DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION ON AGING

**FINAL ANNUAL**

**GPRA PERFORMANCE PLAN FOR**

**FISCAL YEAR 2005**

**and**

**REVISED ANNUAL PERFORMANCE PLAN FOR**

**FISCAL YEAR 2004**

**and**

**ANNUAL PERFORMANCE REPORT FOR**

**FISCAL YEAR 2003**

## 

**February 2004**

**Agency Contacts:** Frank Burns and Sharon Matthews

Office of Evaluation, Administration on Aging

\(202\) 357-3516 and (202) 357-0417

<frank.burns@aoa.gov> and sharon.matthews@aoa.gov

# ***FROM THE ASSISTANT SECRETARY FOR AGING***

The AoA Annual Performance Plan and Report for FY 2005 reflects my
continued commitment to improve the accountability of AoA and its
partners for high quality, effective service to the elderly under the
Older Americans Act (OAA). This plan also represents our efforts to make
significant modifications to AoA's Government Performance and Results
Act (GPRA) as a result of: 1) the availability of new outcome data, 2)
lessons learned from the application of the Office of Management and
Budget's (OMB's) Program Assessment Rating Tool (PART) to AoA's
Community-Based Services Program, and 3) the compelling need of the
Department of Health and Human Services (HHS) to reduce the number of
measures it must track to assess HHS performance.

The first priority of our GPRA plan is to help improve services to
individuals.

-   We help elderly individuals maintain their independence in the
    community by targeting services to the poor, disabled, minorities
    and rural residents. We will work with States and communities to
    improve targeting to these vulnerable groups and measure progress
    yearly.

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-   We must create more balance in the long-term care system by
    intensifying our focus on the cost-effective community care
    preferred by the elderly and their families. AoA will use program
    data in its budget requests to demonstrate that community-based care
    is highly cost effective and valued by elderly Americans and their
    caregivers.

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-   We must improve program efficiency. Working with OMB and HHS, AoA
    has developed efficiency measures to track the efficiency
    improvements of the aging network.

-   Finally, elderly service consumers are in the best position to
    assess the impact of services on their well-being and independence.
    With our new national consumer assessment surveys, we will measure
    and improve consumer assessments of OAA services to the elderly and
    their caregivers over time.

AoA is committed to continuous improvement in measuring program
performance. The significant improvement in OMB's PART assessment of
AoA's community based program to a score of 81 reflects that. However,
in focusing on outcomes, I am most proud of the following results
produced by AoA, states, area agencies and service providers and
presented in this plan and report:

-   86% of family caregivers of OAA clients surveyed by AoA last year
    reported that OAA services allowed them to care longer for the
    elderly than they could without the services. Almost 50% said that
    the service definitely helped them in that way.

-   Approximately 30% of OAA elderly home-delivered meals clients are
    nursing-home eligible because of multiple disabling conditions, but
    are able to remain in the community.

-   The efficiency of the aging network in serving OAA clients, as
    measured by individuals served per million dollars in AoA funding,
    improved each year from 1999 to 2002.

Through his "One HHS" program management initiative, Secretary Tommy
Thompson established consistent accountability among program officials
in HHS, requiring our personal commitment to achieving the performance
outcomes we have included in our performance plans under the Government
Performance and Results Act. Through this plan, I am fully committed to
effective program results for all older Americans.

Josefina G. Carbonell

**EXECUTIVE SUMMARY**

A.  **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 on vulnerable
elderly individuals who are at risk of losing their independence. AoA
seeks to improve the quality of life for all older Americans, by
assisting them to remain independent. AoA works closely with an aging
services network of State and local entities to plan, coordinate and
develop home and community-based systems of services that meet the
unique needs of older persons and their families.

The Older Americans Act, as reauthorized in 2000 for five years, enables
AoA to be the Federal focal point for older persons. AoA is mandated by
Congress to provide essential home and community-based programs, across
the country, that help to keep America's rapidly growing older
population healthy, secure and independent. The Act 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.

Last year, AoA developed a new strategic plan with quantifiable
performance measures that will serve as the agency's road map to foster
accountability for the elderly over the next five years and beyond. The
mission of AoA is to promote the dignity and independence of older
Americans and to help society prepare for an aging population. The
Strategic Plan includes five Strategic Goals:

-   Increase the number of older people who have access to an integrated
    array of health and home and community-based services.

-   Increase the number of older people who stay active and healthy.

-   Increase the number of families who receive help in their efforts to
    care for their loved ones at home and in the community.

-   Increase the number of older people who benefit from programs that
    protect their rights and prevent elder abuse, neglect and
    exploitation.

-   Strengthen the effectiveness and responsiveness of AoA's management
    practices.

To track accomplishments relative to these prioritized goals, AoA uses a
core set of quantifiable performance measures, including 1) efficiency
measures, 2) consumer assessment measures, and 3) targeting measures.
Selected measures are presented below to illustrate AoA's commitment to
track the achievement of long-term priorities.

> ***1. Improve Targeting of Older Americans Act services to Vulnerable
> Elders.***
>
> **Indicators:**

-   By FY 2007, AoA will increase the percentage of Older Americans Act
    clients who live in rural areas to 38% of all clients.

-   By 2010, all States will achieve a "targeting index" greater than
    1.0 for rural and poverty clients.

> Those who are frail, poor, and lack adequate access to care are at the
> greatest risk of institutionalization and loss of independence. AoA's
> measures for this goal recognize: 1) the increased risk the rural
> elderly face and the importance of the HHS initiative to reduce major
> threats to health and well-being of Americans, 2) the need for all
> States to target services to those who are at the greatest risk.
>
> ***2. Improve Program Efficiency.***
>
> **Indicators:**

-   By FY 2007, the rate of non-AoA funding for OAA services will
    increase by 20%.

-   By FY 2007, AoA will increase the number of people served per
    million dollars of AoA community based services program funding by
    15%.

> In the face of a rising elderly population and scarce service
> resources, the integration and coordination of funding and service
> provision for elderly who need care is an essential element of program
> quality. This goal and these measures support Departmental initiatives
> and foster continued efficiency improvement by AoA and State and local
> entities.
>
> ***3. Improve Client Assessments and Results***
>
> **Indicators:**

-   By FY 2007, increase the percentage of elderly individuals served by
    > Older Americans Act (OAA) programs to 17% of the elderly
    > population.

-   By 2007, 30% fewer caregivers will report that they needed help in
    > dealing with agencies or obtaining services.

-   By 2007, 75% of caregivers will report that OAA services have
    > ***definitely*** helped them provide care for a longer period.

> The community-based services of the Older Americans Act programs,
> provided significantly by family members and volunteers, are a
> cost-effective alternative to institutionalization. Serving a greater
> percentage of the elderly population and their caregivers and reducing
> the barriers caregivers confront in accessing care are fundamental
> measures of impact and outreach.

AoA also participates in the development of the strategic goals and
objectives of the Department of Health and Human Services (HHS) each
year. AoA program activities and strategies will continue to support the
achievement of HHS goals and objectives, and AoA program performance
measurement efforts will support HHS efforts to assess the progress of
the Department in achieving the goals and objectives of the HHS
Strategic Plan. The detailed roadmap of linkages of AoA goals and
activities with the HHS Strategic Plan are presented in Appendix 1 of
this plan.

