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, AoA has 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.
Appendices
- Approach to Performance Measurement
- Changes and Improvements
- Linkage to the HHS Strategic Plan
- Linkage with the Budget
Introduction
With the Government Performance and Results Act (GPRA), the
Congress established a management tool that compels Federal
agencies and programs to focus on results. For AoA, GPRA is
an opportunity to document results produced through the programs
the agency administers 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.
However, the heart of the aging network are the 56 State units
on aging, 655 area agencies on aging, 335 tribal organizations,
and thousands of service providers, which deliver program services
to older individuals across the nation.
Through these extensive partnerships, the network produces
the results that the Congress has sought through the OAA. Based
on resources input by AoA, we track network output as measured
by units of service provided. Intermediate outcome measures
indicate that the network targets services to the most vulnerable
elderly individuals in the country. Very high proportions of
service clients are poor and disabled, many are minorities,
and significant proportions reside in rural areas. The end outcome
measures that are under development will allow AoA to demonstrate
that: 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. Approximately
half of the staff, who work for area agencies on aging to coordinate
services for the elderly, are volunteers. 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.
In an attempt to make it more readable and user friendly, AoA
has made a concerted effort to reduce the volume of this plan
and report. Additionally, this allows AoA to focus on the analysis
of the performance data that constitute the core of this plan
and that are central to AoA’s proposed budget for Fiscal Year
(FY) 2003.
Part I – Agency Context for Performance Measurement
1.1 Agency Mission and Long-Term Goals
The Administration on Aging was established in 1965 through
the enactment of the Older Americans Act (OAA), in response
to the growing number of elders and their diverse needs. The
OAA focuses especially on those at risk of losing their independence.
AoA seeks continuously to improve the quality of life for all
older Americans, primarily by assisting them to remain independent,
actively engaged, and productive. AoA works closely with the
aging network to plan, coordinate and develop home and community-based
systems of services that meet the unique needs of older persons
and their families.
The OAA, reauthorized in 2000 for five years, 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 across the country which help to keep America’s rapidly
growing older population healthy, secure and independent. The
Act also charges AoA to serve as the effective and visible advocate
for older individuals within the Department of Health and Human
Services and with other departments and agencies of the Federal
Government.
Strategic Goals of the Administration on Aging
The Older Americans Act (OAA) defines 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. The following
are OAA and agency-generated strategic goals and objectives
that 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 services 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, a choice in living arrangements,
and social assistance. Services will be provided in a coordinated
manner and will be readily available when needed. The system
will maintain a continuum of care for vulnerable older individuals.
- Support freedom, independence, and the free exercise of
initiative to elderly individuals in planning and managing
their own lives. Provide individuals full participation in
the planning and operation of community-based services and
programs provided for protection against abuse, neglect, and
exploitation.
- Provide opportunities for better nutrition and improved
health.
- Promote the development of 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 that foster the participation of elders
in the widest range of civic, cultural, educational, 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. The detailed linkages of AoA
goals and activities with the HHS Strategic Plan are presented
in Appendix 3 of this plan.
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.
In FY 2002, the Assistant Secretary for Aging reorganized the
agency to focus on consumers. The new organizational structure
streamlines the organization, consolidates and elevates AoA’s
external communications functions, strengthens and centralizes
its analytical and policy development activities, and focuses
AoA’s programmatic efforts on those areas of greatest importance
to older Americans.
AoA provides Federal administration of community services programs
that are mandated under the Older Americans Act. The programs
provide meals and various supportive services; they offer the
elderly opportunities to enhance their health and to be active,
independent contributors to their families, communities, and
the nation. AoA funding supports in-home and community-based
services including nutrition, transportation, health promotion,
nursing home ombudsmen, outreach, elder abuse prevention efforts,
and services in support of family caregivers.
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
State, tribal and area agencies on aging ensure 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 well over 25,000 service provider
agencies nationwide, some AAAs deliver services directly when
no local contractor is available. AoA awards funds directly
to 333 Indian tribal organizations and 2 organizations serving
Native Hawaiian elders. These organizations are direct providers
of services to older Native Americans living on or near Indian
reservations, historical Indian lands, Alaska Native villages
and Native Hawaiian communities. 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 not 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 needs of older
Americans. 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
that 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 partnerships within the aging
network, AoA works closely with many Federal agencies on a wide
range of issues.
In the area of nutrition, AoA has worked with the U.S. Department
of Agriculture (USDA) on such issues as dietary guidelines used
as standards for OAA programs. The USDA is also a partial funding
agent for meals provided through the aging network. In fact,
AoA recognizes the partnership between USDA and HHS in providing
meals through the aging network; therefore, the Administration
has proposed the consolidation of these funding activities in
AoA in the FY 2003 budget. Within HHS, AoA works 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.
AoA also participates on such bodies as the Federal Food Safety
Coalition chaired within the Food and Drug Administration; 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, AoA works closely with HHS officials
and the U.S. Department of Transportation on the Coordinating
Council on Access and Mobility 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). The purpose of these projects is to eliminate
health disparities among older racial and ethnic minority 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 the Health Resources and
Services Administration (HRSA) 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 2001, AoA played a major role in advancing HHS’s
initiative to help States implement the Supreme Court’s Olmstead
decision. AoA joined the Department’s internal Olmstead work
group comprised of CMS, OCR, ASPE, SAMHSA, and ADD and assisted
in developing the Real Choice Systems Change Grants which will
provide states with $70 million dollars to make their systems
of long-term care more consumer directed and focused on home
and community-based care. As part of this initiative, AoA worked
with State units on aging to make sure the interests of the
elderly were reflected in state planning efforts related to
the System Change Grants. Finally, AoA co-sponsored a national
conference on Consumer Direction in Long-Term Care in collaboration
with ASPE, CMS, SAMHSA, ADD, and the Robert Wood Johnson Foundation.
1.4 Performance Report Summary
The following performance report summary updates that presented
in the final performance plan for FY 2002. The most significant
advancement in performance reporting for this report is that
it includes final FY 1999 data earlier than originally anticipated,
and preliminary data for FY 2000. AoA and State agencies have
initiated the process of certification for FY 2000 data. The
following chart illustrates the status of AoA reporting of performance
measures included in previous performance plans.
Year |
Measures in Plan |
Results Reported |
Results Met |
Unreported |
1999 |
18 |
18 |
14 |
0 |
2000 |
18 |
18 |
13 |
0 |
2001 |
23 |
2 |
2 |
21 |
2002 |
26 |
NA |
NA |
NA |
2003 |
37 |
NA |
NA |
NA |
The data for the performance measures identified throughout
this plan present a story of performance indicating that the
network produces the results intended by the Older Americans
Act (OAA). The data for each of the four 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.
Part II – Program Planning & Assessment
Introduction — Budget Linkage
The core of GPRA planning and reporting is the presentation
of performance measures that address the results that AoA and
aging network produce with the program resources entrusted to
them. 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 measures that AoA
presents were developed to cover the entirety of its program
activities, and are intended, therefore, to support the entire
budget request of the agency. AoA’s performance plan is not
limited to measures associated with the incremental portion
of the AoA budget.
The linkage of the AoA budget and performance plan is stronger
than the routine justification of the total resources required
for OAA program activities. The results that AoA reported in
its last performance report were considered in the process of
identifying budget initiatives for FY 2003, and the data presented
in that and this report support the AoA budget initiatives that
HHS has submitted to OMB in the FY 2003 budget.
- The data presented under targeting measures that document
the effectiveness of the aging network in targeting services
to vulnerable individuals are relevant to and support the
AoA initiatives to enhance our support of the aging network.
- The data under system measures that indicate that the network
is increasingly leveraging funds from sources other than AoA,
especially for services targeted to the most vulnerable elderly
individuals, support maintenance of AoA service funding.
- The data under systems measures and the measures for the
Medicare Senior Patrols program, that document the reliance
of the network on cost-effective volunteers, support the
Agency’s initiatives to enhance our volunteer utilization
efforts, especially in support of the caregiver program.
- The preliminary pilot-test data under outcomes measures
that document the limited availability of services in support
of family caregivers reinforce the Agency’s efforts to
ensure adequate funding for the family caregiver program.
