1. n4a 2007 Aging Network Survey Preliminary Title VI Survey Results March 2008

2. Background National Association of Area Agencies on Aging (n4a) National Association of Area Agencies on Aging (n4a) with a grant from Administration on Aging with a grant from Administration on Aging contracted with Scripps Gerontology Center, Miami University, Oxford, Ohio to: contracted with Scripps Gerontology Center, Miami University, Oxford, Ohio to: Create a self-assessment survey for Title VI and AAA organizations about key components of Choices for Independence; provide timely and useful reports. Develop training and technical assistance for the aging network for moving forward with long-term care* programming. * home and community based long-term care

3. Major components of the project Annual web-based self-assessment survey and mini- surveys Annual web-based self-assessment survey and mini- surveys Feasibility analysis of a national integrated provider data base Feasibility analysis of a national integrated provider data base Workshops on business planning for Title VI and Title III (AAA) directors Workshops on business planning for Title VI and Title III (AAA) directors Web accessible up-to-date and comprehensive training materials for AAA board members Web accessible up-to-date and comprehensive training materials for AAA board members

4. Survey Web-based survey: designed using SNAP software Mailed option AAA survey-launched June 25, 2007 Title VI survey-launched August 31, 2007 Average completion time: 30-45 minutes Toll free number available for all concerns

5. Survey Development Goals User-friendly Useful Thorough Input Listening sessions Focus groups Advisory Council Key Informant and cognitive interviews

6. Title VI Participation Scripps Title VI Coordinator Support from National Resource Center on Native American Aging Ongoing support from Yvonne Jackson (AoA) Conducted focus group with 5 Title VI program directors (first phase of Title VI Advisory Group) Contracted with Cynthia LaCounte as an independent consultant

7. Different Timelines AAA and Title VI surveys on different timelines due to: Concerns about timing of survey, conflicts with other required reporting Feedback from Title VI Directors Feedback from Tribal Consultants

8. Response Rates AAA survey launched June 25, 2007 AAA survey launched June 25, 2007 81.8% response rate 81.8% response rate Title VI survey launched August 31, 2007 Title VI survey launched August 31, 2007 83% response rate 83% response rate

9. Current Efforts Ended survey completions mid-March, 2008 Ended survey completions mid-March, 2008 Data analysis and meaningful conceptualization Data analysis and meaningful conceptualization Report writing and dissemination Report writing and dissemination Continuing work with Title VI and AAA Advisory Groups Continuing work with Title VI and AAA Advisory Groups Develop and launch mini-surveys Develop and launch mini-surveys

10. In this session….. We present basic and preliminary findings We present basic and preliminary findings We seek your comments We seek your comments We seek a conversation We seek a conversation

11. Organizing Principles (Choices for Independence) Enable elders to remain in their own homes through the provision of home and community-based long-term care Enable elders to remain in their own homes through the provision of home and community-based long-term care Empower consumers to stay active and healthy through disease prevention and health promotion services Empower consumers to stay active and healthy through disease prevention and health promotion services Streamline access to home and community-based services through single point of entry and strategic partnerships Streamline access to home and community-based services through single point of entry and strategic partnerships Enhance organizational capacity of the aging network for the area-wide development and implementation of home and community-based long-term care systems. Enhance organizational capacity of the aging network for the area-wide development and implementation of home and community-based long-term care systems.

12. DRAFT Preliminary Findings and Issues These findings are in draft form and should not be duplicated or shared. These findings are in draft form and should not be duplicated or shared. These findings are based on an earlier, 72% response rate, not the final 83% response rate. These findings are based on an earlier, 72% response rate, not the final 83% response rate. Final analysis will be reported at a later date. Final analysis will be reported at a later date.

