Public Information Collection Requirement Submitted to the Office of Management and Budget (OMB) for Clearance
Federal RegisterSep 29, 1994
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Administration on Aging
Public Information Collection Requirement Submitted to the Office
of Management and Budget (OMB) for Clearance
agency: Administration on Aging, HHS.
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The Administration on Aging (AoA), Department of Health and Human
Services, has submitted to the Office of Management and Budget (OMB)
the following proposal for the collection of information in compliance
with the Paperwork Reduction Act (Pub. L. 96-511):
Title of Information Collection: State Performance Report: Reporting
Requirements for Titles III and VII of the Older Americans Act;
Type of Request: Extension and Revision;
Use: To revise an existing information collection form to conform to
the newly-developed National Aging Program Information System (NAPIS)
resulting from amendments to the Older Americans Act which directed the
Administration on Aging to improve State reporting requirements;
Frequency: Annually;
Respondents: State Agencies on Aging;
Estimated Number of Responses: 57;
Total Estimated Burden Hours: 293,721.
Additional Information or Comments: Written comments and
recommendations for the proposed information collections should be sent
within 10 days of the publication of this notice directly to the
following address: OMB Reports Management Branch, Attention: Allison
Eydt, New Executive Office Building, Room 3208, Washington, DC 20503.
Dated: September 23, 1994.
William F. Benson,
Deputy Assistant Secretary for Aging.
A. Justification
1. Explanation of Necessity
The Older Americans Act (OAA) requires annual program performance
reports from the States. The 1992 reauthorization of the (OAA) directed
the Administration on Aging to develop reporting procedures for use by
States to correct deficiencies in current reporting practices. In
response to this mandate, AoA has developed a new reporting system
known as the National Aging Program Information System (NAPIS) which
necessitates as revised form 0980-0199. The current Form 0980-0199 will
be divided into two separate forms. The first form will be known as the
State Performance Report (SPR) and will require an accounting of
performance under Title III and the newly established Title VII. The
SPR component of the NAPIS which we are submitting is intended to be
phased in over a three year period with levels of detail increasing
annually (except for states that elect faster implementation),
beginning with program information collected in FY 1995. The second
form, which in the past was included in the SPR, will be known as the
State Annual Ombudsman Report to the Administration on Aging and will
be the basis for the National Ombudsman Reporting System (NORS).
AoA will test both the SPR and the State Annual Ombudsman Report in
FY 1995. The test of the new SPR will focus on the new requirements for
registration and data on client characteristics. AoA will seek out the
test states through an open solicitation process. the pilot sites will
include both states which have the capacity to fully implement all
reporting requirements in FY 1995 as well as states that are not as far
along in the development of their reporting system capacities. AoA will
use the test results to evaluate the feasibility of the proposed
reporting specifications. Based on the test results AoA will consider
revision of the timing and the substance of the specifications, as
appropriate. Approval for such final changes will be requested form OMB
by June 30, 1995. However, at this time we fully intend to implement
the reporting system on the proposed schedule.
The revised State Annual Ombudsman Report is to be implemented in
FY 1995 at state option, and required for information collected in FY
1996. Therefore, we ask that OMB extend, also, approval for AoA to use
Part V, Long Term Care Ombudsman Program, of our current Form 0980-0199
through FY 1995.
2.Use of Information and Consequence of Not Collecting
The information will be used to meet existing and new statutory
requirements under the (OAA) which includes evaluation of program
operations; preparation of reports for the Congress and the Office of
Management and Budget; policy analysis; response to other Federal
agencies; and to other public and private sector agencies and
organizations.
If the revised form 0980-0199 is not approved, the Assistant
Secretary for Aging will not be able to comply with (OAA) statutory
requirements for state program performance information in FY 1995 due
to lack of State-by-State data. Introduction of the revised system
during FY 1995 would be prohibited. The current form 0980-0199 expires
on 12/31/94.
3. Information technology and Reducing Burden
State and Area Agencies on Aging (AAAs) are rapidly automating the
collection, processing, and transmission of data. This has a profound
effect on estimates of time and cost to produce program service data. A
few States have limited ADP capacity, but virtually all States will,
within a very short time, have ADP capacity that was rare 10 years ago.
In the past, a large State with many AAAs using a ``paper and pencil
reporting system'' might have used several thousands of hours to
produce an annual report. Furthermore, the burden would be much the
same each year a similar report was developed. Currently, States that
have commonplace and relatively inexpensive ADP capacity perform these
tasks in a fraction of the time needed with a paper system. Beyond
this, the burden is greater in the first year of reporting than in any
subsequent year, because ADP costs load on the front end. AoA has
consulted extensively with States in the development of these
requirements and has limited the burden to the extent practical and
allowable under the OAA.
4. Efforts to Identify Duplication
The information specified for this report is not available form
other collection source.
5. Availability of Similar Information
Similar information is not available from any other source.
6. Small Business or other Small Entities--N/A
7. Consequences of Less Frequent Collection
State performance reports are required on an annual basis by
statute.
8. Guidelines in 5 CFR 1320.6
The existing State Program Report is consistent with 5 CFR 1320 and
this request for extension would have no adverse effect.
9. Outside Consultation
Outside consultation with the aging network on the proposed
reporting specifications has been extensive:
1991
AoA issued an Information Memorandum 91-17 (January, 1991) to
States indicating a need to improve the State Program Report (SPR).
States were provided an opportunity to comment on improvements on the
current SPR. 41 States wrote comments and nearly all wanted substantial
changes in the SPR, including improvements to the taxonomy,
computerization, and changes to facilitate greater accuracy. AoA held a
meeting (June, 1991) with a group of State and Area Agency on Aging
personnel to discuss major issues.
Dimensions International Report (September, 1992-March, 1993)
AoA funded a contractor, Dimensions International (DI), to develop
comprehensive information, analyze program issues and provide
recommendations on a reporting system for (OAA) funded programs. DI
engaged a Policy Committee and a Technical Committee each of which met
twice in Washington, D.C. to provide aging network input to the
recommendations. An executive summary of the findings and
recommendations is attached.
NORS Work Group Activities (1991-1993)
AoA staff worked with numerous state Long-Term Care (LTC) Ombudsman
over a period of two years to develop an improved reporting system for
the Ombudsman Program--the National Ombudsman Reporting System (NORS),
which is currently proposed. At AoA's invitation, State Directors on
Aging reviewed the product of this extensive work by program staff. Of
thirty-two State responses, twenty-five states concurred with the new
system, one state did not concur, and six states provided an ambivalent
response.
Technical Review Meeting (August, 1993)
AoA convened a two day technical work group with State and Area
Agency on Aging Staff from the NY, WA, NC, NY City and Prince Georges
County, MD to review a draft of the reporting requirements which AoA
submitted to OMB in March of 1994.
Information Memoranda
AoA provided States and AAAs a copy and an opportunity to comment
on the DI recommendations in an Information Memorandum (June, 1993).
In March of 1994, an Information Memorandum with a copy of AoA's
Previous submission to OMB was provided to States and AAAs. Three major
areas of concern were identified in the public comments: (1) timing of
the implementation; (2) cost of implementation; and (3) level of
reporting detail. In light of these concerns, AoA proposed the
following revisions to the previous OMB submission:
PSA level reporting was eliminated;
Performance measures were eliminated;
Client registration has been delayed to FY 1996;
Services in the three clusters were rearranged;
Nutritional risk screening was limited to four services--
case management, home delivered and congregate meals and nutrition
counseling;
A number of client descriptors and expenditure related
data requirements were dropped; and
SPR reports will be required to be submitted to AoA
electronically. (AoA will provide software specifications to assist
States in transmitting the required files.)
State Governors and State Agency on Aging Comments (June, 1994)
AoA, in consultation with OMB, provided proposed reporting
specifications to State Governors and Directors of State Agencies on
Aging and requested comments.
Nine Governors made comments on the reporting specifications. Most
governors that responded indicated support for accurate and useful
information gathering; the need for more administrative funds to pay
for information gathering; and, that only necessary information be
gathered. One Governor said that AoA should collect information on the
impact of the services on elderly clients instead of the information
which AoA proposes to collect.
37 State Units on Aging and 11 AAAs provided comments. These
comments were very diverse and often dealt with technical issues
related to services reporting. The more general comments from this
group were similar to the comments received from Governors. A more
detailed account of the comments is included in the enclosed analysis.
Based on this set of comments, AoA has revised the implementation
dates for key components of this reporting system to allow states the
option of a phased implementation over a 3 year period. Moreover, the
collection of information on transfers between parts of Titles III-B
and C and information on modified meals has been dropped. We have again
included a required estimate of the percentage of Title III funds in
expenditures for certain services, based on comments received. The
definition of ``new persons served'' has been simplified and other
definitions were modified to make reporting easier.
10. Confidentiality
To assure confidentiality, CFR 45, Part 1321.19 states ``The State
Agency on Aging must have procedures to protect the confidentiality of
information about older persons collected in the delivery of
services.'' Further regulations, under the U.S. Code, governing
Programs for Older Persons require that information may not be
disclosed by the service provider or agency in a manner which
identifies the person without the informed consent of the person.
11. Questions of a Sensitive Nature
The State program report as applicable to this request for revision
contains no questions of a sensitive nature.
12. Estimated Cost to Federal Government and Respondent
The (OAA) provides funds to States for administration (including
ADP and reporting). Most States use for administrative costs
approximately five percent of the total funds allocated to them by the
OAA. Therefore, large states, such as California and New York State are
provided state administrative funds of $3.7 million and $3 million
respectively, not including required matching funds or administrative
funds from other programs which they administer. AAAs are permitted
under the (OAA) to use approximately 10% of OAA funds they administer
for administrative purposes. In large states, such as California and
New York State, AAAs are provided about $6 million annually for
administrative activities such as providing information on services
provided. Service providers include the costs of administrative
activities in budgets which they negotiate with AAAs. AAAs will
continue to limit the administrative costs of service providers.
However, the mechanism to allocate additional funds to meet legitimate
increased costs for reporting at the services provider level are in
place currently. Most of any increase in reporting burden caused by
these proposed reporting specifications falls outside state
administrative budgets.
AoA has made one-time grants to State Agencies on Aging in FY-94 to
assist States with the start-up costs of meeting the NAPIS requirements
which we propose to OMB. The one-time state grants are $45,000 for
states, with lesser amounts for some of the territories.
AoA has spent approximately $640,000 on staff, expenses, and
contracts to develop the reporting system proposed. it is estimated
that AoA will spend an additional $900,000 in the rest of FY 1994
combined with FY 1995 on staff, expenses, and contracts to implement
the revised reporting system. After FY 1995, the reporting system is
estimated to require $150,000 in AoA staff and expenses each year to
maintain and operate, if no major changes are made in the reporting
system.
13. Burden of Collection Information
AoA has determined through consultation with states that some
states wish to implement all of the proposed reporting requirements in
FY 1995. Other states advise us that they must have the option of
implementing the system in stages. AoA proposes reporting standards
that will permit, at state option, some of the more complicated
reporting requirements to be deferred to FY 1996 and a few requirements
to FY 1997. This optional phased approach to implementation complicates
the estimation of burden hours per year. We are basing our estimate on
the burden an average state might encounter if all of the reporting
requirements are implemented in the first year. However, we assume that
a state that implements the components of the reporting system over a
three year period will have a lower first year burden, but annual
effort may not substantially decline until the fourth year that the
system is employed.
The first year (FY-1995) national reporting burden on the
respondents is estimated to be 294,000 hours. The burden will drop to
70,000 hours in each subsequent year in which these reporting
components are used.
14. Reasons for Changes in Burden
The estimates of burden reflect an increase in reporting required
by 1992 Amendments to the OAA and adjustments to the estimate of the
burden required by the existing AoA reporting requirements for these
programs.
15. Collection of Statistical Information for Publication and
Collection of Information Employing Statistical Methods--N/A.
State Performance Report for Title III and VII of the Older Americans
Act (Excluding LTC Ombudsman Report)
For Implementation In Fiscal Year 1995 by the National Network on Aging
Report Sections
Section I: Estimated Unduplicated Counts of Clients Served
Section II. Utilization Profile
Section III: Expenditure Profile
Section IV: Other Services Profile (Optional)
Section V: Developmental Accomplishments
Section VI: Profile of Community Focal Points and Senior Centers
Section VII: Staffing Profile
Revised Requirements as of: September 20, 1994
Title III and VII Performance Reporting Requirements
Introduction
The Older Americans Act calls for annual performance reporting by
the National Network on Aging. In the 1992 reauthorization of the Older
Americans Act, the Administration on Aging (AoA) was directed to
develop refined reporting procedures for use by state agencies on aging
which correct deficiencies in current reporting practices. As a
response to these mandates, AoA is issuing new reporting guidelines for
Titles III and VII, to be effective in FY95 with the exception of
client registration which will not be required until FY96. As a result,
a number of data elements will be delayed until FY96 and in two cases,
nutritional risk data for congregate meals and new clients data, until
FY97.
This document summarizes the new requirements for the State Program
Performance Report (SPR) for Titles III and VII.
The sections of the new SPR include:
Section I: Estimated Unduplicated Counts of Clients Served
A. Unduplicated Client Count By Type of Service
B. Unduplicated Client Count By Characteristic
Section II: Utilization Profile
A. Service Use
B. Detailed Client Profile for Registered Services (1-6)
C. Summary Client Profile for Other Registered Services (7-9)
Section III: Service Expenditures Profile
A. Title III Expenditures By Part And Service
B. Title VII Expenditures By Chapter
Section IV. Other Services Profile (Optional)
Section V: Developmental Accomplishments
A. For Home and Community Based Programs
B. For A System of Elderly Rights
Section VI: Profile of Community Focal Points/Senior Centers
Section VII: Staffing Profile
A. State Unit on Aging
B. Area Agency on Aging
On the following pages, the SPR format is exhibited through a
series of data tables corresponding with the sections of the SPR listed
above. The tables are for presentation purposes only. AoA is requiring
electronic transmittal of the annual SPR data. The SPR data will be
transmitted in several data files organized around logical groupings of
performance data--clients, units, expenditures and the like. AoA will
provide software which can be used by state units on aging to create
the required transmittal files. Following the forms, SPR instructions
are provided and the specifications for the data files which will be
used to electronically transmit the SPR data to AoA.
While the state long term care ombudsman program is now part of
Title VII of the Older Americans Act, there are distinct reporting
requirements which exist for the ombudsman program. As a result, the
state long term ombudsman report format and related instructions are
described in a separate package.
Legislative Requirements for Reporting
The SPR is designed, first and foremost, to respond to legal
requirements of the Act, while expanding the performance data available
to support management and advocacy by AoA and the National Network on
Aging.