The AoA program categories identified for GPRA presentation
purposes, with the budget line items they comprise are:
- Community-Based Services
- Budget line items:
- Supportive Services and Centers
- Congregate Meals
- Home-Delivered Meals
- Preventive Health Services
- National Family Caregiver Support Program (NFCSP)
- Vulnerable Older Americans
- Budget line item:
- Ombudsman Services
- Prevention of Elder Abuse
- Native American Services
- Research and Development
- Budget line items:
- Training, Research and Discretionary Projects
- Alzheimer’s Disease Demonstration Grants to States
- Aging Network Support Activities
- Senior Medicare Patrols
- Senior Medicare Patrols (HCFAC)
- Program Management
2.1 COMMUNITY-BASED SERVICES
Program Description and Context
(numbers in thousands) |
FY 2000 Enacted |
2001 Enacted |
FY 2002 Enacted |
FY 2003 President’s Budget |
Community Based Services |
$847,446 |
$1,149,512 |
$1,233,841 |
$1,236,286 |
The Community-Based Services program comprises AoA’s budget
line items for programs administered by State and community
agencies, 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 included
the National Family Caregiver Support Program. This performance
plan identifies the first developmental performance measures
to be used to assess performance for this new program activity.
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. AoA, other Federal, and outside source
funds are used by State and area agencies on aging and service
providers to coordinate and to provide services for elderly
individuals.
The Community-Based Services program covers the bulk of the
resources, services and activities of AoA and the aging network.
The program provides “access” services, such as information
and assistance, outreach, and transportation. The program covers
“community” services, which include congregate meals,
senior-center activities, adult day care, pension counseling,
and health promotion and fitness programs. The program provides
“in-home” services, including home-delivered meals, chores,
home maintenance assistance, home-health, and personal care.
Beginning in FY 2001, the program 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
Building on the improvements instituted in AoA’s FY 2002 plan,
this performance plan includes the following types of performance
measures for community-based programs:
- Intermediate outcome targeting measures. Does the
network target services to vulnerable elderly individuals?
- Intermediate outcome system measures. What do the
State and local components of the network contribute to the
elderly in the way of resources, coordination, and emphasis
on the most vulnerable?
- Service output measures. What level of services
will the network provide to elderly individuals each year
for meals, transportation, etc.?
- End outcome measures. From the perspective of elderly
consumers and their caregivers, what results do AoA and the
network produce for the elderly?
Performance Measures Table—Intermediate Outcome Targeting
Measures (Part 1)
Performance
Goals |
Targets |
Actual Performance |
Notes |
INTERMEDIATE OUTCOME TARGETING
MEASURES: Poverty A significant
percentage of OAA Title III service recipients are poor.
Norm: Percent of U.S. elderly population who
are poor:
1998: 9.7%
1999: 10.4%
2000: 10.2%
Improve poor client service percentages for primary aging
network entities (States and Territories)--developmental
Rural Residence
A significant percentage of OAA Title III service recipients
live in rural areas.
Norm: Percent of U.S. elderly population who live
in rural areas:
1998: 24.4%
Improve rural client service percentages for primary
aging network entities (States and Territories) developmental |
FY 03: 32%
FY 02: 25%
FY 01: 25%
FY 00: (New in 01)
FY 03: 5 Entities
FY 02: (New in 03)
FY 03: 34%
FY 02: 25%
FY 01: 25%
FY 00: (New in 01)
FY 03: 5 Entities
FY 02: (New in 03) |
FY 03: 02/05
FY 02: 02/04
FY 01: 02/03
FY 00: 31.8% (preliminary)
FY 99: 31.7%
FY 98: 36.2%
FY 97: 39.1%
FY 03: 02/05
FY 02: 02/04
FY 01: 02/03
FY 03: 02/05
FY 02: 02/04
FY 01: 02/03
FY 00: 33.7% (preliminary)
FY 99: 33.6%
FY 98: 33.5%
FY 97: 32.6%
FY 03: 02/05
FY 02: 02/04
FY 01: 02/03 |
|
Performance Measures Table—Intermediate Outcome Targeting
Measures (Part 2)
Performance Goals |
Targets |
Actual Performance |
Notes |
Intermediate Outcome Targeting Measures
Minorities
A significant percentage of OAA Title III service recipients
are minorities.
Norm: Percent of U.S. elderly population who are
minorities:
1997: 16.4%
Caregivers
Increase the ratio of family caregivers to registered
clients. -- developmental
Disability
Improve disabled client service percentages for primary
aging network entities (States and Territories) --developmental
Services to Senior Elders (75 + years)
Improve older client service percentages for primary
aging network entities (i.e. to elders aged 75+ years)
-- developmental |
FY 03: TBD
FY 02: (New in 03)
FY 03: 5 Entities
FY 02: (New in 03)
FY 03: 5 Entities
FY02: (New in 03) |
FY 03:
FY 02: 02/04
FY 01: (baseline: 02/03)
FY 03: 02/05
FY 02: 02/04
FY 01: 02/03
FY 03: 02/05
FY 02: 02/04
FY 01: 02/03 |
|
(Note: The targeting measures are presented in two tables for
ease in presentation.)
Performance Measures Analysis—Intermediate Outcome Targeting
Measures
The OAA seeks to ensure and to support the well-being of elderly
Americans, particularly those who are most vulnerable, including
the poor, minorities, disabled, and the elderly in rural areas.
It is not enough that the network provide services; the network
must reach out to and serve the most vulnerable among the elderly.
AoA has identified a set of targeting measures to track the
effectiveness of the network in meeting the intent of the OAA
to serve vulnerable elderly individuals, and to target measurable
improvements where appropriate. AoA and the network are also
focusing on targeting services to caregivers to ensure the successful
implementation of the new program.
To demonstrate that the network is targeting services to vulnerable
individuals, data should show that the percentage of clients
who are poor, disabled, minorities and those in rural areas
is significantly higher than the percentage of all elderly persons
who fit these characteristics. This year, AoA has made
two additional improvements to its targeting measures. First,
AoA has made the performance targets for the targeting measures
more rigorous for FY 2003. Second, the plan for FY 2003 includes
three new measures to foster improved performance
by committing to increase the percent of poor, rural, and disabled
served by five program entities (States or Territories) that
currently perform below the national average. To accommodate
this increase in measures, AoA has deleted a developmental poverty
measure that effectively duplicated the targeting measure introduced
last year.
Results for Intermediate Outcome Targeting Measures
For the measures introduced in the FY 2002 performance plan,
the tables above indicate that the aging network effectively
targets services to the vulnerable elderly individuals in the
Nation.
- Poverty Targeting Measures: In each year over 30%
of aging network clients were poor. 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. Performance has declined in recent years—a trend
that AoA is working to reverse.
- Rural Targeting Measure: 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.
- Minority Targeting Measure: Although the percent
of OAA clients who were minorities was higher in all three
years than the total percent of all elderly minority individuals,
the portion of AoA minority clients has been decreasing in
recent years. Figure 2 illustrates this characteristic of
the OAA client population for fiscal years 1997 through 1999.
Again, AoA is committed to increasing minority participation
in future years.
- Disability Targeting Measure: Disability data for
42 entities show that a very high percentage of clients receiving
home delivered meals have limitations in Activities of Daily
Living (ADL’s) and in Instrumental Activities of Daily Living
(IADL’s). This data indicates that reporting entities as
a whole are successfully targeting services to disabled elderly
individuals.
- Senior Elders Targeting Measure: Data on age categories
for 42 states show that a high percentage of clients receiving
registered services are aged seventy-five and above. This
data indicates that reporting entities as a whole are successfully
targeting registered services to elderly individuals aged
seventy-five and above. For the 42 States reporting detailed
client characteristics in FY 1999, over 60% of elderly clients
were aged seventy-five and above.
- Caregiver Targeting Measure: The caregiver program
was implemented in FY 2001. The Network has no results data
to report thus far.
Goals and Targets
Performance targets for FY 2003 are based on the past and current
performance of the network as reflected in the tables above.
Because of the overall performance of the network in targeting
services to vulnerable elderly individuals, at a minimum, AoA
seeks to maintain performance at or near the levels established
as national performance targets over the last few years.
The national targets for FY 2003 for serving poor, minority
and rural clients have been increased to reflect that intention
In its commitment to continuously improve program performance
where it is needed, AoA is proposing to improve performance
for primary service entities that do not perform at the national
average for targeting services. To reflect AoA’s commitment
to its targeting outcome measures, beginning with the FY 2003
performance plan, AoA proposes to improve performance
in five primary service entities for which client service ratios
are below national or multi-State service ratios for poverty,
rural residence, disability status, and service to senior elders.
AoA’s initial targeting measure for the National Family Caregiver
Support Program reflects that this is a new program. The ratio
presented in the table above will serve as an initial indicator
of impact. We expect initially that the ratio of supported caregivers
to registered elderly clients will be very low, probably far
less than one caregiver to twenty registered clients. To demonstrate
that the program is having an impact, even in the early years,
this ratio should increase over time.
