated by each State and area agency
on aging, covering all geographic areas of the country.
Often the first point of contact for assistance, I&A programs
receive the broadest range of inquiries for older persons. I&A
programs assist older persons and caregivers by assessing their
needs, identifying the most suitable services, given these needs,
and linking them to service providers. Knowing that I&A services
are the key to keeping older adults and their caregivers connected
to other essential services, AoA remains actively involved in
stimulating improvements to the operation of I&A systems.
Performance Results for Service Measures
The preliminary data for FY 1999 indicate that AoA met service
performance targets for three of the five measures included in
the FY 1999 annual performance plan. AoA did not meet the performance
target for congregate meals, and provides two observations related
to that phenomenon. First, AoA has noted in performance plans
for FY 2000 and 2001 that States have the flexibility, and have
been encouraged, to transfer funding from congregate to home-delivered
meals to ensure that vulnerable home-bound individuals can remain
in their homes if they choose. Second, after AoA obtained data
for FY 1997, which more accurately reflected the extent to which
congregate meals would be reduced because of this phenomenon,
the Agency lowered its performance targets for FY 2000 and 2001
accordingly. AoA will utilize the same service target for FY 2002
as well.
Corresponding to the actions that lowered the level of congregate
meals, preliminary data for FY 1999 indicate that AoA substantially
exceeded its performance target for home-delivered meals. AoA
will retain the higher performance targets for home-delivered
meals, which were established for the FY 2000 and 2001 plans.
AoA will closely follow up on the preliminary FY 1999 data, which
indicate that units of transportation services were above our
FY 1999 performance targets, but below the levels reported for
both FY 1997 and FY 1998. Because the data are preliminary, we
must first determine if reporting problems are the cause of the
discrepancy. Nevertheless, because it is not the intention of
the Agency to reduce transportation services, AoA will retain
the higher level performance targets identified for FY 2000 and
2001 in the FY 2002 performance plan, and will seek to explain
and reverse declines if they have occurred. AoA does not consider
the preliminary FY 1999 data for Information and Assistance services
to be significantly below the performance target in the FY 1999
performance plan, and will retain the higher performance targets
for FY 2001 and 2002.
FY 2000 Accomplishments—Community Service Activities
Because service activity is so fundamental to OAA program results,
it is important for AoA to also describe the recent achievements
of the Aging Network while data systems and GPRA performance measures
mature. Therefore, we have provided the following narrative summary
of FY 2000 accomplishments for each of the significant community
services program activities. These accomplishments delineate the
contribution of AoA and the agency’s performance partners,
and communicate more clearly than summary measures the ongoing
program performance results that the Aging Network produces on
an ongoing basis. It is not the intention of AoA to minimize the
importance of meaningful quantitative performance measures. Rather,
the information enhances the performance story of the Aging Network
for important program constituents.
Nutrition Services
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 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 2000/2010
- HHS Nutrition Policy Board
- HHS Dietary Guidance Committee
- HHS/USDA Food Security Committee
- Federal Food Safety Coalition
- HHS Dietary Reference Intake Working Group to insure the needs
and special concerns of the older population are addressed
- HHS/USDA Working Group for the National Nutrition Summit
- USDA/ Center for Nutrition Policy and Promotion (CNPP) 2000
Millennium Symposium Lecture Series, Nutrition and Aging: leading
a Healthy, Active Life
- USDA/Food Safety and Inspection Service and HHS/Food and Drug
Administration review of materials for food safety for seniors
- HHS Health Care Financing Administration (HCFA) Nutrition
and Hydration Campaign
- HHS/IHS Congressionally-mandated paper on obesity in American
Indians
Efforts to Target Specific Recipient Groups
During FY 2000, AoA continued to target nutrition services to
high-risk groups including those at high economic risk, nutritional
risk and those who are minorities who have significantly higher
rates of health disparities. The old-old and those with functional
impairments are also at high risk. Data from selected states for
home-delivered meals indicate that participants demonstrate particular
risk. This data indicate that 72 percent of all home-delivered
participants are older women and about 25 percent of the older
women are over the age of 85. Of all home-delivered participants,
70 percent indicate that they have three or more impairments in
instrumental activities of daily living that includes the ability
to shop for food as well as the ability to prepare simple meals.
In addition, 31 percent are even more significantly impaired and
have three or more impairments in activities of daily living which
is a severe level of disability and includes such activities as
being able to feed oneself, bathe, dress, etc.
In addition under Title III, States collect data on the nutritional
risk of participants. This is done to help target nutrition services
to the most “nutritionally needy.” The States are
requested to use check-listed criteria from the Nutrition Screening
Initiative (NSI) to identify older adults at risk of malnutrition
or in need of other nutrition-related services to maintain a healthy
life-style. The information collected by the SUAs and reported
to AoA is 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 needs.
To help end health disparities among older racial and ethnic
minority populations, the AoA awarded $1 million in demonstration
grants to four community coalitions that serve older members of
racial and ethnic minority groups. The grants are intended to
develop initiatives that eliminate the high rates of diabetes
and cardiovascular disease—diseases in which appropriate
nutrition plays both a prevention and treatment role-- in the
African-American, Latino, American Indian and Asian communities.
These grants will address these two chronic diseases through culturally
appropriate prevention activities and the adoption of healthy
lifestyles that acknowledge and integrate appropriate cultural
practices and diets.
Promotion of Service Needs Awareness
In order to encourage collaborative planning and service activities
that produce the most beneficial outcomes, AoA has identified
opportunities and resources for the Network through which greater
awareness of older Americans’ service needs can be realized.
- During FY 2000, AoA participated in HHS Healthy People 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 that provides funding
and direction to Food and Nutrition Board of the Institute of
Medicine of the National Academy of Sciences to determine the
quantifiable amounts of nutrients necessary for health. It also
recommends experts for discussion panels and provides assurance
that the informational needs of the Federal government and other
recipients are met. These values, known as the Dietary Reference
Intakes, include the Recommended Daily Allowances (RDAs) as
a category. The OAA requires that a meal contain one-third of
the RDA. In addition, these values provide the basis for dietary
recommendations for both health promotion/disease prevention
for federal policy as well as the basis for modifying diets
for both acute and chronic disease management.
- AoA actively participated in review of the text for the 5th
edition of the Dietary Guidelines for Americans, released in
May 2000, and reviewed materials developed for implementation
related to its release. During FY2000, AoA helped plan the National
Nutrition Summit, held in May, and will be participating in
follow-up activities including the Surgeon General’s Call
to Action on Obesity.
- AoA worked with the Health Care Financing Administration (HCFA),
Center for Beneficiary Services, to fund a project by the National
Policy and Resource Center on Nutrition and Aging (Center) that
studied the use of the Nutrition Care Alerts with certified
nursing assistants, family and friends as well as professional
staff and the actions that needed to be taken to reduce dehydration
and malnutrition in a nursing home in Florida. The study, which
is part of a Federal initiative to address dehydration and malnutrition
in nursing homes, found that although an heightened awareness
was essential to decreasing malnutrition and dehydration in
nursing homes, it was insufficient to improve nutritional and
hydration status. The resolution of these problems required
changes at multiple levels and within several departments in
a nursing home. The final report is available on the website
for the National Policy and Resource Center on Nutrition and
Aging, http://www.fiu.edu/~nutreldr.
Direct Technical Assistance
AoA provides direct technical assistance to the Aging Network
via telephone; on-site assistance; presentations at national,
regional, state, and tribal conferences; and through professional
meetings. During FY 2000, AoA provided more than 15 presentations
on nutrition at national meetings. Technical assistance was directly
provided via telephone as well as on site at least 2,500 times
to States, tribes, area agencies on aging, service providers and
individuals on issues that relate to the operations of programs
and service provision under Titles III and VI. For example, guidance
was provided on food service and safety, menu planning, menu planning
for special needs, particularly for individuals with diabetes
and hypertension, provision of culturally appropriate meals, application
of the Dietary Reference Intakes to programs, role of nutrition
in health and disease, nutrient needs of older adults, inclusion
of nutrition services in Medicaid waivers, and interpretation
of the Older Americans Act. AoA provided training at national
meetings on the Title VI Resource Manual developed to provide
basic information on program requirements and to assist on program
management and service delivery. As part of its information dissemination
function, AoA supports the National Policy and Resource Center
on Nutrition and Aging (Center). The Center maintains a website
with bibliographies on 45 topics related to nutrition and aging.
The site is connected electronically to related 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 read by approximately
2,500 nutritionists who work with programs that serve older adults.
The Center provided at least 20 presentations to various groups.
During the course of a year, the Center produced a grassroots
survey of nutrition service provider, area agency and State staff
that prioritized needs in the areas of program development, operation,
and training and technical assistance. White papers on “Measuring
Outcomes”, “Technology” and “Lessons from
Other Federal Nutrition Assistance Programs” were also produced.
The Center held two meetings of experts including an Expert Advisory
Council Strategic Planning Meeting and an outcomes workshop that
paired local nutrition service providers with universities to
do outcomes-based research.
