• 1.1 Agency Mission and Long-Term Goals
• 1.2 Organization, Programs, Operations, Strategies and Resources
• 1.3 Partnerships and Coordination
• 1.4 Performance Report Summary

• 2.1 Community-Based Services
  • Intermediate Outcome Targeting Measures
  • Intermediate Outcome System Measures
  • Service Measures
  • Client and Program Outcome Measures
• 2.2 Vulnerable Older Americans
• 2.3 Services for Native Americans
• 2.4 Research and Development
• 2.5 Senior Medicare Patrols
• 2.6 Program Management

• Approach to Performance Measurement
• Changes and Improvements
• Linkage to the HHS Strategic Plan
• Linkage with the Budget

Introduction

With the Government Performance and Results Act (GPRA), the Congress established a management tool that compels Federal agencies and programs to focus on results. For AoA, GPRA is an opportunity to document results produced through the programs the agency administers under the authority of the Older Americans Act (OAA). It is the intent and commitment of AoA, in concert with State and local program partners, to use the performance measurement tools of GPRA to continuously improve OAA programs and services for the elderly.

AoA is the Federal advocacy agency for the elderly and the lead Federal partner of the aging network, which administers programs established under the OAA to support the well being, health and independence of older Americans. In addition to program partners within HHS, AoA works with other Federal Departments and agencies in support of the elderly, including the Departments of Agriculture and Labor, and the Social Security Administration. However, the heart of the aging network are the 56 State units on aging, 655 area agencies on aging, 335 tribal organizations, and thousands of service providers, which deliver program services to older individuals across the nation.

Through these extensive partnerships, the network produces the results that the Congress has sought through the OAA. Based on resources input by AoA, we track network output as measured by units of service provided. Intermediate outcome measures indicate that the network targets services to the most vulnerable elderly individuals in the country. Very high proportions of service clients are poor and disabled, many are minorities, and significant proportions reside in rural areas. The end outcome measures that are under development will allow AoA to demonstrate that: the network improves the lives of people served; the nutritional status of OAA clients is improved through the meals provided; and support services allow elderly individuals to stay in their homes. The network leverages funds from other sources in amounts that are higher than the OAA grants provided by AoA. Approximately half of the staff, who work for area agencies on aging to coordinate services for the elderly, are volunteers. More than half of the senior centers that serve elderly individuals in communities are also community “focal points” responsible for service coordination. Government entities and volunteers pursue excellence and the protection of the rights and well being of individuals in nursing homes. Through the network, the elderly themselves work to improve the integrity of the governmental health-care financing programs that support them.

In an attempt to make it more readable and user friendly, AoA has made a concerted effort to reduce the volume of this plan and report. Additionally, this allows AoA to focus on the analysis of the performance data that constitute the core of this plan and that are central to AoA’s proposed budget for Fiscal Year (FY) 2003.

Part I – Agency Context for Performance Measurement

1.1 Agency Mission and Long-Term Goals

The Administration on Aging was established in 1965 through the enactment of the Older Americans Act (OAA), in response to the growing number of elders and their diverse needs. The OAA focuses especially on those at risk of losing their independence. AoA seeks continuously to improve the quality of life for all older Americans, primarily by assisting them to remain independent, actively engaged, and productive. AoA works closely with the aging network to plan, coordinate and develop home and community-based systems of services that meet the unique needs of older persons and their families.

The OAA, reauthorized in 2000 for five years, has enabled AoA to be the Federal focal point for older persons, their many contributions and their concerns. AoA has the Congressionally mandated role of providing essential home and community-based programs across the country which help to keep America’s rapidly growing older population healthy, secure and independent. The Act also charges AoA to serve as the effective and visible advocate for older individuals within the Department of Health and Human Services and with other departments and agencies of the Federal Government.

Strategic Goals of the Administration on Aging

The Older Americans Act (OAA) defines for AoA and the aging network a compelling set of long-term goals focused on the quality of life of elderly individuals throughout the Nation. The following are OAA and agency-generated strategic goals and objectives that provide the foundation for the activities and performance objectives of AoA and the aging network.

• Provide a comprehensive array of community-based, long-term care services adequate to appropriately sustain older people in their communities and in their homes, including support to family members and other persons providing voluntary care to older individuals needing long-term care services.
• Support efficient community services, including access to low-cost transportation, a choice in living arrangements, and social assistance. Services will be provided in a coordinated manner and will be readily available when needed. The system will maintain a continuum of care for vulnerable older individuals.
• Support freedom, independence, and the free exercise of initiative to elderly individuals in planning and managing their own lives. Provide individuals full participation in the planning and operation of community-based services and programs provided for protection against abuse, neglect, and exploitation.
• Provide opportunities for better nutrition and improved health.
• Promote the development of comprehensive and coordinated service systems based on local needs.
• Provide the best possible physical and mental health services which science can make available without regard to economic status.
• Support activities that foster the participation of elders in the widest range of civic, cultural, educational, training and recreational opportunities.
• Provide opportunities for immediate benefit from proven research knowledge, which can sustain and improve heath and happiness.