Performance Measures Summary Table— Intermediate Outcome
System Measures (Part 1)
Performance
Goals |
Targets |
Actual
Performance |
Ref. |
INTERMEDIATE OUTCOME SYSTEM
MEASURES:
Leverage Funding
Maintain a high ratio of Leveraged funds to AoA funds.
Improve leveraged funding ratios for primary aging network
Entities (States and Territories)--developmental
A high percentage of funding for the following services
will come from leveraged funds:
-
Personal Care
-
Home-Delivered Meals
-
Adult Day Care
Program Income
Maintain a high ratio of network program income to AoA
funding.
Improve program income ratios for primary aging network
entities (States and Territories)—developmental |
FY 03: $1.90 to $1.00
FY 02: $1.50 to $1.00
FY 01: $1.50 to $1.00
FY 00: (New in 01)
FY 03: 5 Entities
FY 02: (New in 03)
FY 03: 74%
FY 02: 70%
FY 01: 70%
FY 00 (New in 01)
FY 03: $.35 to $1.00
FY 02: $.30 to $1.00
FY 01: $.30 to $1.00
(New in 01)
FY 03: 5 Entities
FY 02: (New in 03) |
FY03: 02/05
FY 02: 02/04
FY 01: 02/03
FY 00: $1.90 to $1.00 (preliminary)
FY 99: $1.90 to $1.00
FY 98: $1.90 to $1.00
FY 97: $1.80 to $1.00
FY 03: 02/05
FY 02: 02/04
FY 01: 02/03
FY03: 02/05
FY 02: 02/04
FY 01: 02/03
FY 00: 74% (preliminary)
FY 99: 75%
FY 98: 75%
FY 97: 74%
FY03: 02/05
FY 02: 02/04
FY 01: 02/03
FY 00: $.35 to $1.00 (preliminary)
FY 99: $.35 to $1.00
FY 98: $.37 to $1.00
FY 97: $.37 to $1.00
|
|
Performance Measures Summary Table—Intermediate Outcome
System Measures (Part 2)
Performance Goals |
Targets |
Actual Performance |
Reference |
Intermediate Outcome System Measures
Senior Center Focal Points
Maintain high percentage of senior centers that are community
focal points.
Area Agency Volunteers
Maintain high percentage of volunteer staff among area
agencies on aging.
Caregiver
Increase the number of State agencies on aging that provide
caregiver services in all five service categories --developmental |
FY 03: 60%
FY 02: 50%
FY 01: 50%
FY 00 (New in 01)
FY 03: 46%
FY 02: 40%
FY 01: 40%
FY 00: (New in 01)
FY 03:
FY 02: (New in 03) |
FY03: 02/05
FY 02: 02/04
FY 01: 02/03
FY 00: 59.5% (preliminary)
FY 99: 59.5%
FY 98: 58.8%
FY 97: 57.9%
FY03: 02/05
FY 02: 02/04
FY 01: 02/03
FY 00: 45.4% (preliminary)
FY 99: 45.9%
FY 98: 43.8%
FY 97: 50.7%
FY 03: TBD
FY 02: 02/04
FY 01: Baseline 02/03
|
|
System Measures Discontinued
Increase the amount of funds leveraged for transportation
services.
Increase the amount of funds leveraged for information
and assistance services.
Increase the amount of funds leveraged for case management
services over FY95. |
(dollars in millions)
FY 01: (discontinued)
FY00: $97.3
FY99: $96.4
FY 01: (discontinued)
FY00: $38.9
FY99: $38.5
FY 01: (discontinued)
FY 00: $65.82 |
(dollars in millions)
FY01: (discontinued)
FY00: $93.4 (preliminary)
FY99: $96.5 √
FY95: $95.3
FY01: (discontinued)
FY00: $54.6 (preliminary)
FY99: $46.7 √
FY95: $38.1
FY01: (discontinued)
FY00: $63.5 (preliminary) |
|
Performance Measures Analysis— Intermediate Outcome System
Measures
Intermediate Outcome System measures data should show that:
(1) there is a significant contribution above and beyond funding
provided by AoA ; (2) there is a strong degree of coordination
of services provided through the network; and (3) the network
is community oriented and makes use of community resources.
One of the most significant intermediate outcomes for AoA is
the effectiveness of the aging network to advocate, coordinate,
and support services for elderly individuals in communities
across the nation. AoA uses the intermediate outcome “system”
measures related to the following network characteristics to
track the effectiveness of Federal, State, area agencies on
aging and community-service providers in serving, and advocating
for, vulnerable elderly individuals:
- Funding leveraged by network entities,
- Program income and voluntary contributions generated by
network entities,
- Senior centers as community focal points, and
- Volunteer staffing among local governmental entities.
AoA has made two significant improvements to its intermediate
outcome systems measures. First, AoA has made the performance
targets for the measures more rigorous for FY 2003. Second,
the plan for FY 2003 includes two new measures to foster improved
performance by committing to increase leveraged funding
and program income performance for five program entities (States
or Territories) that perform below the national average.
For the National Family Caregiver Support Program, our initial
objective for the “system” is to develop a well-rounded program
that serves the various needs of caregivers as envisioned by
the OAA. The developmental measure identified above will address
the extent to which State agencies develop comprehensive caregiver
programs that provide the variety of services required by the
OAA.
Results for Intermediate Outcome Systems Measures
The data reported above for AoA’s intermediate outcome system
measures demonstrate the following:
- The funds “leveraged” by the aging network are significant
in total.
- The leveraged funds substantially exceed the funding
provided by AoA for home and community services to the elderly,
particularly the most vulnerable.
- 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 network is characterized by a strong community
orientation, in which senior centers are not only places where
elderly individuals receive services, but are places where
services for the elderly are organized and coordinated.
- The network is committed to local solutions and resources
in support of the elderly, as reflected in data that show
that almost 50% of area agency staff are volunteers.
In the above table, data is reported for multiple years. There
is some variation in these reported numbers from year to year.
This, however, does not represent a significant variation. The
data indicates that the network has been successful in maintaining
performance at a high level for each of the measures.
The following are systems measures performance highlights for
fiscal years 1997 through 1999.
- Leveraged Funding Measures: 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% (See
figure 3 below).
- 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.
- Program Income Measure: 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.
- Senior Center Focal Point Measure: For FY 1997 through
FY 1999, over half of all senior centers participating in
the program were community-service “focal points.”
- Area Agency Volunteer Measure: 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.
- Caregiver Measure: For the National Family Caregiver
Support Program, our initial objective for the “system” is
to develop a well-rounded program that serves the various
needs of caregivers as envisioned by the OAA. The developmental
measure identified above will address the extent to which
State agencies develop comprehensive caregiver programs that
provide the variety of services required by the OAA.
To comply with GPRA requirements, the table above continues
to present data for three discontinued measures that appeared
in the AoA performance plan for FY 2000. Consistent with the
guidelines on reporting analysis provided in A-11, part 2, AoA
met its FY 2000 targets for information and assistance, substantially
met the target for case management services, and preliminary
data indicate that AoA did not meet its target for transportation.
AoA discontinued these measures in favor of the more relevant
and informative measures discussed above.
Goals and Targets
Performance targets for FY 2003 are based on the past and current
performance of the network as reflected in the tables above.
Because of the outstanding overall performance of the network
for all of the defined intermediate outcome systems measures,
AoA seeks to maintain performance at or near the levels established
as national performance targets over the last few years. The
national targets for FY 2003 for leveraging funds, program
income, focal points and area agency volunteers
have been increased to reflect that intention.
AoA is committed to continuously improve program performance
where it is needed. To reflect this commitment for its systems
outcome measures, beginning with the FY 2003 performance plan,
AoA proposes to improve performance in five primary service
entities for which client service ratios are below national
or multi-State service ratios for leveraged funding and program
income.
Performance Measures Summary Table—Service Measures
(Part 1)
Performance Goals |
Targets |
Actual Performance |
Ref. |
SERVICE OUTPUT MEASURES
Nutrition
Increase the number of home-delivered meals provided.
Maintain the number of congregate meals provided.