Transportation Services
Coordinated Services
When the Older Americans Act (OAA) was reauthorized in year 2000,
two legislative provisions were included that addressed long-standing
barriers to coordination. Cost sharing is now an option for States
in certain services such as transportation. States, with safeguards
and conditions, may use a sliding fee scale based on income and
the cost of delivering services. Additionally, a provision was
added to clarify that nothing in Title III shall be construed
as prohibiting the provision of services to non-elderly persons
by using funds from other sources.
To create and improve transportation options, organizations collaborate
and coordinate to: pool their resources, avoid inefficiencies,
and reduce operating costs. According to an October 1999 GAO report,
coordinated services reduce federal transportation program costs
by clustering passengers, using fewer one-way trips and sharing
transportation personnel, equipment and facilitation. Another
report by the Community Transportation Assistance Program (CTAP)
based on five case studies, showed significant reductions in average
cost per passenger trip (a decrease from $7.92 to $4.06) and vehicle
hours (a decline from $12.83 to $6.89) as a result of coordination.
An increase in the number of trips per month and total trips per
passenger hour were also documented.
To generate more coordinated transportation options and resources
for older Americans, AoA is a participating partner in the Department
of Health and Human Services (HHS)/Department of Transportation
(DOT) Coordinating Council on Access and Mobility (CCAM). The
Council is a policy and planning group pledged to work together
to improve the efficiency and effectiveness of transportation
services to clients and to eliminate any federal barriers to coordination.
Council members jointly developed guidance to assist States and
localities to improve and coordinate DHHS- and DOT-funded transportation
services. These planning guidelines were published for public
comment and finalized in year 2000. Council members also developed
a comprehensive strategic plan with overarching goals and performance
measures. For example, goal 1 is to encourage the most cost-effective
use of Federal, State and local resources for transportation and
the CCAM will work with the National Governor’s Association,
Center for Best Practices to develop a measure on assessing state
coordination practices.
As a Council member, AoA contributed to the development of “Planning
Guidelines for Coordinated State and Local Specialized Transportation
Services,” in year 2000. This guide addresses the information
and actions necessary to coordinate the transportation resources
of various programs of DOT and HHS. While each community’s
needs, skills, and resources will differ, leading to unique transportation
service designs for each community, coordinating the resources
of human service and transit agencies will usually create substantial
benefits. In this guide, there is program information, advice
and encouragement for persons and agencies interested in increasing
the amount and quality of transportation services provided to
persons who have special transportation needs. Additionally, the
strategic plan and accompanying performance outcome measures set
a direction and focus for Council activities and assure its accountability.
Technical Assistance and Guidance
The Department recognizes the important role of community transportation
in the removal of barriers to services and in increasing the likelihood
of social engagement and participation among otherwise-isolated
elderly persons. HHS therefore funds the Community Transportation
Assistance Program (CTAP) through the Community Transportation
Association of America (CTAA). AoA is a member of CTAP’s
National Leadership Council, comprised of representatives from
several national organizations of local human service providers.
AoA’s focus is on ensuring that multidisciplinary, multi-agency
technical assistance is available for local aging transportation
service providers. For example, AoA’s efforts resulted in
technical assistance for Maine‘s Bureau of Elder Affairs
regarding their development of a pamphlet on available transportation
services for seniors. AoA also sponsored a national symposium
on “Building the Network on Aging Toolkit” in which
an access track was part of this national symposium in which the
resources of the CTAA, CTAP program and the National Transit Resource
Center were made available to the Aging Network.
AoA regularly provides technical assistance and guidance on transportation
issues that pertain to older persons. As an example, AoA was represented
on a technical committee for a DOT and the Transportation Research
Board contract to identify ways to improve transit options for
older adults. AoA is also working with the DOT agencies (National
Highway and Traffic Safety Administration, Federal Transit Administration,
Federal Highway Administration) Transportation Research Board
and Eno Transportation Foundation and others in developing a document
on “Safe Mobility for a Maturing Society: A Strategic Plan
and National Agenda.”
Information and Assistance Services
Funding to the Eldercare Locator
In the early 1990s, AoA launched the National I&A Initiative
to improve access to Aging Network services. The initiative created
the Eldercare Locator, a national toll free telephone directory
assistance service designed to link callers to I&A services.
The Locator provides information on a wide variety of services
such as meals, home care, transportation, housing, home repair,
legal and community services.
AoA supports the Locator through a cooperative, on-going partnership
with the National Association of Area Agencies on Aging (NAAAA)
and the National Association of State Units on Aging (NASUA).
AoA provides ongoing oversight and examines the performance of
the Locator from a customer-service perspective. For example,
in an attempt to help defray some of the telephone expenses for
long distance caregivers, AoA initiated a pilot project to patch
through calls to referral agencies if the call would result in
long distance charges to the caller. Four States participated
in the initial pilot: Kentucky, Oklahoma, North Carolina, and
Pennsylvania. Over 600 people were saved toll charges
during the pilot project. A second pilot will be initiated in
2001 to further test the viability of national implementation
of the patch through program.
AoA increased funding to the Locator in fiscal year 2000, which
allowed for an increase in the number of information specialists
from 4 to 4.75. The number of persons served per month has increased
from 7,533 in fiscal year 1999 to 9,043 in fiscal year 2000.
Outreach to Minority and Women’s Organizations
The Locator's statistics indicate that most callers are women.
A series of focus groups with African-American, Asian, Caucasian,
Hispanic, and Native American women identified their perceptions
about long-term care and the need to plan for one’s older
years. AoA's has also reached out to the American Indian Advisory
Group (AIAG), composed of representatives from various American
Indian organizations across the country who help make the Locator
culturally responsive to American Indians. AIAG was established
when it became evident that American Indians did not feel well-served
by the Locator.
The results of the focus groups were released at a press briefing
in February 2000. Women representing various minority groups spoke
about the need for more information and assistance regarding long-term
care. The focus group report is being widely distributed to women’s
and minority organizations to heighten awareness about long-term
care issues.
The AIAG has been meeting on a regular basis to discuss outreach
to the American Indian population. It has agreed to initiate a
pilot program to test whether Indian elders and their families
use the Locator in response to specialized promotional and outreach
efforts. Pilot sites for the program are the Chickasaw Nation
Health System in Oklahoma and the Blue Lake Rancheria tribe in
California. The pilot will begin in early 2001. AoA made
funds available for the development of a culturally sensitive
poster to promote the Locator among elderly Indians. The poster
will be distributed widely to the pilot sites and other appropriate
locations.
AoA, in partnership with NASUA and NAAAA, took the initiative
to reach and alert minority and women’s organizations to
the Locator and the services of the National Aging Network and
to discuss ways to reduce barriers to accessing these services.
Outreach activities included meetings with minority organizations,
workshops at minority conferences, exhibits at conferences, distribution
of culturally specific promotional materials, and work with minority
media.
Support of National Aging Information & Referral Center
AoA continued support of the National Aging Information and Referral
(I&R) Support Center. The Center provides assistance to I&A
providers to enhance the quality and professionalism of the I&A
system. The Center also promotes improvements in information and
referral systems design, management, operations, and staff development.
In May the National Aging I&R Symposium and State I&R
Liaison Retreat was co-sponsored by the Center and AoA. I&A
professionals from all sections of the country participated in
information exchanges, tackled barriers to service delivery, and
discussed best practices in service delivery. This year’s
symposium focused on reforming the aging I&A system.
As a result of the Center, States such as Minnesota, New Jersey,
Wisconsin, North Carolina, Georgia, Maryland, Mississippi, North
Dakota, and Florida have begun to assess their I&A systems
and initiate reforms.
Partnership with HCFA
AoA has partnered with HCFA to increase the availability of information
for older persons about their health care choices under Medicare+Choice.
Funds transferred from HCFA to AoA were awarded to States to enable
them to conduct specialized training for the enhancement of the
capacity of I&A programs to effectively advise and refer Medicare
beneficiaries for information about Medicare+Choice. Additional
funds will be used to enhance the technological capacity of the
Aging Network to access Medicare+Choice information via the Internet.
To support State and local programs, AoA collaborated with HCFA
on two national video teleconferences entitled Medicare &
You. The first teleconference was held on November 15, 1999 and
the second was convened on November 2, 2000. The telecast was
broadcast to 130 downlink sites in 39 States.
Since the program began, over 15,000 network on aging staff have
received Medicare+Choice training. The State of Minnesota alone
has trained over 3000 Aging Network staff.
Performance Measures Summary Table—Client and Program Outcome Measures
Performance Goals (Pilot States and Areas
only)
|
Targets
|
Actual Performance
|
Ref.
|
Improve nutritional status scores (developmental/illustrative)
|
FY 02:
FY 01:
FY 00: (New in 01) |
FY 02:
FY 01:
FY 00: TBD 6/01 |
|
A high percentage of new clients for home-delivered meals have high nutritional
risk scores. (developmental/illustrative) |
FY 02:
FY 01:
FY 00: (New in 01)
|
FY 02:
FY 01:
FY 00: 77%
| |
A high percentage of clients rate
transportation service as very good or better.
