The Aging Network

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:

As a summary, the following data elements required to be reported in FY95-FY96 must continue to be reported in FY97 and subsequent years:

• Estimate of the total unduplicated clients served through Title III;

• Unduplicated number of providers (and minority providers) for fourteen listed services;

• Unduplicated number of AAAs directly providing each of the fourteen listed services;

• Unduplicated number of persons estimated to have been served for each of nine listed services;

• Number of service units for each of fourteen listed services;

• Title III expenditures and related program income by service and part;

• Title VII expenditures;

• Developmental accomplishments -- home and community based programs and elder rights;

• Focal point/senior center profile data; and,

• SUA and AAA staffing profile data

For FY 97, AoA is adding as a required submission the following data elements:

• Unduplicated client counts broken down for registered services versus services which did not require registration (See SPR Section I)

• Unduplicated client counts across the nine services requiring client registration

• Client characteristics associated with the unduplicated client counts for registered versus services which did not require registration (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.)

USDA Subsidized Meals -- Data on OAA Section 311 USDA subsidized meals are to be reported, even if no Title III-C funds are part of the meal.

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.

Data Completeness -- All data fields are to be filled by a positive value or a zero. Do not leave blanks.

Client Refusals -- If a prospective or active client refuses to provide requested client registration information, simply note that the client refused to provide the information. Refusal to provide the requested information should not be used as a basis for denying service to that client.

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 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 Title III 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; 2) an estimate of unduplicated clients receiving cluster 3: specified, non registered services and other non-registered services supported by Title III funds; 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 unduplicated client count entered in line 1 is the same as the unduplicated client count, across the nine registered services, documented in Section II.A.

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 funds.

Line 3 -- Enter a best estimate of the total unduplicated persons served in the state through OAA supported programs. This estimate should take into account clients who use multiple services. 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 on client characteristics, by registered services and other services, is required beginning in FY97.

[Note: see Appendix I for definitions of the client descriptors used in this section of the SPR.]

Completion of Section II: Utilization Profile

Service 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

Specific guidelines are as follows:

1) Provide utilization data for any of the 14 listed services, for which OAA Title III 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 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, beginning in FY97. 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 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 the likelihood that some provider organizations are likely to provide more than one of the listed 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.] Also provide an unduplicated count of the number of minority providers supported with OAA funding across all fourteen services, taking into account the likelihood that some providers provide more than one of the listed services.

# 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.

Beginning in FY97, 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: This should be the same number as reported as line 1 in Section I.A. Beginning in FY97, 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. This data item is designed to provide an indicator of client turnover for registered services.

Also, provide an unduplicated count of new persons served, across the nine registered services, recognizing that one person might be newly registered for more than one of the 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 in the planning and service area.]

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. As a guide, information on clients served should be kept for up to four prior years. Clients who have been inactive for more than four years could be purged from the client master file. Should any of these clients reregister for a program/service, they will be considered a new client.

# 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, states are encouraged to use the Nutrition Screening Checklist. States may adopt a nutrition screening instrument other than the Nutrition Screening Checklist as long as the state retains the capacity to identify participants at high nutrition risk, consistent with the core definition of high nutritional risk adopted by AoA, the elements (questions) of the Checklist and scoring logic of the Checklist. High nutritional risk is defined as a score of 6 or higher using the Checklist. See Appendix III for the Checklist and the scoring of nutritional risk status.

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. Include meals provided to volunteers]

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. This section is requ;ired to be submitted beginning in FY97.

The profile of clients in Section II.B. 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 status
• Live alone status
• 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 profile of registered clients.

2. For each cluster 1 service, identify how many persons in each of five racial/ethnic groups were served:

• African American
• Hispanic Origin
• American Indian/Native Alaskan
• Asian/Pacific Islander
• Non-Minority

plus ....

• Race/Ethnicity Missing Category

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 racial/ethnic group a count of total clients served in the registered service. Client data for individual services are subdivided into 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 activity of daily living (ADL) status; then document how many persons in each age/ADL sub-group have no impairments in instrumental activities of daily living (IADLS), 1 IADL, 2 IADLs etc., how many persons were female or male, how many live in rural areas and how many live alone.

Beginning in FY97, AoA is providing a definition of ADL and IADL status to be used as a basis for SPR reporting. See Appendix I for the definitions. States are not expected to adopt these definitions in their own assessment/screening protocols, if they have another definition which is compatible with the AoA definition. Compatability means the following:

a) The categories of impairment used by the state include all those defined in the AoA definition. States may use additional categories or categories with similar names/meanings

b) The AoA categories of impairment must be able to be isolated and a count of impairments determined using just the AoA defined categories of impairment.

c) States must be able to report impairment levels based on classifying a person's impairment status in yes or no terms for each impairment category (i.e. bathing, dressing etc.). States will have the flexibility to develop their own ways of classifying the level of impairment on each ADL and IADL category, so long as the reporting system can, for reporting purposes, distinguish between those who can and cannot perform the ADL or IADL.

Beginning in FY97, AoA is providing a definition of rural to be used as a basis for SPR reporting. See Appendix I for the definition of rural.

[Note: Any persons served by the program that are under age 60 should be reported in the SPR in the "Age 64 and Under" group. Persons served under age 60 applies only to congregate and home delivered meals clients who are spouses of an eligible client, disabled persons who reside in housing facilities occupied primarily by older individuals at which congregate nutrition services are provided and individuals with disabilities who reside at home with and accompany older individuals who are eligible under Title III of the Act. Do not include volunteers receiving meals in the count of clients.]

Remember, a separate record is prepared for each race/ethnicity group served for each of the six services.