Transportation
Maintain the number of units of service provided. |
(numbers in millions)
FY 03: 183.0
FY 02: 183.0
FY 01: 176.0
FY 00: 155.0
FY 99: 119.0
FY 03: 115.2
FY 02: 115.2
FY 01: 115.2
FY 00: 113.1
FY 99: 123.4
FY 03: 50.7
FY 02: 50.7
FY 01: 50.7
FY 00: 46.6
FY 99: 39.5 |
(numbers in millions)
FY 03: 02/05
FY 02: 02/04
FY 01: 02/03
FY 00: 142.4 (preliminary)
FY 99: 134.6 √
FY 98: 129.7
FY 97: 123.4
FY 96: 119.1
FY 95: 119.0
FY 03: 02/05
FY 02: 02/04
FY 01: 02/03
FY 00: 116.0 (preliminary)
FY 99: 112.8 √
FY 98: 114.1
FY 97: 113.1
FY 96: 118.6
FY 95: 123.4
FY 03: 02/05
FY 02: 02/04
FY 01: 02/03
FY 00: 42.3 (preliminary)
FY 99: 45.8 √
FY 98: 45.7
FY 97: 46.6
FY 96: 36.9
FY 95: 39.5 |
|
Performance Measures Summary Table—Service Measures
(Part 2)
Performance Goals |
Targets
|
Actual Performance |
Ref. |
Service Output Measures
Information and Assistance
Maintain the number of units of service provided.
Caregiver Services
Increase the number of caregivers served. – developmental/p>
Discontinued Service Measure:
Maintain hours of case management at the FY 95 level. |
(numbers in millions)
FY 03: 15.2
FY 02: 15.2
FY 01: 15.2
FY 00: 14.0
FY 99: 12.5
FY 03: 250,000
FY 02: (New in 03)
FY 01: (discontinued)
FY 00: 2.98 hours |
(numbers in millions)
FY 03: 02/05
FY 02: 02/04
FY 01: 02/03
FY 00: 13.5 (preliminary)
FY 99: 12.2 √
FY 98: 13.1
FY 97: 14.0
F Y96: 13.7
FY 95: 12.5 Contacts
FY 03: 02/04
FY 02: 02/03
FY 01: 02/02 (baseline)
FY 00: 3.19 (preliminary) |
|
Service Output Measures
The measures in this section of the plan are output measures
that provide a basis for the fundamental tracking of the level
of services that AoA and the other components of the network
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.
For FY 2003, AoA has added a developmental measure for the
National Family Caregiver Support Program, which is consistent
with the expectations of the Congress for the new program. Primarily,
it is the objective of the program to reach out to caregivers.
Thus, initially it is more relevant for AoA to identify the
number of individuals served, rather than the units of service
provided. In addition, AoA and the network must identify consistent
definitions of service units prior to establishing measures
of such units.
Service output data should show that over time performance
outputs are consistent with the level of resources provided
by AoA and the anticipated level of resources provided by other
network entities.
Results for Service Output Measures
The preliminary data for FY 2000 indicate that
AoA met service performance targets for one of the four
output measures included in the FY 2000 annual performance
plan. The data suggest that AoA and the network met the output
levels targeted for congregate meals, but not for home-delivered
meals, transportation, and information and assistance.
However, AoA is not prepared to conclude that output
performance by the network is problematic on the basis of preliminary
data. AoA is not prepared to conclude that output performance
by the Network is problematic for the following reasons: (1)
the data is preliminary and preliminary data are subject to
some understatement of service units because of under-reporting
of some local entities across the country; (2) there was no
basis for AoA to expect that States would match, in the same
year, the increase that AoA provided in FY 2000 for home-delivered
meals; and (3) AoA should not have expected the full increase
in the number of home-delivered meals in one year (FY 2000)
given that State and local entities have two years to expend
funds. The data for FY 2000 are undergoing State and Federal
verification procedures. When final data are certified, we believe
that performance for information and assistance may meet the
target, and that performance for transportation services will
be closer to the target than the preliminary data indicate.
- Home Delivered Meals Output Measures: We do not believe
that the final data will reflect that AoA met the FY 2000
target for home-delivered meals, but the data will reflect
a significant increase in the number of home-delivered meals
provided in FY 2000. The failure to meet the targeted
result will reflect more the difficulty of accurately targeting
the number of meals that will be served than performance expectations.
In the FY 2000 performance plan, AoA projected an over 30
percent increase in the number of home-delivered meals, consistent
with the increase in Federal funding from FY 1999 to FY 2000
for home-delivered meals. However, AoA funding for home-delivered
meals is only 30% of the total provided for this service.
On analysis, we are likely to find that it was not accurate
to assume that: 1) all entities could match the Federal increase
for one service category in the same fiscal year;
and 2) that ongoing cost increases would not have any effect
on the level of services provided
- Congregate Meals Output Measure: Preliminary FY 2000
data indicate that the network exceeded its targets for congregate
meals. We consider that this will be maintained when the
FY 2000 data are finalized. In fact, the trend data in the
table above indicate that output for congregate meals over
the reported years is steady and consistent with stable funding.
- Transportation Output Measure: When final data are
certified for FY 2000, the level of output performance for
transportation service will be closer to but may not meet
the FY 2000 target. AoA overstated the FY 2000 target when
it based the target solely on data for FY 1997. In fact,
when certified data are available, we believe that it will
show that service output for transportation has also been
stable over the last four years consistent with stable funding.
- Information and Assistance Output Measures: When
final data for FY 2000 are certified, the level of output
performance for information and assistance will be closer
to but may not meet the FY 2000 target. AoA overestimated
the FY 2000 target when we established the target based solely
on data from FY 1997. Moreover, once the certified FY 2000
data is available, we believe that it will demonstrate that
service output for information and assistance has also been
stable over the last four years consistent with stable funding.
- Caregiver Output Measure: The caregiver program was
implemented in FY 2001. The network has no output measures
to report thus far.
Goals and Targets for Service Output Measures
Performance targets for FY 2003 are based on the past and current
performance of the Network as reflected in the tables above.
Because the FY 2000 data are preliminary, and because AoA’s
performance for FY 1999 was not out of line with performance
targets, AoA will not propose to reduce the performance targets
for its service output measures at this time. However, AoA also
believes that it would be unrealistic to raise the service output
targets any further until we have taken the opportunity to assess
the processes used to project service levels for the program.
Within the next year, AoA will reassess the methods that were
used to develop these performance targets, and will ensure that
future targets are better linked to projected resource changes.
AoA will retain what it now believes are very high targets for
both FY 2001 and 2002, and will project for FY 2003 that services
will be maintained at the currently projected FY 2002 levels.
This is consistent with the maintenance of Federal funding for
these activities at the FY 2002 levels in the President’s Budget.
Performance Measures Summary Table—Client and Program Outcome
Measures
Performance Goals |
Targets |
Actual Performance |
Ref. |
Client and Program Outcome Measures
(Pilot States and areas only)
Nutrition
The average nutritional risk score for established OAA
clients will be lower than the average score for new clients.
– developmental
A high percentage of new clients for home-delivered meals
have high nutritional risk scores.
Transportation
A high percentage of clients rate transportation service
as very good or better. -- developmental
Information and Assistance
A high percentage of clients report that calls for information
and assistance are answered quickly.
-- developmental
Home Care Services
Improve home care services satisfaction scores. -- developmental
Caregiver
Improve caregiver support services satisfaction scores:
-- developmental |
FY 03:
FY 02: (new in 03)
FY 03:
FY 02:
FY 03:
FY 02:
FY 03:
FY 02:
FY 03:
FY 02:
FY 03:
FY 02: |
FY 03:
FY 02: TBD 6/02
(baseline)
FY 03:
FY 02:
FY 01:
FY 00: 77%
FY 03:
FY 02:
FY 01:
FY 00: 82%
FY 03:
FY 02:
FY 01:
FY 00: 95%
FY 03:
FY 02:
FY 01: TBD 6/02
FY 03:
FY 02:
FY 01:
FY 00: 67% |
|
Performance Measures Analysis—Client and Program Outcome
Measures
IMPORTANT NOTICE: The Administration on Aging has entered
into a contract with WESTAT, Inc. to conduct national performance
outcome measures surveys for the following services in FY 2002:
nutrition, transportation, home care, caregiver support, and
information and assistance. This commitment, the summary table
above, and the analysis that follows, constitute AoA’s response
to the requirements of the Older Americans Act for the development
of performance outcome measures for OAA programs. The surveys
to be conducted this fiscal year will allow AoA and the network
to begin the projection of national performance outcomes in
the next AoA GPRA performance plan.
The end outcome measures that are currently being developed
will identify from the consumer perspective that network programs
meet the needs of elderly individuals. It is AoA’s intention
to begin to collect data through a National survey to demonstrate
the following:
Nutrition Services:
- The extent to which the aging network targets services to
elderly individuals at high nutritional risk.
- The extent to which nutritional risk is improved as a result
of OAA meals programs.
- The level of disability for elderly participants in home-delivered
meals programs.
- Overall consumer satisfaction with meals programs provided
through the network.