**B. Organization, Programs, Operations, Strategies and Resources**

The Administration on Aging provides leadership, coordination and
support to the aging services 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.

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.
A total of 655 area agencies on aging (AAAs) receive OAA funds from the
States. Area agencies contract with approximately 29,000 public or
private providers in local areas. AoA awards funds directly to 241
Indian tribal organizations and two 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 services network.

The national aging services 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 services 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 services network
provide a preferred alternative to nursing home care, enabling people to
live as independently as possible for as long as possible.

C. Overview of Plan and Performance Report

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).

1.  **Summary of Measures --** The performance plan for FY 2005 reflects
    significant substantive and technical improvements sought by HHS and
    OMB, including:

    -   Significantly reduced the number of goals/measures in the plan;

    -   Significantly increased outcome measures as a percent of total
        measures;

    -   **Added efficiency measures for all program;**

    -   **Added new consumer assessment outcome measures;**

    -   **Introduced aggressive long-term performance goals;** and

    -   Used performance data to support the agency's budget
        justification for FY 2005.

Throughout the plan, we identify the performance results and targets
that have contributed to AoA's FY 2005 budget justification. For
example, the new outcome measures will assess the aging services
network's results in response to the Administration's Rebalancing
Initiative, its emphasis on home and community-based long-term care
services, and the Department's efforts to promote service integration.

2.  **Successes, Challenges and Goals in Development --** The data for
    the performance measures identified in this plan present a story of
    performance indicating that the network produces the results
    intended by the Older Americans Act (OAA). The network:

-   Provides services that are instrumental in enabling older persons to
    live as independently as possible.

-   Targets services to vulnerable elderly individuals, including the
    poor, minorities, and individuals from rural areas;

-   Receives very high consumer assessment ratings for the services it
    provides;

-   Leverages funding from other sources in amounts that were almost
    double the funding provided by AoA;

-   Leverages funding for critical in-home and adult-day-care services
    in amounts almost triple the funding provided by AoA; and

-   Improves efficiency, as measured by the increasing number of elders
    served per million dollars of AoA funding from FY 1999 to FY 2002.

3.  **Significant Events Related to Program Performance**

-   ***Initiatives to create more balance in long-term care and better
    integrate community based services.*** Performance data demonstrates
    that OAA programs: 1) serve a significant percentage of the
    vulnerable elderly population in the U.S., 2) provide care at a
    significantly lower cost than institutional programs, and 3) involve
    communities and families more effectively than institutional care.
    These data contributed to the development of an HHS-wide initiative
    to pursue greater balance in long-term care to focus on
    community-based and home care, which is preferred by the elderly.

-   ***Nursing home quality standards.*** Performance data reflecting
    the effectiveness of the Ombudsman program in resolving complaints
    and providing information to nursing home residents contributed to
    an AoA/CMS collaboration to use the Ombudsman program in the
    implementation of the new nursing-home quality standards

4.  **Explanation for Adding/Dropping Measures** -- Consistent with HHS
    and OMB guidance to reduce the number of performance measures, 29
    performance measures were dropped, consolidated or converted to
    efficiency measures.

5.  **Full Cost of Programs and Measures** - The full cost of programs
    in the FY 2005 Performance Plan reflects the allocation of both
    administrative resources and demonstration activities to the program
    areas they support. It includes annual appropriations as well as
    resources from the Medicare trust fund, which are used to support
    health care anti-fraud, waste and abuse activities. It does not
    include accrued liabilities not directly paid by AoA, such as
    employee health benefit and Federal retirement costs. Cost estimates
    for each year reflect changes in the level of appropriations for
    base programs as well as adjustments to reflect new programs and
    activities that were transferred to AoA from other Federal agencies.

**D. Contact Persons**

AoA contacts responsible for the preparation of this plan are Frank
Burns (202-357-3516) and Sharon Matthews (202-357-3417). Cynthia Agens
Bauer (202-357-0145) is responsible for broad aspects of performance
measures development and for PART reviews.

**AoA**

**Performance Plan and Report**

**January 2004**

**TABLE OF CONTENTS**

**AoA Performance Plan and Report**

**PAGE**

**A. Introduction 9**

-   **Agency Mission**

-   **Summary of Measures**

-   **Overview of the Plan and Performance Report**

-   **Special Initiative Linkage**

> **B. DISCUSSION AND PERFORMANCE ANALYSIS 16**
>
> **Section 1: COMMUNITY BASED PROGRAMS 16**

-   **Program Description and Context**

-   **Program Performance Analysis**

> **Section 2: VULNERABLE OLDER AMERICANS 33**

-   **Program Description and Context**

-   **Program Performance Analysis**

> **Section 3: SERVICES FOR NATIVE AMERICANS 36**

-   **Program Description and Context**

-   **Program Performance Analysis**

> **Section 4: SENIOR MEDICARE PATROLS & TECHNICAL 40**
>
> **ASSISTANCE CENTERS**

-   **Program Description and Context**

-   **Program Performance Analysis**

**Section 5: AOA INNOVATIONS AND DEMONSTRATIONS 44**

-   **Program Description and Context**

-   **Program Performance Analysis**

> **Section 6: PROGRAM MANAGEMENT 45**

-   **Program Description and Context**

-   **Program Performance Analysis**

> **c. Appendices to Performance Plan 49**

-   **Linkage to the HHS and Agency Strategic Plans**

###### Changes and Improvements over the Previous Year

###### Partnerships and Coordination

-   **Data Verification, Validation and Other Data Issues**

-   **Summary Full Cost of Performance Program Areas**

# **A. Introduction**

**(1) Mission Statement and Agency Description**

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
vulnerable elderly individuals who are 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
and by supporting their well-being. AoA works closely with an aging
services network of State and local entities to plan, coordinate and
develop home and community-based systems of services that meet the
unique needs of older persons and their families.

The Older Americans Act, as reauthorized in 2000 for five years, enables
AoA to be the Federal focal point to serve older persons. AoA is
mandated by Congress to provide essential home and community-based
programs across the country to help 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.

Last year, AoA developed a new strategic plan that will serve as the
agency's road map to foster accountability for the elderly over the next
five years. The mission of AoA is to promote the dignity and
independence of older Americans and to help society prepare for an aging
population. The Strategic Plan includes five Strategic Goals:

-   Increase the number of older people who have access to an integrated
    array of health and home and community-based services.

-   Increase the number of older people who stay active and healthy.

-   Increase the number of families who receive help in their efforts to
    care for their loved ones at home and in the community.

-   Increase the number of older people who benefit from programs that
    protect their rights and prevent elder abuse, neglect and
    exploitation.

-   Strengthen the effectiveness and responsiveness of AoA's management
    practices.

To track accomplishments relative to these prioritized goals, AoA uses a
core set of quantifiable performance measures, including 1) efficiency
measures, 2) consumer assessment measures, and 3) targeting measures.
Selected measures are presented below to illustrate AoA's commitment to
track the achievement of long-term priorities.

> ***1. Improve Program Efficiency.***
>
> **Indicators:**

-   By FY 2007, the rate of non-AoA funding for OAA services will
    increase by 20%.

-   By FY 2007, AoA will increase the number of people served per
    million dollars of AoA community based services program funding by
    15%.