Linkage with the HHS Strategic Plan

AoA participated actively in the development of the revised strategic goals and objectives of the Department of Health and Human Services (HHS), as published September 30, 2000. AoA program activities and strategies will continue to support HHS in the achievement of HHS goals and objectives, and AoA program performance measurement efforts will support HHS in its efforts to assess the progress of the Department in achieving the goals and objectives of the new HHS Strategic Plan. The detailed linkages of AoA goals and activities with the HHS Strategic Plan are presented in Appendix 3 of this plan.

1.2 Organization, Programs, Operations, Strategies and Resources

The Administration on Aging

The Administration on Aging provides leadership, coordination and support to the aging network on behalf of older Americans. AoA works to heighten awareness among other Federal agencies, organizations, groups, and the public about the valuable contributions that older Americans make to the Nation and alerts them to the needs of vulnerable older people.

In FY 2002, the Assistant Secretary for Aging reorganized the agency to focus on consumers. The new organizational structure streamlines the organization, consolidates and elevates AoA’s external communications functions, strengthens and centralizes its analytical and policy development activities, and focuses AoA’s programmatic efforts on those areas of greatest importance to older Americans.

AoA provides Federal administration of community services programs that are mandated under the Older Americans Act. The programs provide meals and various supportive services; they offer the elderly opportunities to enhance their health and to be active, independent contributors to their families, communities, and the nation. AoA funding supports in-home and community-based services including nutrition, transportation, health promotion, nursing home ombudsmen, outreach, elder abuse prevention efforts, and services in support of family caregivers.

Also under the authority of the Older Americans Act, AoA awards funds to support research, demonstration, and training programs. Research projects collect information about the status and needs of subgroups of the elderly, which is used to plan services and identify opportunities that will assist them. Demonstration projects test new program initiatives that better serve the elderly, especially those who are vulnerable.

The Aging Network

State, tribal and area agencies on aging ensure coordination and enhancement of services that help vulnerable older persons to remain in their own homes. Fifty-six State agencies on aging are allocated funds for support services based on a formula that reflects the number of older residents in their State. Funds are used to plan, develop, and coordinate in-home and community-based service systems in their States. All but nine States are divided into planning and service areas (PSAs). Each PSA is served by an area agency on aging. The 661 area agencies on aging (AAAs) receive OAA funds from their State unit on aging (SUA). In turn, AAAs contract with public or private providers for services. While there are well over 25,000 service provider agencies nationwide, some AAAs deliver services directly when no local contractor is available. AoA awards funds directly to 333 Indian tribal organizations and 2 organizations serving Native Hawaiian elders. These organizations are direct providers of services to older Native Americans living on or near Indian reservations, historical Indian lands, Alaska Native villages and Native Hawaiian communities. The State, local and tribal entities to which AoA awards grants under the authority of the Older Americans Act, and the service providers they support, comprise the aging network.

The Act was not intended, in and of itself, to establish a discrete, independent services program. Rather, the Act put into place a nationwide advocacy and service delivery system -- the aging network -- which identifies service needs and necessary service system modifications, offers State and local plans to remedy needs, coordinates other funding streams, and then weaves the services funded by these into a comprehensive services system. Services funded under the Act frequently are used to “fill program gaps,” for example, by providing services to people in need who are ineligible for help through other programs.

The aging network is responsive to the diverse needs of older Americans. Meals are served in congregate settings such as senior centers, mostly to people who are poor and socially isolated. Many older people with mild functional impairments also need such supportive services as transportation. For older people with more severe limitations, the aging network provides home and community-based long-term care services through a system that it began to develop in the 1970’s. In communities throughout the nation, the home and community-based service systems led by the aging network provide a preferred alternative to nursing home care, enabling people to live as independently as possible for as long as possible.

1.3 Partnerships and Coordination

In addition to the fundamental partnerships within the aging network, AoA works closely with many Federal agencies on a wide range of issues.

In the area of nutrition, AoA has worked with the U.S. Department of Agriculture (USDA) on such issues as dietary guidelines used as standards for OAA programs. The USDA is also a partial funding agent for meals provided through the aging network. In fact, AoA recognizes the partnership between USDA and HHS in providing meals through the aging network; therefore, the Administration has proposed the consolidation of these funding activities in AoA in the FY 2003 budget. Within HHS, AoA works with the Office of Public Health and Science on Dietary Reference Intakes (DRIs), formerly known as Recommended Dietary Allowances and on nutrition performance measures related to the Healthy People 2010 Initiative. AoA also participates on such bodies as the Federal Food Safety Coalition chaired within the Food and Drug Administration; the HHS Nutrition Policy Board; the HHS Dietary Guidance committee; the HHS/USDA Food Security committee; and the HHS Dietary Reference Intake Working Group.