Transportation Services:
- Impact of services on satisfying the needs of elderly individuals
for transportation associated with medical visits and other
essential needs.
- Adequacy of transportation services in terms of frequency,
safety, comfort and reliability.
- Overall consumer satisfaction with transportation services.
Information and Assistance:
- Quality and timeliness of responses to consumer requests
for information and assistance.
- The level of “human” response to consumer inquiries (calls).
- Overall consumer satisfaction with information and assistance
services.
- The level of follow-up on consumer information requests.
Home Care Services:
- Overall consumer satisfaction with components of home care
services such as personal care, home delivered meals, case
management, and adult day care services.
- Establishment of a baseline for network entity comparisons
on home care satisfaction.
Caregiver Support Services:
- Ability of the network to increase availability of caregiver
services
- Caregiver assessment of impact of services to clients and
caregivers on the ability of the client to remain independent
at home and in the community.
- Caregiver assessment of network programs ability to reduce
caregiver burden.
In partnership with the National Association of State Units
on Aging and the National Association of Area Agencies on Aging,
AoA continues the Performance Outcome Measures Project (POMP)
to develop and field-test outcome measures suitable for ongoing
use in assessing community-based services in support of elderly
individuals. To measure performance outcomes, 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. Through its contract with WESTAT, Inc., AoA 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, AoA and its partners in the POMP have developed
survey instruments, implemented sampling procedures, and completed
pilot surveys in the following program domains:
- 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 20 States have participated in the activities
of the POMP, and initial data are available and presented here
for four 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 that the data collected and the findings summarized
here cannot be generalized beyond the program entities that
participated in the pilots. The data referenced here are “test”
data, and should not be viewed as definitive of program conditions.
As planned, the results of these pilots have assisted AoA in
preparing for the national survey of outcome measures. 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.
Next Steps—National Data to Be Collected in FY 2002
AoA is committed to employ the performance outcome measures
on a national basis as soon as possible. Satisfied that the
instruments tested will yield performance data that will speak
to important program results, AoA will conduct a national
survey in FY 2002 utilizing elements of the performance
measurement instruments tested under the outcome measures project.
As reflected in the performance measures table presented above,
AoA believes it is important to establish performance outcome
baselines in the following areas as soon as possible: nutrition,
transportation, caregiver, information and assistance, and homecare.
Results for Outcome Measures (Illustrative)
With the understanding that we cannot make definitive conclusions
about service results on the basis of these data, we 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 Measures: The Nutritional Screening Initiative
(NSI) and the Nutritional Risk (NR) surveys conducted for
both home delivered meals and congregate meals begin to assess
the level of nutritional risk of clients. The data collected
assisted AoA in processing performance measurements in two
major categories. First, the data received in the pilot surveys
indicates that the information collection will serve as a
targeting measure of AoA ability to reach individuals at high
nutritional risk. Test data for new OAA clients for home-delivered
meals (HDM) indicate that 77% of surveyed clients are at high
nutritional risk. Second, and more significantly, the survey
instrument, combined with existing program data, may allow
us to provide a broad indicator of improvement in nutritional
risk scores.
- Transportation Measures: Overall, the results were
outstanding for the AoA-sponsored transportation services.
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. The pilot
transportation surveys also provided information that will
support program improvements, including 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, 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 of their friends.
Ninety-four percent of the clients who left messages had
their call returned the same day, and over 82% of all clients
said that they felt comfortable with the person they had
spoken to. The preliminary tabulations, which totaled 543
interviews, have shown positive results thus far in examining
the perspective of older consumers regarding AoA-sponsored
Information and Assistance services.
- Family Caregiver Support: An important element of
performance outcome measurement is AoA’s intent to measure
the performance for the National Family Caregiver Support
Program. As part of the Performance Outcomes Measures Project,
AoA has initiated testing of consumer assessment measures
of individuals who care for disabled older Americans with
the caregiver support services that are available to them.
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.
Providing care for a friend or relative can be both rewarding
and stressful. The following summary of results was gleaned
from data collected at local sites in Arizona, Florida,
Georgia, Hawaii, Indiana and Ohio. The results reflect the
current reality that services in support of caregivers have
not been universally available, that caregiving involves
burden, but also that caregivers are committed to their
role.
- Older people served by the caregivers surveyed
were receiving a significant level of services
from the Network:
- Case management – 88.5%
- Home health -- 66%
- Homemaker -- 49%
- Respite care -- 35%
- Caregivers expressed satisfaction
with services to elders:
- Very satisfied -- 67%
- Services helped a lot -- 84%
- Limited services were available for
caregivers:
- Support groups --13%
- Training/education -- 6%
- Counseling -- 4%
- The caregivers expressed interest in a variety of services
as their “most desired” services:
- Help line -- 43%
- Tax break/stipend/direct financial support -- 32 to
33%
- Housekeeping -- 28%
- Transportation -- 24%
- Respite Care -- 23%
- Help with bathing/toilet/personal care -- 23%
- Noting that for this limited survey, 75% of those cared
for were female, the following summarizes who the primary
caregivers are:
- Daughter -- 38%
- Wife -- 15%
- Husband -- 14%
- Son -- 12%
- The caregivers provide the elderly a variety
of services:
- Tracking bills and finances -- 90%
- Meals/laundry/shopping -- 85%
- Medical support/personal care -- 75%
- Caregiver burdens are significant:
- Caregiver hours per day -- 15 to 17
- Sole caregiver -- 40%
- One caregiver providing nearly all care -- 67%
- No relief from caregiving -- 25%
- Caregivers w/support from one other person -- 25%
- Caregivers with full or part-time jobs -- 46%
Job impacts:
- Took off early/go in late -- 15%
- Average work missed -- one day per month
- Used vacation for care -- 12%
- Quit work for care -- 11%
- Burdens cited as “nearly always” felt:
- Not enough time to self -- 19%
- Stress -- 18%
- Problems with social life -- 12%
- Neglecting family -- 11%
- Caregivers cite rewards of caregiving:
- Caregiving generally rewarding -- 55%
- Recipient “nearly always” appreciates care
-- 49%
- Helping family -- 38%
Goals and Targets
With the collection and analysis of National data in
2002, AoA will be prepared to establish performance targets
for a varied set of outcome measures in the FY 2004 annual
performance plan. AoA will continue to sponsor the development
of national, State and local performance outcome measurement
projects. 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. AoA
has worked 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, and is prepared within the next
year to conduct a national survey. The results of the outcome
measures project will be used to improve performance measures
for AoA administered programs, and the status of project
implementation and findings will be provided in all updates
of AoA's performance plan submissions.
2.2 Vulnerable Older Americans
Program Description and Context
(numbers in thousands) |
FY 2000 Enacted |
FY 2001 Enacted |
FY 2002 Enacted |
FY 2003 President’s Budget |
Vulnerable Older Americans |
$13,119 |
$14,181 |
$17,681 |
$17,681 |
AoA uses 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.
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. 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 Intermediate
Outcome Measures
Performance Goals |
Targets |
Actual Performance |
Ref. |
Ombudsman Measure
Maintain a high combined resolution / partial resolution
rate for complaints in nursing homes.
Improve combined resolution/ partial resolution rate for
primary Aging network entities (States and Territories) |
FY 03: 74%
FY 02: 70%
FY 01: 70%
FY 00: 70%
FY 99: 71.48%
FY 03: 5 Entities
FY 02: (New in 03) |
FY 03:
FY 02:
FY 01:
FY 00: 74.1%√
FY 99: 74.3% √
FY 98: 70.6%
FY 97: 72.1%
FY 03: 02/05
FY 02: 02/04
FY 01: 02/03 |
|
Performance Measures Analysis—Ombudsman Intermediate Outcome
Measures
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. To demonstrate that the network is targeting services
to vulnerable individuals, data should show that a significant
percentage of complaints are resolved each year. 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. For FY 2003,
at the urging of the Office of Management and Budget and the
Office of the Secretary of HHS, AoA has added a performance
measure to foster improved performance by committing
to increase resolution rates for five program entities (States
or Territories) that currently perform below the national average.
To limit the number of measures presented in the AoA plan, AoA
will not include measures from the CMS plan that were included
in FY 2002.
Results for Ombudsman Intermediate Outcome Measures
-
Complaint Resolution Measure: Consistent with the
objectives of the network, nursing home Ombudsman programs
continue to resolve a high percentage of nursing home complaints
each year. For each of the years included in the table
above, the network has achieved a high combined resolution/partial
resolution rate in excess of 70 percent. For FY
1999 and 2000 the rate has risen to 74%.
