11

Older Americans Act Older Americans Act OrientationOrientation

JEAN LLOYD, MS, RDJEAN LLOYD, MS, RDUS Administration on AgingUS Administration on Aging

44thth State Units on Aging Nutritionists/Administrator Conference State Units on Aging Nutritionists/Administrator ConferenceAugust, 2006August, 2006

22

OverviewOverview

Aging StatisticsAging Statistics

Older Americans ActOlder Americans Act

Nutrition Program Nutrition Program

ResourcesResources

Choices for Choices for

IndependenceIndependence

33

Aging StatisticsAging Statistics

44

Number of Persons Number of Persons 65+ & 85+65+ & 85+ 1900– 1900–20502050

0

10

20

30

40

50

60

70

80

90

1900 1920 1940 1960 1980 2000 2010 2020 2030 2040 2050

65+ 85+

[Numbers in Millions]

55

% of Americans AGE 65 % of Americans AGE 65 Expected to Live to AGE 90Expected to Live to AGE 90

7

14

25 26

42

0

5

10

15

20

25

30

35

40

45

1940 1960 1980 2000 2050

66

Number of Older AdultsNumber of Older Adults

60+ 48.6 M 65+ 35.9 M 85+ 4.6 M

65+ Community

33.4 M (93.5%) Nursing Homes

1.5 M (4.5%) Assisted Living

1 M ( 2%)

77

The New Aging RealityThe New Aging Reality

OLDER AMERICANS LIVE Longer Healthier More independently More functionally fit And in the community.

88

Long Term CareLong Term Care

DefinitionDefinition Range of medical,

social & personal care services to meet health & personal needs of functionally impaired people.

99

Older Americans Act Older Americans Act

1010

Older Americans Act Older Americans Act Programs and Programs and ServicesServices

Established in 1965

Does not have any income requirements, forbids means-testing

Means-testing is the determination of eligibility for services based on a specific level of income

For persons 60+, targeting services to persons in greatest economic and social need, with particular attention to low income minorities and individuals residing in rural areas

1111

MissionMission

To help older people retain their dignity and independence and remain in their own homes and communities for as

long as possible.

1212

Older Americans Act, as Older Americans Act, as amended in 2000 – Overviewamended in 2000 – Overviewhttp://www.aoa.gov/about/legbudg/oaa/legbudg_oaa.asphttp://www.aoa.gov/about/legbudg/oaa/legbudg_oaa.asp

Title ITitle I – – Declaration of Objectives; Definitions

Title IITitle II – – Administration on Aging Title IIITitle III – – Grants for State and Community

Programs on Aging Title IVTitle IV – – Training, Research and

Discretionary Projects and Programs Title VTitle V – – Community Service Employment

Program for Older Americans Title VITitle VI – – Grants for Native Americans Title VIITitle VII – – Vulnerable Elder Rights

Protection Activities

1313

Title I – ObjectivesTitle I – Objectives

PreventionTo inform, empower and assist older persons and

their families to make choices that improve the quality of life

IndependenceOpportunities for older people to remain at home

and avoid institutional placements

ProtectionTo safeguard older consumers’ physical, mental,

emotional and financial well-being

1414

Title II - Administration on Aging

Administration on Aging (AoA) Assistant Secretary for Aging

National Aging Services NetworkNational Aging Services Network Tribal Organizations (243) State Units on Aging (56) Area Agencies on Aging (645) Local Service Provider Agencies (29,000) Nutrition Service Providers (4,400) Senior Centers (6,045) that receive support under the

OAA

1515

Title III – Grants for State and Community Programs on Aging

Part A – General Purpose Part B – Supportive Services and Senior Part B – Supportive Services and Senior

CentersCenters Part C – Nutrition ServicesPart C – Nutrition Services Part D – Disease Prevention and Health Part D – Disease Prevention and Health

PromotionPromotion Part E – National Family Caregivers Support Part E – National Family Caregivers Support

ProgramProgram

1616

Title III – Grants for State and Community Programs on Aging

Part A – General Purpose Sec 301 – Purpose & Administration

It is the purpose of this title to encourage and assist State agencies and area agencies on aging to…foster the development and implementation of comprehensive and coordinated systems …”

Sec 302 – Definitions The term “comprehensive and coordinated

system” means a system for providing all necessary supportive services, including nutrition services…”

1717

Title III – Grants for State and Community Programs on Aging

Part A – General Purpose Sec 303 – Authorization of Appropriations, Uses

of Funds Sec 304 – Allotment; Federal Share Sec 305 – Organization – State Agencies on