In the pursuit of improved transportation services provided through the aging network, AoA works closely with HHS officials and the U.S. Department of Transportation on the Coordinating Council on Access and Mobility to reduce barriers by coordinating approaches to specialized and human services transportation.

AoA is working with the Centers for Disease Control and Prevention (CDC) to expand CDC’s Racial and Ethnic Approaches to Community Health (REACH 2010). The purpose of these projects is to eliminate health disparities among older racial and ethnic minority populations. The initiative will target disparities in cardiovascular disease, diabetes, and immunizations among older racial and ethnic minority populations.

In the area of consumer protection and elder abuse, AoA and the Department of Justice (DOJ) are disseminating information on promising Federal, State and local approaches that empower older people to live healthy and safe lives. Featured approaches also address the coordination of public safety, health and social services that provide effective prevention and intervention strategies and reduce victimization. Specific areas of emphasis by AoA and DOJ include: (1) domestic elder abuse; (2) institutional elder abuse; and (3) fraud and exploitation, including consumer fraud issues such as telemarketing. Our shared objective is to foster enhanced collaboration between the justice, health, aging and human services networks.

AoA is developing a partnership with the Health Resources and Services Administration (HRSA) Bureau of Health Professions, Division of Nursing, to initiate a demonstration program to train nurses specifically to work with, educate and mentor caregivers. Although nurses are well trained in acute care for older persons, there is little or no preparatory training for follow-up care and continuing care of chronic conditions.

During FY 2001, AoA played a major role in advancing HHS’s initiative to help States implement the Supreme Court’s Olmstead decision. AoA joined the Department’s internal Olmstead work group comprised of CMS, OCR, ASPE, SAMHSA, and ADD and assisted in developing the Real Choice Systems Change Grants which will provide states with $70 million dollars to make their systems of long-term care more consumer directed and focused on home and community-based care. As part of this initiative, AoA worked with State units on aging to make sure the interests of the elderly were reflected in state planning efforts related to the System Change Grants. Finally, AoA co-sponsored a national conference on Consumer Direction in Long-Term Care in collaboration with ASPE, CMS, SAMHSA, ADD, and the Robert Wood Johnson Foundation.

1.4 Performance Report Summary

The following performance report summary updates that presented in the final performance plan for FY 2002. The most significant advancement in performance reporting for this report is that it includes final FY 1999 data earlier than originally anticipated, and preliminary data for FY 2000. AoA and State agencies have initiated the process of certification for FY 2000 data. The following chart illustrates the status of AoA reporting of performance measures included in previous performance plans.

The data for the performance measures identified throughout this plan present a story of performance indicating that the network produces the results intended by the Older Americans Act (OAA). The data for each of the four years show that the aging network successfully identified vulnerable elderly individuals, including the poor, minorities, and individuals from rural areas. Each year, the network leveraged funding from other sources in amounts that were 50% higher than the funding provided by AoA. The data presented throughout this plan and report show that the services financed with the funds leveraged from other sources are those services which allow vulnerable older individuals to remain in the community, in their homes. The data show a network that fosters extensive participation of volunteers, even in the local entities that help to administer the OAA programs. The data reflect that the aging network works systematically to improve service coordination, as demonstrated particularly by the high percentage of senior centers, which are “focal points” for community services.

Introduction — Budget Linkage

The core of GPRA planning and reporting is the presentation of performance measures that address the results that AoA and aging network produce with the program resources entrusted to them. There is a strong and intentional linkage between the presentation of program activities in this plan and the presentation of the AoA budget request. The performance measures that AoA presents were developed to cover the entirety of its program activities, and are intended, therefore, to support the entire budget request of the agency. AoA’s performance plan is not limited to measures associated with the incremental portion of the AoA budget.

The linkage of the AoA budget and performance plan is stronger than the routine justification of the total resources required for OAA program activities. The results that AoA reported in its last performance report were considered in the process of identifying budget initiatives for FY 2003, and the data presented in that and this report support the AoA budget initiatives that HHS has submitted to OMB in the FY 2003 budget.