Goals and Targets
Performance targets for FY 2003 are based on the past and current
performance of the network as reflected in the table above.
Because of the successful overall performance of nursing home
Ombudsmen in resolving complaints, AoA seeks to maintain performance
at or near the levels established as national performance targets
over the last few years. The national targets for FY 2003 for
resolving complaints have been increased to reflect that intention.
AoA is committed to continuously improve program performance
where it is needed. To reflect this commitment for its Ombudsman
program intermediate outcome measure, beginning with the FY
2003 performance plan, AoA targets to improve performance
in five primary service entities for which Ombudsman complaint
resolution percents are below the national complaint resolution
percentage.
2.3 SERVICES FOR NATIVE AMERICANS
Program Description and Context
(numbers in thousands) |
FY 2000 Enacted |
FY 2001 Enacted |
FY 2002 Enacted |
FY 2003
President’s Budget |
Grants to Indian Tribes |
$18,457 |
$25,407 |
$27,675 |
$27,675 |
Between 213,000 and 395,000 American Indians and Alaska Natives
over the age of 60 were identified in the 2000 Census. The lower
number represents those individuals who identified themselves
as “American Indian or Alaska Native alone” and the larger number
represents those who identified themselves as “American Indian
or Alaska Native alone or in combination with other races”.
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 as well as the increasing number
of people self-identifying as American Indian or Alaska Native.
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 for home and community-based services, 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 2001, grants were awarded to 233 American
Indian and Alaska Native tribal organizations representing nearly
300 tribes, and two organizations serving Native Hawaiian elders.
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 the Native American Caregiver
Support Program, established in the 2000 amendments to the OAA.
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:
Home-delivered meals
Congregate meals
Transportation service units
Information/referral service units
In-home service units
Other services |
(numbers in thousands)
FY 03: 1,850
FY 02: 1,850
FY 01: 1,795
FY 00: 1,632
FY 99: 1,456
FY 03: 1,650
FY 02: 1,650
FY 01: 1,583
FY 00: 1,439
FY 99: 1,322
FY 03: 732
FY 02: 732
FY 01: 732
FY 00: 665
FY 99: 763
FY 03: 747
FY 02: 747
FY 01: 747
FY 00: 679
FY 99: 632
FY 03: 970
FY 02: 953
FY 01: 953
FY 00: 866
FY 99: 742
FY 03: 660
FY 02: 650
FY 01: 650
FY 00: 591
FY 99: 512 |
(numbers in thousands; ’99 data are final)
FY 03: 02/05
FY 02: 02/04
FY 01: 02/03
FY 00: 1,778 (preliminary)
FY 99: 1,680 √
FY 98: 1,624
FY 97: 1,525
FY 03: 02/05
FY 02: 02/04
FY 01: 02/03
FY 00: 1,348 (preliminary)
FY 99: 1,290 √
FY 98: 1,354
FY 97: 1,386
FY 03: 02/05
FY 02: 02/04
FY 01: 02/03
FY 00: 699 (preliminary)
FY 99: 702 √
FY 98: 719
FY 97: 680
FY 03: 02/05
FY 02: 02/04
FY 01: 02/03
FY 00: 651 (preliminary)
FY 99: 633 √
FY 98: 715
FY 97: 705
FY 03: 02/05
FY 02: 02/04
FY 01: 02/03
FY 00: 929 (preliminary)
FY 99: 942 √
FY 98: 1,032
FY 97: 882
FY 03: 02/05
FY 02: 02/04
FY 01: 02/03
FY 00: 682 (preliminary)
FY 99: 702 √
FY 98: 756
FY 97: 583 |
|
Performance Measures Analysis—Native Americans Programs
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. In the interim,
AoA will continue to supplement its basic measurement data with
the following narrative description of additional program accomplishments.
AoA will also review its performance targets for a selected
number of the service categories included in the plan. With
the support of AoA, tribal entities are meeting the greater
demand for home-delivered meals by reducing the number of congregate
meals provided. In effect, AoA believes that the agency is likely
to continue to exceed its targets for home-delivered meals and
fail to meet its targets for congregate meals. In future versions
of this plan, AoA will modify the targets for these two service
categories to reflect this acceptable phenomenon. AoA will also
analyze and present greater detail on our observation that performance
for “other services” is exceeding our expectations. We believe
that this also positively reflects the exercise of greater flexibility
by local tribal entities. AoA will provide a more detailed illustrative
analysis of this phenomenon in future versions of this plan
and report.
Performance Results for Native American Programs
For the most part, Native American programs have maintained
service levels, adjusted for inflation, in the face of level
funding. The preliminary FY 2000 data indicate successful results
for all performance targets except for information/ referral
services and congregate meals. AoA believes that finalized FY
2000 data will indicate that actual program performance for
these two service areas is closer to the target than preliminary
data indicate. Effectively, we believe that the overall indicator
of stable service levels is confirmed for virtually all services.
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. 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 235 grants provided by AoA, a variety
of in-home support services were provided to tribes, tribal
organizations and Native Hawaiian organizations during FY 2000:
- More than 61,000 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.
- Approximately 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 650,000 units of information
and assistance on issues dealing with Social Security, food
stamps, and other topics were provided to elders and their
families.
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.
In its commitment to continue to increase performance and establish
outcome measures,at the annual Tribal consultation, AoA will
discuss a pilot performance outcomes measure project for Native
American Programs with tribal representatives in FY 2002.
2.4 AoA Research and Development
(numbers in thousands) |
FY 2000
Enacted |
FY 2001
Enacted |
FY 2002
Enacted |
FY 2003
President’s Budget |
Research and Development |
$37,124 |
$46,626 |
$52,148 |
$41,716 |
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 Medicare Patrols & Technical
Assistance Centers
Program Description and Context
(numbers in thousands) |
FY 2001 Enacted |
FY 2001 Enacted |
FY 2002 Enacted |
FY 2003
President’s Budget |
Senior Medicare Patrols and Technical
Assistance Centers |
$1,450 |
$1,542 |
$2,046 |
$2,347 |
HHS, particularly the Centers for Medicare and Medicaid Services
(CMS) and the Office of Inspector General (OIG), has placed
significant emphasis on the identification and reduction of
billions of dollars of fraud and waste in the Medicare program.
AoA has played an active role in addressing this national problem
through two legislative sources.
Health Insurance Portability and Accountability Act
(HIPAA) of 1996
Under the Health Insurance Portability and Accountability Act
of 1996, AoA works in partnership with the Centers for Medicare
and Medicaid Services (CMS), 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. The funding from HIPAA
is now primarily used to fund technical assistance centers that
support the "Senior Medicare Patrols."
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 2001, AoA funded
52 such community-based projects, known as “Senior Medicare
Patrol Projects,” in 47 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. |
Senior Medicare Patrol Measures
Trainers
Increase the number of trainers who educate beneficiaries
Volunteers
Increase the number of beneficiaries who are educated
by the volunteer trainers
Inquiries
Increase the number of substantiated complaints generated
through AoA’s activities (i.e. complaint results in some
action taken). |
FY 03: 56,800
FY 02: 54,800
FY 01: 41,100
FY 00: 17,125
FY 99: (new in 2000)
FY 03: 600,000
FY 02: 500,000
FY 01: (new in 2002)
FY 03: 2,500
FY 02: 380
FY 01: 280
FY 00: 200
FY 99: (new in 2000) |
FY 03: 02/04
FY 02: 02/03
FY 01: 48,076
FY 00: 39,300 trained √
FY 99: 13,700 (baseline)(a)
FY 03: 02/04
FY 02: 02/03
FY 01: 570,000
FY 00: 350,000 (baseline) (b)
FY 03: 02/04
FY 02: 02/03
FY 01: 2,190
FY 00: 1,241 √
FY 99: 133 (baseline) (c)
|
|
Previous reports and plans
may have "percentages" or "percents"
shown for some of the targets. We have concluded that
using percents or percentages may have caused some confusion
for some readers. We have converted all targets to "numbers."
We believe that this will help to eliminate any confusion.
Also, all numbers, for targets and results, are "cumulative"
since inception of the projects – including projects funded
under the Health Insurance Portability and Accountability
Act (HIPAA) of 1996.
- The cumulative total includes volunteers who were
trained under HIPAA. This effort was succeeded by the
"Senior Medicare Patrol" projects authorized
by the Omnibus Consolidated Appropriations Act of 1997
(P. L. 104-209).
- Cumulative including beneficiaries educated under
the authority of HIPAA.
- Baseline total is cumulative including complaints
substantiated under HIPAA.
|
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 collects performance data
from AoA’s Senior Medicare Patrol Projects semi-annually.
