Nutrition

IV. TITLE III PROGRAM ADMINISTRATION AND SERVICE DELIVERY

G.TARGETING OF PROGRAM SERVICES TO PRIORITY GROUPS

While participation in the Title III program is open to all persons age 60 and older, the OAA requires the program to target its services toward certain groups the Congress has deemed particularly in need of nutrition services--those of greatest economic or social need, with special emphasis on low-income minorities. The degree to which this targeting has been successful, in terms of the characteristics of the ENP client population, was discussed in Chapter III. For virtually all racial and ethnic and low-income subgroups of congregate and home-delivered meal programs, the percentage of priority subgroups in the ENP participant population exceeds their representation in the program-eligible U.S. elderly population. This section examines the targeting objectives of the program as perceived by various levels of program staff and identifies operational procedures that have been set up to achieve this targeting. [ See U.S. Department of Health and Human Services, Administration on Aging, and Office of Inspector General 1993. The study surveyed a sample of 20 states to obtain detailed information on states ' implementation of the targeting requirements of the OAA. ] ^, [ Note that the tabulations for activities undertaken by SUAs, AAAs, and projects, as well as for major barriers to targeting, contain relatively larger percentages of responses in the "other " category. We are currently backcoding these responses into existing response categories and creating additional categories. The revised tabulations will appear in the revised version of the final report. ]

1. SUA Targeting Activities

Virtually all SUAs (93 percent) indicated that they encourage the targeting of ENP services to particular groups of priority elders (Table IV.47). The two most common groups that SUAs target are racial and ethnic minorities (84 percent) and elders in greatest economic need (84 percent). About one-third of SUAs also mentioned targeting rural elders.

TABLE IV.47

SUA TARGETING PRIORITIES AND ACTIONS TAKEN

TO TARGET ENP PRIORITY GROUPS

(Percentages)

Source: Elderly Nutrition Program Evaluation, SUA survey.

^a Percentages total more than 100 percent because SUAs may target more than one group.

^b Percentages total more than 100 percent because SUAs may engage in multiple activities.

The activities undertaken most frequently by SUAs to achieve their targeting objectives are directed at the AAAs and/or nutrition projects. Fifty-eight percent of SUAs reported encouraging AAAs and/or nutrition projects to conduct outreach programs, and 48 percent reported monitoring AAA and/or nutrition project targeting efforts (for example, reviewing reports, reviewing AAA plans). Thirty-five percent of SUAs mentioned requiring or encouraging AAAs and/or nutrition projects to place congregate sites in areas in which these priority groups live, and about one-third of SUAs also require or encourage AAAs and/or nutrition projects to provide specialized program services to attract targeted groups into the program, such as ethnic meals or other services specifically designed for special populations.

When asked to identify the targeting activities that were the most successful in increasing target populations participation, SUA respondents felt that initiatives involving outreach programs have the greatest impact on targeting (mentioned by 27 percent). Site selection (15 percent) and monitoring and evaluation efforts (15 percent) were mentioned next most often as activities thought to have the most impact in bringing priority groups into the program. Major barriers to targeting as reported by SUAs include lack of funding (51 percent), lack of training on effective targeting practices (23 percent), lack of data to locate and identify the needs of the targeted groups (21 percent), negative attitudes toward targeting (21 percent), and lack of staff (19 percent). A large proportion of SUAs (51 percent), however, mentioned other barriers, such as racial and ethnic divisions, a lack of minority community leaders or staff for outreach, language barriers, cultural differences, or difficulty in acceptance of different groups by program participants. Other reasons mentioned include a lack of transportation for outreach and a sense that the OAA "gives a double message" on targeting (that special groups should be targeted although all groups are eligible for services).

2. AAA Targeting Activities

Virtually all AAAs (96 percent) reported that they take actions to encourage participation of targeted groups of elders (Table IV.48). As at the SUA level, the most frequently targeted groups are racial and ethnic minorities and populations with the greatest economic need (reported by 84 percent of the AAAs). Rural populations were mentioned by about one-quarter of AAAs. Other groups, such as persons with limited English proficiency or persons with Alzheimer’s or related diseases, although still targeted, were mentioned much less often (fewer than 20 percent).

TABLE IV.48

AAA TARGETING PRIORITIES AND ACTIONS TAKEN TO TARGET ENP PRIORITY GROUPS

(Percentages)

Source: Elderly Nutrition Program Evaluation, AAA survey, weighted tabulations.

^a Percentages total more than 100 percent because AAAs may target more than one group.

^b Percentages total more than 100 percent because AAAs may engage in multiple activities.

The most commonly used methods to target these groups are encouraging nutrition projects to conduct outreach programs (57 percent), providing technical assistance to projects (33 percent), and providing specialized services (28 percent). Providing outreach programs and encouraging the placement of nutrition projects where target groups live are considered the most effective methods. Lack of funding is the most common barrier to targeting success mentioned by AAA staff. Lack of staff, negative attitudes toward targeting, and difficulty locating the targeted groups were also mentioned.

3. Nutrition Project Targeting Activities

Fifty-five percent of Title III nutrition projects reported that they make efforts to target services to people with certain characteristics or needs (Table IV.49). Nutrition projects tend to focus targeting efforts on racial and ethnic minorities (34 percent) and those with the greatest economic need (43 percent). One-third of all Title III projects target persons with severe disabilities. The most commonly targeted racial and ethnic minorities are African Americans (23 percent), Hispanics/Latinos (17 percent), and Asians/Pacific Islanders (10 percent).

TABLE IV.49

NUTRITION PROJECT TARGETING PRIORITIES AND ACTIONS TAKEN TO TARGET PRIORITY GROUPS

(Percentages)

Source: Elderly Nutrition Program Evaluation, Nutrition Project survey, weighted tabulations.

Many different strategies are used by nutrition projects to target services, and no single method dominated the responses. The most common targeting activities are working with other community organizations, using information and referral, encouraging participants to tell their friends about services, and placing meal sites where the targeted groups live. A substantial proportion of other responses were given, including presentations, fairs and open houses, improvements in the physical structures to aid accessibility for wheelchair users, television or newspaper advertising campaigns, and referrals through individuals in the medical profession.

Respondents to the nutrition project survey indicated the following barriers to effective targeting of priority groups in the ENP: (1) inability to overcome the stigma associated with an assistance program; (2) nonacceptance by other participants; and (3) language barriers. Once again, a substantial number mentioned other reasons, including cultural differences (in attitudes or food preferences, for example), project staff’s fear that target groups live in unsafe neighborhoods, lack of funding, lack of minority and bilingual staff, and lack of transportation for frail elders.

Visitor’s Guide | Contact Us | Feedback | Privacy Notice | Disclaimer | Accessibility | Sitemap | A–Z Index | FOIA | Plain Writing Act | USA.gov | HHS.gov