Section 202(a)(19) of the Older Americans Act outlines the
principal requirement for performance reporting, directing AoA to
``Collect for each fiscal year, for fiscal years beginning after
September 30, 1988, directly or by contract, statistical data regarding
programs and activities carried out with funds provided under this Act,
including:
(A) with respect to each type of service provided with such funds:
(i) The aggregate amount of such funds expended to provide such
service;
(ii) the number of individuals who received such service; and
(iii) the number of units of such service provided;
(B) the number of senior centers which received such funds; and
(C) the extent to which each area agency on aging designated under
Section 305(a) satisfied the requirements related to adequate
proportions and the giving of preference to those services to older
individuals with the greatest economic or social needs, with particular
attention to low income minority individuals.''
Section 207(a)(4) of the Act requires that AoA prepare and submit a
report to the President and to the Congress which includes
``statistical data and an analysis of information regarding the
effectiveness of the State agency and area agencies on aging in
targeting services to older individuals with greatest economic need and
older individuals with greatest social need, with particular attention
to low income minority individuals, low-income individuals, and frail
individuals (including individuals with any physical or mental
functional impairment)* * *''
Congress, during the 1992 reauthorization process, expressed strong
reservations and concerns about the quality of reporting related to
Older Americans Act programs. In response to these concerns, Congress
placed new mandates on AoA in section 202(b)(29) to design and
implement, for purposes of compliance with Section 202(a)(19)
performance reporting requirements listed above, uniform data
collection procedures for use by State agencies, including:
(A) uniform definitions and nomenclature:
(B) standardized data collection procedures;
(C) a participant identification and description system;
(D) procedures for collecting information on gaps in services
needed by older individuals, as identified by service providers in
assisting clients through the provision of the supportive services; and
(E) procedures for the assessment of unmet needs for services under
this Act.
Likewise, in the Older Americans Act reauthorization, Congress
inserted language requiring the creation of a National Aging
Information Center. Among the requirements for the Center is the
collection of information, biennially, on the functions, staffing
patterns and funding sources of state agencies and area agencies on
aging.
Framing a Strategy for Future Reporting
Three specific goals have guided the development of the SPR. They
respond to the basic mandates raised by Congress, the information needs
of AoA and capacities of the Aging Network to meet federal reporting
requirements. The goals are:
1. Integrate performance data for Older Americans Act programs into
a broader information acquisition and analysis framework to be
developed and supported by AoA. AoA is developing a three-pronged
information framework which will include: 1) performance data on OAA
funded programs; 2) data on the broader infrastructure of state
administered home and community based services for the elderly; and, 3)
data on the needs and unmet needs of the elderly population.
2. Improve accuracy and quality of information being reported. This
is being accomplished by introducing standard definitions/nomenclature
and the requirement of client registration for selected services. Both
steps are designed to address basic concerns raised by Congress about
the quality of past performance data submitted by AoA.
3. Focus and expanded the collection of data on clients and their
characteristics in ways which help AoA determine if basic targeting
provisions of the Act are being met. Additional data on clients are now
required for nine services requiring client registration. These
additional data items are designed to give Congress, AoA and the rest
of the Aging Network a clearer picture of persons being helped by a
core set of home and community based services. Statistical reporting
priorities include:
Low income status of persons served (to be defined in the
SPR as persons with incomes at or below poverty).
Minority status of persons served.
Frailty status of persons served--defined in the Older
Americans Act as individuals unable to perform at least two activities
of daily living (ADL) with substantial human assistance or due to a
cognitive or mental impairment. (Note, the Act allows states the option
of defining frailty based on impairments in at least three activities
of daily living).
Because of the Congressional requirement for information on the
frailty status of persons served, AoA now requires the determination of
ADL (activities of daily living) status and IADL (instrumental
activities of daily living) status for clients of six services.
While the scope and procedures for reporting has been expanded and
strengthened, it must be reiterated that clients may freely refuse to
provide the requested information and still participate in the program
or receive a needed service without restriction. Specifically, while
information is requested on the number of persons whose income is at or
below the poverty threshold, the Older Americans Act bars means
testing. In no way has the eligibility or participation requirements of
the Act been changed. The new SPR procedures make allowances for
clients' refusal to provide selected information.
An incremental approach to upgrading reporting capacities has been
adopted. In FY94, states will use the current SPR and follow the
current data collection guidelines. Beginning in FY95, selected data
elements of the new SPR will be implemented, such as information on
developmental accomplishments and a profile of state unit on aging and
area agency on aging staffing. In FY96 client registration for nine
services will be required along with specific counts of unduplicated
clients served for each of the nine services requiring client
registration. In FY97 nutrition risk screening for congregate meals
will be required along with information on new clients served.
Key features of the revised SPR include the following:
Adoption of Uniform Definitions and Nomenclature--After extensive
consultation, AoA has identified fourteen services which will be the
focus of annual reporting. There are standard nomenclature and
definitions for all fourteen services. They are organized into 3
clusters, each with distinctive reporting requirements:
Cluster 1--Requies client registration and collection of an
expanded set of client characteristics information, notably information
on the ADL and IADL status. Services in this cluster include:
1. Personal Care
2. Homemaker
3. Chore
4. Home Delivered Meals
5. Adult Day Care/Health
6. Case Management
Cluster 2--Requires client registration and collection of basically
the same information at cluster 1 services except for ADL and IADL
status. Services in this cluster include:
7. Congregate Meals
8. Nutrition Counseling
9. Assisted Transportation
Cluster 3--Requries collection of information on units of services,
expenditures and providers, but does not require client registration or
a profile of client characteristics. The services in this cluster are:
10. Transportation
11. Legal Assistance
12. Nutrition Education
13. Information and Assistance
14. Outreach
As can be seen, the level and type of information to be collected
on the services varies by cluster. More client information is required
on the services in the first cluster, less on the services in the
second cluster and very limited information on the services in the last
cluster.
For all other services supported by the OAA, summary expenditure
information is required. State units may optionally provide information
on each of the ``other'' services related to the mission/purposes of
the service, service expenditures, estimated unduplicated persons
served and service units. See Section IV. of the SPR.
Participant Identification and Description System--For nine of the
fourteen services included in the new SPR performance report format,
client registration is required. It should be noted that states are
still required to make estimates of clients served through services
where client registration is not required.
In the client registration process, it is expected that clients
will be assigned a unique client identification number. For registered
clients, a uniform set of data on client characteristics will be
collected, either at intake or some time during the course of the year.
Area agencies must be able to aggregate client data across providers,
by service, to produce unduplicated client counts and an accurate
profile of the characteristics of the registered clients.
The use of a master client registry does not mean state and area
agencies will need to implement a full scale client tracking system. In
client tracking systems, clients are uniquely identified and service
utilization data are routinely linked or assigned to individual
clients. Under the new SPR data collection procedures, neither service
providers nor area agencies on aging will be required to track units of
service by individual client. However, area agencies on aging will need
to maintain a master client registry which is a list of client names
accompanied by a unique client identifier, a set of descriptive
information on their characteristics and a list of what services the
client is currently receiving. In most cases, a computerized client
index or registry will be required in order to generate the required
PSA level data subsequently compiled into the annual SPR by the state
unit on aging.
While area agencies are likely to require computer capacities to
maintain the client registry, it is assumed that providers without
computers can meet the SPR requirements through manual data collection
procedures. However, in such case, area agencies on aging will need to
develop the capacity to enter client data into a client registry and
assist providers determine if new clients are already registered.
Standardized Data Collection Procedures--AoA has tried to balance
the Congressional mandate for standardized data collection procedures
with the need to provide the National Network on Aging flexibility in
the reporting systems used to collect data. AoA encourages states to
refine or modify existing reporting systems to comply with the new
requirements, where appropriate. To assure standardization across
states, AoA will require the following:
The requirement for client registration for selected
services.
Standardization of information describing the
characteristics of clients served for nine services related to:
--Age, sex, race/ethnicity
--Income status/rural status/living alone
For a subset of the nine services requiring registration,
the requirement for collection of additional information on:
--ADL/IADL Status
--Nutritional risk status
State units on aging will have considerable flexibility in setting
up these procedures and methods for data collection. As feasible, AoA
will make resources available to assist SUAs and AAAs in meeting the
reporting specifications.
Testing
The proposed changes in the SPR requirements will be phased in. For
FY94, states will submit performance data using the current SPR. For
FY95, states will implement those elements of the new reporting
guidelines, which are either the same as the old requirements or a
relatively small change. For FY96, states will be asked to implement a
client registration process and, through client registration, collect
additional information on clients of nine selected services. In FY97,
two additional date elements will be added.
The introduction of client registration data and the collection of
additional data on client characteristics in FY96 represent the largest
change in requirements. Congress requires a test of the proposed
reporting requirements and a report to Congress not later than 1 year
after developing the data collection procedures.
The test of the new SPR requirements will occur in FY95, focusing
on the new requirements for registration and data on client
characteristics. Two basic questions will be addressed in the test: 1)
the feasibility of collection of the data elements to be included in
the SPR, focusing on client related data; and 2) the implementation
tasks and timetable for implementing reporting systems which can
satisfy the SPR requirements.
AoA will seek out, through an open solicitation process, a total of
six states to test the SPR requirements in FY95. The six pilot states
will represent a cross-section of state characteristics, reflecting
variations in the size of the program, number of area agencies on aging
in place (including at least one single PSA state), existing reporting
system capacities, geographic diversity and the breadth of services and
clients supported by OAA funding.
Three of the six test states will be selected based on their
capacities to implement all elements of the SPR data requirements in
FY95. Specifically, they must be able to test the introduction of
client registration and the collection of descriptive information on
clients served which complies with SPR specifications.
The other three test states will be selected because they do not
have reporting systems in place currently responsive to the requirement
of client registration and reporting data on client characteristics.
AoA will follow the progress of these states in terms of implementation
planning, reporting systems development and training of the Aging
Network to meet the SPR requirements. The experience of these states
will help AoA determine how states are preparing to meet the FY96
reporting requirements in the context of their other responsibilities.
Participating sites will be asked to designate a state unit on
aging staff member to serve as a liaison between the state and AoA. An
initial baseline profile will be established for each of the six test
states, at the beginning of FY95. AoA will review the progress in each
test state on a bi-monthly basis, by phone and possibly teleconferences
with all six test sites including information on the reporting system
design which emerges, implementation tasks and timetables, how the SPR
requirements were introduced to the Aging Network within the state, and
what issues/difficulties arose in building the reporting systems
required to meet the SPR specifications. In all six states, input will
be sought from state unit on aging staff and selected staff from area
agencies on aging an provider personnel on SPR implementation issues.
In April-May, 1995, AoA will compile the experiences of the test
sites to use a basis for reporting to Congress and finalizing the
reporting requirements scheduled to go into effect in FY96. Any
revisions to the reporting requirements will be made by June 30, 1995
with states notified of the changes at that time. It should be
indicated that AoA will not introduce any new data elements in FY96 or
FY97 as a result of the testing process. There will be insufficient
time for states to incorporate any such additions and still comply with
the FY96 timetable for SPR reporting.
Use of SPR Data
Right now, AoA finds it difficult to meaningfully analyze
performance of OAA programs relative to fundamental mandates of the
Older Americans Act. The data currently being collected are too limited
and inaccurate. For example, the Older Americans Act provides clear
guidance on targeting services to older individuals in greatest social
need, including such conditions as physical and mental disabilities,
and cultural, social, or geographic isolation, with particular
attention to low income minority older individuals. In the absence of
specific, accurate descriptive information on clients, AoA cannot
determine if this fundamental Congressional mandate is being met. By
requiring additional descriptive information on clients served through
selected services. AoA will be better able to determine when the basic
targeting provisions are being met. Additional client data will also
allow AoA to sharpen its program policies, target technical assistance
efforts and help shape future discretionary grant programs.
With the added emphasis on greater accountability for the use of
federal funds, AoA is now required to include performance indicators as
part of the AoA budget justification for the annual budget
appropriation for aging programs administered by AoA. Reliable,
accurate performance data is proving to be increasingly important to
AoA in acting as an advocate for aging programs and services and the
critical role of the National Network on Aging.
In 1993 Congress passed the Government Performance and Results Act
(GPRA) which calls for the federal government to establish strategic
planning and performance measurement in the federal government. By
1997, departments must prepare and transmit to the Office of Management
and Budget a strategic plan for program activities. Performance plans
will be required for specific program activities. Where possible, the
plans will include performance measures to be used in measuring or
assessing the relevant outputs, service levels, and outcomes of each
program activity; provide a basis for comparing actual program results
with established performance goals; and describe the means to be used
to verify and validate measured values.
AoA has been designated as one of the agencies to test these new
requirements. To comply with GPRA, AoA must begin now to transform its
internal capacities to plan and assess program performance. That means
a new data base capacity must be developed in AoA to collect and
analyze a diverse array of data. Considering the GPRA requirements and
AoA's national leadership role on aging issues, the Administration on
Aging must be able to collect and analyze data responsive to three
basic AoA responsibilities:
1. Assuring Compliance With the Older Americans Act--For example:
What services/activities were supported and how many
service units were provided?
What level of expenditures were incurred?
What type of clients were served and how many, focusing on
target populations cited by the Older Americans Act?
Did the Network comply with the assurances required in the
State Plan by the Older Americans Act?
2. Strategic Planning and Performance/Results Oriented Management--
For example:
How did actual performance comply with planned
performance?
Was the Network effective in meeting targeting priorities?
Were the services of acceptable quality?
Did the Network serve clients cost effectively?
3. Ongoing Advocacy and Program Development--For example:
Do the Network programs, supported in whole or part, make
a difference in clients' lives?
How are client needs changing?
To what extent is the Network keeping up with unmet needs?
Which needs and services will become future priorities?
Over time the SPR must be able to supply accurate data which can be
used to help respond to the basic questions in all three areas of
responsibility. In the near term, the SPR will become an important
vehicle for collecting performance data pertinent to basic compliance
and results oriented management questions. In its current form, the SPR
does not include information on clearly defined outcomes or results.
However, the new SPR requirements represent the first step toward
building improved data to support AoA strategic planning and advocacy.
Accurate information on clients, units and expenditures for selected
services is considered by AoA to be the first building block toward a
results oriented approach to strategic planning and performance
measurement at the federal and state level of the Aging Network.
Summary
The new SPR to be implemented in FY95 provides a vehicle for
improving the accuracy and utility of performance data submitted by
SUAs. The new requirements are designed to focus reporting on selected
clients and services and obtain accurate, complete information about
these clients and services. Through the issuance of the new SPR, AoA is
embarking on a multi-year effort designed to enhance the capacities of
the National Network on Aging and AoA to effectively use performance
data in support of compliance, management and advocacy
responsibilities. AoA is committed to building its own analytic
capacities in ways which will assure the submitted SPR data will be put
to good use. New data bases are being designed by AoA to process the
data. At the same time, AoA is designing related data bases which will
be compatible with the SPR data sets and also provide a broader
information framework for review of OAA supported programs and
services.
BILLING CODE 4150-04-M
TN29SE94.000
TN29SE94.001
TN29SE94.002
TN29SE94.003
TN29SE94.004
TN29SE94.005
TN29SE94.006
TN29SE94.007
TN29SE94.008
TN29SE94.009
TN29SE94.010
BILLING CODE 4150-04-C
Instructions for Completion of the Annual State Performance Report
General Instructions
Development and submission of the Annual State Performance Report
(SPR) by state units on aging in compliance with the provisions of the
Older Americans Act (OAA) should be guided by the following provisions:
Submission Date--The new SPR will be due November 30 of the federal
fiscal year, beginning November 30, 1995.
