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Nutrition

Evaluations Report

V. PROGRAM FUNDING, COSTS, AND EFFICIENCY

D. REASONS FOR FUNDING TRANSFERS AND EXPECTATIONS FOR THE FUTURE

In order to understand the trends in transfers discussed here, we asked State Units on Aging (SUAs), AAAs, and nutrition projects about shifts in resources from congregate meals to support services and to home-delivered meals. Specifically, we asked about reasons for the shifts, perceived impacts of the shifts, and expectations for the future. As discussed, respondents at each level are likely to have different information and therefore different perceptions. These different perceptions are not contradictory but rather complementary, and examining the perceptions of all three levels provides a good picture of funding transfers.

1. Transfers from Congregate Meals to Home-Delivered Meals

a. SUAs

The perceptions of SUAs can suggest statewide trends. Table V.20 reports SUAs' reasons for transfers from congregate to home-delivered meals, perceptions of the impact of transfers, and expectations for the next five years. Eighty-five percent of the SUAs reported transferring resources from congregate to home-delivered meals. This response corresponds to the AoA data that showed 83 percent of states transferred funds from congregate to home-delivered meals in 1994. When SUA administrators were asked to give reasons for the shift, most reported an increase in demand for home-delivered services caused by a number of changes in the elderly population. [ Other reasons not related to the increased demand for home-delivered meals were emergency needs, increased costs of home-delivered meals, and elderly people who are hard to reach, either because they live in isolated rural areas or because they live in urban areas where safety may be compromised.]

TABLE V.20

PERCEIVED REASONS FOR FUNDING TRANSFERS FROM TITLE III-C CONGREGATE TO HOME-DELIVERED MEALS


Percentage


SUAs

AAAs

Nutrition Projects

Resources Have Been Shifted from Congregate to Home-Delivered Meals

85

71

36

Shift Encouraged by AAA

NA

72

NA

Reasons for Shift




Congregate participants becoming older and more frail and switching to home-delivered program

50

59

35

Increasing number of older individuals living alone

30

17

17

Increasing number of functionally impaired elderly individuals

24

21

23

Increase in home- and community-based long-term care rather than institutionalization

22

11

14

More early discharges from hospital due to Medicare Diagnostic Related Groups (DRGs)

17

7

10

Impact of Shift on Ability to Serve Those in Need of Congregate Services




Major impact

12

11

10

Some impact

35

25

29

Minimal impact

28

18

18

No impact/no shift

26

46

43

Expected Shifts over Next Five Years




Increase

58

59

38

Stay about the same

40

39

58

Decrease

2

2

4

Reasons for Expected Increase over Next Five Years




More very old people

43

36

31

More elderly people in general

43

33

38

More elderly people in poor health

43

19

9

More elderly people in need

30

31

27

More elderly people in good health

7

1

2

Pressure/requests from state officials

7

1

1

Sample Size

55

403

242

Source: Elderly Nutrition Program Evaluation; SUA, AAA, and Nutrition Project surveys; weighted tabulations.

NA = Not applicable.

Half of the respondents felt that a reason for the shift was congregate participants switching to home-delivered programs as they become older and more frail. Other reasons for the shift reflect increaseddemand for home-delivered meals. Almost one-third of SUAs reported the increasing number of elderly persons living alone as a reason for the shift. This perception is consistent with national data. The number of persons age 65 and older who live alone rose from 5.0 million in 1970 to 9.1 million in 1990, an increase of more than 80 percent. The increase in the total number of persons over age 65 rose by only 46 percent during that time (U.S. Bureau of the Census 1994).

A majority of the respondents that reported shifting funds from congregate to home-delivered meals believe that the transfers had little or no impact on their ability to serve those in need of congregate services. Slightly more than 10 percent thought the shifts had a major impact on their ability to serve those in need of congregate services, and about one-third believed that the shifts had some impact. As noted, most states are experiencing increasing demand for home-delivered services, but not all of these states also experienced decreasing demand for congregate services, which explains in part why the impact on congregate meals differs across states.