> In the face of a rising elderly population and scarce service
> resources, the integration and coordination of funding and service
> provision for elderly who need care is an essential element of program
> quality. This goal and these measures support Departmental initiatives
> and foster continued efficiency improvement by AoA and State and local
> entities.
>
> ***2. Improve Client Assessments and Results***
>
> **Indicators:**

-   By FY 2007, increase the percentage of elderly individuals served by
    > Older Americans Act (OAA) programs to 17% of the elderly
    > population.

-   By 2007, 30% fewer caregivers will report that they needed help in
    > dealing with agencies or obtaining services.

-   By 2007, 75% of caregivers will report that OAA services have
    > definitely helped them provide care for a longer period.

> The community-based services of the Older Americans Act programs,
> provided significantly by family members and volunteers, are a
> cost-effective alternative to institutionalization. Serving a greater
> percentage of the elderly population and their caregivers and reducing
> the barriers caregivers confront in accessing care are fundamental
> measures of impact and outreach.
>
> ***3. Improve Targeting of Older Americans Act services to Vulnerable
> Elders.***
>
> **Indicators:**

-   By FY 2007, AoA will increase the percentage of Older Americans Act
    clients who live in rural areas to 38% of all clients.

-   By 2010, all States will achieve a "targeting index" greater than
    1.0 for rural and poverty clients.

> Those who are frail, poor, and lack adequate access to care are at the
> greatest risk of institutionalization and loss of independence. AoA's
> measures for this goal recognize: 1) the increased risk the rural
> elderly face and the importance of the HHS initiative to reduce major
> threats to health and well-being of Americans, 2) the need for all
> States to target services to those who are at the greatest risk.
>
> **B. Organization, Programs, Operations, Strategies and Resources**

The Administration on Aging provides leadership, coordination and
support to the aging services 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.

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 units 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.

A total of 655 area agencies on aging (AAAs) receive OAA funds from the
States. Area agencies contract with approximately 29,000 public or
private providers in local areas. AoA awards funds directly to 241
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 services network. The aging services 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 services network
provides home and community-based long-term care services through a
system that it began to develop in the 1970s. In communities throughout
the nation, the home and community-based service systems led by the
aging services network provide a preferred alternative to nursing home
care, enabling people to live independently for as long as possible.

\(2\) Summary of Performance Measures

The FY 2005 Performance Plan has been revised to define a core set of
measures that focuses on program outcomes and efficiency. It includes 4
efficiency measures, which are new. In addition, all measures in the
plan are outcome measures (100%). We have added new outcome measures
that support the Administration's Rebalancing Initiative to place more
emphasis on home and community-based long-term care services and the
Department's efforts to promote service integration. The FY 2005 plan
also incorporates: 1) the long-term outcome measures included in AoA's
Strategic Plan, 2) a presentation of AoA measurable strategic goals, and
3) a detailed roadmap of linkages of AoA goals and activities with the
HHS Strategic Plan (Appendix 1) and AoA's budget request. We continue to
track all measures included in previous plans. The following illustrates
the status of reporting of measures in past GPRA performance plans.

**Total Output Outcome Efficiency Results Results Results Not**

**[Measures]{.underline}\* [Measures]{.underline}
[Measures]{.underline}** **[Measures]{.underline}**
**[Reported]{.underline}** **[Met]{.underline}**
**[Reported]{.underline}**

**1999 18 18 0 NA 18 14 0**

**2000 18 18 0 NA 18 13 0**

**2001 23 15 5 3 23 17 0**

**2002 27 10 17 3 21 17 6**

**2003 46 13 30 3 NA NA NA**

**2004 39 6 30 3 NA NA NA**

**2005 6 0 6 4 NA NA NA**

\_\_\_\_\_\_\_\_\_\_

\* Total Measures are not intended to be the sum of Output, Outcome and
Efficiency Measures since measures often serve the dual purpose of
efficiency and outcome measures.

The data for the performance measures (FY 1997 to FY 2002) identified
throughout this plan present a story of performance indicating that the
network produces the results intended by the Older Americans Act (OAA).
The network:

-   Provides services that are instrumental in enabling older persons to
    live as independently as possible.

-   Targets services to vulnerable elderly individuals, including the
    poor, minorities, and individuals from rural areas;

-   Receives very high consumer assessment ratings for the services it
    provides;

-   Leverages funding from other sources in amounts that were almost
    double the funding provided by AoA;

-   Leverages funding for critical in-home and adult-day-care services
    in amounts almost triple the funding provided by AoA; and

-   Improves efficiency, as measured by the increasing number of elders
    served per million dollars of AoA funding from FY 1999 to FY 2002.

**(3) Structure of Performance Plan/Report and Budget Linkage**

###### 

For GPRA presentation purposes, the AoA programs, by budget line item,
have been grouped into the following six GPRA Programs:

-   **Community-Based Services** contains budget line items:

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-   Home and Community-Based Supportive Services (HCBSS)

-   Congregate Nutrition Services

-   Home-Delivered Nutrition Services

-   Preventive Health Services

-   Nutrition Services Incentive Program (NSIP)

-   National Family Caregiver Support Program (NFCSP)

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-   **Vulnerable Older Americans** contains budget line items:

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-   Ombudsman Services

-   Prevention of Elder Abuse

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-   **Services for Native American** contains budget line item:

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-   Grants for Native Americans

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-   **Senior Medicare Patrols** contains budget line item:

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-   Senior Medicare Patrols (HCFAC)

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-   **Innovation and Demonstrations** contains budget line items:

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-   Program Innovations

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-   Alzheimer's Disease Demonstration Grants to States

-   Aging Network Support Activities

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-   **Program Management** contains budget line items:

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-   Program Administration

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-   White House Conference on Aging

***Beginning in FY 2006, to further improve the efficiency of
presentation of AoA measures, AoA will consolidate all of its program
activities into one all-encompassing program.*** This consolidation will
continue to provide a direct budget to performance linkage since AoA is
not proposing to eliminate the existing performance measures and
indicators for the six program activities presented. For presentation
purposes the indicators for the current program activities will be
represented as indicators under a single, broader measure just as we
currently do for Title III. This will maintain budget linkage and
achieve the secondary objective of reducing the volume of documents HHS
and OMB must manage and review in this process.

The consolidation of program activities has been a GPRA objective since
the development of the first GPRA plans and reports and HHS agencies
continue to consolidate programs to make GPRA plans and reports more
manageable. Because it is possible to achieve a quality level of
analysis and accountability management with the consolidation of our
activities into one program, we believe it is the correct thing to do to
contribute to improving the efficiency of GPRA presentations across the
Department.

AoA has also taken other steps to improve the efficiency of the GPRA
process. Because AoA and HHS separately track management measures under
the President's Management Agenda and other management forums, we
believe it is unnecessary to duplicate that activity in the plan.
Consistent with the Administration's initiative to present the "full
cost" of programs, the costs of AoA's administrative activities has been
applied to both the GPRA programs in this plan and to the performance
measures used to assess those program activities.

AoA's initial FY 2005 Annual Performance Plan, Revised FY 2004 Annual
Performance Plan and FY 2003 Performance Report are organized around
these six GPRA programs. The FY 2005 plan contains a separate section
for each GPRA program. Each section provides a program description, as
well as past performance and future performance goals.

###### Budget Linkage

AoA has strongly linked the initial AoA GPRA Plan for FY 2005 and the FY
2005 budget submission by using GPRA and other program data to help
determine how to allocate resources to best support the strategic
priorities established by the Assistant Secretary and to support its
budget priorities for FY 2005. The data presented in this plan and
report form the basis for AoA's budget focus on maintaining home and
community-based services and supporting family caregivers. This is
clearly demonstrated throughout the budget justification.