FY95 Phase-in--Delays in gaining approval of the reporting
requirements means that states are not likely to have the final
reporting requirements in hand until after FY95 has begun. For that
reason, AoA is prepared to accept, for FY95, estimated performance data
based on implementation of new data collection and reporting procedures
for a portion of FY95, for example, six months, four months, etc.
As background to implementation planning, it is important to
remember that many of the new SPR data elements will require
implementation of data collection and reporting procedures in FY95. The
following data elements must be reported for FY95:
Estimate of the total unduplicated clients served through
Title III and VII.
Number of providers (and minority providers) for fourteen
listed service categories.
Number of AAAs directly providing each of the fourteen
listed service categories.
Number of persons estimated to have been served for each
of nine registered services.
Number of service units for each of fourteen listed
services.
Title III and VII expenditures by service and also by
part, for Title III, plus program income data.
Developmental accomplishments--home and community based
programs plus elder rights.
Focal point/senior center profile data.
SUA and AAA staffing profile data.
For FY95, AoA is deferring submission, except on a voluntary basis,
of the following data elements:
Unduplicated client counts broken down for registered
services versus services which did not require registration (See SPR
Section I.)
Client characteristics associated with the unduplicated
client counts for registered and unregistered services (See SPR Section
I.)
Counts of new persons served (See SPR Section II.A.)
Breakdown of registered clients for services in cluster 1
by client characteristic (See SPR Section II.B.)
Breakdown of registered clients for services in cluster 2
by client characteristic (See SPR Section II.C.)
Count of persons served at high nutritional risk (See SPR
Section II.A.)
Transmittal--SUAs should submit the SPR data, on diskette, using
the data entry and file creation software provided by AoA.
Alternatively, SUAs may generate the required transmittal files using
their own applications software in conjunction with the standardized
file transmittal specifications developed by the Administration on
Aging. File transmittal specifications are provided in Appendix II for
states electing to develop the data files using their own systems
software.
Level of Reporting--Performance data will be reported for the state
as a whole. The only exception is the requirement for a staffing
profile for each area agency on aging.
Scope of Reporting--The revised SPR is designed to provide
information on all clients, service units and expenditures for services
which are funded in whole or in part by Older Americans Act funding.
Include performance data (clients, providers, units of service, program
income etc.) related to the service as a ``whole'', even if the OAA
funding is one of several funding sources used to support the service.
This is based on the assumption that all the units of service and
persons served etc. are attributable to the presence of the OAA
funding.
Instructions for Completion of Individual Sections of the SPR
Completion of Section I: Estimated Unduplicated Count of Clients
Served
Section I of the SPR is designed to provide a summary profile of
the clients served, through programs funded, in whole or in part, by
the Older Americans Act. There are two parts to Section I: (A)
Unduplicated Client Count By Type of Service; and (B) Unduplicated
Client Count By Characteristic.
Section I.A. Unduplicated Client Count by Type of Service
In Section I.A., enter summary counts of the unduplicated persons
served through programs supported by Older Americans Act funding. To
increase the reliability and validity of these unduplicated counts,
three separate counts should be furnished: (1) Unduplicated counts of
persons receiving services where client registration is required (not
required until FY96); (2) an estimate of unduplicated clients receiving
non registered services (not required until FY96); and (3) an estimate
of the total clients receiving services, which takes into account the
two counts/estimates of clients served which are entered on lines 1 and
2.
Line 1--Enter the unduplicated count of persons served for the
first nine services listed in Section II.A. (cluster 1 and 2 services).
It is expected the count of unduplicated clients for the nine services
requiring client registration will be very accurate. The counts entered
in line 1 should correspond with the unduplicated client count, across
the nine registered services.
Line 2--Enter a best estimate of unduplicated persons served
through transportation, legal assistance, nutrition education,
information and referral and outreach plus all other services which are
supported by OAA Title III and VII funds.
Line 3--Enter a best estimate of the total unduplicated persons
served in the state through OAA supported programs. There will, in all
likelihood, be an overlap of clients included in lines 1 and 2. A
single client may receive a registered service(s) and also be assisted
through unregistered services. As a result, line 3 is not simply a sum
of lines 1 and 2.
Section I.B. Summary Estimate by Selected Client Characteristics
In Part B. show the characteristics of the persons served. The
breakdown of data of client characteristics, by registered services and
other services, will not be required until FY96.
[Note: see Appendix I for definitions of the client descriptors used in
this section of the SPR.]
Completion of Section II: Utilization Profile
Servie utilization will be examined in several ways. The focus is
on units of service and clients served. Three different sections are
included in the utilization profile. See Sections II.A., B. and C.
Section II.A. Service Utilization
Section II.A. should be completed using the following guidelines.
(1) Provide utilization data for any or all of the 14 listed
services, for which OAA Title III and Title VII funds were used to
support services provision.
Many states may need to develop a cross-walk between the service
names used for in-state reporting and those used in the SPR. For
example, if a service called Home Aide II is funded in the state which,
in practice, matches the definition of Personal Care [See Appendix I
Service Definitions], then report the performance data for Home Aide II
as Personal Care. Feel free to send AoA any explanations which clarify
how services funded in the state relate to the SPR listed services.
[Note: some states support what is called respite care. Where possible,
include respite care data in the service category which best defines
what type of respite is typically provided; for example, personal care,
adult day care, homemaker/chore services, etc.]
(2) Include performance data related for the service ``as a
whole'', even if the OAA Title III and VII funding is one of several
funding sources used to support the service. For example, document all
service units provided and clients served by a service provider, even
if the OAA funds only 25% of the total cost of the service. Treat OAA
Title V and Title VI funding as other sources of funding in the SPR.
The fourteen services listed in Section II.A. are organized into
three clusters. [Note: see Appendix I for service definitions for these
fourteen services.] Each cluster has distinctive reporting
requirements.
Cluster 1: Registered Services Requiring Detailed Client Profile
All six services included in cluster 1 require registration of
clients. For each service, provide the following information:
Total Number of Providers--Enter a count of the number of providers
who provide each listed service in the state using OAA Title III or
Title VII funding, in whole or part. If an area agency on aging (AAA)
provides the service directly, include the AAA in the count of
providers.
Also provide the unduplicated number of providers supported with
OAA funding across all fourteen services, taking into account that
provider organizations are likely to provide multiple services.
Number of Minority Providers--Of the total providers listed in the
first column, identify how many are minority organizations. [See
Appendix I, for a definition of a minority provider.]
# of AAAs Direct Services Provision--Enter the number of AAAs
providing each listed service directly, using AAA paid and/or volunteer
personnel.
Total Unduplicated Persons Served--Provide an unduplicated count of
persons served in the state. The total count should include all persons
served during the course of the year, regardless of how many services
units individual clients receive.
Provide an unduplicated count of persons served, across the nine
registered services. See the box below the Cluster 2 services on
Section II.A.. Beginning no later than FY96, the count of unduplicated
persons served should be based upon the use of a master client registry
of persons served through the nine registered services in each PSA or
the state as a whole. The registry will, in most states, be maintained
by area agencies on aging (or SUAs in single PSA states).
New Persons Served This Year--By service, identify how many persons
were newly registered for the service during the course of the year.
Also, provide an unduplicated count of persons served, across the nine
registered services. See the box below the Cluster 2 services on
Section II.A.
[Note: a ``new client'' is any client who has never been previously
registered as a client for the service, either in the current fiscal
year or a prior fiscal year by any provider funded with Older Americans
Act funds.]
This data item is designed to help AoA learn more about the extent
of client turnover. Submission of data on new clients will not be
required to be reported until FY97. Voluntary reporting prior to that
point is encouraged.
The count of new persons served should be based upon the use of a
master client registry of persons served through the nine registered
services.
# of Persons Served-At High Nutritional Risk--For four listed
services [home delivered meals, case management, congregate meals and
nutrition counseling], identify the unduplicated number of persons
served who were determined to be at high nutritional risk. To assure
uniformity of the responses, please use the Nutrition Screening
Checklist. High nutritional risk is defined as a score of 6 or higher
using the Checklist. See Appendix III for the checklist and related
instructions.
Provision of information on clients who are at high nutritional
risk will be required for home delivered meals, nutrition counseling
and case management services beginning in FY96 and in FY97 for
congregate meals.
Total Service Units--Enter a total count of service units provided
during the year. If there are multiple service providers for the same
service, the total is a sum of the service units provided by all
providers to all clients. Report all service units, even if the OAA
funding and related match funds are not the exclusive source of funding
for the provider.
[Note: in the case of meals, enter the number of USDA eligible meals.]
Cluster 2. Registered Services Requiring Summary Client Profile
For services 7-9 on Section II.A., please follow the same
directions provided for Cluster 1 services.
Cluster 3. Non-Registered Services
For cluster 3 services, AoA is requesting a more limited set of
data: 1) an unduplicated count of providers; 2) a count of minority
providers; 3) the number of AAAs directly providing the service; and 4)
a count of service units. For these services, it is difficult or
inappropriate to require client registration. As a result, the
provision of client specific information is not required for cluster 3
services.
Section II.B. Detailed Client Profile for Registered Services (1-6)
For the six services in cluster 1, the SPR requires a ``detailed''
profile of client characteristics. The profile is a breakdown of the
unduplicated count of persons served (by service) by client
characteristics. The six services requiring a detailed client profile
are:
1. Personal Care
2. Homemaker
3. Chore
4. Home Delivered Meals
5. Social Adult Day Care/Adult Day Health
6. Case Management
Required data elements include:
Minority status, by individual minority group.
Age group.
ADL/IADL status.
Sex.
Rural.
Live alone.
Poverty status.
To complete Section II.B., the following guidelines apply:
1. Section II.B. Should be completed for each of the six services
requiring a detailed client profile.
2. For each cluster 1 service, identify how many persons in each of
five racial/ethnic groups were served:
African American.
Hispanic.
American Indian/Native Alaskan.
Asian/Pacific Islander.
Non-Minority.
A separate profile will be developed for each racial/ethnic group,
whose members were served. The transmittal guidelines provide for a -9
code for records where the racial/ethnic status of the client is
missing.
3. Provide for each minority group a count of total clients and
total clients in poverty.
[Note: the profile of Non-Poverty Clients will be computed using the
counts for Total Clients and Total Clients In Poverty.]
4. Within the Total Clients category and Total Clients in Poverty
category for each racial/ethnic group, provide a breakdown by age and
ADL status; then document how many persons in each age/ADL sub-group
have no IADLS, 1IADL, 2IADLs etc., how many persons were female or
male, how many live in rural areas and how many live alone.
Remember, a separate record is prepared for each minority group
served for each of the six services.
5. Document missing data. Indicate for each client data element how
many client records, by minority group, which do not contain a valid
response for the data element, either because of data collection
problems or the client refused to provide the required information. See
Section II.B. Missing Information By Data Element for the client data
elements for which a count of missing data is sought. Note that the
counts for missing data are specific to Total Clients and Total Clients
In Poverty.
In the transmittal guidelines, the data files make provision for
reporting the counts of client records with missing data elements. See
Appendix II.
Section II.C. Summary Client Profile for Other Registered Services
A summary client profile is required for three services--congregate
meals, nutrition counseling and assisted transportation. The client
characteristics to be documented for these services include:
Minority status.
Age group.
Sex.
Rural.
Live alone.
Poverty status.
The following guidelines should be used for completion of this
Section:
1. For each Cluster 2 service supported with OAA Title III and/or
VII funds, identify, by individual racial/ethnic group, the total
number of persons served by each of four age groups. Then, for each age
group total, indicate how many of the total clients are female or male,
live in rural areas and how many live alone.
2. Provide a comparable profile as developed for Total Clients for
Clients In Poverty.
3. Document missing data. Follow the same procedures as described
for Section II.B. above.
Completion of Section III. Service Expenditures Profile
Section III calls for OAA expenditure data by service and Title III
Part and Title VII Chapter. Fourteen services are highlighted for data
collection and analysis. In addition, this section calls for summary
expenditure data on the other services supported with OAA funding.
The information to be reported is organized into two segments: A)
Title III Expenditures by Part and Service and B) Title VII
Expenditures By Chapter. Guidelines for completion of each segment are
provided below:
Section III.A. Title Expenditures by Part and Service
Section III.A. is organized by service and Title III part. All
Title III parts included in the Act are listed. The columns for Title
III Parts currently without an appropriation are shaded. No data should
be entered in the shaded columns. To complete this portion of Section
III, please follow these guidelines:
(1) Complete this Section for the fourteen listed services and the
total of ``other'' services supported by OAA funds.
(2) Enter the appropriate data on the following information items
for the fourteen listed services.
Total Title III Expenditure--Enter the total amount of Title III
expenditures for the service in the state. Do not include match in this
total, only the federal portion.
[Note, Total Title III expenditures are defined as ``outlays/payments
made by the AAA or SUA using OAA Title III funds in the form of an
advance or a reimbursement for a payment request submitted by a
provider for the service.]
Percent of Total Service Expenditure--Indicate the percent of total
service expenditures represented by or attributable to OAA Title III
federal funding.
Note: Total Service Expenditures are defined as expenditures for
the service ``contractually linked'' to Title III funds through an
award of funds (contract or grant) which includes federal OAA Title
III funds. When other funding sources and amounts are included in
the award, including Title VII funding, then the total expenditures
attributable to the multiple sources of funding should be reported.
Other sources of funding which may be linked to the OAA funding are
match resources, overmatch, program income or other federal and
state program funds.
Total Program Income--Enter the estimate of total program income
derived as a result of service provision.
OAA Title III Expenditures By Part--Allocate the OAA Title III
expenditures by Title III Part. This should be based on fund accounting
data or an allocation algorithm in states where OAA funds are bundled
and awarded across Title III parts or bundled with other funding
sources.
(3) Provide, on line 15, summary data on the aggregate of
expenditures for other services supported with OAA Title III funds.
Section III.B. Title VII Expenditure Summary
In Part B. please report total Title VII expenditures, exclusive of
match, by individual chapter. Also, indicate how much of the total
service expenditures for the Title VII services were covered by Title
VII funding. See the definition of total service expenditures cited
above. Include any Title III expenditures used for the Title VII
supported services (federal and match) as part of the total service
expenditure.
[Note, for Chapter 4, there is no OAA appropriation at this time, so
this box is shaded out. Do not enter any expenditure data in this box.]
Completion of Section IV. Other Services Profile (Optional)
In Section IV. state units on aging, at their option, may provide
descriptive information on other services supported by the OAA.
For each ``other'' service, SUAs are asked to provide a service
name (up to 30 characters), service unit name (up to 15 characters),
identify the purpose/mission of the service, total Title III
expenditures for the year, the percent of total service expenditures
represented by OAA Title III and Title VII funding, as well as an
estimate of persons served (unduplicated) and service units.