Almost 60 percent of the SUA respondents expect transfers from congregate to home-delivered meals to increase during the next five years. All but one of the remaining 40 percent of SUAs expect their transfers to stay about the same. Those that expect an increase in transfers cite many causes for their expectations, similar to those for currently transferring funds. Two of the most frequent responses werean increasing elderly population in general and more very old people. National population statistics support these observations--the total number of persons over age 65 increased from 25.5 million (or 11 percent of the population) in 1980 to 31.1 million (or 13 percent of the population) in 1990. Additionally, the percentage of persons 75 years old and older as a proportion of persons 65 years old and older increased from 39 percent in 1980 to 42 percent in 1990. The percentage of persons 85 years old and older as a proportion of persons 65 years old and older increased slightly, from 9 to 10 percent, in that time (U.S. Department of Commerce 1994). As might be expected, respondents also cite more elderly individuals in poor health as a reason for increases in transfers to home-delivered meals.

b. AAAs

AAAs' perceptions of funding transfers and the reasons for these transfers were generally very similar to those of SUAs. We asked AAAs an additional question not asked of SUAs or nutrition projects about whether or not the AAA encouraged the shift in funds. Responses to this question suggest that many of the decisions about transferring funds occur at the AAA level--more than 70 percent of the AAAs transferring funds reported that the decision was encouraged by the AAA.

Seventy-one percent of the AAA respondents reported that resources had been shifted to home-delivered from congregate meals. Although this percentage is smaller than the percentage of SUAs reporting such transfers, when AAA responses are aggregated to the state level, they are very consistent with SUA responses--49 states had at least one AAA reporting a shift, and 46 SUAs reported a transfer. Although not all AAAs in a state transferred funds in this direction, most states had at least one AAA making such transfers, and the net of all AAA transfers for most states was in this direction.

As with SUAs, AAAs most frequently cited as a reason for the shifts the number of congregate participants switching to the home-delivered meal program (59 percent).

Other frequently mentioned reasons for the shifts pertain to causes of the increasing demand for home-delivered meals, such as the increasing number of functionally impaired elderly individuals (21 percent)and the increasing number of elderly people living alone (17 percent) (similar to SUA responses). Some AAAs mentioned waiting lists for home-delivered meals. A few have prioritized funds by need and perceive home-delivered meal clients to be more needy.

A smaller percentage of AAAs than SUAs believe transfers have had a significant impact on their ability to serve those in need of congregate services. Forty-six percent of AAA respondents reported that the shifts have had no impact on their ability to serve congregate needs (only 26 percent of SUAs believed likewise). Perhaps the difference between SUA and AAA responses is due to SUAs' appraising statewide needs, which may not be the same for all areas within the state.

AAAs and SUAs expressed very similar expectations for the future, with 60 percent of AAAs expecting increases in transfers to home-delivered meals during the next five years. The reasons for increases in funding were also very similar--the increasing number of very old people and the increasing elderly population in general, along with a continuation in other trends that have heightened demand for home-delivered meals.

c. Nutrition Projects

Many decisions to transfer funds are made before the funds get to nutrition projects. Only 36 percent of the nutrition projects surveyed reported that funds had been transferred from congregate to home-delivered meals.

As with SUAs and AAAs, the most frequent reason for transfers to home-delivered meals was the aging of congregate participants, who then switch to home-delivered meals. Other frequent responses were the increasing number of functionally impaired individuals and the growing number of older individuals living alone. Like AAAs, several nutrition projects reported long waiting lists and an increasing demand for home-delivered meals. A few nutrition projects, however, indicated that the decision to transfer was mandated by the AAA or the state. Like AAAs, only a few nutrition projects thought that transfers had much impact on their ability to serve those in need of congregate meals.

A majority of the nutrition projects expect little change in their transfers to home-delivered meals in the next five years. A significant minority (almost 40 percent), however, expect to increase transfers to home-delivered meals--more than the number currently reporting transfers. As with SUAs and AAAs, the most frequent reasons for increasing transfers were more elderly people in general, more very old people, and more elderly people in need. Interestingly, nutrition projects were far less likely than SUAs or AAAs to consider the increasing number of elderly individuals in poor health as a cause for the shifts.

2 .Transfers from Congregate Meals to Supportive Services

a. SUAs

Table V.21 reports responses about transfers from congregate meals to supportive services. Sixty percent reported shifting resources from congregate services to supportive services, again consistent with AoA data. One of the most common reasons for the transfer was transportation needs, mentioned by more than one-third of respondents. More than half noted demographic changes as a reason for the increasing need for other supportive services, such as homemaker services and case management. One of the most important changes has been the increased use of home- and community-based long term-care rather than institutionalization. Additional changes include the increasing number of congregate participants becoming older, the increasing number of functionally impaired individuals, and the increasing number of elderly people living alone.