The categories of measures and the associated budget priorities they
support include:

-   AoA's outcome targeting measures and indicators (which document the
    effectiveness of the aging services network in targeting services to
    vulnerable individuals) **support the AoA priorities to maintain
    home and community-based services and improve the integration of
    access to services in the aging services network. States and
    communities target services to vulnerable elderly individuals at
    significantly higher levels than the representation of these
    populations among the total elderly population**.

-   AoA's efficiency outcome measures and indicators **support AoA
    efforts to maintain program funding and its pursuit of improvements
    in the integration of home and community-based services across the
    network. In addition, States leverage funds from other sources at
    approximately double the AoA funding rate.**

-   The Senior Medicare Patrols Program measures and indicators (which
    document the use of seniors to support efforts to reduce Medicare
    fraud) **support continued funding of efforts to train elders for
    this effort.**

-   Whereas AoA's intermediate outcome measures and indicators support
    the cost-effectiveness and efficiency of OAA programs in targeting
    services to the most vulnerable elderly individuals utilizing
    cost-effective community-based and family care resources, **AoA's
    end outcome measures and indicators demonstrate the effectiveness
    and quality of services from the perspective of elderly consumers
    and family caregivers**.

-   In support of AoA's FY 2005 budget, the end outcome data that
    contribute most directly to AoA's initiatives to create more balance
    in long-term care and better integrate home and community-based
    services are those that indicate that: **1) a large percentage of
    OAA in-home service clients are nursing-home eligible, but are being
    successfully cared for in the community, and 2) 86% of family
    caregivers report that OAA services help them to care for the
    elderly longer than they would be able to without the services;
    about 50% reported the services *"definitely"* help in this way.**

**(4.) Other Linkages**

**President's Management Agenda** - AoA's FY 2005 Budget presentation on
the PMA identifies quantitative performance measures used by the agency
to track performance in support of three components of the President's
Management Agenda for AoA. Performance measures are included for
financial management, strategic management of human capital and
e-government**.** We have decided not to duplicate the presentation of
those measures here.

**The HHS Strategic Plan -** AoA also participates in the development of
the strategic goals and objectives of the Department of Health and Human
Services (HHS) each year. AoA program activities and strategies will
continue to support the achievement of HHS goals and objectives, and AoA
program performance measurement efforts will support HHS efforts to
assess the progress of the Department in achieving the goals and
objectives of the HHS Strategic Plan. The detailed roadmap of linkages
of AoA goals and activities with the HHS Strategic Plan are presented in
Appendix 1 of this plan.

**Full Cost of Programs and Measures** - The full cost of programs in
the FY 2005 Performance Plan reflects the allocation of both
administrative resources and demonstration activities to the program
areas they support. It includes annual appropriations as well as
resources from the Medicare trust fund, which are used to support health
care anti-fraud, waste and abuse activities. It does not include accrued
liabilities not directly paid by AoA, such as employee health benefit
and Federal retirement costs. Cost estimates for each year reflect
changes in the level of appropriations for base programs as well as
adjustments to reflect new programs and activities that were transferred
to AoA from other Federal agencies.

**B. Discussion/Performance Analysis**

**Section 1: COMMUNITY-BASED SERVICES PROGRAM**

**Program Description and Context**

The legislative intent of the Community-Based Services program is to
make community-based services available to elders who are at risk of
losing their independence. It is intended further that States and
communities participate actively in funding community-based services and
develop the capacity in communities across the States to support the
home and community-based service needs of elderly individuals,
particularly the poor, minorities and those who live in rural areas
where access to services may be limited.

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 Older Americans line, which we
have elected to show separately for GPRA purposes. 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.
(NSIP is based on the number of meals served in the previous fiscal
year.) Funds from AoA, other Federal agencies, and from outside sources
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 majority of the
resources, services and activities of AoA and the aging services
network. The program provides **"access"** services, such as information
and assistance, outreach, and transportation; **"community"** services,
which include congregate meals, senior-center activities, adult day
care, and health promotion and fitness programs; **"in-home"** services,
including home-delivered meals, chores, home maintenance assistance,
home-health, and personal care; and **"caregiver"** support, such as
respite services and information and assistance to caregivers for the
coordination of health and social services. The FY 2005 Budget request
for these programs is \$1.26 billion, an increase of \$10 million over
the FY 2004 conference level.

Appropriated Funds: FY 2003 Enacted: \$1,247.100 Million

> FY 2004 Final Conference: \$1,249.197 Million

FY 2005 Budget Request \$1,259.600 Million

Full-Cost Budget: FY 2003 Enacted: \$1,303.220 Million

> FY 2004 Final Conference: \$1,310.198 Million

FY 2005 Budget Request \$1,313.229 Million

####### 

**Performance Measurement Changes for FY 2005**

Because of the very significant modifications to the AoA GPRA plan for
this program activity, AoA has restructured the presentation and
analysis of measures. In addition to incorporating indicators to support
the measures where appropriate, we have divided measures into a two-part
presentation: 1) measures for FY 2005 and beyond, and 2) measures for
prior years. The first set of performance measures presented in this
section of the plan identifies and analyzes only the performance
measures that will be utilized for FY 2005 and beyond.

The analysis briefly addresses the following for each measure included
in the FY 2005 portion of the plan:

-   baseline and past performance to the extent available,

-   the basis for performance targets,

-   the components of the full-cost of the measure, and

-   how the measure supports the AoA budget request.

Because the Government Performance and Results Act requires AoA to track
the commitments presented in previous plans, we must continue to present
and analyze the measure for prior years until complete reporting on
those measures has been concluded. To accommodate this requirement, the
plan includes a second set of tables and narrative that identify and
analyze actual performance and performance trends for those measures as
well as how performance using those measures has contributed to AoA's
budget initiatives.