Aging, designation/de-designation of planning and service areas, single planning and service areas, area plan, funding formula

1818

Title III – Grants for State and Community Programs on Aging

Part A – General Purpose Sec 306 – Area Plans Sec 307 – State Plans Sec 308 – Planning, Coordination, Evaluation &

Administration of State Plans – State administration costs, transfers, waivers for transfers

Sec 309 – Payments Section 310 – Disaster Relief Reimbursements

1919

Title III – Grants for State and Community Programs on Aging

Part A – General Purpose Sec 311 – Nutrition Services Incentive Program Sec 312 – Multipurpose Senior Centers;

Recapture of Payments Sec 313 - Audit Sec 314 – Rights relating to In-Home Services

for Frail Older Individuals Sec 315 - Consumer Contributions- Cost

Sharing and Voluntary Contributions Sec 316 - Waivers

2020

Title III-BSupportive Services &Senior Centers

Information & Assistance Case Management Transportation Homemaker/Chore Personal Care Senior Centers Health and Nutrition Education “Any other services necessary for the

general welfare of older individuals”

2121

Title III-CElderly Nutrition Program

Congregate Nutrition Services (C-1) 5 or more days a week Congregate setting, including Adult Day Care Nutrition Education & Counseling, including

caregivers

Home-Delivered Nutrition Services –Homebound (C-2) Hot, cold, frozen, dried, canned or supplemental meals Nutrition Education & Counseling, including

caregivers

2222

Title III-DDisease Prevention/Health Promotion

Information at Senior Centers, Meal Sites & Home-Delivered Meals Programs

Health Screening & Risk Assessments Hypertension -- Cholesterol Glaucoma -- Vision Hearing -- Diabetes

Physical Fitness Prevention & Reduction of Alcohol, Substance

Abuse, Smoking Cessation Medication Management Nutrition Counseling, including caregivers

2323

Title III-ENational Family CaregiverSupport Program

Service Categories Information about Services Assistance with Access to Services Individual Counseling, Support Groups,

Caregiver Training Respite Care Supplemental Services, on a Limited

Basis

Focus on Caregiver vs. Care Recipient

2424

Title IVTraining, Research, and Discretionary Projects and Programs

Education Training Demonstrations Innovations Funding – 2006 - $24,595,000

2525

Title VCommunity Service Employment for Older Americans

Administered by U.S. Department of Labor

Subsidized Employment & Training for Low-Income Seniors 55 Years of Age & Older

2626

Title VIGrants for Native Americans

Part A – Indian Program American Indians Alaska Natives

Part B – Native Hawaiian Program Part C – Native American Caregiver

Support Program ($5 million included in Title III-E)

2727

Title VIIVulnerable Elder Rights Protection

Long-term Care Ombudsman Program Prevention of Elder Abuse, Neglect &

Exploitation Legal Assistance Development

2828

Public Health Service Act – Section 398

Alzheimer’s Disease Demonstration Grants to States Program – Total Funding – 2006- $11,668,000 Outreach Training Support Groups Respite Services Focused on hard-to-reach populations

2929

Older Americans Act, 2006Older Americans Act, 2006http://www.aoa.gov/about/legbudg/current_budg/legbudg_current_budg.asphttp://www.aoa.gov/about/legbudg/current_budg/legbudg_current_budg.asp

TITLETITLE SERVICESSERVICES FUNDING $FUNDING $

III-B Supportive III-B Supportive Transportation Senior Centers

350.6 M

III-C NutritionIII-C Nutrition

C-1, C-2, NSIPC-1, C-2, NSIP

Meals: congregate, home-delivered

715 M

III-D HPDPIII-D HPDP Screening, med. management

21.4 M

III-E NFCSPIII-E NFCSP I&R, Support Groups, Respite

156.1 M

VI-Amer IndianVI-Amer Indian Same as III 32.4 M

VII-Elder RightsVII-Elder Rights Ombudsman 20.1 M

3030

AoA: AoA: 2006 Budget2006 Budget

1%2%

2%

4%

12%52%

26%

TOTAL Title III TOTAL Title III BudgetBudget = $1.3 B

NUTRITION NUTRITION = $715 M

NUTRITION NUTRITION = >½ BudgetConsistently

NUTRITION SERVICES

HCBS

CG

3131

Older Americans Act Nutrition Older Americans Act Nutrition ProgramProgram

3232

OAA Nutrition Program Purposes

Promote health Provide nutritious

meals Reduce social

isolation Link to other social

& rehabilitative services

3333

Purpose of the OAA Nutrition Program

Promote health Primary prevention: health, wellness & functionality

activities Secondary & tertiary: risk reduction, disease management

and treatment, i.e. diabetes self management, diabetes support group, provision of a renal diet

Includes either the provision of or referral to health promotion/disease prevention programs, i.e., physical activity, medication management, etc.