• The data presented under targeting measures that document the effectiveness of the aging network in targeting services to vulnerable individuals are relevant to and support the AoA initiatives to enhance our support of the aging network.
• The data under system measures that indicate that the network is increasingly leveraging funds from sources other than AoA, especially for services targeted to the most vulnerable elderly individuals, support maintenance of AoA service funding.
• The data under systems measures and the measures for the Medicare Senior Patrols program, that document the reliance of the network on cost-effective volunteers, support the Agency’s initiatives to enhance our volunteer utilization efforts, especially in support of the caregiver program.
• The preliminary pilot-test data under outcomes measures that document the limited availability of services in support of family caregivers reinforce the Agency’s efforts to ensure adequate funding for the family caregiver program.

The AoA program categories identified for GPRA presentation purposes, with the budget line items they comprise are:

• Community-Based Services
  • Budget line items:
    • Supportive Services and Centers
    • Congregate Meals
    • Home-Delivered Meals
    • Preventive Health Services
    • National Family Caregiver Support Program (NFCSP)
• Vulnerable Older Americans
  • Budget line item:
    • Ombudsman Services
    • Prevention of Elder Abuse
• Native American Services
  • Budget line item:
    • Grants to Indian Tribes
• Research and Development
  • Budget line items:
    • Training, Research and Discretionary Projects
    • Alzheimer’s Disease Demonstration Grants to States
    • Aging Network Support Activities
• Senior Medicare Patrols
  • Senior Medicare Patrols (HCFAC)
• Program Management
  • Budget line item:
    • Program Administration

2.1 COMMUNITY-BASED SERVICES

Program Description and Context

(numbers in thousands)	FY 2000 Enacted	2001 Enacted	FY 2002 Enacted	FY 2003 President’s Budget
Community Based Services	$847,446	$1,149,512	$1,233,841	$1,236,286

The Community-Based Services program comprises AoA’s budget line items for programs administered by State and community agencies, with the exception of the Protection of Vulnerable Americans line, which we have elected to show separately for GPRA purposes. Beginning in FY 2001, this line item also included the National Family Caregiver Support Program. This performance plan identifies the first developmental performance measures to be used to assess performance for this new program activity.

State agencies on aging are allocated funds for State and community programs based on formulas that reflect the number of older residents in their State. AoA, other Federal, and outside source funds are used by State and area agencies on aging and service providers to coordinate and to provide services for elderly individuals.

The Community-Based Services program covers the bulk of the resources, services and activities of AoA and the aging network. The program provides “access” services, such as information and assistance, outreach, and transportation. The program covers “community” services, which include congregate meals, senior-center activities, adult day care, pension counseling, and health promotion and fitness programs. The program provides “in-home” services, including home-delivered meals, chores, home maintenance assistance, home-health, and personal care. Beginning in FY 2001, the program includes “caregiver” support, such as respite services and information and assistance to caregivers for the coordination of health and social services.

Goal-by-Goal Presentation of Performance

Building on the improvements instituted in AoA’s FY 2002 plan, this performance plan includes the following types of performance measures for community-based programs:

• Intermediate outcome targeting measures.  Does the network target services to vulnerable elderly individuals?
• Intermediate outcome system measures.  What do the State and local components of the network contribute to the elderly in the way of resources, coordination, and emphasis on the most vulnerable?
• Service output measures.  What level of services will the network provide to elderly individuals each year for meals, transportation, etc.?
• End outcome measures.  From the perspective of elderly consumers and their caregivers, what results do AoA and the network produce for the elderly?

Performance Measures Table—Intermediate Outcome Targeting Measures (Part 1)

Performance Measures Table—Intermediate Outcome Targeting Measures (Part 2)

(Note: The targeting measures are presented in two tables for ease in presentation.)

Performance Measures Analysis—Intermediate Outcome Targeting Measures

The OAA seeks to ensure and to support the well-being of elderly Americans, particularly those who are most vulnerable, including the poor, minorities, disabled, and the elderly in rural areas. It is not enough that the network provide services; the network must reach out to and serve the most vulnerable among the elderly.

AoA has identified a set of targeting measures to track the effectiveness of the network in meeting the intent of the OAA to serve vulnerable elderly individuals, and to target measurable improvements where appropriate. AoA and the network are also focusing on targeting services to caregivers to ensure the successful implementation of the new program.

To demonstrate that the network is targeting services to vulnerable individuals, data should show that the percentage of clients who are poor, disabled, minorities and those in rural areas is significantly higher than the percentage of all elderly persons who fit these characteristics.  This year, AoA has made two additional improvements to its targeting measures. First, AoA has made the performance targets for the targeting measures more rigorous for FY 2003. Second, the plan for FY 2003 includes three new measures to foster improved performance by committing to increase the percent of poor, rural, and disabled served by five program entities (States or Territories) that currently perform below the national average. To accommodate this increase in measures, AoA has deleted a developmental poverty measure that effectively duplicated the targeting measure introduced last year.