If other services are individually reported in this Section, please
complete all data elements. Note: do not include ombudsman as an other
service. A separate set of reporting requirements have been developed
for the long term care ombudsman program.
To identify the mission or purpose of the service, use one code (A-
F) from the list below which best fits the purpose of the service.
A. Services Which Address Functional Limitations
B. Services Which Maintain Health
C. Services Which Protect Elder Rights
D. Services Which Promote Socialization/Participation
E. Services Which Assure Access and Coordination
F. Services Which Support Other Goals and Purposes
When assigning the services to the mission/purpose categories,
consider the following ``other'' services as potentially falling in
each mission/purpose category:
A. Services Which Address Functional Limitations
Home Modification.
Home Repair.
Alternative Living Arrangements/Supportive services.
B. Services Which Maintain Health
Medical Alert.
Health Screening.
Exercise/Physical Fitness.
Wellness.
C. Services Which Protect Elder Rights
Adult Protective Services, Guardianship.
Consumer Protection Services.
Crime Prevention Services.
Protective Payee Services.
D. Services Which Promote Socialization/Participation
Recreation.
Friendly Visiting.
Telephone Reassurance.
Letter Writing.
Interpreting/Translation.
Volunteer Development/Opportunities.
E. Services Which Assure Access and Coordination
Counseling.
Screening.
Geriatric assessment.
Home or Roommate Matching.
Placement services.
F. Services Which Support Other Goals/Outcomes
Employment Assistance.
Utility Assistance.
Financial Assistance/Material Aid (including discounts).
Completion of Section V. Developmental Accomplishments
This section of the SPR is designed to provide a narrative summary
of developmental accomplishments in the state by the SUA and/or AAAs in
two areas: 1) development of home and community based programs (Section
V.A.) and 2) development of system of elder rights (Section V.B.).
Guidelines for completion of these two sub-sections are as follows:
Section V.A. Developmental Accomplishments for Home and Community Based
Programs
State units on aging are requested to identify and describe three
key accomplishments during the year which enhanced the array of home
and community based services which meet the health and long term care
needs of non-institutionalized older persons.
1. In each of the three accomplishment narratives, describe the
result, the potential impact on older persons, the process/steps
followed and what organization(s) were primarily responsible for the
accomplishment.
2. For each accomplishment, identify the type of development
activities which were undertaken. Use one or more of the following
development type codes and place the codes at the conclusion of each
accomplishment narrative:
a. Public education/awareness
b. Resource development
c. Training/education
d. Research and development
e. Policy development
f. Legislative development
g. Other
Section V.B. Developmental Accomplishments for a System of Elder Rights
Follow the same guidelines as outlined in Section V.A.
Completion of Section VI. Profile of Community Focal Points and Senior
Centers
This section is used to document the status of focal point
designations and the use of senior centers by the National Network on
Aging. The data elements are self-explanatory.
Completion of Section VII. Staffing Profile
In Section VII, two staffing profiles are required, one for the
state unit on aging and one for each area agency on aging. Guidelines
for completion of each profile are provided below:
Section VII.A. State Unit on Aging
To complete this section, follow these steps:
1. Categorize all paid SUA staff by the categories listed on lines
1-3. The definitions for each personnel category are provided in
Appendix I.
2. Develop the staffing profile based on a snapshot taken on any
given day during the fiscal year. The SUA should select what day(s)
during the year is appropriate.
3. Determine the total number of full time equivalents (FTEs) for
each position category. The number of FTEs should reflect filled or
staffed positions at the time of the survey. Do not include authorized
but unfilled positions. Add the FTE totals for lines 1, 2 and 3 to
create an agency total in line 4.
[Note, full time equivalents (FTEs) should be based on a state
definition of what constitutes a full time employee.]
4. For each personnel category, identify how many FTEs are filled
by minority staff. Enter this number in the column titled (Number of
Minority FTEs).
5. Identify, by personnel category, how many FTEs are paid for, in
full or in part, using OAA funds.
Section VII.B. Area Agency on Aging
Follow the same guidelines as outlined for Section VII.A. Make sure
Section VII.B. is completed for each area agency on aging in the state.
[Note: this section includes a count of the volunteers who assist the
area agency in carrying out its responsibilities either in direct
service provision or any of its planning, development, administration,
access/care coordination roles. Include volunteers in the count of
Total AAA staff on line 5.]
Summary
Remember the SPR data will be transmitted electronically, The
specifications for the data files to be sent by SUAs to AoA are
included in Appendix II to this document. These transmittal guidelines
take precedence over the SPR forms as a basis for actually submitting
the performance data to AoA.
Remember, the ombudsman annual report is submitted separately,
using a special report format and set of instructions.
Appendix I. Definitions
The following definitions should be used when completing the SPR.
A. Client Descriptors
1. Minority Status--Minority older persons are confined to the
following designations:
African American, Not of Hispanic Origin--A person having
origins in any of the black racial groups of Africa.
Hispanic Origin--A person of Mexican, Puerto Rican, Cuban,
Central or South American or other Spanish culture or origin,
regardless of race.
American Indian or Alaskan Native--A person having origins
in any of the original peoples of North America, and who maintain
cultural identification through tribal affiliation or community
recognition.
Asian American/Pacific Islander--A person having origins
in any of the original peoples of the Far East, Southeast Asia, the
Indian Subcontinent, or the Pacific Islands. This area includes, for
example, China, Japan, Korea, the Philippine Islands, Samoa and the
Hawaiian Islands.
Non-Minority--Any person who is not considered a minority.
2. Activities of Daily Living--States may use their own definition
of activities of daily living (ADL) when reporting the number of ADL
impairments. AoA will continue to explore options for a standard
definition of ADLs working with the Aging Network and other federal
agencies. If long term care reform occurs, any definitions of
disability used for eligibility determination will be considered in
framing a standardized definition of ADLs.
3. Instrumental Activities of Daily Living--States may use their
own definition of instrumental activities of daily living (IADL) when
reporting the number of IADL impairments. AoA will continue to explore
options for a standard definition of IADLs working with the Aging
Network and other federal agencies.
4. Poverty--Persons considered to be in poverty are those whose
income is at or below the official poverty guideline (as defined each
year by the Office of Management and Budget, and adjusted by the
Secretary (DHHS) in accordance with subsection 673(2) of the Community
Services Block Grant Act (42 U.S.C. 9902(2)).
5. Living alone--A one person household (using the Census
definition of household) where the householder lives by his or herself
in an owned or rented place of residence in an non-institutional
setting, including board and care facilities, assisted living units and
group homes.
B. Service Definitions
Standardized names, definitions, and service units are provided for
the fourteen services which are singled out in the SPR for reporting.
1. Personal Care (1 Hour)--Providing personal assistance, stand-by
assistance, supervision or cues for persons having difficulties with
one or more of the following activities of daily living: eating,
dressing, bathing, toileting, and transferring in and out of bed.
2. Homemaker (1 Hour)--Providing assistance to persons having
difficulty with one or more of the following instrumental activities of
daily living: preparing meals, shopping for personal items, managing
money, using the telephone or doing light housework.
3. Chore (1 Hour)--Providing assistance to persons having
difficulty with one or more of the following instrumental activities of
daily living: heavy housework, yard work or sidewalk maintenance.
4. Home Delivered Meals (1 Meal)--Provision, to an eligible client
or other eligible participant at the client's place of residence, a
meal which:
(a) complies with the Dietary Guidelines for Americans (published
by the Secretaries of the Department of Health and Human Services and
the United States Department of Agriculture;
(b) provides, if one meal is served, a minimum of 33 and \1/3\
percent of the current daily Recommended Dietary Allowances (RDA) as
established by the Food and Nutrition Board of the National Research
Council of the National Academy of Sciences;
(c) provide, if two meals are served, together, a minimum of 66 and
\2/3\ percent of the current daily RDA; although there is no
requirement regarding the percentage of the current daily RDA which an
individual meal must provide, a second meal shall be balanced and
proportional in calories and nutrients; and,
(d) provides, if three meals are served, together, 100 percent of
the current daily RDA; although there is no requirement regarding the
percentage of the current daily RDA which an individual meal must
provide, a second and third meals shall be balanced and proportional in
calories and nutrients.
5. Adult Day Care/Adult Day Health (1 hour)--Provision of personal
care for dependent adults in a supervised, protective, congregate
setting during some portion of a twenty-four hour day. Services offered
in conjunction of adult day care/adult health typically include social
and recreational activities, training, counseling, meals for adult day
care and services such as rehabilitation, medications assistance and
home health aid services for adult day health.
6. Case Management (1 Case)--Assistance either in the form of
access or care coordination in circumstances where the older person
and/or their caregivers are experiencing diminished functioning
capacities, personal conditions or other characteristics which require
the provision of services by formal service providers. Activities of
case management include assessing needs, developing care plans,
authorizing services, arranging services, coordinating the provision of
services among providers, follow-up and reassessment, as required.
7. Congregate Meals (1 Meal)--Provision, to an eligible client or
other eligible participant at a nutrition site, senior center or some
other congregate setting, a meal which:
(a) complies with the Dietary Guidelines for Americans (published
by the Secretaries of the Department of Health and Human Services and
the United States Department of Agriculture;
(b) provides, if one meal is served, a minimum of 33 and \1/3\
percent of the current daily Recommended Dietary Allowances (RDA) as
established by the Food and Nutrition Board of the National Research
Council of the National Academy of Sciences;
(c) provides, if two meals are served, together, a minimum of 66
and \2/3\ percent of the current daily RDA; although there is no
requirement regarding the percentage of the current daily RDA which an
individual meal must provide, a second meal shall be balanced and
proportional in calories and nutrients; and,
(d) provides, if three meals are served, together, 100 percent of
the current daily RDA; although there is no requirement regarding the
percentage of the current daily RDA which an individual meal must
provide, a second and third meals shall be balanced and proportional in
calories and nutrients.
8. Nutrition Counseling (1 Hour)--Provision of individualized
advice and guidance to individuals, who are at nutritional risk,
because of their health or nutritional history, dietary intake,
medications use or chronic illnesses, about options and methods for
improving their nutritional status, performed by a health professional
in accordance with state law and policy.
9. Assisted Transportation (1 One Way Trip)--Provision of
assistance, including escort, to a person who has difficulties
(physical or cognitive) using regular vehicular transportation.
10. Transportation (1 One Way Trip)--Provision of a means of
transportation for a person who requires help in going from one
location to another, using a vehicle. Does not include any other
activity.
11. Legal Assistance (1 Hour)--Provision of legal advice,
counseling and representation by an attorney or other person acting
under the supervision of an attorney.
12. Nutrition Education (1 Session)--A program to promote better
health by providing accurate and culturally sensitive nutrition,
physical fitness, or health (as it relates to nutrition) information
and instruction to participants or participants and caregivers in a
group or individual setting overseen by a dietitian or individual of
comparable expertise.
13. Information and assistance (1 Contact)--A service for older
individuals that (A) provides the individuals with current information
on opportunities and services available to the individuals within their
communities, including information relating to assistive technology;
(B) assesses the problems and capacities of the individuals; (C) links
the individuals to the opportunities and services that are available;
(D) to the maximum extent practicable, ensures that the individuals
receive the services needed by the individuals, and are aware of the
opportunities available to the individuals, by establishing adequate
follow-up procedures.
14. Outreach (1 Contact)--Interventions initiated by an agency or
organization for the purpose of identifying potential clients and
encouraging their use of existing services and benefits.
[Note: respite care services which offer temporary, substitute supports
or living arrangements for older persons in order to provide a brief
period of relief or rest for family members or other caregivers, should
be assigned to the service which best matches the form of respite being
offered--such as home health aide or personal care. If the respite care
service is designed to offer a temporary, alternative living
arrangement, do not assign the respite care service to any of the
fourteen services. In SPR IV., list this activity as institutional
respite care and also include the expenditure/resource data for this
service as part of the total for ``other service'' in Section III.]
C. Other Definitions
A variety of other terms are used in the SPR. Definitions for these
terms are as follows:
Agency Executive/Management Staff--Personnel such as SUA director,
deputy directors, directors of key divisions and other positions which
provide overall leadership and direction for the state agency.
Other Paid Professional Staff--Personnel who are considered
professional staff who are not responsible for overall agency
management or direction setting but carry out key responsibilities or
tasks associated with the SUA in the following areas:
Planning--Includes such responsibilities as needs
assessment, plan development, budgeting/resource analysis, inventory,
standards developmental and policy analysis.
Development--Includes such responsibilities as public
education, resource development, training and education, research and
development and legislative activities.
Administration--Includes such responsibilities as bidding,
contract negotiation, reporting, reimbursement, accounting, auditing,
monitoring, and quality assurance.
Access/Care Coordination--Includes such responsibilities
as outreach, screening, assessment, case management, information and
referral.
Service Delivery--Includes those activities associated
with the direct provision of a service which meets the needs of an
individual older person and/or caregiver.
Clerical/Support Staff--All paid personnel who provide support to
the management and professional staff.
Minority Provider--A business concern that (a) is at least 51
percent owned by one or more individuals who are either an African
American, Hispanic origin, American Indian/Native Alaskan/Native
Hawaiian, Asian American/Pacific Islander minority or a publicly owned
business having at least 51 percent of its stock owned by one or more
minority individuals and (b) has its management and daily business
controlled by one or more minority individuals.
New Persons Served--Any client who has never been previously
registered as a client for the service, either in the current fiscal
year or a prior fiscal year by any provider funded with Older Americans
Act funds.
Total OAA Expenditures--Outlays/payments made by the AAA or SUA
using OAA federal funds in the form of an advance or a reimbursement
for a payment request submitted by a provider for the service.
Percent of Total Service Expenditures--The portion of total service
expenditures for the year which were covered by the federal portion of
the Older Americans Act funding.
Rural--States may use their own definition of rural until such time
as AoA adopts, by rule, a uniform definition of rural.
Appendix II. Title III/VII SPR Transmittal Requirements
To ensure compatibility of State Program Report (SPR) data across
states, AoA has developed a standard set of guidelines for transmittal
of the Title III and VII SPR data, exclusive of the LTC Ombudsman
Program by state units on aging.
AoA will provide software to states which will allow entry of the
SPR data and creation of the required data files. Those states with
their own data systems may wish to create the data files directly,
eliminating the need to reenter summary data into the AoA software
package. In such cases, this section of the SPR guidelines provides
file transmittal specifications. [Note: only those states choosing to
use their own systems software to generate the transmittal files will
need to use the specifications outlined in this Appendix.]
The transmittal specifications are organized around a set of data
files to be forwarded by states using diskettes or a modem. Each
submitted file must be in the format specified below. It must
incorporate the codes for selected data files specified by AoA as well.
General Guidelines
When preparing the files, please observe the following:
1. AoA is requesting that state agencies provide SPR data in a
machine readable format, conveyed either by diskette or by modem. The
data files can be transmitted as ASCII files, or .DBF files. AoA
prefers .DBF for data oriented files but will accept ASCII files which
comply with the specifications addressed in this document. In the case
of selected narrative information requested in Title III and VII
reporting requirements, please provide text files.