Provide nutritious meals Meet RDAs and Dietary Guidelines for Americans Meet special needs: health, racial/ethnic, religious Meals meet participant preferences, could include choice

3434

Purpose of the OAA Nutrition Program

Reduce social isolation Congregate activities, social, physical, cognitive Active social engagement, volunteer opportunities Transition home delivered participants to congregate

participation as much as possible Home delivered, personal interaction, friendly visiting,

telephone reassurance

Link to other social, rehabilitative services within HCB LTC Other food and nutrition assistance services, i.e. the Food

Stamp Program, food pantries HP/DP programs, physical activity, falls prevention,

depression screening, medication management, immunization

Other supportive services, i.e., transportation, or in-home services, i.e., personal care

3535

Title III-C, OAA Nutrition Program or Elderly Nutrition Program Congregate Nutrition Services

Congregate settings, including adult day care, intergenerational settings

Does not provide for take out meals Home Delivered Nutrition Services

Homebound, in home service Meals: 5 or more days per week Nutrition Screening, Education and Counseling

3636

Section 339 Requirements

Program Partially federally funded, state administered “A State that establishes and operates a

nutrition project under this chapter shall…” State must solicit advice of a dietitian or

individual of comparable expertise in planning nutritional services and ensuring….

Indicates that meals, other than in-home meals, must be provided in settings close to residences of older individuals

3737

Section 339 Requirements

Meals 1/3 RDA; Dietary Guidelines for Americans,

2005; state & local foodservice law Design meals to meet special dietary needs

(cultural/ethnic preferences, health, religious needs)

Design “appealing” meals, i.e. food/menu choice OAA provides the authority for program

implementation to vary state by state

3838

Section 339 Requirements

Other Program Requirements Some states delegate more responsibility to

AAAs and local service providers than others Local nutrition service providers must

implement the program with the expertise of a dietitian or individual of comparable expertiseas well as the input from meal participants, and other knowledgeable individuals

Provide for nutrition screening, education and counseling

3939

Meal Service TrendsMeal Service Trends

FY

Total Meals

C-1 C-2 % C-2

1975 48.5 M n/a n/a n/a

1977 101.0 M 86.2 M 14.8 M 15%

1987 232.6 M 146.7 M 85.9 M 37%

1997 240.0 M 116.5 M 123.5 M 51%

2004 247.9 M 105.0 M 142.9 M 58%

4040

Participant TrendsParticipant Trends

FY

TOTAL C-1 C-2 % C-2

1995 3,401,206 2,412,468 988,738 29

1997 3,003,413 2,112,924 890,489 15

1999 2,644,010 1,760,068 883,942 33

2000 2,696,330 1,743,292 953,038 35

2004 2,746,057 1,777,995 968,062 35

4141

Congregate Congregate ExpendituresExpenditures

FY

Title III - $ Other Sources - $

Total - $ % Title IIII

1995 249,687,321 272,356,673 523,043,994 48

1997 244,053,197 299,833,168 543,886,365 45

1999 244,890,396 311,390,223 556,280,619 44

2000 248,518,121 313,850,484 562,368,605 44

2004 251,350,262 361,964,947 613,315,209 41

4242

Home Delivered Home Delivered ExpendituresExpenditures

FY

Title III - $ Other Sources - $

Total - $ % Title

III

1995 134,119,129 262,570,482 396,689,611 34

1997 139,734,714 321,158,337 460,893,051 30

1999 148,249,211 351,184,005 499,433,216 30

2000 164,638,849 367,274,096 531,912,945 31

2004 203,102,209 467,217,933 670,320,142 30

4343

Nutrition Program Income Nutrition Program Income as a % of Total Expendituresas a % of Total Expenditures

C-1C-1 C-2C-2

FYFY Total - $Total - $ %% Total - $Total - $ %%

19971997 $100,861,104$100,861,104 18.518.5 $ 86,482,422$ 86,482,422 18.818.8

19991999 $104,433,078$104,433,078 18.718.7 $ 93,026,909$ 93,026,909 18.618.6

20002000 $107,260,124$107,260,124 19.019.0 $ 94,783,521$ 94,783,521 17.817.8

20042004 $125,238,651$125,238,651 20.520.5 $114,390,223$114,390,223 17.117.1

4444

Average Cost of Meals Average Cost of Meals Based on Total Based on Total ExpendituresExpenditures