To demonstrate that the network is educating older Americans
how to take an active role in their health care and protect
the integrity of the Medicare and Medicaid services, the data
should show an increase in the number of trainers who educate
beneficiaries, an increase in the number of beneficiaries educated
by volunteer trainers, and an increase in the number of complaints
that have been reported and acted upon as a result of the AoA
programs.
Results for the Senior Medicare Patrol Program
For the measures presented in the table above, the data indicates
that the aging network effectively educates and informs older
Americans how to take an active role in their health care and
maintain the integrity of the Medicare and Medicaid systems.
-
Volunteers Trained Measure: The first measurement
is directed at 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. However, by the end of FY 1999
we had trained 13,700 (on a cumulative basis) community
volunteers under the HIPAA and Senior Medicare Patrol projects.
During FY 2000 materials and effective training strategies
were more widely utilized by the grantees, which meant that
we could increase the target of the number of volunteers
trained to 17,125.
The performance for FY 2001 exceeded the target, by reaching
approximately 48,000 volunteers trained. We do not anticipate
that the grantees will train as many new volunteers during FY2002
and later years because the effort will build on the large pool
of experienced volunteers who will continue to conduct sessions
during those years.
- Beneficiaries Educated Measure: The second measurement
is directed toward increasing the number of beneficiaries
who are educated by the volunteer trainers. This measurement
is new for FY 2002. It is the beneficiaries, who have to learn
to detect possible fraud, waste and abuse in the Medicare
payments. As of FY 2001, the “trainers” trained 570,000 beneficiaries
for both HIPAA and the Senior Medicare Patrol projects. Preliminary
trend data indicates that by the end of FY 2003 the trainers
will have reached over 600,000 beneficiaries since inception
of these projects.
- Inquiries Submitted and Acted Upon Measure: The third
measurement consists of the number of inquiries submitted
by AoA’s projects and volunteers to health care providers,
Centers for Medicare and Medicaid Services (CMS), 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 (for both the HIPAA and Senior Medicare Patrol
projects) that resulted in some sort of corrective action
being taken. In FY2001, the projects exceeded the projected
target, with more than 2,100 cases that resulted in some action
being taken.
Goals and Targets
Performance targets for FY 2003 are based on the past and current
performance of the network as reflected in the table above.
Because the network significantly exceeded performance targets
in all three of the performance measures, AoA has increased
the FY03 targets. AoA's commitment to increased performance
is reflected in the increase in FY03 performance targets for
the Senior Medicare Patrol Program.
2.6 PROGRAM MANAGEMENT
Program Description and Context
(numbers in thousands) |
FY 2000 Enacted |
FY 2001 Enacted |
FY 2002 Enacted |
FY 2003
President’s Budget |
Program Direction |
$16,458 |
$18,172 |
$19,088 |
$18,999 |
From the outset of GPRA implementation, AoA has agreed with
the HHS principle that management challenges should be addressed
in the GPRA context, and included two process measures in its
original FY 1999 annual performance plan. With the FY 2002
plan, AoA reestablished its commitment to include management
measures in the annual performance plan by including additional
management measures for financial management, program reporting,
and workforce planning. This Annual Performance Plan for FY
2003 takes an additional step in that commitment by adding new
performance measures that are specifically related to the five
management initiatives identified by the Office of Management
and Budget and HHS for FY 2003.
AoA retains for FY 2003 the performance measures added for
FY 2002, which commit the agency to a clean financial opinion,
to using a formal workforce plan, and to improving the timeliness
of program data reporting. With the FY 2003 plan, AoA defines
a performance target for the workforce planning measure and
adds two related measures: to increase the agency’s employee
to supervisor ratio and to reduce the average grade of agency
employees. AoA also adds a performance measure to make greater
use of performance based contracting and another to reflect
our implementation of the electronic submission and processing
of selected agency grant applications.
AoA’s performance measures for management activities now cover
the following areas:
- Financial Management
- Acquisitions/Grants Management/E-Government
- Workforce Planning and Restructuring
- Program Information Collection and Reporting
The areas covered and the measures employed track very closely
with the management priorities of OMB and HHS.
Goal-by-Goal Presentation of Performance
Performance Measures Summary Table—Program Management Measures
Performance Goals |
Targets |
Actual Performance |
Ref. |
Program Management Measures
Financial Management
Results of audits of AoA financial statements.
Strategic Management of Human Capital
A high percentage of AoA hires will be based on a formal
AoA Workforce Plan.
Increase the ratio of employees to supervisors.
Decrease the average grade of AoA career employees.
Acquisitions/Grants Management/E-Government
Increase the percentage of procurement dollars that are
subjected to performance-based contracts.
Increase the percentage of discretionary grant applications
that are submitted and processed electronically, including
via the Internet.
Program Information Collection and Reporting
Reduce the time lag (in months) for making NAPIS data
available for GPRA purposes and for publication. |
FY 03: Clean Opinion for 2002
FY 02: Clean Opinion for 2001
FY 01: Clean Opinion for 2000
FY 00: (New in FY 01)
FY 99: Not applicable
FY 03: 80%
FY 02: 80%
FY 01: (New in FY 02)
FY 03: 5.0 to 1
FY 02: (New in FY 03)
FY 03: 13.0
FY 02: (New in FY 03)
FY 03: 20%
FY 02: 20%
FY 01: (New in FY 02)
FY 03: 10%
FY 02: (New in FY 03)
FY 03: 15 months
FY 02: 15 months
FY 01: 15 months
FY 00: (New in FY 01) |
FY 03: 2/03
FY 02: 2/02
FY 01: Clean Opinion
for FY 2000
FY 03:
FY 02:
FY 01:
FY 03:
FY 02:
FY 01: 4.3 to 1
FY 03:
FY 02:
FY 01: 13.5
FY 03:
FY 02:
FY 01: 0% (baseline)
FY 03:
FY 02:
FY 01: 0% (baseline)
FY 03:
FY 02:
FY 01:
FY 00:
FY 99: 22 months
FY 98: 26 months |
|
Results for Program Management Measures
Financial Management Measures: In FY 2001, AoA
received a clean opinion on the audit of its FY 2000 financial
statements (balance sheet). As reflected in the management
priorities circulated by OMB for the FY 2003 budget process,
improving financial management is a significant management priority,
and the achievement of a clean financial opinion is a fundamental
indicator of financial management quality. AoA is committed
to expanding the annual audit to its full financial statements,
and to receiving a clean opinion in the audit each year. AoA
will retain this measure as a fundamental indicator of financial
management quality and commitment in its annual performance
plans.
Strategic Management of Human Capital Measures: An extensive
AoA review of workforce and structural conditions found that
improvements are necessary and achievable in: 1) “delayering”
the organization, 2) grade structure, and 3) skill mix. To track
its accountability for implementing improvements, AoA has included
three performance measures related to workforce planning and
restructuring in its FY 2003 GPRA performance plan. AoA will
improve span of control specifically by increasing the employee
to supervisor ratio for the agency. The agency will achieve
a measurable reduction in the average grade of employees over
the next few years. Finally, further defining a “developmental”
performance goal that appeared in the agency’s FY 2002 GPRA
performance plan, eighty percent of AoA new-hires will be in
strict conformance with the priorities of the agency’s formal
workforce plan.
To achieve these measurable goals, AoA will be required to
move forward with restructuring plans that significantly reduce
management layers and supervisory positions and grades within
the agency. Achievement will also require that the agency maintain
its formal workforce planning processes and conduct its hiring
processes in conformance with that plan.
Acquisitions/Grants Management/E-Government Measures: AoA
has initiated work to apply the efficiencies of electronic transactions
to one of its most significant operational activities, and will
pursue the application to a second such activity within the
next year. AoA has initiated work to apply e-government solutions
to its grants processing efforts, and will work with State and
local government entities to identify the feasibility of applying
such technology to the submission of detailed program information
requirements.
The grants application process is one of AoA’s most significant
workload processes, and involves significant staff and related
resources on the part of AoA and potential grantees. Believing
that electronic processes offered a significant opportunity
for improved efficiency for AoA and its grantees, AoA has developed
and is prepared to test information technology that will allow
grantees to apply for AoA funding electronically, including
by way of the Internet. To ensure maintenance and the realization
of these electronic process improvements, AoA has included a
performance goal in its annual GPRA performance plan that calls
for the agency to increase the percentage of discretionary applications
that are submitted and processed electronically to 10 percent
by FY 2003.
AoA is also committed to improve performance in an activity
related to OMB’s initiative to expand electronic government,
which is specifically referenced in section 31.9 of OMB Circular
A-11 (2001). AoA has complied with an HHS initiative for improved
agency planning to increase the use of performance-based contracts.