13. Organizational Capacity Average (mean) # of Clients Served:278 Average (mean) # of Clients Served:278 25 th Percentile:85 25 th Percentile:85 50 th Percentile:150 (median) 50 th Percentile:150 (median) 75 th Percentile:374 75 th Percentile:374 Average (mean) # of Employed Staff: Average (mean) # of Employed Staff: Full Time:3.9 Full Time:3.9 Part Time:3.2 Part Time:3.2 Average Length of Current Director (years): 7.0 Average Length of Current Director (years): 7.0 Average Length of Previous Director (years): 3.7 Average Length of Previous Director (years): 3.7

14. Services Participants were asked to identify which home and community-based services (out of a list of 28) they provide and whether those services were provided with OAA funding and/or other funding. Participants were asked to identify which home and community-based services (out of a list of 28) they provide and whether those services were provided with OAA funding and/or other funding. They were also asked to identify if select services were provided with a consumer directed option. They were also asked to identify if select services were provided with a consumer directed option.

15. Services Assistive devices Assistive devices Case management Case management Chore Chore Native American Family Caregiver Support Program Native American Family Caregiver Support Program Home delivered meals Home delivered meals Home health Home health Homemaker Homemaker Home modification Home modification Home repair and maintenance Home repair and maintenance Official eligibility determinations for public programs Congregate meals Food pantry Information and referral/assistance Legal assistance Outreach Ombudsman Paperwork and money management Translator/interpret er assistance Medication Management Medication Management Personal Care Personal Care Respite Care Respite Care Transportation Transportation Adult day service Adult day service Adult Protective Services Adult Protective Services Assessment for care planning Assessment for care planning Assessment for long- term care service eligibility Assessment for long- term care service eligibility Benefits counseling Benefits counseling

16. Services (Proportion of programs who offer select services)

17. Services (Proportion of programs who offer selected services with OAA funding and with funding other than OAA) OAA Funding OAA Funding Congregate Meals 95.4% Congregate Meals 95.4% Home delivered meals 90.8% Home delivered meals 90.8% IR/A 88.4% IR/A 88.4% Outreach 82.1% Outreach 82.1% NAFCSP 71.7% NAFCSP 71.7% Transportation 71.7% Transportation 71.7% Other Funding Home repair and maintenance 66.7% Transportation 66.7% Assistive devices 60.5% Home modification 59.3% Medication management 55.6% Home health 49.4% IR/A 49.4% Benefits Counseling 49.4%

18. Consumer Directed Services Analysis issue: How did respondents interpret consumer directed services? 22.5% of programs stated that their program provides consumer/self-directed services. 22.5% of programs stated that their program provides consumer/self-directed services. Most common consumer directed services include: Most common consumer directed services include: Respite care 82.1% Respite care 82.1% NAFCSP 30.8% NAFCSP 30.8% Chore 30.8% Chore 30.8% Personal care 23.1% Personal care 23.1%

19. Funding Sources Medicare 5.6 Medicare 5.6 Medicaid 12.5 Medicaid 12.5 Medicaid waiver 16.3 Medicaid waiver 16.3 Indian Health Service 70.6 Indian Health Service 70.6 American Indian Relief Council 4.4 American Indian Relief Council 4.4 Revenue from gaming 20.6 Revenue from gaming 20.6 Other tribal funding 73.1 Other tribal funding 73.1 Title III funding 41.3 Title III funding 41.3 Other state funding 28.8 Other state funding 28.8 SSBG 13.1 SSBG 13.1 Grant funds 15.6 Grant funds 15.6 Private pay clients 3.1 Private pay clients 3.1 Other 16.9 Other 16.9 Percent of respondents providing home and community-based services with funds other than OAA funds:

20. Funding Sources Percent of programs that use at least some funding from each of the following sources.

21. Disease Prevention and Health Promotion Services or Programs (proportion of programs that provide disease prevention and health promotion services or programs-regardless of funding source)