Performance Measures Table---Community Based Services Program

+------------------------------+---------------+----------------+-----+
| # **Performance Goals**      | ## Targets    | **Actual       | **N |
|                              |               | Performance**  | ote |
|                              |               |                | s** |
+------------------------------+---------------+----------------+-----+
| **MEASURES FOR FY05 AND      | FY 07:        | FY 05: 02/07   | #   |
| BEYOND:**                    | Baseline +    |                | # 1 |
|                              | 15%           | FY 04: 02/06   |     |
| **Measure 1.1 Improve        |               |                | #   |
| Program Efficiency**         | FY 06:        | FY 03: 02/05   | # 6 |
|                              | Baseline +    |                |     |
| > **FULL COST %** FY05: 100% | 10%           | FY 02: 5,700   | #   |
| >                            |               |                | # 6 |
| > FY04: 100%                 | FY 05:        | FY 01: 5,688   |     |
| >                            | Baseline + 8% | (baseline)     | **  |
| > FY03: 100%                 |               |                | 6** |
|                              | FY 04:        | FY 02: 439,000 |     |
| **Indicator 1.1.1** Increase | Baseline + 6% |                |     |
| client to funding ratio      |               | FY 03: 11/04   |     |
| (with no decline in service  | FY 03: Not    |                |     |
| quality).                    | applicable    | FY 02: 13      |     |
|                              |               | months         |     |
| **Indicator 1.1.2** Increase | FY 02: Not    |                |     |
| caregivers served**.**       | applicable    | FY 01: 15      |     |
|                              |               | months         |     |
| **Indicator 1.1.3**. Reduce  | FY 01: New in |                |     |
| time-lag for program data.   | FY 04         | FY 00: 19      |     |
|                              |               | months         |     |
| Measure 1.2 Improve Client   | FY 07: 1      |                |     |
| Assessments and Results      | million       | FY 99: 22      |     |
|                              |               | months         |     |
| > **FULL COST %** FY05: 100% | FY 06:        |                |     |
| >                            | 900,000       | FY 98: 26      |     |
| > FY04: 100%                 |               | months         |     |
| >                            | FY 05:        |                |     |
| > FY03: 100%                 | 800,000       | FY 03: 93%     |     |
|                              |               | (baseline)     |     |
| **Indicator 1.2.1** Maintain | FY 04:        |                |     |
| high satisfaction with       | 500,000       | FY 03: 82%     |     |
| home-delivered meals.        |               | (baseline)     |     |
|                              | FY 03:        |                |     |
| **Indicator 1.2.2** Maintain | 250,000       | FY 03: 87%     |     |
| high satisfaction with       |               | (baseline)     |     |
| transportation services.     | FY 02: New in |                |     |
|                              | FY 03         | FY 03: 93%     |     |
| **Indicator 1.2.3** Maintain |               |                |     |
| high level of caregiver      | FY 09. 6      | FY 03: 48%     |     |
| satisfaction.                | months        | (baseline)     |     |
|                              |               |                |     |
| **MEASURES FOR FY05 AND      | FY 05: 12     | FY 03: 64%     |     |
| BEYOND:**                    | months        | (baseline)     |     |
|                              |               |                |     |
| **(continued)**              | FY 04: 13     | FY 03: 280,454 |     |
|                              | months        | (baseline)     |     |
| **Indicator 1.2.4** Maintain |               |                |     |
| high satisfaction with       | FY 03: 15     | FY 05: 02/07   |     |
| congregate meals.            | months        |                |     |
|                              |               | FY 04: 02/06   |     |
| **Indicator 1.2.5**.         | FY 02: 15     |                |     |
| Increase percent of          | months        | FY 03: 02/05   |     |
| caregivers who report that   |               |                |     |
| services ***definitely***    | FY 01: 15     | FY 02: 29.2%   |     |
| help them care longer for    | months        |                |     |
| older individuals.           |               | FY 01: 30.4%   |     |
|                              | FY 00: (New   |                |     |
| **Indicator 1.2.6** Reduce   | in FY 01)     | FY 00: 32.9%   |     |
| the percent of caregivers    |               |                |     |
| who report difficulty in     | FY 05: 93%    | FY 99: 33.6%   |     |
| getting services.            |               |                |     |
|                              | FY 04: Not in | FY 98: 33.5%   |     |
| **Indicator 1.2.7** Increase | FY 04 plan    |                |     |
| severely disabled clients    |               | FY 05: 02/07   |     |
| receiving services.          | FY 03: New in |                |     |
|                              | FY 05         | FY 04: 02/06   |     |
| **Measure 1.3 Targeting to   |               |                |     |
| Vulnerable Elders**          | FY 05: 82%    | FY 03: 02/05   |     |
|                              |               |                |     |
| **FULL COST %** FY05: 100%   | FY 04: Not in | FY 02: 9       |     |
|                              | FY 04 plan    | States         |     |
| > FY04: 100%                 |               |                |     |
| >                            | FY 03: New in | FY 01: 8       |     |
| > FY03: 100%                 | FY 05         | States         |     |
|                              |               |                |     |
| **Indicator 1.3.1** A        | FY 05: 87%    |                |     |
| significant percentage of    |               |                |     |
| OAA Title III service        | FY 04: Not in |                |     |
| recipients live in rural     | FY 04 plan    |                |     |
| areas. \[outcome measure\]   |               |                |     |
|                              | FY 03: New in |                |     |
| **Norm:** Percent of U.S.    | FY 05         |                |     |
| elderly population who live  |               |                |     |
| in rural areas in 2000:      | FY 05: 93%    |                |     |
| 17.5%                        |               |                |     |
|                              | FY 04: Not in |                |     |
| **Indicator 1.3.2** Increase | FY 04 plan    |                |     |
| the number of states that    |               |                |     |
| increase the percentage of   | FY 03: New in |                |     |
| clients served who are poor. | FY 05         |                |     |
|                              |               |                |     |
|                              | FY 07: 75%    |                |     |
|                              |               |                |     |
|                              | FY 06: 68%    |                |     |
|                              |               |                |     |
|                              | FY 05: 62%    |                |     |
|                              |               |                |     |
|                              | FY 04: Not in |                |     |
|                              | FY 04 plan    |                |     |
|                              |               |                |     |
|                              | FY 03: New in |                |     |
|                              | FY 05         |                |     |
|                              |               |                |     |
|                              | FY 07: 35%    |                |     |
|                              |               |                |     |
|                              | FY 06: 43%    |                |     |
|                              |               |                |     |
|                              | FY 05: 50%    |                |     |
|                              |               |                |     |
|                              | FY 04: Not in |                |     |
|                              | FY 04 plan    |                |     |
|                              |               |                |     |
|                              | FY 03: New in |                |     |
|                              | FY 05         |                |     |
|                              |               |                |     |
|                              | FY 07:        |                |     |
|                              | baseline +    |                |     |
|                              | 15%           |                |     |
|                              |               |                |     |
|                              | FY 06:        |                |     |
|                              | baseline + 8% |                |     |
|                              |               |                |     |
|                              | FY 05:        |                |     |
|                              | baseline + 4% |                |     |
|                              |               |                |     |
|                              | FY 04: Not in |                |     |
|                              | FY 04 plan    |                |     |
|                              |               |                |     |
|                              | FY 03: New in |                |     |
|                              | FY 04         |                |     |
|                              |               |                |     |
|                              | FY 07: 38%    |                |     |
|                              |               |                |     |
|                              | FY 05: 34%    |                |     |
|                              |               |                |     |
|                              | FY 04: 34%    |                |     |
|                              |               |                |     |
|                              | FY 03: 34%    |                |     |
|                              |               |                |     |
|                              | FY 02: 25%    |                |     |
|                              |               |                |     |
|                              | FY 01: 25%    |                |     |
|                              |               |                |     |
|                              | FY 00: (New   |                |     |
|                              | in 01)        |                |     |
|                              |               |                |     |
|                              | FY 07: 18     |                |     |
|                              | States        |                |     |
|                              |               |                |     |
|                              | FY 05: 15     |                |     |
|                              | States        |                |     |
|                              |               |                |     |
|                              | FY 04: 12     |                |     |
|                              | States        |                |     |
|                              |               |                |     |
|                              | FY 03: 5      |                |     |
|                              | States        |                |     |
|                              |               |                |     |
|                              | FY 02: New in |                |     |
|                              | 03            |                |     |
+------------------------------+---------------+----------------+-----+

#######  Analysis of Performance Measures and Indicators for FY 2005

The major components of performance outcome measurement for AoA's
Community Based Services Program for annual and long-term measurement
are: 1) efficiency, 2) consumer impact and satisfaction, and 3) service
targeting. The performance measures and indicators in this plan, and
others which address more specific aspects of performance but which are
not needed to assess performance at the Department level, are used by
AoA to regularly assess program performance, to identify budget
initiatives, and to guide in-depth program evaluation activity.