TABLE V.21

PERCEIVED REASONS FOR FUNDING TRANSFERS FROM CONGREGATE TO SUPPORT SERVICES

(Percentages)


SUAs

AAAs

Nutrition Projects

Resources Have Been Shifted from Congregate to Support Services

60

26

6

Shift Encouraged by AAA Staff

NA

76

NA

Reasons for Shift




Transportation needs

37

31

30

Increase in home- and community-based long-term care services

25

14

9

Congregate participants becoming older and more frail and switching to home-delivered program

22

16

30

Increasing support for caregivers who work outside the home and provide ongoing care for homebound elderly individuals

16

5

3

Increasing number of functionally impaired elderly individuals

16

10

2

Increasing number of older individuals living alone

16

4

9

Early discharge from hospitals due to Medicare Diagnostic Related Groups (DRGs)

6

3

49

Impact of Shift on Ability to Serve Those in Need of Congregate Services




Major impact

10

11

2

Some impact

27

17

15

Minimal impact

40

29

48

No impact

23

43

34

Expected Shifts over Next Five Years




Increase

21

14

9

Stay about the same

73

81

91

Decrease

6

5

1

Reasons for Increase




More very old people

27

23

8

More elderly people in general

36

18

18

More elderly people in poor health

27

13

11

More elderly people in need

27

16

27

More elderly people in good health

9

3

2

Pressure/requests from state officials

0

4

6

Sample Size

55

403

242

Source: Elderly Nutrition Program Evaluation; SUA, AAA, and Nutrition Project surveys; weighted tabulations.

NA = Not applicable.

The AoA data showed that the amounts transferred to supportive services overall were substantially less than the amounts transferred to home-delivered meals. We expected the impact of the transfer of funds from congregate to supportive services to be smaller than the impact of the transfer from congregate to home-delivered meals. This pattern was indeed observed, with almost 65 percent of respondents indicating that the shift to supportive services had no or minimal impact on congregate services.

Respondents were much more likely to expect increased funding shifts to home-delivered meals rather than to expect increased transfer of funds to supportive services in the next five years. Only 20 percent expected the transfer of funds to supportive services to increase. The reasons given for expecting increased transfers to supportive services were similar to the reasons given for expecting increased transfers to home-delivered meals.

b. AAAs

Only about one-fourth of the AAAs reported transferring funds to supportive services. At first glance, this percentage looks low compared to the 60 percent of SUAs that responded positively. However, in many states it appears that some but not all AAAs transfer funds, since the AAAs reporting such transfers are located in 51 state jurisdictions. Although transfers to supportive services occur in almost every state at one or more AAAs, most AAAs do not make such transfers. In addition, some AAAs may be unaware of transfers at the state level (only about 30 states reported net transfers in this direction).

The reasons for transfers were again very similar to those of SUA respondents. The supportive service reported most frequently as in need of more funding was transportation. AAAs mentioned a wide variety of other services as the reasons for transferring funds, including outreach and targeting, case management, ombudsman, homemaker services, and recreational activities at congregate sites. Some AAAs believe funding levels are not changing with the changing needs of the elderly population. Like SUAs, very few AAAs thought the shifts have had much impact on their ability to provide congregate services, most likely because the shifts have been relatively small.

Not many AAAs expect transfers to supportive services to increase in the next five years. Those that expect increases cite different services that need additional funding, but the underlying reasons--more very old people, more elderly people in general, and other demographic changes--are the same.

c. Nutrition Projects

As with transfers to home-delivered meals, very few nutrition projects (less than six percent) reported transferring resources to supportive services. Reasons for transfers include outreach and other services,in particular, services for elderly people needing home- and community-based long-term care. Ninety-one percent of the nutrition projects do not expect to change transfer of funds in the next five years. The nine percent that expect transfers to increase cite transportation needs, case management services, and increasing numbers of those in need and/or those who are frail as the main reasons.

d. Summary

Eighty-five percent of SUAs reported a transfer in funds from congregate to home-delivered meals, and 71 percent reported a transfer from congregate meals to supportive services. Only a few states believe that these funding transfers had large impacts on their ability to provide congregate services, but a number of states recognize that the shifts had some impact. In the next five years, more than half expect transfers to home-delivered meals to increase, but fewer than one-fourth expect shifts to supportive services to increase. Reasons for the expected increases are similar to states' reasons for transferring funds in the first place--the elderly population and the number of very old and frail people are increasing.

Almost three-quarters of AAAs reported transfers of funds from congregate to home-delivered meals, but only one-quarter reported transferring funds from congregate meals to supportive services. AAAs' reasons for transfers are very similar to SUAs' reasons, as are their expectations for the future.


Last Modified: 12/31/1600