22. Funding Sources (Disease Prevention and Health Promotion) Medicare 3.8 Medicare 3.8 Medicaid 9.6 Medicaid 9.6 Medicaid waiver 9.0 Medicaid waiver 9.0 Indian Health Service 78.8 Indian Health Service 78.8 American Indian Relief Council 3.8 American Indian Relief Council 3.8 Revenue from gaming 10.3 Revenue from gaming 10.3 Other tribal funding 49.4 Other tribal funding 49.4 Title III funding 28.8 Title III funding 28.8 Other state funding 15.4 Other state funding 15.4 SSBG 5.1 SSBG 5.1 Grant funds 15.4 Grant funds 15.4 Private pay clients 2.6 Private pay clients 2.6 Other 10.3 Other 10.3 Percent of respondents providing disease prevention and health promotion services and programs with funds other than OAA funds, from the following sources:

23. Involvement in Key Programs ADRC: How did respondents define ADRCs? ADRC: How did respondents define ADRCs? Evidence-Based Programming: How did respondents define ADRCs? Evidence-Based Programming: How did respondents define ADRCs? Transition Programming: How did respondents define transitioning elders from nursing home back to community? Transition Programming: How did respondents define transitioning elders from nursing home back to community? Targeting: How did respondents define targeting? Targeting: How did respondents define targeting?

24. Single Point of Entry How did respondents define single point of entry? How did respondents define single point of entry?

25. Partnerships Participants were asked to identify which partnerships (out of a list of 20) they maintain with federal, state and local organization or affiliations. Participants were asked to identify which partnerships (out of a list of 20) they maintain with federal, state and local organization or affiliations. They were also asked to identify if the partnership was formal (formalized with a contract, compact or memorandum of agreement) or informal (non-contractual) They were also asked to identify if the partnership was formal (formalized with a contract, compact or memorandum of agreement) or informal (non-contractual)

26. Partnerships Federal agencies Federal agencies Medicaid Medicaid Indian Health Service Indian Health Service Tribal organization or consortium Tribal organization or consortium Department of Health Department of Health MR/DD organizations MR/DD organizations Disability service orgs. Disability service orgs. Mental/Behavioral health Mental/Behavioral health Adult Protective Services Adult Protective Services Public housing authority or other housing programs Public housing authority or other housing programs Health care providers and maintenance Health care providers and maintenance Managed care/HMO network Managed care/HMO network Businesses Businesses Advocacy organizations Advocacy organizations Charitable organizations Charitable organizations Educational institutions Educational institutions Research institutions Research institutions Religious organizations Religious organizations Other social service orgs. Other social service orgs. Other Other

27. Partnerships-Formal and Informal (5 most common and 5 least common partnerships)

28. Partnerships (Most common formal and informal) Formal Partnerships Formal Partnerships Tribal organization or consortium 44.4% Tribal organization or consortium 44.4% Indian Health Service 42.6% Indian Health Service 42.6% Health care providers 38.0% Health care providers 38.0% Federal agencies 27.8% Federal agencies 27.8% Department of Health 25.9% Department of Health 25.9% Informal Partnerships Health care providers 83.7% Indian Health Service 80.7% Public housing authority or other housing programs 74.7% Adult Protective Services 71.7% Department of Health 70.5%

29. Progress Questions Sets of questions related to Choices principles Sets of questions related to Choices principles Response Options: Response Options: Do not plan to work on this. Do not plan to work on this. Would like to work on this but cannot. Would like to work on this but cannot. Plan to work on this but have not begun. Plan to work on this but have not begun. Have made progress. Have made progress. Have this in place. Have this in place.

30. Helping Elders to Remain in their Own Homes: Most progress Asking elders about their service preferences. Asking elders about their service preferences. Assessing elder satisfaction with their services. Assessing elder satisfaction with their services. Assisting elders in planning in advance for long-term care. Assisting elders in planning in advance for long-term care.(Discuss)

31. Helping Elders to Remain in their Own Homes: Least progress Providing vouchers or cash to elders so they may purchase services. Providing vouchers or cash to elders so they may purchase services. Providing services to elders who pay for their own services. Providing services to elders who pay for their own services. Building billing systems for private pay elders. Building billing systems for private pay elders. Developing policies and procedures to serve private pay/insurance elders. Developing policies and procedures to serve private pay/insurance elders. Developing policies and procedures for elders who pay for a part of their services. Developing policies and procedures for elders who pay for a part of their services.