Results for Intermediate Outcome Targeting Measures

For the measures introduced in the FY 2002 performance plan, the tables above indicate that the aging network effectively targets services to the vulnerable elderly individuals in the Nation.

• Poverty Targeting Measures: In each year over 30% of aging network clients were poor. As figure 1 indicates, the percent poor among OAA clients substantially exceeds the percent poor for all elderly individuals (60 and over) in the U.S. Performance has declined in recent years—a trend that AoA is working to reverse.
  
  
  
• Rural Targeting Measure: One-third of OAA program participants in FY 1999 lived in rural areas, compared to less than one-quarter for the total population age 60 and above for 1998, the most recent year for which national estimates are available.
  
  
  
  
• Minority Targeting Measure:  Although the percent of OAA clients who were minorities was higher in all three years than the total percent of all elderly minority individuals, the portion of AoA minority clients has been decreasing in recent years. Figure 2 illustrates this characteristic of the OAA client population for fiscal years 1997 through 1999. Again, AoA is committed to increasing minority participation in future years.
  
  
• Disability Targeting Measure: Disability data for 42 entities show that a very high percentage of clients receiving home delivered meals have limitations in Activities of Daily Living (ADL’s) and in Instrumental Activities of Daily Living (IADL’s). This data indicates that reporting entities as a whole are successfully targeting services to disabled elderly individuals.
  
  
• Senior Elders Targeting Measure: Data on age categories for 42 states show that a high percentage of clients receiving registered services are aged seventy-five and above. This data indicates that reporting entities as a whole are successfully targeting registered services to elderly individuals aged seventy-five and above. For the 42 States reporting detailed client characteristics in FY 1999, over 60% of elderly clients were aged seventy-five and above.
  
  
• Caregiver Targeting Measure: The caregiver program was implemented in FY 2001. The Network has no results data to report thus far.

Goals and Targets

Performance targets for FY 2003 are based on the past and current performance of the network as reflected in the tables above. Because of the overall performance of the network in targeting services to vulnerable elderly individuals, at a minimum, AoA seeks to maintain performance at or near the levels established as national performance targets over the last few years. The national targets for FY 2003 for serving poor, minority and rural clients have been increased to reflect that intention

In its commitment to continuously improve program performance where it is needed, AoA is proposing to improve performance for primary service entities that do not perform at the national average for targeting services. To reflect AoA’s commitment to its targeting outcome measures, beginning with the FY 2003 performance plan, AoA proposes to improve performance in five primary service entities for which client service ratios are below national or multi-State service ratios for poverty, rural residence, disability status, and service to senior elders. 

AoA’s initial targeting measure for the National Family Caregiver Support Program reflects that this is a new program. The ratio presented in the table above will serve as an initial indicator of impact. We expect initially that the ratio of supported caregivers to registered elderly clients will be very low, probably far less than one caregiver to twenty registered clients. To demonstrate that the program is having an impact, even in the early years, this ratio should increase over time.

Performance Measures Summary Table— Intermediate Outcome System Measures (Part 1)

Performance Measures Summary Table—Intermediate Outcome System Measures (Part 2)

Performance Measures Analysis— Intermediate Outcome System Measures

Intermediate Outcome System measures data should show that: (1) there is a significant contribution above and beyond funding provided by AoA ; (2) there is a strong degree of coordination of services provided through the network; and (3) the network is community oriented and makes use of community resources.

One of the most significant intermediate outcomes for AoA is the effectiveness of the aging network to advocate, coordinate, and support services for elderly individuals in communities across the nation. AoA uses the intermediate outcome “system” measures related to the following network characteristics to track the effectiveness of Federal, State, area agencies on aging and community-service providers in serving, and advocating for, vulnerable elderly individuals:

• Funding leveraged by network entities,
• Program income and voluntary contributions generated by network entities,
• Senior centers as community focal points, and
• Volunteer staffing among local governmental entities.

AoA has made two significant improvements to its intermediate outcome systems measures. First, AoA has made the performance targets for the measures more rigorous for FY 2003. Second, the plan for FY 2003 includes two new measures to foster improved performance by committing to increase leveraged funding and program income performance for five program entities (States or Territories) that perform below the national average.

For the National Family Caregiver Support Program, our initial objective for the “system” is to develop a well-rounded program that serves the various needs of caregivers as envisioned by the OAA. The developmental measure identified above will address the extent to which State agencies develop comprehensive caregiver programs that provide the variety of services required by the OAA.

Results for Intermediate Outcome Systems Measures

The data reported above for AoA’s intermediate outcome system measures demonstrate the following:

1. The funds “leveraged” by the aging network are significant in total.



2. The leveraged funds substantially exceed the funding provided by AoA for home and community services to the elderly, particularly the most vulnerable.