Efficiency Measure and Indicators

There are three efficiency indicators for the AoA Community-Based
Services program. The first addresses the efficiency of performance of
the program overall, including all levels of the aging services network.
The second addresses output efficiency for the caregiver because
tracking the number of caregivers served under this new program was a
significant and stated objective of the program under the Act in the
early years of program implementation. The third indicator addresses the
efficiency of AoA for a program management activity that supports
outcome measurement. The indicators are:

-   Increase clients to funding ratio with no decline in service
    quality.

-   Increase the number of caregivers served.

-   Reduce the time-lag for program data.

**Baseline and past performance:** Available data for these indicators
show significant and positive results to support the success of the
efficiency measure overall. The number of people served per million
dollars of AoA funding improved by approximately 2% from FY 1999 to FY
2001. The aging network served significantly more caregivers in FY 2002
(439,000) than required by the Congress and anticipated by AoA when the
program was first launched (250,000). To support performance
measurement, AoA has reduced the time lag for making program data
available from 26 months for the FY 1998 data to 13 months for the FY
2002 data.

**Aggressive targeting:** The steady improvement has led to the
establishment of more aggressive annual and long-term performance
targets for each of these performance indicators to ensure continued
program and management improvement.

-   By 2005, AoA will improve the program efficiency measure by 8% over
    the FY 2001 target, which is double the annual improvement rate
    observed for FY 1999 to 2001, and projects an improvement of 15% by
    FY 2007, which is almost quadruple the current annual improvement.

-   Because it is critical to continue to continue to focus on reaching
    caregivers under the caregiver program, AoA is targeting an increase
    of over 90% (to 800,000) by FY 2005.

-   For the data efficiency measure, AoA will virtually eliminate the
    time lag for program data by FY 2009, and targets that certified
    program data for all states for a given fiscal year will be
    available six months after the end of the fiscal year.

**Components of Full Cost:** The cost of each of AoA's performance
measures is the full cost of the programs they represent. AoA
intentionally selected performance measures that would represent the
entirety of program responsibilities and expectations, and so cover the
full AoA cost of the program. The program efficiency measure is a
measure that is associated with serving all elderly people and
caregivers served under the program, so the AoA costs associated with
the measure are all AoA costs each fiscal year. The same is true of the
consumer assessment and results measures and the targeting measures.
Producing the results associated with each of these measures requires
the full AoA cost for the community based services program.

**Support of the AoA Budget Request:** The program efficiency measure is
very closely related to AoA's FY 2005 budget initiatives in that the
ability of AoA and the aging services network to achieve the aggressive
improvement targets depends in part on AoA's budget initiatives. AoA has
not requested significant increases in its community-based services
programs; the agency has requested additional funding for innovation and
demonstration grants which are specifically intended to 1) create
greater balance in long-term care funding from other sources toward more
cost-effective community based services, such as those provided by the
aging services network, and 2) improve the integration of program
activity across the aging services network. AoA has not increased its
budget request for any program or administrative activity to continue
pursuing the improvement in the timeliness of its data.

Client Assessment and Results Measure

The FY 2005 annual performance plan includes seven indicators supporting
AoA's measure of consumer impact and results. To AoA, these are the core
performance outcome indicators for this program because they reflect
program assessments obtained directly from the elderly individuals and
caregivers who receive the services. AoA has multiple satisfaction
indicators in this plan because the assessment surveys address distinct
types of service, such as: meal programs, transportation, homemaker
services, information and assistance, and caregiver services. The
consumer impact and results indicators included in the plan for FY 2005
for the community based services program are:

-   **Caregiver Satisfaction**: Increase the percentage of caregivers
    reporting that services have ***"definitely"*** helped them provide
    care for a longer period.

-   **Increase Severely Disabled Clients**: Increase the number of
    home-delivered meal clients with 3 or more ADL limitations (nursing
    home eligible).

-   **Caregiver Difficulty Reduction**: Decrease the number of
    caregivers reporting difficulties in dealing with agencies to obtain
    services.

-   **Caregiver Impact Assessment**: Maintain the percent of caregivers
    rating case management services good to excellent.

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-   **Transportation Satisfaction**: Maintain the percentage of
    transportation service recipients rating the service very good to
    excellent.

-   **Home-Delivered Meals Satisfaction**: Maintain the percentage of
    home-delivered meal clients reporting they like the meals.

-   **Congregate Meals Satisfaction**: Maintain the percentage of
    congregate meal clients reporting they like the way the food tastes.

###### Aggressive Targeting: AoA is proposing aggressive improvements in the targets for three of the consumer impact indicators presented in the table above, and will maintain the very high consumer satisfaction levels for the other four indicators. We are proposing to increase the number of home delivered meals clients who are nursing home eligible by 4% during FY 2005 over the base of 280,454 identified in a FY 2003 survey. AoA is proposing this without a comparable increase in service budgets because efforts to improve service and funding integration and the rebalancing of long-term care toward community-based efforts are expected to contribute significantly in helping the network achieve this target. The performance targets related to caregiver assessments presented above are similarly aggressive. One indicator calls for a 14% increase in two years in the percent of caregivers who report that OAA services "definitely" help them care longer for the elderly they serve. The second calls for a 14% reduction over the same time period in the percent of caregivers who report difficulty in getting services. To AoA, aggressive targeting for these three indicators is critical because these indicators represent more directly than any others the mission of AoA and the network to help vulnerable elderly individuals remain in the community. 

###### 

###### The levels of satisfaction with OAA program services (congregate and home-delivered meals, transportation and caregivers) are so high that it is not realistic to target measurable increases. However, the target to maintain these high levels of performance is aggressive when taken in the context of the AoA commitment to aggressively improve program efficiency in the near and long term. It is essential that AoA maintain a high level of satisfaction with services even as the aging services network increases the number of elderly individuals served per one million dollars in AoA funding.

###### 

###### Components of Full Cost: As indicated above for the efficiency measure, the cost of each of AoA's performance measures is the full cost of the programs they represent. AoA intentionally selected performance measures that would represent the entirety of program responsibilities and expectations, and so cover the full AoA cost of the program. The consumer assessment and results measure is associated with all AoA program activity in support of elderly people and caregivers served under this program, so the AoA costs associated with the measure are all AoA costs each fiscal year. Producing the results associated with each of these measures requires the full AoA cost for the community based services program.

**Support of the AoA Budget Request:** The consumer assessment and
results measure and indicators for this program were a significant
element in the FY 2005 budget initiatives proposed by AoA, and they
complement the efficiency and targeting measures that also support the
FY 2005 budget. The success of AoA budget initiatives in improving
program efficiency must be balanced by the ability of the aging services
network to maintain the current high level of satisfaction with services
and improvements in results reported by consumers. Similarly, success in
improving consumer results must be balanced by the critical need to
ensure that the programs are reaching the most vulnerable elderly
individuals. The AoA indicator to increase home-delivered meals clients
who are nursing-home eligible is a fundamental and necessary outcome for
the AoA budget activity that supports the initiative to create more
balance in the national long-term care service delivery system. AoA's
budget request to maintain caregiver funding, along with AoA's
integration and evidence-based health promotion activities will support
the AoA performance target to reduce the percentage of caregivers who
have difficulty with the system and will also support the goal to
increase the percentage of caregivers who report that OAA services help
them care longer for elderly individuals.