32. Helping Elders Get Home and Community-Based Services: Most progress Developing collaborations with our local Area Agency on Aging (Title III) Developing collaborations with our local Area Agency on Aging (Title III) Improving our Information and Referral/Assistance System. Improving our Information and Referral/Assistance System.

33. Helping Elders Get Home and Community-Based Services: Least progress Electronically maintaining a billing system. Electronically maintaining a billing system. Developing innovative technology to improve elder access. Developing innovative technology to improve elder access.

34. Helping Elders Get Home and Community-Based Services: Mixed progress Positioning our organization as the single point of entry for long-term care in our area. Positioning our organization as the single point of entry for long-term care in our area. Coordinating a single assessment and eligibility determination process. Coordinating a single assessment and eligibility determination process. Electronically maintaining information about elders and their services. Electronically maintaining information about elders and their services. Electronically maintaining health information about elders (ADLs, IADLs, diagnoses). Electronically maintaining health information about elders (ADLs, IADLs, diagnoses). Electronically maintaining provider information. Electronically maintaining provider information.

35. Building Home and Community-Based Long-Term Care Systems: Most progress Developing a system to provide home and community- based services to older adults. Developing a system to provide home and community- based services to older adults. Acquiring board/governance support for home and community-based service provision. Acquiring board/governance support for home and community-based service provision. (Discuss: Did respondents mean tribal government support as opposed to organization board?) (Discuss: Did respondents mean tribal government support as opposed to organization board?) Acquiring Tribal Council support for providing home and community-based services. Acquiring Tribal Council support for providing home and community-based services. Having culturally competent staff. Having culturally competent staff.

36. Building Home and Community-Based Long- Term Care Systems: Least progress Developing a system to provide home and community- based services to persons of all ages. Developing a system to provide home and community- based services to persons of all ages. Building a tribal nursing home.

37. Building Home and Community-Based Long- Term Care Systems: Mixed progress Having enough staff to move forward with new programs. Having enough staff to move forward with new programs. Case managing long-term care services. Case managing long-term care services. Having financial resources to move forward with new programs. Having financial resources to move forward with new programs. Seeking grants for programs. Seeking grants for programs. Obtaining grants for programs. Obtaining grants for programs. Fund-raising and development. Fund-raising and development. Developing relationships with universities or research centers to evaluate our programs and activities. (Discuss) Developing relationships with universities or research centers to evaluate our programs and activities. (Discuss) Marketing to attract elders to our services. Marketing to attract elders to our services. Building a tribal assisted living facility. Building a tribal assisted living facility. Expanding the types of services we offer. Expanding the types of services we offer.

38. Training and TA Needs Understanding the LTC system 69.3 Understanding the LTC system 69.3 Resource development 60.8 Resource development 60.8 Strategic planning 60.8 Strategic planning 60.8 Learning more about Medicare 46.4 Learning more about Medicare 46.4 Learning more about Medicaid 44.6 Learning more about Medicaid 44.6 Strategic alliances 27.1 Strategic alliances 27.1 Choices for Independence as a strategic framework 26.5 Choices for Independence as a strategic framework 26.5 Percent of respondents who identified the following training and technical assistance needs as most useful to their organization:

41. In memory of Alan Allery And in honor of his important contribution to this effort.

42. For further information: linscoae@muohio.edu linscoae@muohio.edu linscoae@muohio.edu mcgrewkb@muohio.edu mcgrewkb@muohio.edu mcgrewkb@muohio.edu kunkels@muohio.edu kunkels@muohio.edu kunkels@muohio.edu Scripps Gerontology Center Scripps Gerontology Center Miami University Oxford, OH 45056 513-529-2914