Nutrition
Evaluations Report
V. PROGRAM FUNDING, COSTS, AND EFFICIENCY
D. REASONS FOR FUNDING TRANSFERS AND EXPECTATIONS
FOR THE FUTURE
In order to understand the trends in transfers discussed here,
we asked State Units on Aging (SUAs), AAAs, and nutrition projects
about shifts in resources from congregate meals to support services
and to home-delivered meals. Specifically, we asked about reasons
for the shifts, perceived impacts of the shifts, and expectations
for the future. As discussed, respondents at each level are likely
to have different information and therefore different perceptions.
These different perceptions are not contradictory but rather complementary,
and examining the perceptions of all three levels provides a good
picture of funding transfers.
1. Transfers from Congregate Meals to Home-Delivered Meals
a. SUAs
The perceptions of SUAs can suggest statewide trends. Table V.20
reports SUAs' reasons for transfers from congregate to home-delivered
meals, perceptions of the impact of transfers, and expectations
for the next five years. Eighty-five percent of the SUAs reported
transferring resources from congregate to home-delivered meals.
This response corresponds to the
AoA data that showed 83 percent of states transferred funds from
congregate to home-delivered meals in 1994. When SUA administrators
were asked to give reasons for the shift, most reported an increase
in demand for home-delivered services caused by a number of changes
in the elderly population. [ Other reasons not related to the
increased demand for home-delivered meals were emergency needs,
increased costs of home-delivered meals, and elderly people who
are hard to reach, either because they live in isolated rural
areas or because they live in urban areas where safety may be
compromised.]
TABLE V.20
PERCEIVED REASONS FOR FUNDING TRANSFERS FROM TITLE III-C CONGREGATE TO HOME-DELIVERED MEALS
|
Percentage
|
|
SUAs
| AAAs
| Nutrition Projects
|
| Resources Have Been Shifted from Congregate
to Home-Delivered Meals
| 85
| 71
| 36
|
| Shift Encouraged by AAA
| NA
| 72
| NA
|
| Reasons for Shift
|
|
|
|
| Congregate participants becoming older
and more frail and switching to home-delivered program
| 50
| 59
| 35
|
| Increasing number of older individuals
living alone
| 30
| 17
| 17
|
| Increasing number of functionally impaired
elderly individuals
| 24
| 21
| 23
|
| Increase in home- and community-based long-term
care rather than institutionalization
| 22
| 11
| 14
|
| More early discharges from hospital due
to Medicare Diagnostic Related Groups (DRGs)
| 17
| 7
| 10
|
| Impact of Shift on Ability to Serve Those
in Need of Congregate Services
|
|
|
|
| Major impact
| 12
| 11
| 10
|
| Some impact
| 35
| 25
| 29
|
| Minimal impact
| 28
| 18
| 18
|
| No impact/no shift
| 26
| 46
| 43
|
| Expected Shifts over Next Five Years
|
|
|
|
| Increase
| 58
| 59
| 38
|
| Stay about the same
| 40
| 39
| 58
|
| Decrease
| 2
| 2
| 4
|
| Reasons for Expected Increase over Next
Five Years
|
|
|
|
| More very old people
| 43
| 36
| 31
|
| More elderly people in general
| 43
| 33
| 38
|
| More elderly people in poor health
| 43
| 19
| 9
|
| More elderly people in need
| 30
| 31
| 27
|
| More elderly people in good health
| 7
| 1
| 2
|
| Pressure/requests from state officials
| 7
| 1
| 1
|
| Sample Size
| 55
| 403
| 242
|
Source: Elderly Nutrition Program Evaluation; SUA, AAA, and Nutrition Project surveys; weighted tabulations.
NA = Not applicable.
Half of the respondents felt that a reason for the shift was congregate
participants switching to home-delivered programs as they become
older and more frail. Other reasons for the shift reflect increaseddemand
for home-delivered meals. Almost one-third of SUAs reported the
increasing number of elderly persons living alone as a reason
for the shift. This perception is consistent with national data.
The number of persons age 65 and older who live alone rose from
5.0 million in 1970 to 9.1 million in 1990, an increase of more
than 80 percent. The increase in the total number of persons over
age 65 rose by only 46 percent during that time (U.S. Bureau of
the Census 1994).
A majority of the respondents that reported shifting funds from
congregate to home-delivered meals believe that the transfers
had little or no impact on their ability to serve those in need
of congregate services. Slightly more than 10 percent thought
the shifts had a major impact on their ability to serve those
in need of congregate services, and about one-third believed that
the shifts had some impact. As noted, most states are experiencing
increasing demand for home-delivered services, but not all of
these states also experienced decreasing demand for congregate
services, which explains in part why the impact on congregate
meals differs across states.