2. Use the file names included in the file descriptions provided
below.
3. Please embed the state ID in the name of data file submitted by
the state. The naming convention should place the state ID as the first
two characters of the file name, as a substitute for the XX which is
included in each generic file name. For example, Alabama when
submitting expenditure data by Part will submit a file named
ALEXPTYP.DBF.
4. Submit the files no later than 60 days following the end of the
federal fiscal year, beginning November 30, 1995;
5. Please use the following codes to denote individual services in
the services ID field:
01--Personal Care
02--Homemaker
03--Chore
04--Home Delivered Meals
05--Adult Day Care/Health
06--Case Management
07--Congregate Meals
08--Nutrition Counseling
09--Assisted Transportation
10--Transportation
11--Legal Assistance
12--Nutrition Education
13--Information and Assistance
14--Outreach
99--Other Services
6. Please use the following codes to denote racial/ethnic groups:
1--African-American
2--Hispanic Origin
3--American Indian/Native Alaskan
4--Asian/Pacific Islander
5--Non-Minority (White, not of Hispanic origin)
9--Missing
7. Round all expenditure data to the nearest dollar;
For Title III and Title VII SPR, excluding ombudsman, 10 data files
are required along with one optional file. The record layout is
provided for each file including the field number, field name, field
type and field width. The field types are coded as follows:
C = Character
D = Date
L = Logical
N = Numeric
The transmittal files should fit on a single diskette.
1. Unduplicated Client Count File--XXUNDUPL.DBF
This file will contain the summary data on unduplicated clients
served through services and programs supported by the Older Americans
Act. See SPR Section I, for the table which includes the data requested
in this file. The record layout for the file is:
------------------------------------------------------------------------
Field No. Field name Type
------------------------------------------------------------------------
1......... State ID........................................ C2
2......... Fiscal Year..................................... N4
3......... Registered Services--Total undup................ N7
4......... Other Services--Total unduplicated.............. N7
5......... Total Unduplicated (All services)............... N8
6......... Registered Svcs--African American............... N7
7......... Registered Svcs--Hispanic-origin................ N7
8......... Registered Svcs--American Indian................ N7
9......... Registered Svcs--Asian Amer./PI................. N7
10........ Registered Svcs--Non-Minority................... N7
11........ Registered Svcs--Rural.......................... N7
12........ Registered Svcs--Clients in poverty............. N7
13........ Registered Svcs--In poverty/minority............ N7
14........ Other Svcs--African American.................... N7
15........ Other Svcs--Hispanic-origin..................... N7
16........ Other Svcs--American Indian..................... N7
17........ Other Svcs--Asian Amer./PI...................... N7
18........ Other Svcs--Non-Minority........................ N7
19........ Other Svcs--Rural............................... N7
20........ Other Svcs--Clients in poverty.................. N7
21........ Other Svcs--In poverty/minority................. N7
22........ Total--African American......................... N7
23........ Total--Hispanic-origin.......................... N7
24........ Total--American Indian.......................... N7
25........ Total--Asian American/PI........................ N7
26........ Total--Non-Minority............................. N7
27........ Total--Rural.................................... N7
28........ Total--Clients in poverty....................... N7
29........ Total--In poverty/minority...................... N7
------------------------------------------------------------------------
2. Abbreviated Client Profile Date File--XXCLBREV.DBF
This file will contain records which contain descriptive
information on each client served by five different services which
require client registration and an abbreviated set of client
characteristics (congregate meals, nutrition counseling,
transportation, assisted transportation and legal assistance). See SPR
II.C. for the data elements.
------------------------------------------------------------------------
Field No. Field name Type
------------------------------------------------------------------------
1......... State ID........................................ C2
2......... Fiscal Year..................................... N4
3......... Service ID...................................... N2
Please use the following codes to denote individual services:
07--Congregrate Meals
08--Nutrition Counseling
09--Assisted Transportation
4......... Race/ethnicity ID............................... N1
(Data fields 5-44 are numeric and 7 positions in width)
5......... Total Clients, Age 60-64........................ N7
6......... Total Clients, Age 60-64, Female
7......... Total Clients, Age 60-64, Male
8......... Total Clients, Age 60-64, Rural
9......... Total Clients, Age 60-64, Alone
10-14..... Repeat for Poverty Clients, Age 60-64
15-19..... Repeat for Total Clients, Age 65-74
20-24..... Repeat for Poverty Clients, Age 65-74
25-29..... Repeat for Total Clients, Age 75-84
30-34..... Repeat for Poverty Clients, Age 75-84
35-39..... Repeat for Total Clients, Age 85+
40-44..... Repeat for Poverty Clients, Age 85+
45........ Total Clients Served (For the Service).......... N8
In fields 46--56 of this file, please provide the count of client
records with missing data elements, by type. The format for these
fields is numeric and 6 positions wide
46........ Total Clients--Income data missing.............. N6
47........ Total Clients--Age data missing
48........ Total Clients--Sex data missing
49........ Total Clients--Rural status data missing
50........ Total Clients--Live alone status data missing
51........ Poverty Clients--Age data missing
52........ Poverty Clients--Sex data missing
53........ Poverty Clients--Rural status data missing
54........ Poverty Clients--Live alone data missing
55........ New Clients (Optional FY95/96; required FY97)... N8
56........ # High Nutr. Risk (Required FY97 for Cong Meals N8
and FY96 for Nutr. Counseling).
------------------------------------------------------------------------
3. Detailed Client Profile Data File--XXCLDET.DBF
States will use this file format to transmit data which satisfy the
requirements for data contained in SPR Section II.B. The record
description for this file includes the following:
------------------------------------------------------------------------
Field No. Field name Type
------------------------------------------------------------------------
1......... State ID........................................ C2
2......... Fiscal Year..................................... N4
3......... Service ID...................................... N2
Please use the following codes to denote individual services:
01--Personal Care
02--Homemaker
03--Chore
04--Home Delivered Meals
05--Adult Day Care/Health
06--Case management
4......... Race/ethnicity ID............................... N1
(Data fields 5-301 are all numeric and 7 positions wide.)
5......... Total Clients, Age 60-64, Total
6......... Total Clients, Age 60-64, with 0 ADL, Total
7......... Total Clients, Age 60-64, with 0 ADL, No IADLs
8......... Total Clients, Age 60-64, with 0 ADL, 1 IADL
9......... Total Clients, Age 60-64, with 0 ADL, 2 IADLs
10........ Total Clients, Age 60-64, with 0 ADL, 3+IADLs
11........ Total Clients, Age 60-64, with 0 ADL, Female
12........ Total Clients, Age 60-64, with 0 ADL, Male
13........ Total Clients, Age 60-64, with 0 ADL, Rural
14........ Total Clients, Age 60-64, with 0 ADL, Live Alone
15........ Total Clients, Age 60-64, with 1 ADLs, Total
16........ Total Clients, Age 60-64, with 1 ADLs, No IADLs
17........ Total Clients, Age 60-64, with 1 ADLs, 1 IADL
18........ Total Clients, Age 60-64, with 1 ADLs, 2 IADLs
19........ Total Clients, Age 60-64, with 1 ADLs, 3+IADLs
20........ Total Clients, Age 60-64, with 1 ADLs, Female
21........ Total Clients, Age 60-64, with 1 ADLs, Male
22........ Total Clients, Age 60-64, with 1 ADLs, Rural
23........ Total Clients, Age 60-64, with 1 ADLs, Live
Alone
24........ Total Clients, Age 60-64, with 2 ADLs, Total
25........ Total Clients, Age 60-64, with 2 ADLs, No IADLs
26........ Total Clients, Age 60-64, with 2 ADLs, 1 IADL
27........ Total Clients, Age 60-64, with 2 ADLs, 2 IADLs
28........ Total Clients, Age 60-64, with 2 ADLs, 3+IADLs
29........ Total Clients, Age 60-64, with 2 ADLs, Female
30........ Total Clients, Age 60-64, with 2 ADLs, Male
31........ Total Clients, Age 60-64, with 2 ADLs, Rural
32........ Total Clients, Age 60-64, with 2 ADLs, Live
Alone
33........ Total Clients, Age 60-64, with 3+ADLs, Total
34........ Total Clients, Age 60-64, with 3+ADLs, No IADLs
35........ Total Clients, Age 60-64, with 3+ADLs, 1 IADL
36........ Total Clients, Age 60-64, with 3+ADLs, 2 IADLs
37........ Total Clients, Age 60-64, with 3+ADLs, 3+IADLs
38........ Total Clients, Age 60-64, with 3+ADLs, Female
39........ Total Clients, Age 60-64, with 3+ADLs, Male
40........ Total Clients, Age 60-64, with 3+ADLs, Rural
41........ Total Clients, Age 60-64, with 3+ADLs, Live
Alone
42-78..... Repeat for Poverty Clients, Age 60-64
79-115.... Repeat for Total Clients, Age 65-74
116-152... Repeat for Poverty Clients, Age 65-74
153-189... Repeat for Total Clients, Age 75-84
190-226... Repeat for Poverty Clients, Age 75-84
227-263... Repeat for Total Clients, Age 85+
264-300... Repeat for Poverty Clients, Age 85+
301....... Total Clients Served
(In the following data fields of this file, please provide the count of
missing data elements, by type. The format for the fields is numeric
and 6 positions wide)
302....... Total Clients--Income Missing................... N6
303....... Total Clients--Age Missing
304....... Total Clients--ADL Status Missing
305....... Total Clients--IADL Status Missing
306....... Total Clients--Sex Missing
307....... Total Clients--Rural Status Missing
308....... Total Clients--Live Alone Status Missing
309....... Total Poverty Clients--Age Missing
310....... Total Poverty Clients--ADL Status Missing
311....... Total Poverty Clients--IADL Status Missing
312....... Total Poverty Clients--Sex Missing
313....... Total Poverty Clients--Rural Status Missing
314....... Total Poverty Clients--Live Alone Missing
315....... New Clients (Optional FY95/96; req. FY97)....... N8
316....... # At High Nutr. (Req. FY96 Case Mgt, HDM)....... N8
Because of the number of variables, this file may be segmented into two
subfiles, labeled XXCLDET1.DBF and XXCLDET2.DBF. Please indicate in a
ReadMe file which variables are in each sub-file. Remember that the
first four data elements uniquely identify each record in each subfile
------------------------------------------------------------------------
4. Expenditure Data by Type of Resource File--XXEXPTYP.DBF
This file will be used to transmit expenditure data for 14 listed
services and aggregate expenditure data for all other services
supported by OAA funds. See SPR Section III form for the data elements.
Remember, expenditure data should be rounded to the nearest dollar. Use
code 99 to denote the information on ``other'' services. The record
layout for each service is defined below:
------------------------------------------------------------------------
Field No. Field name Type
------------------------------------------------------------------------
1......... State ID........................................ C2
2......... Fiscal Year..................................... N4
3......... Service ID...................................... N2
4......... Total OAA Expenditure........................... N8
5......... % of Total Serv Exp............................. N2
6......... Total Progam Income $........................... N7
7......... Part B $........................................ N8
8......... Part C1 $....................................... N8
9......... Part C2 $....................................... N8
10........ Part D $........................................ N7
11........ Part F $........................................ N7
------------------------------------------------------------------------
5. Other Expenditures File--XXOTHEXP.DBF
This file is used to report expenditures on other services or
activities not associated with the listed 14 services in the SPR
requirements. The record layout for this file is as follows:
------------------------------------------------------------------------
Field No. Field name Type
------------------------------------------------------------------------
1......... State ID........................................ C2
2......... Fiscal Year..................................... N4
3......... Title VII Ombudsman $........................... N8
4......... Title VII Elder Abuse $......................... N8
5......... Title VII Benefit Assist $...................... N8
6......... Ombudsman % of Total Serv Exp................... N2
7......... Elder Abuse % of Total Serv Exp................. N2
8......... Benefits Asst % of Tot Serv Exp................. N2
------------------------------------------------------------------------
6. Service Units Data File--XXUNITS.DBF
This file will contain records containing information on service
units organized around one or more of fourteen listed services. The
record layout is:
------------------------------------------------------------------------
Field No. Field name Type
------------------------------------------------------------------------
1......... State ID........................................ C2
2......... Fiscal Year..................................... N4
3......... Personal Care Units............................. N6
4......... Homemaker Units................................. N6
5......... Chore Units..................................... N6
6......... Home Delivered Meals Units...................... N6
7......... Adult Day Care/Health Units..................... N6
8......... Case Management Units........................... N6
9......... Congregate Meals Units.......................... N6
10........ Nutrition Counseling Units...................... N6
11........ Assisted Transport Units........................ N6
12........ Transportation Units............................ N6
13........ Legal Assistance Units.......................... N6
14........ Nutrition Education Units....................... N6
15........ Info and Assistance Units....................... N6
16........ Outreach Units.................................. N6
------------------------------------------------------------------------
7. Provider Profile File--XXPROVDR.DBF
------------------------------------------------------------------------
Field No. Field name Type
------------------------------------------------------------------------
1......... State ID........................................ C2
2......... Fiscal Year..................................... N4
3......... Personal Care--Total Providers.................. N4
4......... Personal Care--# Minority Provdrs............... N4
5......... Personal Care--# of AAA Providers............... N4
6......... Homemaker--Total................................ N4
7......... Homemaker--# Minority........................... N4
8......... Homemaker--# of AAA Providers................... N4
9......... Chore--Total.................................... N4
10........ Chore--# Minority............................... N4
11........ Chore--# of AAA Providers....................... N4
12........ Home Del. Meals--Total.......................... N4
13........ Home Del. Meals--# Minority..................... N4
14........ Home Del. Meals--# of AAA Providers............. N4
15........ Adult Day Care/Hlth--Total...................... N4
16........ Adult Day Care/Hlth--# Minority................. N4
17........ Adult Day Care/Hlth--# of AAA Prov.............. N4
18........ Case Management--Total.......................... N4
19........ Case Management--# Minority..................... N4
20........ Case Management--# of AAA Providers............. N4
21........ Congregate Meals--Total......................... N4
22........ Congregate Meals--# Minority.................... N4
23........ Congregate Meals--# of AAA Providers............ N4
24........ Nutrition Counseling--Total..................... N4
25........ Nutrition Counseling--# Minority................ N4
26........ Nutrition Counseling--# of AAA Providers........ N4
27........ Transportation--Total........................... N4
28........ Transportation--# Minority...................... N4
29........ Transportation--# of AAA Providers.............. N4
30........ Assist. Transportation--Total................... N4
31........ Assist. Transportation--# Minority.............. N4
32........ Assist. Transportation--# of AAA Providers...... N4
33........ Legal Assistance--Total......................... N4
34........ Legal Assistance--# Minority.................... N4
35........ Legal Assistance--# of AAA Providers............ N4
36........ Nutrition Education--Total...................... N4
37........ Nutrition Education--# Minority................. N4
38........ Nutrition Education--# of AAA Providers......... N4
39........ Info and Assistance--Total...................... N4
40........ Info and Assistance--# Minority................. N4
41........ Info and Assistance--# of AAA Providers......... N4
42........ Outreach--Total................................. N4
43........ Outreach--# Minority............................ N4
44........ Outreach--# of AAA Providers.................... N4
45........ Total Providers (14 svcs)....................... N4
46........ Total Minority Providers (14 svcs).............. N4
------------------------------------------------------------------------
8. Development Accomplishments Data File--XXDEVLOP.TXT (DOS Text file)
This file will contain brief narratives describing the
developmental accomplishments in the state related to the development
of home and community based programs and a system of elder rights.