Targeting Vulnerable Elders Measure

The FY 2005 performance plan retains two targeting indicators to track
the performance of the aging services network in targeting services to
the most vulnerable elderly in the nation as specifically required by
the Older Americans Act. AoA will continue to monitor other targeting
indicators internally, and will utilize different targeting indicators
as proxies to represent targeting efforts in future GPRA plans. The
targeting indicators AoA is using in the FY 2005 plan are:

-   A significant percentage of OAA Title III service recipients live in
    rural areas.

-   Increase participation by poor elderly individuals in selected
    states by over 10%.

The aging services network has already demonstrated success in targeting
services to poor individuals and those who live in rural areas. In each
of the recent reporting years, approximately 30% of OAA clients are
poor, while fewer than 10% of all elderly individuals are poor. While
the percent of clients who live in rural areas appears to have declined
in recent years, the 28% of OAA clients who live in rural areas is
significantly higher than the 2000 Census estimate, which indicates that
17.5% of all elderly individuals reside in rural areas. Despite the
success, AoA believes that continued focusing on and improvement in
targeting to vulnerable elders is basic to the mission of the agency and
the intent of the OAA. The targeting indicators also reflect different
aspects of performance monitoring that is important for the network. The
rural indicator focuses on improvement at the national level, while the
"poverty" indicator focuses in on the pursuit of improvements among the
State agencies that administer the program.

**Aggressive Targeting:** AoA's pursuit of a significant increase in the
percentage of elderly clients who reside in rural areas is aggressive,
particularly in light of the data above that indicate that this
percentage has declined in recent years. The decline in the percentage
of clients who live in rural areas should not be viewed with concern in
that it is consistent with Census data, which show a similar trend for
all elders in the nation. Nevertheless, because it is important to
target services where access is more difficult, AoA intends to reverse
the trend and accomplish the stated performance goal.

The FY 2005 target is aggressive for the poverty indicator because it
not only commits to improve performance in over 25 percent of all states
over a short period of time, but it also commits to a significant 10%
improvement in each of those states in that same time period.

**Components of Full Cost:** As indicated above for the other measures,
the cost of each of AoA's performance measures is the full cost of the
programs they represent. AoA intentionally selected performance measures
that would represent the entirety of program responsibilities and
expectations, and so cover the full AoA cost of the program. The
targeting measure is associated with all AoA program activity in support
of individuals served under this program, so the AoA costs associated
with the measure are all AoA costs each fiscal year. Producing the
results associated with each of these measures requires the full AoA
cost for the community based services program.

###### Support of the AoA Budget Request: In the past few years, the observed success of the aging services network in targeting services to vulnerable elderly individuals has served as an impetus for AoA to pursue initiatives that will expand national use of the services of the network to improve the lives of elderly individuals across the nation. AoA's initiatives to integrate services and funding, to rebalance long-term care, and to increase the use of evidence-based health promotion activities will help state and community programs to focus resources toward difficult to serve populations. The initiatives address directly the intent of AoA and the network to increasingly target community-based services toward those who are most at risk of institutionalization, which includes the poor, those in rural areas, minorities, and other vulnerable elders.

###### MEASURES FOR PRIOR YEARS

The following table and analytical presentation reflect a significant
change to AoA's GPRA performance plan and report. Because of the
necessary reduction in the number of performance measures in the AoA and
HHS plans, there is little comparability between the FY 2005 plan and
previous plans. Attempting to analyze the FY 2005 plan alongside the
previous plans would cause tremendous confusion. As a result, AoA has
opted to present separately the performance results for GPRA plans for
previous fiscal years. For the sake of efficiency in presentation, AoA
will not reiterate the rationale for the measures and targets which were
included in those plans, but will focus the analysis on the extent to
which performance goals and measures were achieved and how performance
for those measures affected AoA budget initiatives. It should be noted
that AoA will continue to internally track performance for many of the
measures included in prior year plans, and may propose to include some
of these measures as indicators of performance in future GPRA plans as
appropriate. The following table presents measures that were included in
previous GPRA plans, but are not included in the FY 2005 plan.

**Performance Measures Table---Community Based Services Program**

+-------------------------+-----------------+-------------------+-----+
| ##                      | ### **Targets** | ### **Act         | **N |
| # **Performance Goals** |                 | ual Performance** | ote |
|                         |                 |                   | s** |
+-------------------------+-----------------+-------------------+-----+
| **MEASURES FOR PRIOR    | FY 04: 32%      | FY 04: 02/06      |     |
| YEARS**                 |                 |                   |     |
|                         | FY 03: 32%      | FY 03: 02/05      |     |
| **Measure 1.14** A      |                 |                   |     |
| significant percentage  | FY 02: 25%      | FY 02: 28.1%      |     |
| of OAA Title III        |                 |                   |     |
| service recipients are  | FY 01: 25%      | FY 01: 29.3%      |     |
| poor.                   |                 |                   |     |
|                         | FY 00: (New in  | FY 00: 30.3%      |     |
| \[outcome measure\]     | 01)             |                   |     |
|                         |                 | FY 99: 31.7%      |     |
| **Norm:** Percent of    | FY 04: 34%      |                   |     |
| U.S. elderly population |                 | FY 98: 36.2%      |     |
| who are poor in 2000:   | FY 03: 34%      |                   |     |
| 10.2%                   |                 | FY 04: 02/06      |     |
|                         | FY 02: 25%      |                   |     |
| **Measure 1.15** A      |                 | FY 03: 02/05      |     |
| significant percentage  | FY 01: 25%      |                   |     |
| of OAA Title III        |                 | FY 02: See        |     |
| service recipients live | FY 00: (New in  | Measures for      |     |
| in rural areas.         | 01)             | FY05\...          |     |
| \[outcome measure\]     |                 |                   |     |
|                         | FY 04: 9 States | FY 01: 30.4%      |     |
| **Norm:** Percent of    |                 |                   |     |
| U.S. elderly population | FY 03: 5 States | FY 00: 32.9%      |     |
| who live in rural areas |                 |                   |     |
| in 2000: 23%            | FY 02: (New in  | FY 99: 33.6%      |     |
|                         | 03)             |                   |     |
| **Measure 1.16**        |                 | FY 98: 33.5%      |     |
| Increase rural          | FY 04: 1.5 to   |                   |     |
| participation in States | 10              | FY 04: 02/06      |     |
| \[outcome measure\]     |                 |                   |     |
|                         | FY 03: 1.0 to   | FY 03: 02/05      |     |
| **Measure 1.17**        | 10              |                   |     |
| Increase the ratio of   |                 | FY 02: Not        |     |
| family caregivers to    | FY 02: (New in  | Available         |     |
| registered clients.     | 03)             |                   |     |
|                         |                 | FY 04: 02/06      |     |
| **Measure 1.18** A      | FY 04: 20%      |                   |     |
| significant percentage  |                 | FY 03: 02/05      |     |
| of OAA Title III        | FY 03: 19%      |                   |     |
| service recipients are  |                 | FY 02: 1.4 to 10  |     |
| minorities.\[outcome    | FY 02: 17%      | (baseline)        |     |
| measure\]               |                 |                   |     |
|                         | FY 01: 17%      | FY 04: 02/06      |     |
| **Norm:** Percent of    |                 |                   |     |
| U.S. elderly population | FY 00: (New in  | FY 03: 02/05      |     |
| who are minorities in   | 01)             |                   |     |
| 2000: 16.3%             |                 | FY 02: 20.5%      |     |
|                         | FY 04: 9 States |                   |     |
| **Measure 1.19**        |                 | FY 01: 18.8%      |     |
| Increase participation  | FY 03: 5 States |                   |     |
| by disabled elderly in  |                 | FY 00: 19.1%      |     |
| States \[outcome        | FY 02: (New in  |                   |     |
| measure\]               | 03)             | FY 99: 19.3%      |     |
|                         |                 |                   |     |
| **Measure 1.20**        | FY 04: 9 States | FY 98: 19.6%      |     |
| Increase participation  |                 |                   |     |
| by senior elders in     | FY 03: 5 States | FY 04: 02/06      |     |
| States \[outcome        |                 |                   |     |
| measure\]               | FY02: (New in   | FY 03: 02/05      |     |
|                         | 03)             |                   |     |
| **Measure 1.21**        |                 | FY 02: 9 States   |     |
| Increase the ratio of   | FY 04: \$2.20   |                   |     |
| leveraged funds to AoA  | to \$1.00       | FY 04: 02/06      |     |
| funds \[outcome and     |                 |                   |     |
| efficiency measure\]    | FY 03: \$1.90   | FY 03: 02/05      |     |
|                         | to \$1.00       |                   |     |
|                         |                 | FY 02: Not        |     |
|                         | FY 02: \$1.50   | Available         |     |
|                         | to \$1.00       |                   |     |
|                         |                 | FY 04: 02/06      |     |
|                         | FY 01: \$1.50   |                   |     |
|                         | to \$1.00       | FY 03: 02/05      |     |
|                         |                 |                   |     |
|                         | FY 00: (New in  | FY 02: \$1.92 to  |     |
|                         | 01)             | \$1.00            |     |
|                         |                 |                   |     |
|                         |                 | FY 01: \$2.10 to  |     |
|                         |                 | \$1.00            |     |
|                         |                 |                   |     |
|                         |                 | FY 00: \$1.90 to  |     |
|                         |                 | \$1.00            |     |
|                         |                 |                   |     |
|                         |                 | FY 99: \$1.90 to  |     |
|                         |                 | \$1.00            |     |
|                         |                 |                   |     |
|                         |                 | FY 98: \$1.90 to  |     |
|                         |                 | \$1.00            |     |
+-------------------------+-----------------+-------------------+-----+