(developmental/illustrative)
|
FY 02:
FY 01:
FY 00 (New in 01)
|
FY 02:
FY 01:
FY 00: 95%
| |
A high percentage of clients report that calls
for information and assistance are answered
quickly. (developmental/illustrative)
|
FY 02:
FY 01:
FY 00: (New in 01)
|
FY 02:
FY 01:
FY 00: 82%
| |
Improve home care services satisfaction
scores. (developmental/illustrative)
|
FY 02:
FY 01:
FY 00: (New in 01)
|
FY 02:
FY 01:
FY 00: TBD 6/01
| |
Improve caregiver support services satisfaction scores: (developmental/illustrative)
|
FY 02:
FY 01:
FY 00 (New in 01)
|
FY 02:
FY 01:
FY 00: TBD 6/01
| |
Performance Measures Analysis—Client and Program Outcome Measures
In partnership
with the National Association of State Units on Aging and the National
Association of Area Agencies on Aging, AoA has undertaken the Performance
Outcome Measures Project (POMP) to develop and field-test performance outcome
measures suitable for ongoing use in assessing community-based services in
support of elderly individuals. The Aging Network participants in the POMP,
with technical guidance and financial support provided by AoA, have adopted a
consumer-based, quality assessment approach, which is focused on local
service-delivery activities, to measure performance outcomes for Aging Network
programs. This approach is consistent with the consumer-assessment efforts,
which other HHS components, such as the Agency for Healthcare Research and
Quality (AHRQ) and the Health Care Financing Administration (HCFA), have
employed for health services provided to elderly and other individuals under
Medicare and Medicaid. The POMP measurement areas also track closely with
indicators identified in “Older Americans 2000: Key Indicators of
Well-Being,” published by the Federal Interagency Forum on Aging. To
foster maximum consistency with significant approaches used by researchers in
the field of quality assessment in human service programs, AoA, through a
contract with WESTAT, Inc., has arranged for known researchers from the Scripps
Gerontology Center, Boston University, and Florida International University, to
participate extensively in the design and application of measurement
instruments, and in the analysis of performance data.
In the past year, the State and area
participants in the POMP, the technical contractors and researchers, and AoA
staff have developed survey instruments, developed and implemented sampling
procedures, and completed surveys in the following program domains, which the
POMP participants decided were most appropriate for performance measurement:
- nutritional status and risk (along with physical and
social functioning and emotional well-being),
- transportation services satisfaction,
- home-care services satisfaction,
- caregiver support and satisfaction, and
- information and assistance satisfaction.
Area agencies in 12 States
participated in the first-year activities of the POMP, and initial data are
available and presented here for three of the domains cited above. A
significant aspect of the POMP, as it relates to the long-term potential of the
Aging Network to assess program results through performance measures, is that
local entities have taken the lead in developing the performance measurement
instruments, in selecting the statistical samples for information gathering, and
in administering the survey instruments to obtain the assessment data for their
areas.
Because the initial focus of the POMP
is on the usefulness of outcome measures for local program assessment, it should
be noted at the outset of this presentation, that the data collected and the
findings summarized here cannot be generalized beyond the program entities,
which participated in the pilots. The data referenced here are
“test” data, and should not be viewed as definitive of program
conditions, even for the areas for which data were gathered. We do believe that
the results of these pilots will assist the Network in selecting measures to be
used on a more regular basis in the near future. The data collection
instruments, sampling procedures and methods, and information collection
processes and procedures were all new and untested. As a result, the data
presented as measures in the table above are illustrative of the types of
measures that AoA and its partners are testing under the POMP. The measures
that are finally selected for measurement purposes may be different, and will be
influenced by a full analysis by AoA and its POMP partners. Nevertheless, AoA
summarizes the findings of the activity conducted to demonstrate the progress
which has been made by the participating program entities, and to illustrate the
potential long-term significance of these measurement domains for the assessment
of community-based services for the elderly.
Performance Results for Outcome Measures (Illustrative)
With the understanding that we cannot make definitive conclusions about service results
on the basis of these data, we do believe that the initial findings of the
pilots are informative for purposes of moving forward in selecting more
permanent measures, and seek to share results relative to that objective.
Nutrition
Test data for new OAA clients for home-delivered meals (HDM) indicate that these
clients are at high nutritional risk. Fully 77% of the new HDM clients surveyed
were at high nutritional risk. We believe that this measure will serve the
Network as another strong indicator of the extent to which the Network targets
services to needy, vulnerable individuals. New clients for congregate meals
were less likely to be at high nutritional risk, but at 37%, the rate is not
insignificant.
Transportation
Respondents to the pilot surveys on transportation services reported a high degree of
satisfaction with the services (82% rated them very good or better), and 90%
reported that they felt safe and that the drivers were always polite. Other
information from the transportation surveys, which will support program
improvements, include the following:
- major trip purposes include doctor and other medical
appointments, shopping, and visits to senior centers;
- the most recommended improvement was longer hours of
service to better accommodate medical appointments; and
- one-fifth of the respondents depended entirely on the
service for their transportation needs, and 60% reported they were able to move
about more than before.
Information and Assistance
As the table above indicates,
95% of information and assistance clients surveyed reported their call was
answered quickly, and 90% reported that they spoke to a person, and not a
machine. A large percentage of the clients interviewed (75%) were first-time
callers. The same percentage reported that they were provided the names of
other places to call, and follow-up interviews indicated that two-thirds of
these individuals made the necessary follow-up calls. Eighty-percent of the
individuals interviewed said they would recommend the service to their
friends.
Family Caregiver Support
An important element of performance
outcome measurement for AoA is addressing early on AoA’s intent to measure
the performance of programs that will be devoted to services to caregivers of
elderly individuals. As part of the Performance Outcomes Measures Project, AoA
has initiated testing of satisfaction measures of individuals who care for
disabled older Americans with the caregiver support services that are available
to them. Preliminary data are available for only two sites, and reflect
primarily that services for caregivers are in fact very limited at this time.
Nevertheless, even the early pilot-test surveys promise to identify who the
caregivers are, their satisfaction with services to them and to the elderly they
serve, and the burden associated with care. In the two sites tested, data
indicated that caregiving tasks often fall primarily on one individual, that
caregivers are generally very satisfied with the care their charges are
receiving through the Network, that stress and time away from their own families
are significant among caregiver burdens, and that there are positive rewards to
them for the care they provide.
Next Steps
AoA will continue to sponsor the development of State and local performance outcome measurement projects, and will respond constructively to the new requirements of the OAA for the
identification of performance outcome measures by December 31, 2001. As AoA has
with the development of GPRA measures as a whole, decisions on outcome measures
will be iterative, and the Agency, with input and guidance from the Network,
will continue to improve outcome measures over time. It is important to note
also, that AoA does not intend to impose outcome measurement requirements on
State and Area agencies in the process of complying with the new requirements of
the OAA. AoA is working with statistical consultants to determine how
statistical tools can be employed to derive national data for the performance
outcome measures that are approved for use for the Aging Network. Because State
participation was based on capacity and willingness to participate and not as
part of a statistical sampling process, additional data collection would almost
certainly be required to derive a statistically valid national sample. Direct
application of tested performance measures to all States can not be projected
until the results of the test are completed and the Aging Network develops
consensus on measures that have the potential to be applied on a wider scale.
AoA and the Aging Network will assess the correlation of results for these
measures with administrative data that may more readily serve as proxy measures.
The results of the outcome measures project will be used to improve performance
measures for AoA administered programs as soon as possible, and the status of
project implementation and findings will be provided in all updates of AoA's
performance plan submissions.
2.2 Ombudsman Services
Program Description and Context
(numbers in
thousands) |
FY 1999 Enacted |
FY 2000 Enacted |
FY 2001 Enacted |
FY 2002 President’s Budget |
Vulnerable Older Americans |
$12,181 |
$13,179 |
$14,181 |
$14,181 |
For the near future, AoA will use its measurement
activity for the Ombudsman program to represent the broader budget activity
“Vulnerable Older Americans,” which also includes funding for other
activities associated with the protection of the rights of elder individuals.
In future plans, AoA will address performance measurement for related program
activities as appropriate. 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 and work to effect systems changes
at 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; and
- 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.
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; and
- promoting public awareness of the ombudsman
program.
Goal-by-Goal Presentation of Performance
Performance Measures Summary Table—Ombudsman Services Measures
Performance Goals
|
Targets
|
Actual Performance
|
Ref. |
Maintain the combined resolution / partial resolution rate of 70 percent of complaints in nursing homes. |
FY02: 70%
FY01: 70%
FY00: 70%
FY99: 71.48%
|
FY02:
FY01:
FY00: 11/01
FY99: 74.3%√
FY98: 70.6%
FY97: 72.1%
FY96: 74.0%
FY95: 71.5%
| |
HCFA Nursing-Home
Outcome Measures
|
Decrease the prevalence of
restraints in nursing homes (HCFA developmental measure)
|
FY02: 10%
FY01: 10%
FY00: 10%
FY99: 14%
|
FY02:
FY01:
FY00: 9.8%√
FY99: 11.9%
FY96: 17.2% (baseline)
| |
Decrease the prevalence of
pressure ulcers in nursing homes.
(HCFA developmental measure.)
|
FY02: 9.5%
FY01: 9.6%
FY00: N.A.
FY99: New in 2000
|
FY02:
FY01:
FY00: 9.8% (baseline)
FY99: N.A.
| |
Performance Measures Analysis—Ombudsman Service Measure
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. AoA and the Aging
network will achieve its objectives by assisting residents, families, friends
and others to resolve problems related to care and conditions in nursing homes.