3. The network does not rely solely on funds provided by other sources, but every year generates a significant amount of revenue, which is put back into the program for services.



4. The network is characterized by a strong community orientation, in which senior centers are not only places where elderly individuals receive services, but are places where services for the elderly are organized and coordinated.



5. The network is committed to local solutions and resources in support of the elderly, as reflected in data that show that almost 50% of area agency staff are volunteers.

In the above table, data is reported for multiple years. There is some variation in these reported numbers from year to year. This, however, does not represent a significant variation. The data indicates that the network has been successful in maintaining performance at a high level for each of the measures.

The following are systems measures performance highlights for fiscal years 1997 through 1999.

• Leveraged Funding Measures: For all three years reported, FY 1997 through FY 1999, funds leveraged by State and local agencies exceeded funds provided by AoA by more than 50% (See figure 3 below). 
  
  
  



• In each of the three fiscal years from 1997 to 1999, approximately three-quarters of the funding that supported personal care, home-delivered meals, and adult day care combined, came from sources other than AoA.



• Program Income Measure: Data for all three fiscal years indicate that revenue generated by the aging network (e.g., voluntary contributions for meals) is a significant funding source, representing approximately one-third of the amount provided by AoA each year.



• Senior Center Focal Point Measure: For FY 1997 through FY 1999, over half of all senior centers participating in the program were community-service “focal points.”



• Area Agency Volunteer Measure: The percentage of the staff of area agencies on aging that is made up of volunteers was between 40 and 50 percent in FYs 1997, 1998 and 1999.



• Caregiver Measure: For the National Family Caregiver Support Program, our initial objective for the “system” is to develop a well-rounded program that serves the various needs of caregivers as envisioned by the OAA. The developmental measure identified above will address the extent to which State agencies develop comprehensive caregiver programs that provide the variety of services required by the OAA.

To comply with GPRA requirements, the table above continues to present data for three discontinued measures that appeared in the AoA performance plan for FY 2000. Consistent with the guidelines on reporting analysis provided in A-11, part 2, AoA met its FY 2000 targets for information and assistance, substantially met the target for case management services, and preliminary data indicate that AoA did not meet its target for transportation. AoA discontinued these measures in favor of the more relevant and informative measures discussed above.

Goals and Targets

Performance targets for FY 2003 are based on the past and current performance of the network as reflected in the tables above. Because of the outstanding overall performance of the network for all of the defined intermediate outcome systems measures, AoA seeks to maintain performance at or near the levels established as national performance targets over the last few years. The national targets for FY 2003 for leveraging funds, program income, focal points and area agency volunteers have been increased to reflect that intention. 

AoA is committed to continuously improve program performance where it is needed. To reflect this commitment for its systems outcome measures, beginning with the FY 2003 performance plan, AoA proposes to improve performance in five primary service entities for which client service ratios are below national or multi-State service ratios for leveraged funding and program income.

Performance Measures Summary Table—Service Measures  (Part 1)

Performance Measures Summary Table—Service Measures  (Part 2)

Service Output Measures

The measures in this section of the plan are output measures that provide a basis for the fundamental tracking of the level of services that AoA and the other components of the network provide. Rather than encumber the plan with extensive counts for a variety of services, AoA will continue to report on major service categories identified in the table above, with the view that they are representative of AoA funded activity.

For FY 2003, AoA has added a developmental measure for the National Family Caregiver Support Program, which is consistent with the expectations of the Congress for the new program. Primarily, it is the objective of the program to reach out to caregivers. Thus, initially it is more relevant for AoA to identify the number of individuals served, rather than the units of service provided. In addition, AoA and the network must identify consistent definitions of service units prior to establishing measures of such units.

Service output data should show that over time performance outputs are consistent with the level of resources provided by AoA and the anticipated level of resources provided by other network entities.

Results for Service Output Measures

The preliminary data for FY 2000 indicate that AoA met service performance targets for one of the four output measures included in the FY 2000 annual performance plan. The data suggest that AoA and the network met the output levels targeted for congregate meals, but not for home-delivered meals, transportation, and information and assistance.

However, AoA is not prepared to conclude that output performance by the network is problematic on the basis of preliminary data.  AoA is not prepared to conclude that output performance by the Network is problematic for the following reasons: (1) the data is preliminary and preliminary data are subject to some understatement of service units because of under-reporting of some local entities across the country; (2) there was no basis for AoA to expect that States would match, in the same year, the increase that AoA provided in FY 2000 for home-delivered meals; and (3) AoA should not have expected the full increase in the number of home-delivered meals in one year (FY 2000) given that State and local entities have two years to expend funds.   The data for FY 2000 are undergoing State and Federal verification procedures. When final data are certified, we believe that performance for information and assistance may meet the target, and that performance for transportation services will be closer to the target than the preliminary data indicate.