Almost 60 percent of the SUA respondents expect transfers from
congregate to home-delivered meals to increase during the next
five years. All but one of the remaining 40 percent of SUAs expect
their transfers to stay about the same. Those that expect an increase
in transfers cite many causes for their expectations, similar
to those for currently transferring funds. Two of the most frequent
responses werean increasing elderly population in general and
more very old people. National population statistics support these
observations--the total number of persons over age 65 increased
from 25.5 million (or 11 percent of the population) in 1980 to
31.1 million (or 13 percent of the population) in 1990. Additionally,
the percentage of persons 75 years old and older as a proportion
of persons 65 years old and older increased from 39 percent in
1980 to 42 percent in 1990. The percentage of persons 85 years
old and older as a proportion of persons 65 years old and older
increased slightly, from 9 to 10 percent, in that time (U.S. Department
of Commerce 1994). As might be expected, respondents also cite
more elderly individuals in poor health as a reason for increases
in transfers to home-delivered meals.
b. AAAs
AAAs' perceptions of funding transfers and the reasons for these
transfers were generally very similar to those of SUAs. We asked
AAAs an additional question not asked of SUAs or nutrition projects
about whether or not the AAA encouraged the shift in funds. Responses
to this question suggest that many of the decisions about transferring
funds occur at the AAA level--more than 70 percent of the AAAs
transferring funds reported that the decision was encouraged by
the AAA.
Seventy-one percent of the AAA respondents reported that resources
had been shifted to home-delivered from congregate meals. Although
this percentage is smaller than the percentage of SUAs reporting
such transfers, when AAA responses are aggregated to the state
level, they are very consistent with SUA responses--49 states
had at least one AAA reporting a shift, and 46 SUAs reported a
transfer. Although not all AAAs in a state transferred funds in
this direction, most states had at least one AAA making such transfers,
and the net of all AAA transfers for most states was in this direction.
As with SUAs, AAAs most frequently cited as a reason for the shifts
the number of congregate participants switching to the home-delivered
meal program (59 percent).
Other frequently mentioned reasons for the shifts pertain to causes
of the increasing demand for home-delivered meals, such as the
increasing number of functionally impaired elderly individuals
(21 percent)and the increasing number of elderly people living
alone (17 percent) (similar to SUA responses). Some AAAs mentioned
waiting lists for home-delivered meals. A few have prioritized
funds by need and perceive home-delivered meal clients to be more
needy.
A smaller percentage of AAAs than SUAs believe transfers have
had a significant impact on their ability to serve those in need
of congregate services. Forty-six percent of AAA respondents reported
that the shifts have had no impact on their ability to serve congregate
needs (only 26 percent of SUAs believed likewise). Perhaps the
difference between SUA and AAA responses is due to SUAs' appraising
statewide needs, which may not be the same for all areas within
the state.
AAAs and SUAs expressed very similar expectations for the future,
with 60 percent of AAAs expecting increases in transfers to home-delivered
meals during the next five years. The reasons for increases in
funding were also very similar--the increasing number of very
old people and the increasing elderly population in general, along
with a continuation in other trends that have heightened demand
for home-delivered meals.
c. Nutrition Projects
Many decisions to transfer funds are made before the funds get
to nutrition projects. Only 36 percent of the nutrition projects
surveyed reported that funds had been transferred from congregate
to home-delivered meals.
As with SUAs and AAAs, the most frequent reason for transfers
to home-delivered meals was the aging of congregate participants,
who then switch to home-delivered meals. Other frequent responses
were the increasing number of functionally impaired individuals
and the growing number of older individuals living alone. Like
AAAs, several nutrition projects reported long waiting lists and
an increasing demand for home-delivered meals. A few nutrition
projects, however, indicated that the decision to transfer was
mandated by the AAA or the state. Like AAAs, only a few nutrition
projects thought that transfers had much impact on their ability
to serve those in need of congregate meals.
A majority of the nutrition projects expect little change in their
transfers to home-delivered meals in the next five years. A significant
minority (almost 40 percent), however, expect to increase transfers
to home-delivered meals--more than the number currently reporting
transfers. As with SUAs and AAAs, the most frequent reasons for
increasing transfers were more elderly people in general, more
very old people, and more elderly people in need. Interestingly,
nutrition projects were far less likely than SUAs or AAAs to consider
the increasing number of elderly individuals in poor health as
a cause for the shifts.
2 .Transfers from Congregate Meals to Supportive Services
a. SUAs
Table V.21 reports responses about transfers from congregate meals
to supportive services. Sixty percent reported shifting resources
from congregate services to supportive services, again consistent
with AoA data. One of the most common reasons for the transfer
was transportation needs, mentioned by more than one-third of
respondents. More than half noted demographic changes as a reason
for the increasing need for other supportive services, such as
homemaker services and case management. One of the most important
changes has been the increased use of home- and community-based
long term-care rather than institutionalization. Additional changes
include the increasing number of congregate participants becoming
older, the increasing number of functionally impaired individuals,
and the increasing number of elderly people living alone.