Until we have greater experience with the use of the complaint-resolution data,
we will use a general performance target of resolving or partially resolving 70%
of complaints. Performance thus far has been generally consistent with this
goal.
The Ombudsman activities of AoA and the
Aging Network are directly relevant to and support HCFA and HHS’s
performance goals related to improving the quality of care in Nursing Homes. To
indicate AoA’s support of these performance goals, we have incorporated
HCFA’s nursing-home outcome measures into this plan as relevant to the
activities of AoA and the Network. Information supporting the Ombudsman program
activities of the Network, indicate that the top five nursing home complaints
have consistently been in categories involving poor resident care, lack of
respect for residents and physical abuse. Just as HCFA’s measures to
reduce the use of restraints and the incidence of pressure ulcers can indicate
quality improvements, they also serve as indicators of results of the
responsiveness of the Ombudsman program to the most serious complaints raised on
behalf of nursing home residents.
Performance Results for the Ombudsman Program
AoA will use the resolution
rate as an ongoing representative indicator, which will serve to track
performance and provide a trigger for program decision-making. However,
maintenance of an acceptable resolution rate is only part of the performance
story for the protection activities of the Aging Network. The following
information is provided to summarize additional program characteristic
associated with Ombudsman services that are relevant to and supportive of
AoA’s representative outcome indicator for these activities.
- The top five nursing home complaints have consistently
been in categories involving poor resident care, lack of respect for residents
and physical abuse.
- In FY 1998, ombudsmen nationwide opened 136,424 cases and
closed 121,686 cases involving 201,053 individual
complaints.
- Most complaints were filed by residents or by friends and
relatives of residents.
- Eight-two percent of cases were in nursing home settings;
17 percent involved board and care, assisted living and similar facilities; and
one percent were in non-facility settings.
- A three-year comparison of the top-twenty nursing home
complaints indicates that the greatest increases were for complaints about
physical abuse, toileting, personal hygiene and unheeded requests for
assistance. The analysis suggests persistent problems with lack of care for
residents and the need for increased numbers of trained staff to assist
residents.
- The top-five board and care complaints were about menu
quality, medication management, discharge/eviction, lack of respect for
residents and physical abuse; the greatest increases over a three-year period
were in the first three of these categories.
- Seventy-two percent of nursing home complaints and 67
percent of board and care complaints were resolved or partially resolved to the
resident’s or complainant’s
satisfaction.
- Ombudsmen reported that there were 18,227 nursing homes
and 1.83 million beds in FY 1998, a slight decrease in the number of facilities
but not of beds from previous years.
- Ombudsmen reported that 41,292 licensed board and care,
assisted living and similar homes, with 797,036 beds, were operating nationwide;
this is a 20% increase over the number of this type of facilities
reported in FY 1997.
- The ratio of paid ombudsman FTE to long-term care
facility beds was one to 2,832 in FY 1998.
Ombudsman staff and volunteers visited almost 80 percent
of nursing homes and 45 percent of board and care homes on a regular basis, not
in response to a
complaint.
2.3 Services for Native Americans
Program Description and Context
(numbers in thousands) |
FY 1999 Enacted |
FY 2000 Enacted |
FY 2001 Enacted |
FY 2002 President’s Budget |
Native American Programs |
$18,457 |
$18,457 |
$23,457 |
$25,457 |
The 1990 Census counted almost 166,000 American
Indians and Alaska Natives over the age of 60. Although older adults represent
only about eight percent of the total American Indian and Alaska Native
population, their numbers are increasing rapidly. This increase is due to better
health and living conditions. Today, older American Indians, Alaska 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, Alaska
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, Alaska Native and Native Hawaiian older adults living in the Title VI
service area. In 2000, grants were awarded to 225 American Indian and Alaska
Native tribal organizations representing nearly 300 tribes, and two 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, legal assistance, and
caregiver support services. 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,
Alaska Native and Native Hawaiian older
adults.
Performance Measures Summary Table—Native Americans Program
Performance Goals
|
Targets
|
Actual Performance
|
Ref.
|
Initially increase and then maintain units
of service in the following categories:
|
(numbers in thousands)
|
(numbers in thousands; ’99 data are
preliminary)
|
|
home-delivered meals.
|
FY02: 1,850
FY01: 1,795
FY00: 1,632
FY99: 1,456
|
FY02: 02/04
FY01: 02/03
FY00: 02/02
FY99: 1,698√
FY98: 1,624
FY97: 1,525
FY96: 1,400
| |
congregate meals
|
FY02: 1,650
FY01: 1,583
FY00: 1,439
FY99: 1,322
|
FY02: 02/04
FY01: 02/03
FY00: 02/02
FY99: 1,327√
FY98: 1,354
FY97: 1,386
FY96: 1,313
| |
transportation service units
|
FY02: 732
FY01: 732
FY00: 665
FY99: 763
|
FY02: 02/04
FY01: 02/03
FY00: 02/02
FY99: 739√
FY98: 719
FY97: 680
FY96: 756
| |
Information/referral service units
|
FY02: 747
FY01: 747
FY00: 679
FY99: 632
|
FY02: 02/04
FY01: 02/03
FY00: 02/02
FY99: 647√
FY98: 715
FY97: 705
FY96: 703
| |
In-home service units
|
FY02: 953
FY01: 953
FY00: 866
FY99: 742
|
FY02: 02/04
FY01: 02/03
FY00: 02/02
FY99: 944√
FY98: 1,032
FY97: 882
FY96: 507
| |
Other services
|
FY02: 650
FY01: 650
FY00: 591
FY99: 512
|
FY02: 02/04
FY01: 02/03
FY00: 02/02
FY99: 1,085√
FY98: 756
FY97: 583
FY96: 507
|
|
Performance Measures Analysis—Native
Americans Program
At the present time,
a limited array of performance output measures is available for the analysis of
AoA’s Native American programs under GPRA. Nevertheless the measures will
be useful for analysis of the stability of program support and services for the
programs. For future performance plans, AoA will pursue additional measures for
Native American programs, possibly including the establishment of performance
outcome measures pilots for these programs. For now, AoA will continue to
supplement its basic measurement data with the following narrative description
of additional program accomplishments.
Performance Results for Native Americans
Programs
For the most part, Native American programs have maintained service levels, adjusted for inflation, in the face of level funding. The preliminary FY 1999 data indicate successful results for all performance targets except for transportation services. Effectively,
we believe that the overall indicator of stable service levels is confirmed for
virtually all services. Even though it appears that “other
services” category was substantially exceeded, we will first confirm the
reliability of those data and the significance of the change from FY 1998 before
drawing conclusions for expectations for future years. Although we did not
achieve the target for transportation services, AoA will retain higher targets
for FY 2001 and 2002. AoA’s increasing targets for both home-delivered
and congregate meals are consistent with the agency’s budget request for
these service activities.
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 53,000 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 700,000 rides were provided to older Native American
adults to meal sites, medical appointments, grocery stores and other
destinations.
- Nearly a million units of individual and family support
services, such as visitation and respite, were provided to elders and their
families. More than 600,000 units of information and assistance on issues
dealing with Social Security, food stamps, and other topics were provided to
elders and their families.
In-home services are permitting Native American older adults to remain in their homes
for as long as possible. Costs associated with the premature
institutionalization of older adults are, accordingly, somewhat contained.
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 information about their right to
receive Social Security, food stamps and other services aimed at improving their
health and standard of living.
FY 2000 Accomplishments—Native American Program Services
As AoA continues to develop
performance measures that are relevant indicators for AoA programs in support of
Native Americans, the agency will provide supplementary narrative that is
relevant to the continuous improvement of services to this important group of
elderly Americans.
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 2000, focusing on the empowerment of older Native
Indian adults through enhanced services.
During
FY 2000, 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.
The identification of Home and Community Based Long-Term Care (HCBLTC) needs in Indian communities and barriers to addressing these needs.
The design and development of strategies for HCBLTC in Indian communities have proceeded with
limited involvement of Federal and State agencies. Among various tribes,
historical differences in the availability and use of Federal, tribal and State
programs have resulted in an erratic or nonexistent infrastructure for HCBLTC.
AoA is addressing this in two ways:
- 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.
- Also, under 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 to addressing HCBLTC
needs were identified in the survey by tribal officials. They include
fragmented and insufficient funds, minimal appreciation of local need, limited
access to decision-makers, and excessive
regulations.
During FY 2000 AoA, the Native
Elder Health Care Resource Center, and the National Resource Center on Native
American Aging used survey-generated 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. Accordingly, they have begun to tap into available funding sources
and to identify and pursue training opportunities to help in developing and
improving HCBLTC services in their communities. AoA will work with tribes to
use data from needs assessments to plan necessary HCBLTC programs and
services.
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.
Under Title VI, activities of other Federal departments and agencies are
coordinated, grants to Native Americans are administered, and information
related to the problems of older Native Americans is collected and disseminated.