• Home Delivered Meals Output Measures: We do not believe that the final data will reflect that AoA met the FY 2000 target for home-delivered meals, but the data will reflect a significant increase in the number of home-delivered meals provided in FY 2000.  The failure to meet the targeted result will reflect more the difficulty of accurately targeting the number of meals that will be served than performance expectations.  In the FY 2000 performance plan, AoA projected an over 30 percent increase in the number of home-delivered meals, consistent with the increase in Federal funding from FY 1999 to FY 2000 for home-delivered meals.  However, AoA funding for home-delivered meals is only 30% of the total provided for this service.  On analysis, we are likely to find that it was not accurate to assume that: 1) all entities could match the Federal increase for one service category in the same fiscal year; and 2) that ongoing cost increases would not have any effect on the level of services provided
• Congregate Meals Output Measure: Preliminary FY 2000 data indicate that the network exceeded its targets for congregate meals.  We consider that this will be maintained when the FY 2000 data are finalized.  In fact, the trend data in the table above indicate that output for congregate meals over the reported years is steady and consistent with stable funding.
• Transportation Output Measure: When final data are certified for FY 2000, the level of output performance for transportation service will be closer to but may not meet the FY 2000 target.  AoA overstated the FY 2000 target when it based the target solely on data for FY 1997.  In fact, when certified data are available, we believe that it will show that service output for transportation has also been stable over the last four years consistent with stable funding.
• Information and Assistance Output Measures: When final data for FY 2000 are certified, the level of output performance for information and assistance will be closer to but may not meet the FY 2000 target.  AoA overestimated the FY 2000 target when we established the target based solely on data from FY 1997.  Moreover, once the certified FY 2000 data is available, we believe that it will demonstrate that service output for information and assistance has also been stable over the last four years consistent with stable funding.
• Caregiver Output Measure: The caregiver program was implemented in FY 2001.  The network has no output measures to report thus far.

Goals and Targets for Service Output Measures

Performance targets for FY 2003 are based on the past and current performance of the Network as reflected in the tables above. Because the FY 2000 data are preliminary, and because AoA’s performance for FY 1999 was not out of line with performance targets, AoA will not propose to reduce the performance targets for its service output measures at this time. However, AoA also believes that it would be unrealistic to raise the service output targets any further until we have taken the opportunity to assess the processes used to project service levels for the program. Within the next year, AoA will reassess the methods that were used to develop these performance targets, and will ensure that future targets are better linked to projected resource changes. AoA will retain what it now believes are very high targets for both FY 2001 and 2002, and will project for FY 2003 that services will be maintained at the currently projected FY 2002 levels. This is consistent with the maintenance of Federal funding for these activities at the FY 2002 levels in the President’s Budget.

Performance Measures Summary Table—Client and Program Outcome Measures

Performance Measures Analysis—Client and Program Outcome Measures

IMPORTANT NOTICE: The Administration on Aging has entered into a contract with WESTAT, Inc. to conduct national performance outcome measures surveys for the following services in FY 2002: nutrition, transportation, home care, caregiver support, and information and assistance. This commitment, the summary table above, and the analysis that follows, constitute AoA’s response to the requirements of the Older Americans Act for the development of performance outcome measures for OAA programs. The surveys to be conducted this fiscal year will allow AoA and the network to begin the projection of national performance outcomes in the next AoA GPRA performance plan. 

The end outcome measures that are currently being developed will identify from the consumer perspective that network programs meet the needs of elderly individuals. It is AoA’s intention to begin to collect data through a National survey to demonstrate the following:

Nutrition Services:

• The extent to which the aging network targets services to elderly individuals at high nutritional risk.
• The extent to which nutritional risk is improved as a result of OAA meals programs.
• The level of disability for elderly participants in home-delivered meals programs.
• Overall consumer satisfaction with meals programs provided through the network.

Transportation Services:

• Impact of services on satisfying the needs of elderly individuals for transportation associated with medical visits and other essential needs.
• Adequacy of transportation services in terms of frequency, safety, comfort and reliability.
• Overall consumer satisfaction with transportation services.

Information and Assistance:

• Quality and timeliness of responses to consumer requests for information and assistance.
• The level of “human” response to consumer inquiries (calls).
• Overall consumer satisfaction with information and assistance services.
• The level of follow-up on consumer information requests.

Home Care Services:

• Overall consumer satisfaction with components of home care services such as personal care, home delivered meals, case management, and adult day care services.
• Establishment of a baseline for network entity comparisons on home care satisfaction.

Caregiver Support Services:

• Ability of the network to increase availability of caregiver services
• Caregiver assessment of impact of services to clients and caregivers on the ability of the client to remain independent at home and in the community.
• Caregiver assessment of network programs ability to reduce caregiver burden.

