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Transcript of 1 Older Americans Act Orientation JEAN LLOYD, MS, RD US Administration on Aging 4 th State Units on...
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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
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?