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 to improve services to older Indians. The Director of
the Office of American Indian, Alaska Native and Native Hawaiian Programs chairs
this Task Force. Task Force members focus on three areas of concern: health,
transportation, and data. 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 and dissemination of culturally appropriate
material to the tribes. Participating members of the subcommittees include the
Veterans Administration (VA) and the Health Care Financing Administration
(HCFA). The FY 2000 Interagency Task Force on Older Indians
Subcommittee’s efforts will lead to the dissemination of culturally
appropriate materials to Indian tribes to heighten their sensitivity to the
needs of elders and to increase understanding of changes in Medicare/Medicaid
services.
Training and certification of family caregivers will
empower them to offer more culturally sensitive and appropriate care to their
elderly relatives. 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.
2.4 AoA Research and Development
(numbers in thousands) |
FY 1999 Enacted |
FY 2000 Enacted |
FY 2001 Enacted |
FY 2002 President’s Budget |
Research and Development |
$23,970 |
$37,124 |
$46,626 |
$28,348 |
With the FY 2002 budget, AoA has changed the
title of the budget activity “State and Local Innovations and Projects of
National Significance” to “Research and Development.”
Accordingly, the title change is reflected in this GPRA presentation.
AoA’s Research and Development projects are intended 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. Because these projects and other evaluation activities
support the fundamental program characteristics of the Aging Network programs,
AoA will not establish a separate set of performance measures for these
activities. The ability of AoA and the Network to achieve the service, outcome
and systems performance goals of the OAA programs relies in part on the projects
and activities carried out under this program category. Significant new program
activity and program improvements have their roots in such research and
development projects, including nutrition programs for the elderly, the new
caregiver program, and the long-term care Ombudsman
program.
2.5 Senior Medicar Patrols & Technical Assistance Centers
Program Description and Context
(numbers in thousands) |
FY 1999 Enacted |
FY 2000 Enacted |
FY 2001 Enacted |
FY 2002 President’s Budget |
Senior Medicare Patrols and Technical Assistance
Centers |
$1,400 |
$1,450
|
$1,500 |
$2,000
|
At the outset of this presentation, it should be
noted that AoA has modified the title for this program activity. In previous
versions of the plan, AoA referred to this program activity as:
“Operation Restore Trust.” That title did reflect the initiation of
activity to involve seniors in fighting Medicare fraud and abuse, but it no
longer reflects the generic scope of the activity that AoA has formalized in
response to legislative initiatives. AoA has played an active role in
addressing this national problem through two legislative
sources.
Health Insurance Portability and Accountability Act of 1996
Under the Health
Insurance Portability and Accountability Act of 1996, AoA works in partnership
with the Health Care Financing Administration (HCFA), the Office of Inspector
General (OIG), the Department of Justice, and other federal, state, and local
partners in a coordinated effort to educate and inform older Americans how they
can play an important role in protecting the benefit integrity of the Medicare
and Medicaid programs. AoA’s primary efforts under this initiative have
been to: 1) fund state and local projects to train aging network professionals
to recognize and report potential instances of waste, fraud, and abuse; 2)
develop and disseminate consumer education materials to beneficiaries; and 3)
support technical assistance efforts designed to share and replicate common
strategies and successful practices among federal, state and local officials,
health care professionals, community service providers who serve older
Americans, and beneficiaries and their families.
Omnibus Consolidated Appropriations Act of 1997
Beginning with the Omnibus
Consolidated Appropriations Act of 1997 (P.L. 104-209), AoA has been charged
with establishing innovative community-based projects that seek to utilize the
skills and expertise of retired professionals in educating older Americans
regarding how to help protect the benefit integrity of the Medicare and Medicaid
programs. During FY 2000, AoA funded 48 such community-based projects, known as
“Senior Medicare Patrol Projects,” in 43 states, plus the District
of Columbia and Puerto Rico. These Senior Medicare Patrol Projects recruit and
train retired professionals, such as doctors, nurses, teachers, lawyers,
accountants, and others to work in their communities, teaching beneficiaries how
to take an active role in protecting their Medicare numbers and their health
care.
Goal-by-Goal Presentation of Performance
Performance Measures Summary Table— Senior Medicare Patrol Measures
Performance Goals
|
Targets
|
Actual Performance
|
Ref.
|
Increase the number of trainers who educate beneficiaries
|
FY02: 100% increase
FY01: 100% increase
FY00: 125% increase
FY99: (new in 2000)
|
FY02: 02/03
FY01: 02/02
FY00: 187% increase√
(39,300 trained)
FY99: 13,700 (baseline)
|
|
Increase the number of substantiated complaints
generated through AoA’s activities (ie: complaint results in some action taken).
|
FY02: 75%
FY01: 60%
FY00: 200
FY99: (new in 2000)
|
FY02: 02/03
FY01: 02/02
FY00: 1241 √
FY99: 133 (baseline)
|
|
Discontinued Measure
Increase the recouped Medicare and Medicaid funds
that are directly attributable to AoA’s program
activities.
|
FY01: Discontinued
FY00: $2.70 million
FY99: (new in 2000)
|
FY00: $46.65million √
FY99: $1.34 million
(baseline)
|
|
Performance Measures Analysis—Senior
Medicare Patrol Program
AoA has
elected to employ a set of fundamental results measures that reflect the
agency’s commitment of educating and informing older Americans how to take
an active role in their health care, thereby helping to maintain the benefit
integrity of the Medicare and Medicaid programs. The DHHS OIG gathers
performance measure data from AoA’s Senior Medicare Patrol Projects
semi-annually.
Performance Results for the Senior Medicare Patrol Program
The first measurement involves
increasing the number of volunteers trained by AoA’s grantees, who in turn
educate an increasing number of beneficiaries regarding how to take an active
role in protecting their health care. In FY 1999, the Senior Medicare Patrol
Projects were just beginning to develop their training activities and materials,
and trained 13,700 community volunteers. The target in FY 2000 was to increase
the number of volunteers trained by 125%, once materials and effective training
strategies were more widely utilized by the grantees. The performance for FY
2000 exceeded this target, reaching nearly a 200% increase in the number of
volunteers trained (25,600) from the previous year. During FY 2000, these
additional 25,600 volunteers directly educated more than 500,000 beneficiaries
through community education and one-on-one sessions. We do not anticipate that
the grantees will train as many new volunteers during FY2001 and FY2002 because
the large pool of experienced volunteers will continue to conduct sessions
during those years.
The second measurement
consists of the number of inquiries submitted by AoA’s projects and
volunteers to health care providers, HCFA, the OIG, and other appropriate
sources that result in some action being taken. In FY 1999, this system of
reporting was just beginning to be developed and AoA’s projects started
with a baseline of 133 cases that resulted in some sort of corrective action
being taken. In FY2000, the projects exceeded this target, with more than 1,200
cases that were reported by AoA’s grantees resulting in some action being
taken. Much of this increase over the previous year was due to the fact that a
large number of new projects were added during FY2000. We do not project as
large an increase in these types of cases between FY2000 and FY2001 because the
number of projects in operation will remain relatively the same. A target has
been set in 2001 for a 60% increase in the number of reported cases that result
in some action, based on the fact that the Senior Medicare Patrol Projects and
volunteers will become more experienced about the types of quality cases they
should submit for follow-up examination by health care providers or other
appropriate sources.
During FY 1999 and FY
2000, AoA worked with HCFA and the OIG to try to track funds recouped by the
Medicare and Medicaid programs that could be directly attributable to the
activities of AoA’s program efforts. Due to confidentiality issues and
other factors, this effort proved to not be feasible. In its semi-annual report
to AoA, the OIG wrote, “It should be noted that the most substantial
savings which are expected to arise from projects under the programs will be
derived from a sentinel effect whereby fraud and error are reduced in light of
Medicare beneficiaries’ scrutiny of their bills. Savings will also result
from reports of fraud and error made to the Medicare contractors and to the OIG
fraud hotline. It is not feasible, however, to track these effects
entirely.” Despite these limitations, documented savings of $46.65
million were attributable to the efforts of AoA’s grantees in FY 2000.
Given the infeasibility of tracking individual case outcomes, and the fact that
AoA’s efforts and programs are contributing to the Department’s
achievement of exceeding the goal under the Health Insurance Portability and
Accountability Act to return more than $7 for every $1 spent, AoA will no longer
attempt to gather and report this performance outcome
measure.
Fiscal Year 2000 Accomplishments
Delivery of Grant Funded Technical Assistance and Training
Based on input from volunteers, partners and stakeholders, in FY 2000, AoA worked to develop numerous technical
resource activities. These activities included:
- a compilation of best practice strategies, products, and
recommendations;
- a limited access internet communication system for
sharing information and answering questions among AoA’s grantees and
partners;
- a web page with training manuals, pamphlets, brochures,
and other consumer information; and
- regional and national technical assistance conferences
which brought together experts from the OIG, HCFA, Medicare carriers, health
care providers, senior volunteers and others to develop and institutionalize
strategies for protecting the benefit integrity of Medicare and
Medicaid.