FYFY C-1C-1 C-2C-2

19971997 $4.70$4.70 $3.74$3.74

19991999 $4.93$4.93 $3.72$3.72

20002000 $4.86$4.86 $3.71$3.71

20032003 $5.87$5.87 $4.63$4.63

20042004 $5.81$5.81 $4.68$4.68

4545

Older Americans Act Older Americans Act Congressional ActionCongressional Action

House Action - ReauthorizationHouse Action - Reauthorization H.R. 5293, Senior Independence Act of 2006, H.R. 5293, Senior Independence Act of 2006,

introduced May 2006introduced May 2006

Senate Action - ReauthorizationSenate Action - Reauthorization S. 3570, Older Americans Act Amendments of S. 3570, Older Americans Act Amendments of

2006, introduced June 20062006, introduced June 2006

Appropriation bills have not been passed in Appropriation bills have not been passed in either chamber, continuing resolutions are either chamber, continuing resolutions are usual usual

4646

ResourcesResources

4747

Dietary Guidelines for Americans 2005 Dietary Guidelines for Americans 2005 HHS Toolkit for Health HHS Toolkit for Health ProfessionalsProfessionals

Getting Older. Living Healthier. Feeling Better.

Consumer Brochure Older Adult Health Fact Sheets (8) (8)

Specific info re healthy diets & phys activity for health professionals

Nutrition Service Providers Guide Assistance materials for planning meals for older adults in group settings

Available July, 2006 www.healthierus.gov/dietaryguidelines//

4848

ResourcesResources National Resource Center on

Nutrition, Physical Activity & Aging Florida International Universityhttp://nutritionandaging.fiu.edu Subscribe: NAN Listserve

for BiWeekly Highlights Older Americans Nutrition Program Toolkit Creative Solutions Information on DRIs, Dietary Guidelines Topics A - Z

4949

ResourcesResources US Administration on Aging

www.aoa.gov

Eldercare Locator: access service info www.eldercare.gov

5050

Modernizing the OAA for the 21st Century: Choice for

Independence

5151

Empowering Individuals to Make Empowering Individuals to Make Informed Choices Informed Choices

Through “one-stop shop” resource centers and public education campaigns

Builds onBuilds onOwn Your Future CampaignAging & Disability Resource Centers

5252

Offering More Choices for High-Risk IndividualsThrough Flexible Service Dollars And Through Flexible Service Dollars And

Consumer-Directed Approaches Consumer-Directed Approaches

Helping Moderate and Low-Income

Individuals at High Risk of Nursing Home

Placement

Builds on The Cash & Counseling Demo

5353

Building Prevention IntoCommunity Living

Evidence-based programs, such as:Chronic Disease Self-Management Chronic Disease Self-Management Falls PreventionFalls PreventionNutritionNutritionPhysical ActivityPhysical Activity

Delivered Through Aging Services Providers

Builds onBuilds on AoA’s Evidence-Based Initiative

5454

Contact InformationContact Information

JEAN L. LLOYD, MS, RDNational Nutritionist

US Department of Health & Human Services

Administration on Aging

Washington, DC 20001

202-357-3582

jean.lloyd@aoa.hhs.gov

55

Older Americans Act Older Americans Act Frequently Asked Frequently Asked

QuestionsQuestions

Floristene Johnson, MS, RD, LD Region VI

Joseph M. Carlin, MS, RD Region I

How can I get my How can I get my questions answeredquestions answered??

Does the State need Does the State need to have a nutrition to have a nutrition

policy and procedure policy and procedure manual?manual?

Is the nutrition Is the nutrition program required to program required to

provide services in an provide services in an adult day care?adult day care?

Who may participate in Who may participate in the OAA Nutrition the OAA Nutrition

Program?Program?

Are family caregivers Are family caregivers eligible for home eligible for home delivered meals?delivered meals?

Who may not Who may not participate in the OAA participate in the OAA Nutrition Program?Nutrition Program?

If an older individual is accompanied by a younger If an older individual is accompanied by a younger

person who is seeking Title III-C nutrition services person who is seeking Title III-C nutrition services

under the spousal eligibility provision of Section 339 (2)under the spousal eligibility provision of Section 339 (2)

(I) and the two individuals (I) and the two individuals self-identifyself-identify as “husband” as “husband”

and “wife” for the purposes of meeting the Federal and “wife” for the purposes of meeting the Federal

definition, what provisions exist within the Act definition, what provisions exist within the Act

authorizing the State Agency to inquire further about authorizing the State Agency to inquire further about

age, marital status and gender of such persons?age, marital status and gender of such persons?