Please furnish the data in a DOS text file, making sure to include at
the end of text describing each narrative the codes identifying the
type of developmental activities involved:
1. Public education/awareness
2. Resource development
3. Training/education
4. Research and development
5. Policy development
6. Legislative development
7. Other
9. Focal Point Data File--XXFOCAL.DBF
This file is used to transmit data on focal points required to be
reported by states under provisions of the Older Americans Act.
------------------------------------------------------------------------
Field No. Field name Type
------------------------------------------------------------------------
1......... State ID........................................ C2
2......... Fiscal Year..................................... N4
3......... Total # of Focal Points Designated Under Section N4
306(a)(3) of the Act in Operation in the Past
Year.
4......... Of the Total # of Focal Points Designated Under N4
Section 306(a)(3) of the Act in Operation in
the Past Year, the Number That Were Senior
Centers.
5......... Total Number of Senior Centers in the PSA in the N4
Past Fiscal Year.
6......... Total Number of Senior Centers in the PSA in the N4
Past Fiscal Year That Received Funds During the
Past Fiscal Year.
------------------------------------------------------------------------
10. Staffing Profile Data File--XXSTAFF.DBF
Use one file to transmit both the state unit staffing profile and
area agency staffing profiles. Identify the state unit on aging record
by placing a -99 in the PSA ID field. To further identify the PSAs/
AAAs, please include a ReadMe file with the PSA names and IDs.
------------------------------------------------------------------------
Field No. Field name Type
------------------------------------------------------------------------
1......... State ID........................................ C2
2......... PSA ID.......................................... C6
3......... Fiscal Year..................................... N4
4......... # of Agency Executive/Mgt Staff FTEs............ N4
5......... # of Agency Executive/Mgt Staff Minority FTEs... N4
6......... # of Agency Executive/Mgt Staff FTEs -Pd w/OAA N4
funds.
7......... # of Paid Prof. Staff With Planning Resp. FTEs.. N4
8......... # of Paid Prof. Staff With Planning Resp. N4
Minority FTEs.
9......... # of Paid Prof. Staff FTEs W/Plan. Resp.-Pd w/ N4
OAA funds.
10........ # of Paid Professional Staff with Development N4
Resp. FTSs.
11........ # of Paid Professional Staff With Development N4
Resp. Minority FTEs.
12........ # of Pd Profess. Staff FTEs W/Development Resp.- N4
Pd w/OAA funds.
13........ # of Paid Professional Staff With Admin. Resp. N4
FTEs.
14........ # of Paid Professional Staff With Admin. Resp. N4
Minority FTEs.
15........ # of Pd Profess. Staff FTEs With Admin. Resp.-- N4
Paid with OAA funds.
16........ # of Paid Professional Staff With Serv. Del. N4
Resp. FTEs.
17........ # of Paid Professional Staff With Serv. Del N4
Resp. Minority FTEs.
18........ # of Paid Profess. Staff FTEs With Serv. Del. N4
Resp.--Paid with OAA funds.
19........ # of Paid Professional Staff With Access Resp. N4
FTEs.
20........ # of Paid Professional Staff With Access Resp. N4
Minority FTEs.
21........ # of Paid Profess. Staff FTEs With Access Resp.-- N4
Paid with OAA funds.
22........ # of Paid Professional Staff With Other Resp. N4
FTEs.
23........ # of Paid Professional Staff With Other Resp. N4
Minority FTEs.
24........ # of Paid Profess. Staff FTEs With Other Resp.-- N4
Paid with OAA funds.
25........ # of Clerical Staff FTEs........................ N4
26........ # of Clerical Staff Minority FTEs............... N4
27........ # of Clerical Staff FTEs paid with OAA funds.... N4
28........ # of Volunteer FTEs (AAAs only)................. N4
29........ # of Volunteer Minority FTEs (AAAs only)........ N4
30........ Total Staff FTEs (All).......................... N4
31........ Total Minority Staff FTEs--All.................. N4
32........ Total Staff FTEs--Pd with OAA funds............. N4
------------------------------------------------------------------------
11. Other Services Profie (Optional)--XXOTHSER.DBF
States units on aging may, at their option, submit a file
containing information on other services supported by OAA funds. The
format for this file will be as follows:
------------------------------------------------------------------------
Field No. Field name Type
------------------------------------------------------------------------
1......... State ID........................................ C2
2......... Fiscal Year..................................... N4
3......... # of Other Services Being Reported.............. N2
(Field #3 is used as check to make sure all ``other'' services are
included in the file.)
4......... Service Name.................................... C30
5......... Service Unit Name............................... C15
6......... Service Purpose................................. C1
Please use the following codes to identify the purpose:
A--Services which address functional limitations
B--Services which maintain health
C--Services which protect elder rights
D--Services which promote socialization/participation
E--Services which assure access and coordination
F--Services which support other goals/outcomes
7......... OAA Expenditures................................ N8
8......... % of Total Serv. Exp............................ N2
9......... Persons Served.................................. N8
10........ Service Units................................... N8
Repeat the above format for additional services
------------------------------------------------------------------------
Appendix III. Nutritional Risk Status Screen
The Nutrition Screening Checklist was developed as part of the
Nutrition Screening Initiative jointly sponsored by The American
Academy of Family Physicians, The American Dietetic Association and the
National Council on the Aging, Inc. The Checklist appears on the next
page. It will be used as a tool to determine which clients are at high
nutritional risk.
BILLING CODE 4150-04-M
TN29SE94.011
BILLING CODE 4150-04-C
Instructions for Completing the State Long Term Care Ombudsman Program
Reporting Form for The National Ombudsman Reporting System (NORS)
Part I--Cases, Complainants and Complaints
A. Cases Opened.
Provide the total number of cases opened during the reporting
period. Use definition of case provided on form.
B. Complainants/Case Closed.
For all cases closed during the reporting period, provide the
number of complainants, by type of facility/setting. Refer to
discussion of type of facility or other setting under D.1, below.
Use definition of case closed provided on the form. A case is
closed when all complaints which are part of the case have been
resolved and/or no further ombudsman action can be taken for reasons
listed in Part I. E.2.
(A word about the definition of closed cases: Ombudsman sometimes
must refer complaints to another agency for resolution. The ombudsman
should follow up on these complaints and record the outcome under the
appropriate category in Part I, E.2, Complaint Disposition. Disposition
categories d. (1) and (2) in Part I, E.2 are for use only in those
instances when the agency to which the case was referred fails to act
on a complaint or provide a response to the ombudsman's attempts to
follow up, or follow-up is otherwise not possible. Since this outcome,
although undesirable, occasionally occurs with complaints, it is
included in the definition of closed case.)
A complainant is an individual or a party (i.e., husband and wife;
siblings) who files one or more complaints with the ombudsman program.
A referring agency is not a complainant, but staff of another agency
may be aware of a situation and file a complaint about it, thus
qualifying as a complainant. The number of complainants will equal the
number of cases filed.
If more than one person or party independently file separate
complaints about the same situation in the same facility, or the same
problem outside of any facility, count as separate cases. If more than
one person jointly file complaint(s) about the same situation in the
same facility or outside the facility, count as one complainant and one
case.
Clarification of selected categories (self-evident categories not
repeated):
2. Relative/friend or resident includes relatives who are also
guardians or legal representatives but not friends who are also
guardians/legal representatives. For friends, use category 3.
6. Physician, other medical staff includes physicians and staff of
hospitals, hospices, clinics, visiting nurse programs and similar
programs, which are primarily oriented toward medical/health care.
7. Representative of other social services agency or program
includes individuals other than ombudsmen or ombudsman volunteers who
file complaints (not merely refer other complainants) and are
affiliated with such agencies as area agencies on aging, facility
licensure and certification, homemaker agencies and similar agencies
which are primarily oriented toward social services.
9. Other includes any complainant whose identity is known but who
does not fit easily into a listed category. Examples: banker, law
enforcement officer. If you report complainants in this category,
indicate in the space on the form the types included.
C. Total Complaints
For all cases closed during the reporting period, provide the total
number of complaints received. This will be the same number as the
combined total from Part I, D, Types of Complaints, including
complaints from nursing facilities, board and care and similar types of
facilities and other settings. (Do not report complaints in cases which
are still open at the end of the reporting period. Save those for the
next reporting period, after the case is closed.)
D. Type of Complaints
1. General Instructions for Complaint Categories
For all cases closed during the reporting period, provide the total
number of complaints received by the statewide ombudsman program in
each of the complaint categories listed. Use the definition of
complaint provided in Part I, C, page 1 on the form.
Type of Facility. For each type of complaint, place in the first
column the number received involving a skilled nursing facility as
defined in section 1819 of the Social Security Act or a nursing
facility as defined in section 1919(a) of the Social Security Act.
Place in the second column totals of complaints received from
facilities termed board and care homes, adult congregate living
facilities, assisted living facilities, foster care facilities and
other similar group facility which: provides room, board and personal
care services to older individuals and which the ombudsman program is
authorized to serve under Section 102(34) (C) and (D) of the Older
Americans Act and includes within its purview.
Place in the last section, Q, numbers of ombudsman complaints
involving settings other than nursing or board and care or similar
facilities, such as home care, hospitals, hospices, shelters, or
congregate housing where personal care to residents is not provided.
(The categories in Section Q are provided for documenting numbers of
complaints only; the form does not include types of complaints for
these settings, as such settings are not included within the purview of
the Ombudsman Program in the Older Americans Act.)
The first four major headings (Residents Rights, Resident Care,
Quality of Life and Administration) are for complaints involving acts
of commission or omission by staff or management of the facility, or
problems which staff or management has the responsibility to resolve.
The fifth major heading is for complaints against individuals or
agencies outside the facility, or problems which can be resolved only
by outside agencies or individuals.
As stated in the definitions of case and complaint, each case may
have more than one complaint. However, each problem, or complaint, will
have only one code. Use only one category for each type of problem
(i.e., do not check both A.3 and D.26 for the same staff behavior--
determine which category is most appropriate to the particular problem)
and report only the primary complaint or complaints, not problems which
are incidental to, or even causal to, the primary complaint.
For example: A resident complains of lack of fresh water by her
bedside and odors in the bathroom. Both problems may be due to any one
of the problems listed under M. Staffing, but only the codes for the
primary problems reported--lack of water (category J.70) and odors
(category K.83)--should be entered on the intake form. (The narrative
section on the ombudsman intake form will, of course, reflect the
ombudsman's assessment of why the problems occurred and what is
required to solve them; but if all of these concerns were coded as
complaints, the purpose and value of the complaint categories would be
eroded.)
For each other category, list in the space provided on the form
other types of complaints included in the number listed.
2. Clarification and Definitions of Selected Complaint Categories
Complaint categories provide only the identification of the problem
area, not a statement of the problem. The assumption is that the
complaint is about a problem of commission or omission. Otherwise,
there would be no problem and thus no complaint.
Each category has been assigned its own number in order to avoid
confusion and aid in aggregating the data by computer. (If States wish
to add other categories for their own use, they can place these at the
end of the NORS list. However, these must be included in the annual
report under one of the 133 categories; i.e., at the end of the year,
they must be ``folded'' into one of the NORS categories, which may
include the ``other'' category listed for each group of types of
complaints.)
Many of the categories are self-explanatory. The following
definitions/explanations are for those major complaint headings and
specific categories where further interpretation is required.
Residents Rights
A. Abuse, Gross Neglect, Exploitation
Use categories in this section for serious complaints of willful
mistreatment of residents by facility staff, management, other
residents (use category 6) or unknown or outside individuals who have
gained access to the resident through negligence or lax security on the
part of the facility. (Use P.117 and P.121 for complaints of abuse,
exploitation by family members, friends and others whose actions the
facility could not reasonably be expected to oversee or regulate.)
For all categories in this part, use the broad definitions of
abuse, neglect and exploitation in the Older Americans Act and
Paragraph 483.13(b) of the Health Care Financing Administration's
Survey Forms and Interpretive Guidelines for the Long Term Care Survey
Process, April 1992:
The term abuse means the willful (A) infliction of injury,
unreasonable confinement, intimidation, or cruel punishment with
resulting physical harm, pain or mental anguish; or (B) deprivation by
a person, including a caregiver, of goods or services that are
necessary to avoid physical harm, mental anguish, or mental illness.
(Older Americans Act, Section 102 [13])
The term (financial) exploitation means the illegal or improper act
or process of an individual, including a caregiver, using the resources
of an older individual for monetary or personal benefit, profit or
gain. (Older Americans Act, Section 102[26])
In addition to the above broad definitions, use the following
specific definitions from the HCFA Interpretive Guidelines:
Physical abuse (A.1) includes hitting slapping, pinching, kicking,
etc. It also includes controlling behavior through corporal punishment.
Examples of effects of abuse include, but are not limited to,
substantial or multiple skin bruising, burns, bone fractures,
poisoning, subdural hematoma, soft tissue swelling, suffocation. (from
Colorado adult protection statute)
Sexual abuse (A.2) includes, but is not limited to, sexual
harassment, sexual coercion, or sexual assault.
Verbal abuse (A.3) refers to any use of oral, written or gestured
language that includes disparaging and derogatory terms to residents or
their families, or within their hearing distance, to describe
residents, regardless of their age, ability to comprehend, or
disability. (Use D.3 for less severe forms of staff rudeness or
insensitivity; use M.5 if staff is unavailable, unresponsive to
residents' needs.)
Mental abuse (A.3) includes, but is not limited to, humiliation,
harassment, threats of punishment or deprivation.
Involuntary seclusion (A.3) means separation of a resident from
other residents or from his or her room against the resident's will or
the will of the resident's legal representative. Emergency or short
term monitored separation will not be considered involuntary seclusion
* * * if used for a limited period of time as a therapeutic
intervention to reduce agitation. * * *
For financial exploitation (A.4) and gross neglect (A.5), use the
definitions of exploitation and deprivation (Part B of abuse
definition) in the Older Americans Act, provided above. Use A.5 only
for the most extreme forms of willful neglect. Use the appropriate
categories under Resident Care, Quality of Life or, in some cases,
Administration for less severe forms or manifestations of resident
neglect. Use resident-to-resident physical or sexual abuse (A.6) only
for complaints of abuse by a resident against one or more other
residents which meet the definitions of abuse provided above. For less
severe forms of resident-to-resident conflict, use I.66 if conflict is
with a roommate or other appropriate category (such as F.51) if it is
with a resident other than a roommate.