Following the implementation of these technical assistance activities, AoA’s grantees
reported in their semi-annual progress reports that they spent less time
developing training manuals and informational brochures, testing various methods
for recruiting and maintaining volunteers, and seeking to establish new
partnerships. The Senior Medicare Patrol Projects reported that they instead
spent more time and energy in FY 2000 training new volunteers, disseminating
consumer information and public service announcements, developing better quality
cases and inquiries, and conducting outreach to hard-to-reach and vulnerable
beneficiaries. Evidence of this increased productivity in FY 2000 as a result
of AoA’s technical assistance efforts can be seen through the substantial
increases in the numbers of beneficiaries educated, the more than 30 million
individuals reached through media events, an increase by more than 500% in the
number of cases reported by AoA’s grantees that resulted in some action
being taken, and reports by grantees of their increased efforts to conduct
outreach and education to rural, isolated, and non-English-speaking
beneficiaries.
Delivery of Consumer Information
AoA provided consumer
information to the public designed to: 1) increase awareness and empower
individuals to take greater personal responsibility for monitoring their own
health care; 2) prevent the serious consequences associated with the small
number of unscrupulous individuals who seek to exploit the Medicare and Medicaid
programs through fraudulent or abusive practices; and 3) provide advice and
guidance on preventive techniques and methods that can help reduce victimization
of older Americans. Examples of major presentations in FY 2000
included:
- The development, production, and dissemination of more than
2,500 videos and 65,000 brochures in English, Spanish, and Mandarin
Chinese.
Another major activity was the distribution of more than 75,000
health care journals to Medicare/Medicaid beneficiaries, which
AoA developed in partnership with doctors, other health care professionals,
and its Senior Medicare Patrol Projects.
The journal was a particularly
useful tool used for several purposes. It was used by beneficiaries to record
information such as, the date and purpose of their health care visits,
medications prescribed, services received, instructions given, and other patient
information. The journal helped to facilitate communication and understanding
between health care providers and patients, and served as a record for
beneficiaries to use in reconciling their Medicare statements. This
information ultimately helped them to better understand their legitimate health
care financial obligations, as well as to recognize questionable health care
charges. This increased understanding is, to a degree, evidenced in the growing
number of consumer inquiries to health care providers and to the Senior Medicare
Patrol Projects regarding the nature of the health care services received by
beneficiaries.
Since the implementation of these consumer information activities, calls from senior citizen groups,community service organizations, health care personnel, and older Americans and
their families for additional materials and speakers have more than tripled.
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 beneficiaries can take an active role in
understanding their health care services and bills under Medicare and Medicaid.
These trends highlight an increasing awareness among these groups to obtain a
better understanding of the health care services they receive, and the need to
protect their Medicare and Medicaid numbers as they would their credit card.
Program Description and Context
(numbers in thousands) |
FY 1999 Enacted |
FY 2000 Enacted |
FY 2001 Enacted |
FY 2002 President’s Budget |
Program Direction
|
$14,795 |
$16,458 |
$17,219 |
$18,122 |
AoA agrees with the HHS principle that management
challenges should be addressed in the GPRA context, and included two primitive
process measures in its original FY 1999 annual performance plan. With the FY
2002 plan, AoA initiates efforts to reestablish its commitment to include
management measures in the annual performance plan. The initial developmental
measures identified below are ones associated with fundemental management
challenges which the Agency faces: financial management, human resources
management, and information management. AoA is undergoing an audit of its
financial statements for the first time for FY 2000. Consistent with the HHS
approach to addressing this activity in its GPRA performance plans, AoA will
establish as an ongoing measure the achievement of a clean financial opinion on
its financial statements.
For human services programs, AoA faces the same
challenges that confront other Federal agencies, ensuring that it meets
challenges caused by retiring employees and streamlining administration. AoA
believes that both must be addressed through workforce planning, and that it is
appropriate to measure performance through the extent that hiring is consistent
with a workforce plan. The agency will identify performance targets when new
leadership has the opportunity to participate in that process. AoA’s most
significant challenge in the area of information management is associated with
the timely collection and processing of program data. In previous GPRA
performance plans, it appeared that the Agency would be unable to use program
data for GPRA reporting purposes for up to two years after the end of the fiscal
year. Agency management has found this to be unacceptable and unnecessary and
has initiated work to improve the timeliness of data, and has included a new
performance measure in this GPRA plan to ensure tracking of that objective.
Goal-by-Goal Presentation of Performance
Performance Measures Summary Table—Program Management Measures
Performance Goals
|
Targets
|
Actual Performance
|
Ref.
|
Results of audits of AoA financial
statements.
|
FY02: Clean Opinion for 2001
FY01: Clean Opinion for 2000
FY00: (New in 2001)
FY99: Not applicable
| FY02: 2/02
FY01: 5/01
FY00: N.A
FY99: 11/00
| |
A high percentage of AoA
hires will be based on a formal AoA Workforce Plan.
(Developmental) |
FY02: To be determined
FY01: New in 2002
| FY02:
FY01: | |
Reduce the time lag (in months) for making NAPIS data available for GPRA purposes and for
publication. (Developmental) |
FY02:
FY01: To be determined | FY02:
FY01:
FY00:
FY99: 24 months | |
Discontinued Measures
Achieve Y2K Compliance in FY
1999 | FY00: discontinued FY99: meet compliance
| FY99: goal met√ | |
Complete implementation of new
computer systems (process measure)
|
FY00: discontinued
FY99: completed implementation of systems
| FY99: system implemented throughout AoA √ |
|
Maintain grants operation performance (process measure)
| FY00: discontinued
FY99: continue operation |
FY99: operation continued.√ | |
Performance Results for Program Management Measures
AoA engaged in the management
improvement processes for both grants management and information systems
improvement that allow the Agency to declare that the process measures in the
original FY 1999 performance plan have been completed. However, the agency does
not believe that such activity measures are appropriate in the GPRA context, and
has discontinued both measures. Interestingly, the measure of a “clean
financial opinion” is also a form of process measure, but it also reflects
a result and not an activity. This form of process measure is appropriate in
the GPRA context because it reflects a performance result, and so will be
retained in future AoA plans. The other new measures that AoA has identified,
and any future measures which are established for important management
activities will be results measures.
To
initiate the identification and tracking of significant, ongoing management
challenges in the GPRA context, this plan includes three developmental
performance measures for program management activities.
- The first, to obtain clean financial opinions from
financial statement audits is consistent with measures that HHS as a whole and
other OPDIVs have included in agency performance plans for several years.
- AoA has engaged in a significant workforce planning
effort, and so proposes initially to assess performance with a measure that
represents maintenance and use of the planning effort. This measure is clearly
developmental because the agency must determine if the measure is useful and
must identify an appropriate level of performance for the indicator.
- Reflecting the firm commitment of the agency to improve
the quality, reliability, and timeliness of data from the NAPIS system, and to
reduce the burden that it imposes on the Network, the plan includes AoA’s
commitment for a developmental measure that reflects a necessary system outcome.
For AoA to successfully reduce the time lag for making NAPIS data available for
GPRA purposes, it must address and achieve the objectives of reducing burden and
improving data quality.
Appendix 1
Approach to Performance Measurement
Methodology and Rationale
The fundamental elements of AoA’s approach to
performance measurement are consistent with the guidelines established by the
Department of Health and Human Services because AoA shares many of the same
measurement challenges that other HHS components face. AoA is the lead HHS
component for support programs for elderly individuals, which are administered
day-to-day by State and local governmental entities and numerous business and
non-profit service providers. This fundamental program partnership dictates
that AoA approach performance measurement mindful of the needs and constraints
of the non-Federal partners which share program authority and responsibility.
AoA has instituted performance measurement
with the approach of utilizing existing information resources to the full extent
possible, and reducing new and potentially burdensome information gathering to
that which is important to program assessment and which is consistent with views
of the partnership. AoA was limited in its first performance plans by the lack
of mature, reliable data because of the status of implementation of a new
information management system: The National Aging Program Information System
(NAPIS). As a result, performance measures in the early GPRA plans were limited
for the most part to output measures associated with service unit counts. With
the FY 2002 Annual Performance Plan, reflecting the increasing maturity of the
NAPIS system and AoA’s developing Performance Outcome Measures Project,
AoA has completely restructured its performance plan, particularly for its large
State and Community-Based programs, and defined performance measures that
reflect the achievement of the Aging Network in: targeting services to
elderly individuals in need, establishing an effective system of services
utilizing funding from multiple sources, maintaining service outputs
across a variety of domains, and producing outcomes that are relevant to
the network and focus on consumer assessment.
AoA continues to face a number of performance measurement constraints that are common to HHS programs.
- AoA relies on State and local governmental entities and
service providers for the data required to measure performance. Because of the
complex relationships, AoA cannot expect to have data available for GPRA
purposes within six months of the end of a fiscal year. In previous years, AoA
did not anticipate having data available for two years after the end of the
fiscal year, but our work within AoA and with the cooperation of State and local
agency representatives, we have already reduced those time frames.
- Like other HHS components, AoA is one of many providers
of services to individuals, and can neither reasonably attribute broad changes
in the characteristics and conditions of large population groups to its program
activities, nor reasonably project measurable changes in significant population
groups over short periods of time. These factors limit both the choice of
measures available to AoA for GPRA purposes and the performance targets the
agency can reasonably expect to achieve.