What are the eligibility What are the eligibility criteria for meals to be criteria for meals to be

served in OAA served in OAA Nutrition Programs? Nutrition Programs?

Can meals served to Can meals served to recipients of Medicaid waiver recipients of Medicaid waiver

meals who are 60 years or meals who are 60 years or over, or disabled under 60 over, or disabled under 60

years be reported as eligible years be reported as eligible Title III-C meals?Title III-C meals?

How are contributions How are contributions to be used?to be used?

Does AoA have a written Does AoA have a written response that has been response that has been

officially released to officially released to States, regarding sending States, regarding sending "bills" for home delivered "bills" for home delivered

meals? meals?

Should we deny meals Should we deny meals to potential to potential

clients/participants clients/participants based on citizenship based on citizenship or national origin? or national origin?

Are participants Are participants required to sign in?required to sign in?

What is the guidance What is the guidance on waiting lists? on waiting lists?

Does a Title III meal have Does a Title III meal have to be the noon meal? to be the noon meal?

Can the daily meal be an Can the daily meal be an early evening meal early evening meal

everyday? everyday?

Can a meal be counted Can a meal be counted as an eligible meal if as an eligible meal if

the client does not eat the client does not eat everything served? everything served?

If a client asks for a part If a client asks for a part of a meal after eating a of a meal after eating a complete meal, can the complete meal, can the

second helping be second helping be considered an eligible considered an eligible

meal? meal?

Are “Carry-out”/”Take-Are “Carry-out”/”Take-Out” meals considered Out” meals considered

eligible meals? eligible meals?

What should SUAs be What should SUAs be doing with Title VI? doing with Title VI?

Does the OAA (or AoA) Does the OAA (or AoA) require an SUA to use require an SUA to use

a menu pattern? a menu pattern?

Could you please clarify the Could you please clarify the requirement for home delivered meals requirement for home delivered meals to provide milk if the client does not to provide milk if the client does not

drink milk? Is there a recommendation drink milk? Is there a recommendation for record-keeping purposes that the for record-keeping purposes that the

client refuses a portion of the meal and client refuses a portion of the meal and then not send the milk? then not send the milk?

Is there any expectation that Is there any expectation that we collect and include in we collect and include in

reporting the NSI risk scores reporting the NSI risk scores for recipients of meals from for recipients of meals from the "other"/non-contractual the "other"/non-contractual

funding sources?funding sources?

Do we have to use the Do we have to use the NSI checklist for our NSI checklist for our

State Program Report State Program Report (SPR)?(SPR)?

Can NSIP money be used Can NSIP money be used to buy frozen meals that to buy frozen meals that meet 1/3 RDA for home meet 1/3 RDA for home

delivered meal delivered meal recipients? recipients?

Can a 60 year old caregiver Can a 60 year old caregiver (family, volunteer, paid or not) (family, volunteer, paid or not) receive a home-delivered meal receive a home-delivered meal

along with the 60+ client receiving along with the 60+ client receiving HD meals and have it counted as HD meals and have it counted as

an NSIP HDM which means it an NSIP HDM which means it would be paid for with T-III would be paid for with T-III

C2 funds?C2 funds?

Can a congregate meal provider provide an Can a congregate meal provider provide an

evening or weekend meal at a congregate evening or weekend meal at a congregate

site to an eligible meal participant who is site to an eligible meal participant who is

identified as a high nutritional risk and can identified as a high nutritional risk and can

that meal be funded by Title III C1 funds? If that meal be funded by Title III C1 funds? If

the meal is funded with local dollars, is the the meal is funded with local dollars, is the

meal eligible for NSIP?   meal eligible for NSIP?  

When is a waiver of the When is a waiver of the 5-day a week 5-day a week

requirement needed?requirement needed?

What about holidays? What about holidays? May nutrition sites May nutrition sites

close for major close for major holidays and still meet holidays and still meet the 5-day a week rule? the 5-day a week rule?

How many cans of a How many cans of a liquid supplement can liquid supplement can be counted as a meal? be counted as a meal?

If an eligible client meets If an eligible client meets the criteria for a home-the criteria for a home-

delivered meal is not "at delivered meal is not "at home", can they still have home", can they still have

the meal delivered? the meal delivered?

Can the client's meal be Can the client's meal be delivered to her child’s delivered to her child’s workplace which is not workplace which is not the client's, "place of the client's, "place of

residence" as described residence" as described in NAPIS?in NAPIS?