In partnership with the National Association of State Units on Aging and the National Association of Area Agencies on Aging, AoA continues the Performance Outcome Measures Project (POMP) to develop and field-test outcome measures suitable for ongoing use in assessing community-based services in support of elderly individuals. To measure performance outcomes, the aging network participants in the POMP, with technical guidance and financial support provided by AoA, have adopted a consumer-based, quality assessment approach, which is focused on local service-delivery activities. Through its contract with WESTAT, Inc., AoA has arranged for known researchers from the Scripps Gerontology Center, Boston University, and Florida International University, to participate extensively in the design and application of measurement instruments, and in the analysis of performance data.

In the past year, AoA and its partners in the POMP have developed survey instruments, implemented sampling procedures, and completed pilot surveys in the following program domains:

• nutritional status and risk (along with physical and social functioning and emotional well-being),
• transportation services satisfaction,
• home-care services satisfaction,
• caregiver support and satisfaction, and
• information and assistance satisfaction.  

Area agencies in 20 States have participated in the activities of the POMP, and initial data are available and presented here for four of the domains cited above. A significant aspect of the POMP, as it relates to the long-term potential of the aging network to assess program results through performance measures, is that local entities have taken the lead in developing the performance measurement instruments, in selecting the statistical samples for information gathering, and in administering the survey instruments to obtain the assessment data for their areas.

Because the initial focus of the POMP is on the usefulness of outcome measures for local program assessment, it should be noted that the data collected and the findings summarized here cannot be generalized beyond the program entities that participated in the pilots. The data referenced here are “test” data, and should not be viewed as definitive of program conditions. As planned, the results of these pilots have assisted AoA in preparing for the national survey of outcome measures. The data collection instruments, sampling procedures and methods, and information collection processes and procedures were all new and untested. As a result, the data presented as measures in the table above are illustrative of the types of measures that AoA and its partners are testing under the POMP.

Next Steps—National Data to Be Collected in FY 2002

AoA is committed to employ the performance outcome measures on a national basis as soon as possible. Satisfied that the instruments tested will yield performance data that will speak to important program results, AoA will conduct a national survey in FY 2002 utilizing elements of the performance measurement instruments tested under the outcome measures project. As reflected in the performance measures table presented above, AoA believes it is important to establish performance outcome baselines in the following areas as soon as possible: nutrition, transportation, caregiver, information and assistance, and homecare.

Results for Outcome Measures (Illustrative)

With the understanding that we cannot make definitive conclusions about service results on the basis of these data, we believe that the initial findings of the pilots are informative for purposes of moving forward in selecting more permanent measures, and seek to share results relative to that objective:

• Nutrition Measures:  The Nutritional Screening Initiative (NSI) and the Nutritional Risk (NR) surveys conducted for both home delivered meals and congregate meals begin to assess the level of nutritional risk of clients.  The data collected assisted AoA in processing performance measurements in two major categories.  First, the data received in the pilot surveys indicates that the information collection will serve as a targeting measure of AoA ability to reach individuals at high nutritional risk.   Test data for new OAA clients for home-delivered meals (HDM) indicate that 77% of surveyed clients are at high nutritional risk.   Second, and more significantly, the survey instrument, combined with existing program data, may allow us to provide a broad indicator of improvement in nutritional risk scores. 
  
  
• Transportation Measures:  Overall, the results were outstanding for the AoA-sponsored transportation services.  Respondents to the pilot surveys on transportation services reported a high degree of satisfaction with the services (82% rated them very good or better) and 90% reported that they felt safe and that the drivers were always polite. The pilot transportation surveys also provided information that will support program improvements, including the following:
  1. major trip purposes include doctor and other medical appointments, shopping, and visits to senior centers;
  2. the most recommended improvement was longer hours of service to better accommodate medical appointments; and
  3. one-fifth of the respondents depended entirely on the service for their transportation needs, and 60% reported they were able to move about more than before.
  
  
  
• Information and Assistance:  As the table above indicates, 95% of information and assistance clients surveyed reported their call was answered quickly, and 90% reported that they spoke to a person, not a machine. A large percentage of the clients interviewed (75%) were first-time callers.  The same percentage reported that they were provided the names of other places to call, and follow-up interviews indicated that two-thirds of these individuals made the necessary follow-up calls.  Eighty-percent of the individuals interviewed said they would recommend the service of their friends.

  Ninety-four percent of the clients who left messages had their call returned the same day, and over 82% of all clients said that they felt comfortable with the person they had spoken to.  The preliminary tabulations, which totaled 543 interviews, have shown positive results thus far in examining the perspective of older consumers regarding Ao