5. Document missing data. Indicate for each client data element how many client records, by race/ethnicity 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 broken down into two categories, Total Clients and Total Clients In Poverty.

In the transmittal file 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 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 III 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 submitted for Title III Parts without an appropriation. 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.]

% of Total Service Expenditure -- Indicate the percent of total service expenditures represented by or attributable to OAA Title III federal funding. While total service expenditures are not reported, this total must be calculated in order to derive the % of total service expenditures which are Title III. AoA will calculate the total service expenditures based on the % of total expenditures reported by the state unit on aging.

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 considered. 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.

When determining total service expenditure, include, also, funding which is administered by the SUA or AAA which provides the same service with the same service standards as Title III (even if the funding is not in the same contract as the Title III funds).

Total Program Income -- Enter the estimate of total program income derived as a result of service provision. Do not confuse total program income with total service expenditure. See Appendix II for a definition of program income.

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. 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 submit any expenditure data for Chapter 4..]

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 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 a 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 for 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. Single PSA states should not provide any AAA staffing data, as if the state unit were acting as an 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.

Do include ombudsman information in this Section. Ombudsman program staff who work directly for the state and area agency and any ombudsman volunteers who work for ombudsman programs located in and/or directly sponsored by the area agency should be included in the Staffing Profile. Include the same data in the Staffing Profile of the Ombudsman Report. While the data are similar, the sets of information in the two reports serve two different purposes.

For the SPR, count ombudsman staff FTEs under the functional responsibility category which best describes the function they perform for the ombudsman program. Staff or volunteers who work for agencies under contract or grant by the area agency should not be included in the Staffing Profile of the SPR.

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. FTE estimates can reflect fractions of an employee's time spent over a year in various activities which can then be aggregated in the appropriate categories specified in the SPR. The estimates may be made by supervisors familiar with employee work activities for the year. AoA does not expect State and Area Agencies on Aging to implement additional work measurement or record keeping to estimate the FTEs. A sincere effort by supervisors to describe the allocation of their employee's work activities to the categories provided will meet the intent of this requirement of the OAA and provide useful information.

[Note, full time equivalents (FTEs) should be based on a state definition of what constitutes a full time employee. As an additional point of clarification, information systems activities should be included under "administration". ]

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.

6. Include volunteers in the count of Total SUA staff on line 5.

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.

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. Impairments in Activities of Daily Living -- Beginning with FY97 AoA is introducing a definition for ADL impairments which reflects AoA analysis and testing in FY95 and FY96. The definition of ADL impairment to be implemented in FY97 is as follows: "the inability to perform one or more of the following six activities of daily living without personal assistance, stand-by assistance, supervision or cues: eating, dressing, bathing, toileting, transferring in and out of bed/chair, and walking. "

3. Impairments in Instrumental Activities of Daily Living -- AoA is introducing, effective in FY97, a definition for IADL impairments to be used for OAA reporting purposes. The definition will be: the inability to perform one or more of the following eight instrumental activities of daily living without personal assistance, or stand-by assistance, supervision or cues: preparing meals, shopping for personal items, medication management, managing money, using telephone, doing heavy housework, doing light housework, and transportation ability.

Transportation ability refers to the individual's ability to make use of available transportation.

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 a 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 with the inability to perform with one or more of the following activities of daily living: eating, dressing, bathing, toileting, transferring in and out of bed/chair or walking.

2. Homemaker (1 Hour) -- Providing assistance to persons with the inability to perform 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) 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.

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 day health typically include social and recreational activities, training, counseling, meals for adult day care and services such as rehabilitation, medications assistance and home health aide services for adult day health.

6. Case Management (1 Hour) -- 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 going from one location to another. 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. [Note: this is the only service of the 14 listed services in the SPR where the unit measure (one session) refers to either an individual or group service. In this case, for example, a group of people attending a session on nutrition issues for the elderly would count as one unit of "Nutrition Education".]

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. [Note: states are reminded that the service units for information and assistance refer to individual, one-on-one contacts between an information and assistance provider and an elderly client or a care giver. An activity that involves a contact with several current or potential clients/caregivers (what is considered group services) should not be count as a unit of information and assistance. Group services might be defined as "public education" or a similiar designation which states may adopt and, at the option of the state reported in Section IV. -- Profile of Other Non-Registered Services Supported By Title III (Optional)

14. Outreach (1 Contact) -- Interventions initiated by an agency or organization for the purpose of identifying potential clients (or their care givers) and encouraging their use of existing services and benefits. [Note: states are reminded that the service units for outreach refer to individual, one-on-one contacts between a service provider and an elderly client or care giver. An activity that involves a contact with several current or potential clients/care givers (what is considered group services) should not be counted as a unit of outreach. Group services might be defined as "public education" or a similiar designation which states may adopt and, at the option of the state reported under in Section IV. -- Profile of Other Non-Registered Services Supported By Title III (Optional)

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 homemaker 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 Section 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 or area agency on aging.
• 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 state or area agency the following areas:
• Planning -- Includes such responsibilities as needs assessment, plan development, budgeting/resource analysis, inventory, standards development 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 not for profit organization whose controlling board is comprised of at least 51% minority individuals or a business concern that 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 having 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.
• Program Income -- Gross income received by the grantee or subgrantee directly generated by the grant supported activity, or earned only as a result of the grant agreement during the grant period. [Note: this is the same definition of program income as used in 45 CFR Part 92-Uniform Administrative Requirements for Grants and Cooperative Agreements to State and Local Governments.]
• Rural -- Beginning with FY97, the AoA is introducing a standard definition for rural for purposes of SPR reporting. A rural area is: any area that is not defined as urban. Urban areas comprise (1) urbanized are