Planned AoA activities include:
-
Management review of contract areas that would benefit
from performance-based contracting;
-
Extensive staff training in the methods and processes of
performance-based contracts; and
-
Creation of integrated project teams to achieve broad participation
in defining contract results, performance standards and
measures, and quality assurance surveillance plans.
AoA has included a new performance measure for FY 2002 and
2003 in this GPRA performance plan to increase the use of performance-based
contracts in its procurement activities to 20 percent of its
procurement dollars.
Program Information Collection and Reporting:Reflecting the
firm commitment of the agency to improve the quality, reliability,
and timeliness of data from the National Aging Program Information
System (NAPIS), and to reduce the burden that it imposes on
the network, the FY 2002 plan included a developmental measure
that reflects a necessary system outcome.
Recognizing the need for immediate improvement in the timeliness
and quality of data provided under the State Program Report
(SPR), AoA has engaged in the following during FY 2001:
- An extensive review of the SPR requirements particularly
as they affect the timing of reporting and the quality of
data, and
- An acceleration of the tabulation and certification of FY
1999 SPR data and the collection of the FY 2000 data.
The review has resulted in the following related to the SPR
information collection system.
- AoA accelerated the initial tabulation of FY 1999 data to
make it available for the FY 2002 performance plan and report.
- AoA accelerated the final certification of FY 1999 data,
to the effect of making the data available for this performance
report submission and four months earlier than the FY 1998
data.
- AoA has accelerated the collection and certification of
the FY 2000 data with the objective of making that data available
for the FY 2003 annual performance plan and report, which
will be submitted to Congress in February, two months earlier
in the year than the FY 2002 plan was submitted.
- AoA has formed a team of AoA, state and area agency representatives
to modify the SPR over the next year, with the principal objective
of reducing the burden and complexity of reporting.
Finally, AoA has finalized the GPRA performance measure that
appears in this annual GPRA performance plan. It calls for
AoA to reduce the time required for making data available for
GPRA purposes and for the public from 26 months for the FY 1998
data to 15 months for the data for fiscal years 2001 and 2002.
Appendices
- Approach to Performance Measurement
- Changes and Improvements
- Linkage to the HHS Strategic Plan
- Linkage with the Budget
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 that 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.
Beginning in FY 2002, AoA completely restructured its performance
plan, particularly for its large State and community-based programs.
To illustrate for that program, AoA 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.
Consistent with the improvements reflected in the FY 2002 performance
plan, for FY 2003 AoA illustrates how its measures reflect a
broad logic model that is comparable to that used by entities
such as the United Way of America for social service programs.
In the model, AoA identifies a mix of output, intermediate outcome,
and end outcome measures associated with inputs provided by
AoA and other program entities.
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 through 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.
Presentation
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 Verification, Validation and Other Data Issues
AoA has continued to make progress in the two data initiatives
highlighted prominently in the FY 2002 performance plan. AoA
and State agencies engaged in a formal assessment effort that
has resulted in the certification of FY 1999 data months earlier
than originally anticipated. AoA has initiated certification
of FY 2000 data, and we will revise routine information collection
activities to reduce reporting burden, improve timeliness and
reliability of data, and incorporate reporting for the National
Family Caregiver Support Program into the standard data collection
process. AoA and the network continue to focus on the assessment
of quality through the consumer, where it counts the most, at
the community level, through the Performance Outcome Measures
Project, and have initiated efforts to conduct a national survey
of performance outcomes within the next year.
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.
Despite the data challenges that the network is addressing
and the time-consuming validation processes that remain in place
at the present time, AoA and the network have been able to certify
the FY 1999 data cited in this report. The FY 1999 data are
final. Nevertheless, AoA and the States must immediately engage
in a comparable exercise of verification and validation before
data for FY 2000 can be utilized for performance reporting purposes.
AoA and the States will review a significant number of individual
data items, which are generated from data reported by local
components, for accuracy and validity.
AoA and its program partners have initiated an assessment of
the data requirements of the OAA and will 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 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 yet have national baselines for outcomes
to set targets for FY 2003. Because of AoA’s Performance Outcome
Measures Project, which was expanded to approximately 30 area
agencies in 16 pilot States in FY 2000, AoA is now able to commit
to the conduct of a national performance outcome measures survey
within the next year, which will allow the Agency to establish
performance measure baselines for FY 2002, and performance measure
targets for FY 2004.
Because of the data limitations addressed in this Appendix,
AoA classifies many 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
Because AoA made significant modifications to its GPRA performance
plan for FY 2002, the modifications for FY 2003 are far less
significant. We believe strongly that it is important to maintain
continuity in the performance plan, and repeated wholesale modifications
are not warranted.
AoA’s most significant changes for FY 2003 are the identification
of initial developmental performance measures for the National
Family Caregiver Support Program and the significant expansion
of measures for program management to address the priorities
of the Administration and the Secretary of HHS. The initial
FY 2003 plan includes targeting, systems and service measures
for the plan, and retains the descriptive information related
to the development of outcome measures for this and other programs
as well.
The agency has also significantly expanded its discussion of
budget linkage in the introduction to Part 2 of the plan, adding
significant analytical linkages between the agency’s performance
measures and its FY 2003 budget initiatives.
Finally, the agency has focused intentionally on reducing the
length of the performance plan and report. In the past, we
relied on narrative descriptions of accomplishments because
quantitative measures were not compelling. With the revisions
incorporated for the FY 2002 budget cycle, AoA believes that
such narrative presentations are no longer appropriate.
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 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 and maintain a high percentage of new clients
for home delivered meals who have high nutritional risk
scores. |
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 |
Improve poor client service
percentages for primary Aging network entities--developmental |
Community Based Services: Targeting
Measures |
A significant percentage of
OAA Title III service recipients are poor. |
Community Based Services: Targeting
Measures |
A significant percentage of
OAA Title III service recipients are minorities. |
Community Based Services: Targeting
Measures |
A significant percentage of
OAA Title III service recipients live in rural areas |
Community Based Services: Targeting
Measures |
Improve rural client service
percentages for primary aging network --developmental |
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 |
The average nutritional risk
score for established OAA clients will be lower than the
average score for new clients. -- developmental |
Community Based Services: Client
Outcome Measures – Transportation Satisfaction |
A high percentage of clients
rate transportation service as very good or better. --
developmental |
Community Based Services: Client
Outcome Measures – Information and Assistance Satisfaction
|
A high percentage of clients
report that calls for information and assistance are answered
quickly. -- developmental |
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 74 percent
of complaints in nursing homes. |
Protection of
Vulnerable Older Americans – Long Term Care Ombudsman
Outcome Measures |
Improve combined
resolution/ partial resolution rate for primary aging
network entities (States and Territories) -- developmental |
Community Based Services: Home
Care Satisfaction Measure |
Improve home care services satisfaction
scores. – developmental |
Community Based Services: Caregiver
Support Services Measure |
Improve caregiver support services
satisfaction scores – developmental |
Community Based Services: Caregiver
Support Services Targeting Measure |
Increase the ratio of family
caregivers to registered clients--developmental |
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 CMS 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 number of beneficiaries who
are educated by the volunteer trainers. -- developmental |
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). |
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 74 percent of complaints in nursing
homes. |
Appendix 4
Performance Measurement Linkage with the Budget
Budget Linkage Table ($ Amounts in 000’s)
AoA FY 2002 Performance
Plan Areas |
Program/Budget Line
Items |
FY 2000 Enacted |
FY 2001
Enacted |
FY 2002
Enacted |
FY 2003 President’s
Budget |
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 |
$1,149,512 |
$1,233,841 |
$1,236,286 |
Vulnerable Older Americans |
Vulnerable Older Americans |
$13,179 |
$14,181 |
$17,681 |
$17,681 |
Services for Native Americans |
Grants to Indian Tribes
(Native American Caregiver Support program funding included
in “Community-Based Services” above) |
$18,457 |
$25,407 |
$27,675 |
$27,675 |
Research and Development |
Research and Development
Alzheimer’s Disease Demonstration Grants to States
Aging network Support Activities |
$37,124 |
$46,626 |
$52,148 |
$41,716 |
Senior Medicare Patrols and Technical Assistance
Centers |
Senior Medicare Patrols (HCFAC) |
$1,450 |
$1,542 |
$2,046 |
$2,347 |
Program Administration |
Program Direction |
$16,458 |
$18,172 |
$19,088 |
$18,999 |
|
Total Budget |
$934,114 |
$1,256,740 |
$1,352,479 |
$1,344,704 |