- Over the years, AoA has represented a relatively stable
source of service support to elderly individuals across the country, and so
cannot expect on an annual basis to produce broad based changes, increases or
improvements in the results that are produced through the Aging Network. As a
result, AoA and the Aging Network are in the process of defining levels of
performance that reflect significant performance year in and year out, and
which, if not met would result in the need for evaluation and enhanced program
support.
These constraints do not
hinder AoA action to use GPRA and performance measurement as important tools for
program assessment, but they force the Agency to recognize the limits and the
proper uses of this assessment tool. GPRA must be used in combination with
other assessment mechanisms and information sources to “inform”
program assessment and planning. With reasoned use and realistic expectations
for this assessment tool, program managers throughout AoA and the Aging Network
will increasingly realize the value of ongoing performance measurement. By
facing and addressing these performance measurement challenges directly, AoA is
developing a performance measurement program that has the potential to be useful
to program managers and decision makers for years to come. HHS has correctly
fostered an “iterative” approach to the implementation of GPRA and
performance measurement. As AoA’s GPRA performance measures mature and
performance trends emerge, program executives and managers throughout AoA and
HHS, and decision makers outside the Department, can expect to use trend data to
seek the coordinated improvement of AoA and related HHS programs on an ongoing
basis. The data will support agency efforts for: 1) assessing program activity
and results, 2) engaging in program evaluation where deeper assessment is
required, 3) redefining program strategies to produce improved results, and 4)
modifying future performance targets to be consistent with available resources
and up-to-date priorities and policy decisions.
Data Verification, Validation and Other Data Issues
As indicated in the introduction
to this performance plan and report, AoA and the Aging Network face a
significant challenge in obtaining data to measure performance for programs of
this kind. For the sake of context, it is important to reiterate those
challenges here while addressing the extensive processes that AoA and the States
utilize to improve the validity and reliability of the NAPIS data. All levels
of the Aging Network, from AoA through the state and area agencies on aging to
local centers and service providers, know well the challenge of producing client
and service counts by critical program and client characteristics for a program
which coordinates service delivery through approximately 29,000
local providers. Many OAA program services do not require a one-time
registration for service on the part of clients; eligible clients may obtain
services on an ad hoc and irregular basis. This makes the tracking of services
to individuals and the generation of “unduplicated” counts of
clients a very difficult task at the local level, particularly if local entities
lack information technology that simplifies client and service record-keeping
and information management. Federal and State reviews of data provided for FY
1997, 1998 and 1999 under NAPIS suggest that significant limitations in the
adequacy of information infrastructure at the local level inhibit their ability
to routinely and consistently produce the data that are required by law for the
Older Americans Act programs and form the basis for many of AoA’s GPRA
performance measures. Extensive and repeated Federal and State efforts to
provide technical assistance and to isolate and correct common data problems
have been helpful for local areas in the majority of States and for most data
elements required by the OAA through NAPIS. Nevertheless, much remains to be
done to ensure that local service providers and area agencies have the capacity
to reliably provide important data without excessive
burden.
Technical Assistance, Standard Software Packages, Electronic Edits
AoA and
the State Units on Aging have long recognized the effects that local capacity
limitations could have on the generation of reliable data for programs and
services of this type, and have taken significant steps to support local
entities in producing the NAPIS data. There are at least two commercial
packages now available to States and local entities to assist them in the
preparation of the NAPIS data. These packages have fostered far greater
consistency in the data generated for NAPIS than was possible in the early years
of implementation. AoA developed an extensive set of electronic edits for all
data elements, which are applied to the electronic submissions of State
entities. AoA contractors work with State data administrators to correct data
elements that fail electronic edits to ensure that data meet standard logic
checks. Following standard electronic checks, knowledgeable AoA regional and
central office staff conduct extensive reviews of edited data for
“reasonableness,” to ensure that significant value changes from one
year to another reflect program circumstances and not the limitations of the
program data. These processes have been extremely slow, burdensome and time
consuming, and they must be modified. AoA and State agency representatives are
investigating ways to streamline the data verification and validation process
without compromising data quality.
Because of the data challenges that the Network is addressing and the time-consuming
validation processes that remain in place at the present time, the FY 1999 data
cited in this report must be classified as “preliminary” data. This
means that AoA and the States are still reviewing a significant number of
individual data items, which were generated from data reported by local
components, for accuracy and validity. Agencies in two small States have not
yet been able to generate program data for FY 1999, and so we have used FY 1998
data for those States to allow us to provide preliminary national estimates for
this performance report. It should be noted that potential error for all
national data elements caused by the use of FY 1998 data for these two States is
less than one tenth of one percent, so it is not a significant limitation. In
addition, AoA has reviewed the data elements used in this report for all other
States, and believes that data are reasonable. The known errors that remain
with the data for a significant number of States will not significantly change
the totals reported here, when the errors are detected and the data corrected.
Over the next year, AoA and its program
partners will review the data requirements of the OAA and consider alternatives
to the collection of the most complicated data that cause most of the burden and
validity problems. This will be done in conjunction with agency efforts to
renew approval of NAPIS data collection efforts under the Paperwork Reduction
Act. AoA will pursue efforts to support local information technology
improvements, particularly Internet and web-based solutions to data reporting
and accessibility. AoA will work with State and local program representatives
to improve their understanding of HHS’s performance measurement
principles, and better demonstrate the constructive uses of performance
information to improve programs. AoA and State and local representatives will
together assess the potential linkages of the performance outcome and service
data that AoA will use for GPRA performance measurement purposes. Together we
will seek to identify the correlation between service measures and program
outcomes to demonstrate the value of collecting data on client and service
characteristics on an ongoing basis.
AoA and
the Aging Network face a similar challenge with the measurement of outcomes.
Although we have made significant progress with the initial development and
testing of outcome measures, we do not have national baselines for outcomes to
set targets for FY 2002. AoA’s Performance Outcome Measures Project,
which was expanded to approximately 30 area agencies in 16 pilot States in FY
2000, is a promising endeavor, and we will pursue statistical methods to obtain
national estimates for the outcome measures that will be tested in the pilot
States over the next year. Nevertheless, the routine, annual and program-wide
measurement of performance outcomes will not be initiated within the next year.
Because of the data limitations addressed in
this Appendix, AoA classifies most of its GPRA performance measures as
“developmental.” This classification means that although AoA will
immediately make use of available data in the context of the GPRA performance
plan and report, the measures and the data on which they are based lack the
maturity to directly support decision-making immediately. In fact, this is not
unusual for the assessment of performance for health and human service programs.
As the Department has observed in previous HHS performance plan and report
summaries, performance measurement data will become more useful over time as
performance measures mature and trends in performance can be
observed.
Appendix 2
Changes and Improvements over the Previous Year
AoA has made significant modifications to its GPRA
performance plan over the past, nearly doubling the number of measures included
in the original plan, deleting measures that did not focus on results, and
reorganizing the structure of the plan to more effectively present performance
information and to make it more consistent with the budget presentation of which
it is a part. The following chart identifies all of the changes to performance
measures that are reflected in this submission of the AoA GPRA performance
plan.