B. Access to Information
Use the appropriate category for complaints involving access to
information or assistance made by or on behalf of the resident or the
resident's representative. Use B.9 if ombudsman is denied access in
response to a complaint. If there is a general problem with ombudsman
access to one or more particular facilities or types of facilities, but
no complaint has been filed, do not use complaint categories. Describe
the access problem under Part III, B--Statewide Coverage.
C. Admission, Transfer, Discharge, Eviction
Use the appropriate category for complaints involving placement,
whether into, within or outside of the facility. If resident requests
assistance in transferring to another facility and there is no stated
problem (complaint), record as ``information and assistance to
individuals,'' Part III, F.5 on page 13.
D. Autonomy, Choice, Exercise of Rights, Privacy
Use the appropriate category for any complaint involving the
resident's right, as stated in the category. If it is a related
problem, but not one specific to this heading, use a category under
another heading. For example, if the resident is permitted to choose
her personal physician but that physician is unavailable, use P.125.
Use D.29 if the resident has a communication or language barrier. Use
M.96 if staff have the communication or language barrier. Use D.27 for
right to smoke. Use K.77 for smoke-polluted air.
E. Financial, Property (Except for Financial Exploitation)
Use the appropriate category for complaints involving non-criminal
mismanagement or carelessness with residents' funds and property and
billing problems. Use A.4 for complaints involving willful financial
exploitation, including, but not limited to, possible criminal
activity.
F. Care
Use the appropriate category for complaints involving negligence,
lack of attention and poor quality in the care of residents. If the
care situation is so poor that the resident is in a condition of
overall neglect which is threatening to health and/or life, use A.5,
gross neglect.
G. Rehabilitation or Maintenance of Function
Use the appropriate category for complaints involving failure to
provide needed rehabilitation or services necessary to resident to
maintain the expected level of function.
H. Restraints
Use the appropriate category for any complaint involving the use of
physical or chemical restraint.
I. Activities and Social Services
Use categories under this heading for complaints involving social
services for and/or social interaction of residents. Note that
transportation is included in category I.65 because community
interaction is sometimes (not always) dependent upon transportation.
Use I.65 for any complaint involving the resident's need for
transportation, for whatever reason.
J. Dietary
Use the appropriate category for complaints involving food and
fluid intake. Use J.74 for failure to follow special/therapeutic diet.
Use J.75 for inadequate nutrition. Use the appropriate category under A
(either 1 or 5) for severe cases of food deprivation.
K. Environment
Use the appropriate category for complaints involving the physical
environment of the facility and resident's space. Use K.77 for smoke-
polluted air. For lack of supplies, including nursing supplies, use
K.85.
L. Policies, Procedures, Attitudes, Resources
Categories under this heading are for acts of commission or
omission by facility managers, operators or owners in areas other than
staffing or the specific problems included in previous sections, such
as policies on advance directives; fair and due process on admissions,
transfers and discharges; billing; management of residents' funds. Use
L.90 for complaints involving falsification of records.
M. Staffing
Use appropriate categories under this heading for complaints
involving staff unavailability, training, turnover, and supervision.
Use M.96 for staff language or other communication barrier. (Use D.29
if problem involves resident inability to communicate.) Use M.100 if
staff is unresponsive or unavailable. (Use D.26 if staff is available
but rude or otherwise disrespectful to resident; use A.3 or other
category under A if rudeness or disrespect is so severe that it
qualifies as abuse.)
N. Certification/Licensing Agency
Use categories under this heading for all complaints involving
decisions, policies, actions or inactions by the agency in the State
which licenses nursing facilities and certifies them for participation
in Medicaid and Medicare. Use any category which also may apply to
decisions, policies, actions or inactions by the agency which licenses
board and care or similar facilities, using the board and care/similar
column. (If the problem is failure to license and regulate such
facilities, or inadequate regulation, use P.119.) Use N.106 if
appropriate intermediate sanctions are required and have not been
applied, if intermediate sanctions which are applied are not
appropriate, or if intermediate sanctions negatively impact on
residents.
O. State Medicaid Agency
Categories in this section are for complaints about Medicaid
coverage, benefits and services.
P. System/Others
Use appropriate categories in this section to document the range of
complaints against or involving individuals who are not managers/staff
of facilities or of the State's licensing and certification or Medicaid
agency. Use P.124 for problems involving implementation of the
Preadmission Screening and Annual Resident Review (PASSAR) requirements
of the Nursing Home Reform Amendments of the Omnibus Budget
Reconciliation Act (OBRA) of 1987. Use P.126 for complaints involving
the agency in the State charged with investigating reports of adult
abuse and exploitation and providing protective services for victims of
abuse and exploitation.
Q. Complaints in Other Than Nursing Facility or Board and Care/Similar
Settings
Use categories in this section to document any complaints accepted
and acted upon by the ombudsman involving individuals living in (1)
private residences, (2) hospitals or in hospice care, (3) congregate
and/or shared housing not providing personal care, or (4) shelters.
Add totals in both columns, sections A through P, to total for
Section Q. Place grand total at Total Complaints on page 7 and in box
at C on page 1.
Part I, E. Action on Complaints
1. Verification: Provide, for cases closed during the reporting
period, the total number of complaints which were verified, by type of
facility. Use the definition of verified on the form. Complaints not
included are considered unverified.
(Note: Some States investigate complaints which cannot be verified;
other States do not. For this reason, the definition of ``case
closed'' on page 1 of the form includes ``complaint cannot be
verified'' as a reason for closing a case. However, the disposition
categories in Part I, E. 2 do not include ``complaint unverified.''
States which do not investigate unverified complaints should use 2.e
or another category which best describes the disposition of a
particular unverified complaint.)
2. Disposition: Provide, for cases closed during the reporting
period, the total number of complaints, by type of facility or setting,
for each disposition category. Where there are two possible choices,
the ombudsman must choose the one category which best describes the
outcome of the complaint. See note above for documentation of
unverified complaints. Total must be same as total number of complaints
received, as provided on page 7 and in box at C on page 1.
Part I, F. Optional Discussion of Legal Assistance/Remedies:
Instruction Provided on Form
Part I, G. Optional Complaint Description: Instruction Provided on Form
Part II--Major Issues: Instruction Provided on Form
Part III--Program Information and Activities
A. Facilities and Beds
Provide, for both nursing facilities and licensed board and care
and similar adult care facilities, as instructed on form, the number of
facilities which were licensed in the State during the reporting period
and the number of beds in those facilities.
B. Program Coverage
Instruction provided on form.
C. Local Programs
Provide, according to type of host organization, the number of
regional or local entities which were geographically located outside of
the State Office of the Ombudsman and where one or more paid staff and/
or volunteers were designated by the State Ombudsman to investigate
complaints and represent the State Ombudsman Program. As indicated on
form, include regional offices of the State Ombudsman Office.
D. Staff and Volunteers
Instruction provided on form; include all volunteers who worked for
the program during the reporting period except those who served only as
members of advisory or policy committees.
E. Program Funding
Provide funds expended during the reporting period on the Ombudsman
Program as it is defined under Section 712 of the Older Americans Act.
Do not include amounts which were budgeted or obligated but not
expended. Do not include amounts which were expended on ombudsman
activities not authorized under Section 712 (i.e., ombudsman activity
in settings other than long-term care facilities, as defined in the
Act). Provide on the third line Title III expenditures for State or
local ombudsman activity made by the State from Title III funding under
Section 304(d)(1)(B) of the Act. Provide on the fourth line Title III
expenditures for local ombudsman activity made by area agencies on
aging from Title III funding provided under Section 304(d)(1)(D) of the
Act. Provide other funding, by source, as specified on form.
F. Other Ombudsman Activities
Provide the information requested in the appropriate column. Use
the State column for activities performed by the State Office of the
Ombudsman. Use the local column for activities performed by local or
regional designated ombudsman programs or regional offices of the State
Ombudsman Program. Provide exact numbers wherever possible; where not
possible, provide your best estimate of the numbers requested. Please
be sure to record each activity only once, under the most appropriate
heading. Do not, for example, count a media interview under both items
10 and 11. Clarification of items listed on chart:
1. Training for Ombudsman Staff and Volunteers
In the State Office column, give the number of training sessions
(meetings) and total hours provided or otherwise arranged by staff of
the State Office of the Ombudsman for State or local program staff and
volunteers, whether the meetings were held in the State capital or
elsewhere in the State. In the local program column give the total
number of sessions and total hours provided or otherwise arranged by
staff of local ombudsman entities or regional offices for staff and
volunteers of the local program. For each, provide the total number of
people trained (not an unduplicated count of individuals) during the
reporting year. For this item, a session is a meeting, whether it lasts
for three hours, all day or all week.
2. Technical Assistance to Local Ombudsman and/or Volunteers
Provide in the State column an estimate of the percentage of total
staff time which paid staff of the State Office of the Ombudsman (i.e.,
State Ombudsman, plus other staff) devote to developing and assisting
local programs, whether in person or by telephone. Provide in the local
column an estimate of the percentage of total staff time which local
program paid staff devote to developing volunteers programs and
supporting other staff and volunteers. Include staff time spent in
developing and delivering training as well as in providing informal
assistance.
3. Training for Facility Staff
Give the number of sessions provided at both State and local levels
and the three most frequent topics of training at each level. (Hours
are not requested. It is assumed that most sessions for facility staff
are would last for 45 minutes to an hour. If sessions are two hours,
count as two sessions; three hours, three sessions, etc.)
4. Consultation to Facilities
Ombudsman often provide information and assistance to facility
managers and staff. To capture the extent of this important activity,
report the number of such consultations provided during the year. If
there are repeated consultations to the same facility, count each
consultation separately. Do not count training sessions, documented in
F.3. Provide the three most frequent subject areas of consultation.
5. Information and Consultation to Individuals
Provide the number of individuals assisted by telephone or in
person on a one-to-one basis on needs ranging from how to select a
nursing home to residents' rights to understanding Medicaid. Count each
separate request for information or assistance (but not each call
related to the same request), whether made by someone who requested
assistance earlier in the year or by a new caller. Do not include here
participants in community education sessions documented in F.10.
Document the three most frequent topics/areas of requests or needs.
6. Resident Visitation
Document the number of facilities (unduplicated count) covered on a
regular basis (weekly, bi-weekly, monthly or quarterly) in any
ombudsman visitation program established in the State. If there is no
visitation program, write N.A.
7. Participation in Facility Survey
Provide the number of facility surveys in which the Ombudsman or
designated ombudsman representatives participated, including
participation in exit interviews. Do not count survey team contacts to
the ombudsman regarding complaints against the facility. (HCFA survey
procedure requires surveyors to contact the ombudsman to inquire
whether complaints have been received about the facility and obtain
information about any complaints. If surveyors fail to make this
contact, document as an ombudsman-filed complaint under complaint
category N.108.)
8./9. Work With Resident and Family Councils
Provide the total count of all resident and family council meetings
attended by designated ombudsman representatives during the reporting
period, for both State and local levels.
10. Community Education
Provide the total number of presentations made to and or other
meetings with community groups, students, churches, etc.
11. Work With Media
Provide the information requested at both State and local levels.
12. Monitoring/Work on Laws, Regulations, Government Policies and
Actions
Provide, for both state and local levels, a best estimate of the
percentage of total paid staff time spent working with other agencies
and individuals, both inside and outside of government, on laws,
regulations, policies and actions to improve the health, welfare,
safety and rights of long-term care residents.
State:-----------------------------------------------------------------
Fiscal Year: 199______
State Annual Ombudsman Report to the Administration on Aging
Agency or organization which sponsors the State Ombudsman Program:
----------------------------------------------------------------------
Part I--Cases, Complainants and Complaints
A. Provide the total number of cases opened during reporting
period.
Case: Each inquiry brought to, or initiated by, the ombudsman on
behalf of a resident or group of residents involving one or more
complaints or problems which requires opening of a case file and
includes ombudsman investigation, fact gathering, setting of objectives
and/or strategy to resolve, and follow-up.
B. Provide the number of cases closed, by type of facility/setting,
which were received from the types of complainants listed below.
Closed: Ombudsman activity on a case has stopped for any of the
following reasons: (1) resolution or partial resolution, (2) by request
of complainant, (3) complaint(s) unresolvable, (4) complaint(s) not
verified, (5) resident died and no further investigation was required
or (6) complaint(s) referred to other agency for resolution and final
disposition was not obtained and/or reported to ombudsman.
------------------------------------------------------------------------
Board and
Complainants Nursing care (or Other
facility similar) settings
------------------------------------------------------------------------
1. Resident......................
2. Relative/friend of resident...
3. Non-relative guardian, legal
representative..................
4. Ombudsman/ombudsman volunteer.
5. Facility administrator/staff..
6. Other medical: physician/staff
7. Representative of other social
service agency or program.......
8. Unknown/anonymous.............
9. Other; specify types..........
--------------------------------------
Total number of cases
closed during the
reporting period:
------------------------------------------------------------------------
C. For cases which were closed during the reporting period (those
counted in B above), provide the total number of complaints received:
Complaint: A concern brought to, or initiated by, the ombudsman for
investigation and action by or on behalf of one or more residents of a
long-term care facility relating to health, safety, welfare or rights
of a resident. One or more complaints constitute a case.
D. Types of Complaints, by Type of Facility.
Below and on the following pages provide the total number of
complaints for each specific complaint category, for nursing facilities
and board and care or similar type of adult care facility. The first
four major headings are for complaints involving action or inaction by
staff or management of the facility. The last major heading is for
complaints against others outside the facility. See Instructions for
additional clarification and definitions of types of facilities and
selected complaint categories.
Ombudsman Complaint Categories
------------------------------------------------------------------------
Board and
Residents' rights Nursing care (or
facility similar)
------------------------------------------------------------------------
A. Abuse, Gross Neglect, Exploitation:
1. Abuse, physical (including corporal
punishment)..............................
2. Abuse, sexual..........................
3. Abuse, verbal/mental (including
involuntary seclusion)...................
4. Financial exploitation (use E for less
severe forms of financial complaints)....
5. Gross neglect (use categories under
Resident Care for less severe forms of
neglect).................................
6. Resident-to-resident physical or sexual
abuse....................................
7. Other--specify.........................
B. Access to Information:
8. Access to own records..................
9. Access to ombudsman/visitors...........
10. Access to facility survey.............
11. Information regarding advance
directive................................
12. Information regarding medical
condition, treatment and any changes.....
13. Information regarding rights,
benefits, services.......................
14. Information communicated in
understandable language..................
Other--specify............................
C. Admission, Transfer, Discharge, Eviction:
16. Admission contract and/or procedure...
17. Appeal process--absent, not followed..
18. Bed hold--written notice, refusal to
readmit..................................
19. Discharge/eviction--planning, notice,
procedure................................
20. Discrimination in admission due to
condition, disability....................
21. Discrimination in admission due to
Medicaid status..........................
22. Room assignment/room change/
intrafacility transfer...................
Other--specify............................
D. Autonomy, Choice, Exercise of Rights,
Privacy:
24. Choose personal physician, pharmacy...
25. Confinement in facility against will
(illegally)..............................