TABLE V.21
PERCEIVED REASONS FOR FUNDING TRANSFERS FROM CONGREGATE TO SUPPORT SERVICES
(Percentages)
|
SUAs
| AAAs
| Nutrition Projects
|
| Resources Have Been Shifted from Congregate
to Support Services
| 60
| 26
| 6
|
| Shift Encouraged by AAA Staff
| NA
| 76
| NA
|
| Reasons for Shift
|
|
|
|
| Transportation needs
| 37
| 31
| 30
|
| Increase in home- and community-based long-term
care services
| 25
| 14
| 9
|
| Congregate participants becoming older
and more frail and switching to home-delivered program
| 22
| 16
| 30
|
| Increasing support for caregivers who work
outside the home and provide ongoing care for homebound
elderly individuals
| 16
| 5
| 3
|
| Increasing number of functionally impaired
elderly individuals
| 16
| 10
| 2
|
| Increasing number of older individuals
living alone
| 16
| 4
| 9
|
| Early discharge from hospitals due to Medicare
Diagnostic Related Groups (DRGs)
| 6
| 3
| 49
|
| Impact of Shift on Ability to Serve Those
in Need of Congregate Services
|
|
|
|
| Major impact
| 10
| 11
| 2
|
| Some impact
| 27
| 17
| 15
|
| Minimal impact
| 40
| 29
| 48
|
| No impact
| 23
| 43
| 34
|
| Expected Shifts over Next Five Years
|
|
|
|
| Increase
| 21
| 14
| 9
|
| Stay about the same
| 73
| 81
| 91
|
| Decrease
| 6
| 5
| 1
|
| Reasons for Increase
|
|
|
|
| More very old people
| 27
| 23
| 8
|
| More elderly people in general
| 36
| 18
| 18
|
| More elderly people in poor health
| 27
| 13
| 11
|
| More elderly people in need
| 27
| 16
| 27
|
| More elderly people in good health
| 9
| 3
| 2
|
| Pressure/requests from state officials
| 0
| 4
| 6
|
| Sample Size
| 55
| 403
| 242
|
Source: Elderly Nutrition Program Evaluation; SUA, AAA, and Nutrition Project surveys; weighted tabulations.
NA = Not applicable.
The AoA data showed that the amounts transferred to supportive
services overall were substantially less than the amounts transferred
to home-delivered meals. We expected the impact of the transfer
of funds from congregate to supportive services to be smaller
than the impact of the transfer from congregate to home-delivered
meals. This pattern was indeed observed, with almost 65 percent
of respondents indicating that the shift to supportive services
had no or minimal impact on congregate services.
Respondents were much more likely to expect increased funding
shifts to home-delivered meals rather than to expect increased
transfer of funds to supportive services in the next five years.
Only 20 percent expected the transfer of funds
to supportive services to increase. The reasons given for expecting
increased transfers to supportive services were similar to the
reasons given for expecting increased transfers to home-delivered
meals.
b. AAAs
Only about one-fourth of the AAAs reported transferring funds
to supportive services. At first glance, this percentage looks
low compared to the 60 percent of SUAs that responded positively.
However, in many states it appears that some but not all
AAAs transfer funds, since the AAAs reporting such transfers are
located in 51 state jurisdictions. Although transfers to supportive
services occur in almost every state at one or more AAAs, most
AAAs do not make such transfers. In addition, some AAAs may be
unaware of transfers at the state level (only about 30 states
reported net transfers in this direction).
The reasons for transfers were again very similar to those of
SUA respondents. The supportive service reported most frequently
as in need of more funding was transportation. AAAs mentioned
a wide variety of other services as the reasons for transferring
funds, including outreach and targeting, case management, ombudsman,
homemaker services, and recreational activities at congregate
sites. Some AAAs believe funding levels are not changing with
the changing needs of the elderly population. Like SUAs, very
few AAAs thought the shifts have had much impact on their ability
to provide congregate services, most likely because the shifts
have been relatively small.
Not many AAAs expect transfers to supportive services to increase
in the next five years. Those that expect increases cite different
services that need additional funding, but the underlying reasons--more
very old people, more elderly people in general, and other demographic
changes--are the same.
c. Nutrition Projects
As with transfers to home-delivered meals, very few nutrition
projects (less than six percent) reported transferring resources
to supportive services. Reasons for transfers include outreach
and other services,in particular, services for elderly people
needing home- and community-based long-term care. Ninety-one percent
of the nutrition projects do not expect to change transfer of
funds in the next five years. The nine percent that expect transfers
to increase cite transportation needs, case management services,
and increasing numbers of those in need and/or those who are frail
as the main reasons.
d. Summary
Eighty-five percent of SUAs reported a transfer in funds from
congregate to home-delivered meals, and 71 percent reported a
transfer from congregate meals to supportive services. Only a
few states believe that these funding transfers had large impacts
on their ability to provide congregate services, but a number
of states recognize that the shifts had some impact. In the next
five years, more than half expect transfers to home-delivered
meals to increase, but fewer than one-fourth expect shifts to
supportive services to increase. Reasons for the expected increases
are similar to states' reasons for transferring funds in the first
place--the elderly population and the number of very old and frail
people are increasing.
Almost three-quarters of AAAs reported transfers of funds from
congregate to home-delivered meals, but only one-quarter reported
transferring funds from congregate meals to supportive services.
AAAs' reasons for transfers are very similar to SUAs' reasons,
as are their expectations for the future.
| Last Modified: 1/15/2009 11:05:58 AM |
|