Original FY 2001 |
Revised FY 2002 |
Rationale for Change |
N/A |
Targeting Measure: Provide OAA Title III services to a
significant percentage of U.S. poor elderly individuals. |
While similar information was presented in the text of
the 2001 performance plan, it is included in the 2002 plan as a developmental
performance goal. |
N/A |
Targeting Measure: A significant percentage of OAA Title
III service recipients are poor. |
While this information was presented in the text of the
2001 performance plan, it is included in the 2002 plan as a developmental
performance goal. |
N/A |
Targeting Measure: A significant percentage of OAA Title
III service recipients are minorities. |
While this information was presented in the text of the
2001 performance plan, it is included in the 2002 plan as a developmental
performance goal. |
N/A |
Targeting Measure: A significant percentage of OAA Title
III service recipients live in rural areas. |
New developmental performance goal. |
Original FY 2001 |
Revised FY 2002 |
Rationale for Change |
N/A |
System Measure: Maintain a high ratio of Leveraged
funds to AoA funds. |
AoA previously reported dollar amounts for leveraged
funding for several specific services. We believe the ratio of Older Americans
Act dollars to leveraged dollars is more informative. This is a new
developmental performance goal. |
N/A |
System Measure: Maintain a high ratio of Network program
income to AoA funding. |
New developmental performance goal. |
N/A |
System Measure: A high percentage of funding for the
following services will come from leveraged funds:
- Personal Care
- Home-Delivered Meals
- Adult Day Care
|
New developmental performance goal. |
N/A |
System Measure: Maintain high percentage of senior
centers that are community focal points. |
New developmental performance goal. |
N/A |
System Measure: Maintain high presence (pct.) of
volunteer staff among area agencies on aging. |
New developmental performance goal. |
N/A |
System Measure: Increase internet connectivity for area
agencies on aging |
New developmental performance goal. |
Increase the amount of funds leveraged for
transportation services. |
Performance goal discontinued. |
Replaced with different measures relying on ratios of
appropriated funds to leveraged funds. |
Original FY 2001 |
Revised FY 2002 |
Rationale for Change |
Increase the amount of funds leveraged for information and assistance services. |
Performance goal discontinued. |
Replaced with different measures relying on ratios of appropriated funds to leveraged funds. |
N/A |
Client and Program Outcome Measures: Improve nutritional status scores |
|
N/A |
Client and Program Outcome Measures: A high percentage
of new clients for home-delivered meals have high nutritional risk
scores. |
The client and program outcome measures have been
developed with a pilot group of states and area agencies under AoA’s
performance outcomes measures project. While previous versions of this plan
have described this project, this is the first time these measures are being
included as developmental performance goals. |
N/A |
Client and Program Outcome Measures: A high percentage
of clients rate transportation service as very good or better. |
|
N/A |
Client and Program Outcome Measures: A high percentage
of clients report that calls for information and assistance are answered
quickly |
|
N/A |
Client and Program Outcome Measures: Improve caregiver
support services satisfaction scores. |
|
N/A |
Ombudsman Services Measures: Decrease the prevalence of
restraints in nursing homes. |
HCFA’s measures to reduce the use of restraints
and the incidence of pressure ulcers can indicate quality improvements and also
serve as indicators of results the of the responsiveness of the Ombudsman
program. |
|
Ombudsman Services Measures: Decrease the prevalence of
pressure ulcers in nursing homes. |
|
Name of Section: State and Local Innovations and Projects of National Significance |
Name of Section: Research and Demonstration |
With the FY 2002 budget, AoA has changed the title of
the budget activity “State and Local Innovations and Projects of National
Significance” to “Research and Development.” |
Original FY 2001 |
Revised FY 2002 |
Rationale for
Change |
Name of Section: Health Care Anti-Fraud |
Name of Section: Senior Medicare Patrols and Technical
Assistance Centers |
The earlier title reflected the initiation of activity
to involve seniors in fighting Medicare fraud and abuse. However, it no longer
reflects the generic scope of the activity that AoA has formalized in response
to legislative initiatives, and has thus been changed. |
N/A |
Program Management Measures: Results of audits of AoA
financial statements. |
New developmental performance goal. |
N/A |
Program Management Measures: A high percentage of AoA
hires will be based on a formal AoA Workforce Plan. |
New developmental performance goal. |
N/A |
Program Management Measures: Reduce the time lag (in
months) for making NAPIS data available for GPRA purposes. |
New developmental performance goal. |
Appendix 3
Linkage to the HHS Strategic Plan
Part 1 of this performance plan provides a summary presentation of the linkage between the AoA GPRA performance plan and the HHS Strategic Plan. The following chart is intended to provide a more descriptive and definitive illustration of the detailed links between individual
AoA program activities and the detailed goals and objectives in the FY 2000 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 Program
|
Performance Goal
|
Home Delivered Meals |
Increase the number of home-delivered meals
provided. |
Congregate Meals |
Maintain the number of congregate meals
served. |
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 by
maintaining the level of provision of community-based services. |
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 the Proportion of
Older Americans Who Stay Active and Healthy |
AoA Program
|
Performance Goal
|
Community Based Services: Targeting
Measures |
Assure that a large percentage of U.S. poor elderly
receive OAA Title III services. |
Community Based Services: Targeting
Measures |
Maintain percentage of OAA Title III service recipients
who are poor. |
Community Based Services: Targeting
Measures |
Maintain percentage of OAA Title III service recipients
who are minorities. |
Community Based Services: Service Measures --
Nutrition |
Increase the number of home-delivered meals provided and
maintain the number of congregate meals served. |
Community Based Services: Service Measures --
Transportation |
Maintain the number of one-way rides
provided. |
Community Based Services: Service Measures –
Information and Assistance |
Maintain the number of information and assistance
contacts. |
Community Based Services: Client Outcome Measures
– Nutritional Risk (developmental) |
Determine normative scores through administration of the
Nutritional Risk survey instrument |
Community Based Services: Client Outcome Measures
– Transportation Satisfaction (developmental) |
Determine normative scores through administration of the
Transportation Satisfaction survey instrument |
Community Based Services: Client Outcome Measures
– Information and Assistance Satisfaction (developmental) |
Determine normative scores through administration of the Information and Assistance Satisfaction instrument |
HHS Strategic Objective 2.6: Increase the Independence and Quality of Life of Persons with Long-Term Care needs |
AoA Program |
Performance Goal |
Protection of Vulnerable Older Americans – Long Term Care Ombudsman Outcome Measures |
Maintain the combined resolution / partial resolution rate of 70 percent of complaints in nursing homes. |
Community Based Services: Home Care Satisfaction Measure |
Determine normative scores in the areas of homemaker, home health aide, case management, home-delivered meals and grocery service through administration of the satisfaction survey instruments. |
Community Based Services: Caregiver Support Services Satisfaction Measure |
Determine normative scores through administration of the Caregiver Support Satisfaction survey instrument. |
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 |
AoA Program |
Performance Goal |
Senior Medicare Patrol Measures |
Increase the number of trainers who conduct activities to educate beneficiaries |
Senior Medicare Patrol Measures |
Increase the number of substantiated complaints generated. |
Senior Medicare Patrol Measures |
Increase the amount of Medicare funds recouped. (Discontinued) |
HHS Strategic Objective 3.6: Improve the Health Status of American Indians and Alaska Natives |
AoA Program |
Performance Goal |
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 by maintaining the level of provision of community-based services. |
HHS Strategic Goal 4: Improve the Quality
of Health Care and Human Services |
HHS Strategic Objective 4.1: Enhance the Appropriate
Use of Effective Health Services |
AoA Program |
Performance Goal |
Community Based Services: System Measures |
Maintain a high ratio of leveraged funds to AoA funds. |
Community Based Services: System Outcome Measures |
Maintain a high ratio of network program income to AoA funding. |
Community Based Services: System Outcome Measures |
A high percentage of funding for personal care, home-delivered meals and adult day care will come from leveraged funds. |
Community Based Services: System Outcome
Measures |
Maintain a high percentage of senior centers that are
community focal points. |
Community Based Services: System Outcome Measures |
Maintain high presence of volunteer staff among area agencies on aging. |
Community Based Services: System Outcome
Measures |
Increase the amount of funds leveraged for transportation services(Discontinued). |
Community Based Services: System Outcome Measures |
Increase the amount of funds leveraged for information and assistance services (Discontinued). |
Community Based Services: System Outcome Measures |
Capacity Building Outcome Measure – determine method to develop normative score from area agency director interview guide |
Community Based Services: System Outcome Measures |
Reducing Barriers to Services Outcome Measure – determine method to develop normative score from area agency director interview guide |
Community Based Services: System Outcome Measures |
Support greater internet connectivity among the Aging Network and Older Americans |
HHS Strategic Objective 4.2: Reduce Disparities in the
Receipt of Quality Health Care Services |
AoA Program
|
Performance Goal
|
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 by
maintaining the level of provision of community-based services. |
HHS Strategic Objective 4.4: Improve Consumer
Protection |
AoA Program
|
Performance Goal
|
Protection of Vulnerable Older Americans – Long
Term Care Ombudsman Outcome Measures |
Maintain the combined resolution / partial resolution
rate of 70 percent of complaints in nursing homes. |
Appendix 4
Performance Measurement Linkage with the Budget and Other Management Functions
For AoA at the present time, the relevant linkages
for GPRA are with the AoA budget and AoA’ s program evaluation function.
The linkages with the budget are briefly defined in Part 2 of the plan, and are
illustrated in more detail in the chart below. The linkages between AoA’s
GPRA and program evaluation activities are better presented in narrative form.
To foster consistency between the two program assessment methodologies, AoA has
located responsibility for both GPRA and program evaluation in the same program
component. In addition, to ensure the development of outcome measurement as a
tool that assists with directing program evaluation activity, some program
evaluation funding is being devoted to the development of performance outcome
measures for the Aging Network. For the foreseeable future, AoA will continue
to support a limited set local performance outcome measures projects with
program evaluation funds, and will meet the requirements of the OAA for defining
outcome measures by December 31, 2001, and developing initial national measures
in the same manner.
The AoA budget linkage table is shown in its entirety on the following page.
Budget Linkage Table ($ Amounts in 000’s)
AoA FY 2002 Performance Plan Areas
|
Program/Budget Line Items
|
FY 2000 Appropriation
|
FY 2001 Appropriation
|
FY 2002 Proposed
|
Community-Based Services:
- Targeting Measures
- System Measures
- Service Measures
- Client and Program Outcome Measures
|
Supportive Services and
Centers
Congregate
Meals
Home-Delivered
Meals
Preventive Health
Services
Caregivers (NFCSP) |
$847,446 |
$1,001,610 |
$1,011,610
|
Ombudsman Services |
Vulnerable Older Americans |
$13,179
|
$14,181
|
$14,181
|
Services for Native Americans
|
Grants to Indian Tribes
|
$18,457
|
$23,457
|
$25,457
|
Research and Development
|
Research and Development
Alzheimer’s Disease Demonstration Grants to States
Aging Network Support Activities
|
$37,124
|
$46,626
|
$28,348
|
Senior Medicare Patrols and Technical Assistance
Centers
|
Operation Restore Trust (HCFAC)
|
$1,450
|
$1,500
|
$2,000
|
Program Administration
|
Program Direction
|
$16,458
|
$17,219
|
$18,122
|
|
Total Budget
|
$934,114
|
$1,104,593
|
$1,099,718
|
|