26. Dignity, respect--staff attitudes.....
27. Exercise choice and/or civil rights
(includes right to smoke)................
28. Exercise right to refuse care/
treatment................................
29. Language barrier in daily routine.....
30. Participate in care planning by
resident and/or designated surrogate.....
31. Privacy--telephone, visitors, couples,
mail.....................................
32. Privacy in treatment, confidentiality.
33. Response to complaints................
34. Reprisal, retaliation.................
35. Other--specify........................
E. Financial, Property (Except for Financial
Exploitation):
36. Billing/charges--notice, approval,
questionable, accounting wrong or denied
(includes overcharge of private pay
residents)...............................
37. Personal funds--mismanaged, access
denied, deposits and other money not
returned (report criminal-level misuse of
personal funds under A.4)................
38. Personal property lost, stolen, used
by others, destroyed.....................
39. Other--specify........................
Resident Care:
F. Care:
40. Accidents, improper handling..........
41. Call lights, requests for assistance..
42. Care plan/resident assessment--
inadequate, failure to follow plan or
physician orders (put lack of resident/
surrogate involvement under D.30)........
43. Contracture...........................
44. Medications--administration,
organization.............................
45. Personal hygiene (includes oral
hygiene).................................
46. Physician services....................
47. Pressure sores........................
48. Symptoms unattended, no notice to
others of change in condition............
49. Toileting.............................
50. Tubes--neglect of catheter, NG tube
(use D.28 for inappropriate/forced use)..
51. Wandering, failure to accommodate/
monitor..................................
52. Other--specify........................
G. Rehabilitation or Maintenance of Function:
53. Assistive devices or equipment........
54. Bowel and bladder training............
55. Dental services.......................
56. Mental health, psychosocial services..
57. Range of motion/ambulation............
58. Therapies--physical, occupational,
speech...................................
59. Vision and hearing....................
60. Other--specify........................
H. Restraints--Chemical and Physical:
61. Physical restraint--assessment, use,
monitoring...............................
62. Psychoactive drugs--assessment, use,
evaluation...............................
63. Other--specify........................
Quality of Life:
I. Activities and Social Services:
64. Activities--choice and appropriateness
65. Community interaction, transportation.
66. Roommate conflict.....................
67. Social services--availability/
appropriateness/ (use G.56 for mental
health, psychosocial counseling/service).
68. Other--specify........................
J. Dietary:
69. Assistance in eating or assistive
devices..................................
70. Fluid availability/hydration..........
71. Menu--quantity, quality, variation,
choice...................................
72. Snacks, time span between meals.......
73. Temperature...........................
74. Therapeutic diet......................
75. Weight loss due to inadequate
nutrition................................
76. Other--specify........................
K. Environment:
77. Air temperature and quality (heating,
cooling, ventilation, smoking)...........
78. Cleanliness, pests....................
79. Equipment/building--disrepair, hazard,
poor lighting, fire safety...............
80. Furnishings, storage for residents....
81. Infection control.....................
82. Laundry--lost, condition..............
83. Odors.................................
84. Space for activities, dining..........
85. Supplies and linens...................
86. Other--specify........................
Administration:
L. Policies, Procedures, Attitudes, Resources
(See other complaint headings, of above, for
policies on advance directive, due process,
billing, management residents' funds):
87. Abuse investigation/reporting.........
88. Administrator(s) unresponsive,
unavailable..............................
89. Grievance procedure (use C for
transfer, discharge appeals).............
90. Inadequate record-keeping.............
91. Insufficient funds to operate.........
92. Operator inadequately trained.........
93. Offering inappropriate level of care
(for B&C's/similar)......................
94. Resident or family council/committee
interfered with, not supported...........
95. Other--specify........................
M. Staffing:
96. Communication, language barrier (use
D.29 if problem involves resident
inability to communicate)................
97. Shortage of staff.....................
98. Staff training, lack of screening.....
99. Staff turn-over, over-use of nursing
pools....................................
100. Staff unresponsive, unavailable......
101. Supervision..........................
102. Other--specify.......................
N. Certification/Licensing Agency:
103. Access to information (including
survey)..................................
104. Complaint, response to...............
105. Decertification/closure..............
106. Intermediate sanctions...............
107. Survey process.......................
108. Survey process--ombudsman
participation............................
109. Transfer or eviction hearing.........
110. Other--specify.......................
O. State Medicaid Agency:
111. Access to information, application...
112. Denial of eligibility................
113. Non-covered services.................
114. Personal Needs Allowance.............
115. Servcies.............................
116. Other--specify.......................
P. System/Others:
117. Abuse/abandonment by family member/
friend/guardian or, while on visit out of
facility, any other person...............
118. Bed shortage--placement..............
119. Board and care/similar facility
licensing, regulation....................
120. Family conflict......................
121. Financial exploitation by family or
other not affiliated with facility.......
122. Legal--guardianship, conservatorship,
power of attorney, wills.................
123. Medicare.............................
124. PASARR...............................
125. Resident's physician not available...
126. Protective Service Agency............
127. SSA, SSI, VA, Other Benefits.........
128. Other--specify.......................
Total, categories A through P...........
-------------------------
Q. Complaints in Other Than Nursing or Board
and Care/Similar Settings:
129. Home care............................
130. Hospital or hospice..................
131. Public or other congregate housing
not providing personal care..............
132. Shelters.............................
133. Other--specify.......................
Total, Heading Q........................
-------------------------
Total Complaints\1\.....................
=========================
------------------------------------------------------------------------
\1\(Add total of nursing facility complaints, board and care/similar
complaints and complaints in Q, above. Place this number in Part I,
C).
E. Action on Complaints: Provide for cases closed during the
reporting period the total number of complaints, by type of facility or
other setting, for each item listed below.
------------------------------------------------------------------------
Board and
Nursing care (or Other
facility similar) settings
------------------------------------------------------------------------
1. Complaints which were
verified:
Verified: It is determined after work [interviews, record inspection,
observation, etc.] that the circumstances described in the complaint
are substantiated or generally accurate.
2. Disposition: Provide for all
complaints reported in C and D,
whether verified or not, the
number:
a. For which government
policy or regulatory change
or legislative action was
required to resolve (this
may be addressed in the
issues section).............
b. Which were not resolved\1\
to satisfaction of resident
or complainant..............
c. Which were withdrawn by
the resident or complainant.
d. Which were referred to
other agency for resolution
and:........................
(1) report of final
disposition was not
obtained................
(2) other agency failed
to act on complaint.....
e. For which no action was
needed or appropriate.......
f. Which were partially
resolved\1\ but some problem
remained....................
g. Which were resolved\1\ to
the satisfaction of resident
or complainant..............
--------------------------------------
Total......................
======================================
Grant Total (Same number as
that for total complaints
on pages 1 and 7).........
------------------------------------------------------------------------
\1\Resolved: The complaint/problem was addressed to the satisfaction of
the resident or complainant.
F. Legal Assistance/Remedies (Optional) Discuss on an attached
sheet the types and percentages of total complaints for which (a) legal
consultation was needed and/or used; (b) regulatory enforcement action
was needed and/or used; (c) an administrative appeal or adjudication
was needed and/or used; and (d) civil legal action was needed and/or
used.
G. Complaint Description (Optional): Provide on an attached sheet a
concise description of the most interesting and/or significant
individual complaint your program handled during the reporting period.
State the problem, how the problem was resolved and the outcome.
Part II--Major Long-Term Care Issues
Describe on attached sheets the priority long-term care issues
which your program identified and/or worked on during the reporting
period. For each issue, briefly state: (a) The problem, (b) barriers to
resolution, and (c) recommendations for system-wide changes needed to
resolve the issue, or how the issue was resolved in your State.
Part III--Program Information and Activities
A. Facilities and Beds
1. How many nursing facilities are licensed and operating in your
State?
2. How many beds are there in these facilities?
3. Provide the type-name(s) and definition(s) of the types of board
and care facilities and any other adult care home similar to a nursing
or board and care facility for which your ombudsman program provides
services, as authorized under Section 102(19) and (34), 711(6) and
712(a)(3)(A)(i) of the Older Americans Act:
(Continue on back of sheet if insufficient space.)
(a) How many of the board and care and similar adult care
facilities described above are licensed in your State?
(b) How many beds are there in these facilities?
B. Program Coverage
In the space below describe how your program provides statewide
ombudsman coverage for nursing facilities and board and care or similar
adult care facilities, described in Part III, A.3 above. If you are not
able to provide statewide coverage, what are the barriers and what do
you plan to do to overcome the barriers? Use additional sheet if
needed.
Statewide coverage: Residents of both nursing homes and a board and
care homes (and similar adult care facilities) and their friends and
families throughout the State have access to knowledge of the ombudsman
program and how to contact it, and complaints received from any part of
the State are investigated and documented and steps are taken to
resolve problems in a timely manner, in accordance with Federal and
State requirements.
Nursing Facilities
Board and Care/Similar Adult Care Facility
C. Local Programs
Provide for each type of host organization the number of local or
regional ombudsman entities (programs) designated by the State
Ombudsman to participate in the statewide ombudsman program:
Local entities hosted by:
Area agency on aging.....................................
Other local government entity............................
Legal services provider..................................
Social services non-profit agency........................
Free-standing ombudsman program..........................
Regional office of State ombudsman program...............
Other; specify...........................................
------------
Total Designated Local Ombudsman Entities............ ...........
D. Staff and Volunteers
Provide numbers of staff and volunteers, as requested, at State and
local levels.
----------------------------------------------------------------------------------------------------------------
State Local
Type of staff Measure office programs
----------------------------------------------------------------------------------------------------------------
Paid program staff.................................... FTE's.........................
Number people working full-
time on ombudsman program.
Paid clerical staff................................... FTE's.........................
Volunteer ombudsmen certified to address complaints... Number volunteers.............
Certified Volunteer: An individual who has completed a training course prescribed by the State Ombudsman and is
approved by the State Ombudsman to participate in the statewide Ombudsman Program.
Other volunteers...................................... Number volunteers.............
----------------------------------------------------------------------------------------------------------------
E. Program Funding
Provide the amount of funds expended from each source for your
statewide program:
Federal--Older Americans Act (OAA) Title VII, Chapter 2........ $
Federal--Older Americans Act (OAA) Title VII, Chapter 3........ $
Federal--OAA Title III provided at State level................. $
Federal--OAA Title III provided at AAA level................... $
Other Federal; specify:........................................ $
State funds.................................................... $
Local; specify................................................. $
--------
Total Program Funding.................................... $
F. Other Ombudsman Activities
Provide below and on the next page information on ombudsman program
activities other than work on complaints.
------------------------------------------------------------------------
Activity Measure State Local
------------------------------------------------------------------------
1. Training for Number sessions......
ombudsman staff, and
volunteers.
Number hours.........
Total number of
trainees.
2. Technical Estimated percentage
assistance to local of total staff time.
ombudsmen and/or
volunteers.
3. Training for Number sessions......
facility staff.
3 most frequent
topics for training.
4. Consultation to 3 most frequent areas
facilities of consultation.
(Consultation:
providing
information and
technical
assistance, often by
telephone).
Number of
consultations.
5. Information and 3 most frequent State
consultation to requests/needs.
individuals (usually
by telephone).
Local
Number of
consultations.
6. Resident Number Nursing
visitation (other Facilities visited
than in response to (unduplicated).
complaint).
Number Board and Care
(or similar)
facilities visited
(unduplicated).
7. Participation in Number of surveys....
Facility Surveys.
8. Work with resident Number of meetings
councils. attended.
9. Work with family Number of meetings
councils. attended.
10. Community Number of sessions...
Education.
11. Work with media.. Number of interviews/
discussions.
Number of press
releases.
12. Monitoring/work Estimated percentage
on laws, of total paid staff
regulations, time.
government policies
and actions.
------------------------------------------------------------------------
State Annual Ombudsman Report; File Transmittal Requirements
To ensure compatibility of data submitted as part of the State
Annual Ombudsman Report across states, AoA has developed a standard set
of guidelines for transmittal of the State Annual Ombudsman Report data
by state units on aging.
These specifications are organized around a set of seven data files
to be forwarded by states using diskettes or a modem. Each submitted
file must be in the format specified below.
General Guidelines
When preparing the files, please observe the following:
1. AoA is requesting that state agencies provide annual report data
in a machine readable format, conveyed either by diskette or by modem.
The data files can be transmitted as ASCII files, or .DBF files. AoA
prefers .DBF for data oriented files but will accept ASCII files which
comply with the specifications addressed in this document. In the case
of narrative information, please provide text files.
2. Use the file names included in the file descriptions provided
below.
3. Please embed the state ID in the name of data file submitted by
the state. The naming convention should place the state ID as the first
two characters of the file name, replacing the XX in each file name.
For example, Alabama when submitting ombudsman program summary data
will submit a file named ALOMBSUM.DBF.
4. Submit the files no later than 60 days following the end of the
federal fiscal year, beginning November 30, 1995.
5. Round all expenditure data to the nearest dollar.
Like the Title III data sets, AoA has developed transmittal
guidelines designed to encourage the use of electronic media. As a
reminder, the ombudsman report is only for the state aggregate, not by
PSA or other local program component. The files should be transmitted
in .DBF format, where possible. The layout for each transmittal file is
as follows:
1. Summary Performance Data--XXOMBSUM.DBF
This file summarizes data contained in Part I.A. B. and C. of the
Ombudsman Report format. Please refer to the Ombudsman Report format
and instructions for further definitions and explanations of the data
elements to be reported in this file. The file format for this single
record file is as follows:
1. State ID............................................... C2
2. Fiscal Year............................................ N4
3. Name of Agency/Organization Sponsor.................... C30
4. Total Cases Opened During Year......................... N6
The remaining fields all are numeric and 5 positions wide.
5. Number Cases Closed--NF, Resident......................
6. Number Cases Closed--NF, Relative/friend of Resident...
7. Number Cases Closed--NF, Non-relative Guardian, Legal
Representative.
8. Number Cases Closed--NF, Ombudsman/Ombudsman Volunteer.
9. Number Cases Closed--NF, Facility Administrator/Staff..
10. Number Cases Closed--NF, Other Medical: Physician/
staff.
11. Number Cases Closed--NF, Representative of Other
Agency.
12. Number Cases Closed--NF, Unknown/Anonymous............
13. Number Cases Closed--NF, Other (In a separate text
file describe Other).
14. Number Cases Closed--B&C, Resident....................
15. Number Cases Closed--B&C, Relative/friend of Resident.
16. Number Cases Closed--B&C, Non-relative Guardian, Legal
Representative.
17. Number Cases Closed--B&C, Ombudsman/Ombudsman
Volunteer.
18. Number Cases Closed--B&C, Facility Administrator/Staff
19. Number Cases Closed--B&C, Other Medical: Physician/
staff.
20. Number Cases Closed--B&C, Representative of Oth
This text is long and has been trimmed here. Open the source document for the complete record.
This is a copy of a public record, reproduced as it was published. It is not legal advice, and it may not be the version a court would rely on. Check the official source before you cite it.