#######  

####### 

**Performance Measures Table---Community Based Services Program**

+--------------------------+--------------+---------------------+-----+
| #                        | ###          | ### **A             | **N |
| ## **Performance Goals** |  **Targets** | ctual Performance** | ote |
|                          |              |                     | s** |
+--------------------------+--------------+---------------------+-----+
| **MEASURES FOR PRIOR     | FY 04: 8     | FY 04: 02/06        |     |
| YEARS (Cont.)**          | States       |                     |     |
|                          |              | FY 03: 02/05        |     |
| **Measure 1.22**         | FY 03: 5     |                     |     |
| Increase leveraged       | States       | FY 02: 02/04        |     |
| funding ratios for       |              |                     |     |
| States **\[outcome       | FY 02: (New  | FY04: 02/06         |     |
| measure\]**              | in 03)       |                     |     |
|                          |              | FY03: 02/05         |     |
| **Measure 1.23** A high  | FY 04: 76%   |                     |     |
| percentage of funding    |              | FY 02: 73.0%        |     |
| for the following        | FY 03: 74%   |                     |     |
| services will come from  |              | FY 01: 74.5%        |     |
| leveraged funds:         | FY 02: 70%   |                     |     |
|                          |              | FY 00: 74%          |     |
| -   Personal Care        | FY 01: 70%   |                     |     |
|                          |              | FY 99: 75%          |     |
| -   Home-Delivered Meals | FY 00 (New   |                     |     |
|                          | in 01)       | FY 98: 75%          |     |
| -   Adult Day Care       |              |                     |     |
|                          | FY 03: \$.35 | FY 03: 02/05        |     |
| **\[outcome measure\]**  | to \$1.00    |                     |     |
|                          |              | FY 02: \$.44 to     |     |
| **Measure 1.24**         | FY 02: \$.30 | \$1.00              |     |
| Maintain a high ratio of | to \$1.00    |                     |     |
| network program income   |              | FY 01: \$.37 to     |     |
| to AoA                   | FY 01: \$.30 | \$1.00              |     |
| funding.**\[outcome      | to \$1.00    |                     |     |
| measure\]**              |              | FY 00: \$.35 to     |     |
|                          | (New in 01)  | \$1.00              |     |
| **Measure 1.25**         |              |                     |     |
| Increase program income  | FY 04: 5     | FY 99: \$.35 to     |     |
| ratios for States)       | States       | \$1.00              |     |
|                          |              |                     |     |
| **\[outcome measure\]**  | FY 03: 5     | FY 98: \$.37 to     |     |
|                          | States       | \$1.00              |     |
| **Measure 1.26**         |              |                     |     |
| Maintain high percentage | FY 02: (New  | FY 04: 02/06        |     |
| of senior centers that   | in 03)       |                     |     |
| are community focal      |              | FY 03: 02/05        |     |
| points.                  | FY 04: 62%   |                     |     |
|                          |              | FY 02: Not          |     |
| **Measure 1.27**         | FY 03: 60%   | Available           |     |
| Maintain high percentage |              |                     |     |
| of volunteer staff among | FY 02: 50%   | FY 04: 02/06        |     |
| area agencies on aging.  |              |                     |     |
|                          | FY 01: 50%   | FY 03: 02/05        |     |
|                          |              |                     |     |
|                          | FY 00 (New   | FY 02: 63.0%        |     |
|                          | in 01)       |                     |     |
|                          |              | FY 01: 58.1%        |     |
|                          | FY 03: 46%   |                     |     |
|                          |              | FY 00: 61.2%        |     |
|                          | FY 02: 40%   |                     |     |
|                          |              | FY 99: 59.5%        |     |
|                          | FY 01: 40%   |                     |     |
|                          |              | FY 03: 02/05        |     |
|                          | FY 00: (New  |                     |     |
|                          | in 01)       | FY 02: 45.5%        |     |
|                          |              |                     |     |
|                          |              | FY 01: 41.8%        |     |
|                          |              |                     |     |
|                          |              | FY 00: 44.1%        |     |
|                          |              |                     |     |
|                          |              | FY 99: 45.9%        |     |
|                          |              |                     |     |
|                          |              | FY 98: 43.8%        |     |
+--------------------------+--------------+---------------------+-----+

**Performance Measures Table---Community Based Services Program**

+------------------------+------------------+-------------------+-----+
| ###                    | ### **Targets**  | ### **Act         | **N |
|  **Performance Goals** |                  | ual Performance** | ote |
|                        |                  |                   | s** |
+------------------------+------------------+-------------------+-----+
| **MEASURES FOR PRIOR   | FY 04: 5 States  | FY 04: 02/06      |     |
| YEARS (Cont.)**        |                  |                   |     |
|                        | FY 03: Number of | FY 03: 02/05      |     |
| **Measure 1.28**       | States (new in   |                   |     |
| Increase volunteer     | 04)              | FY 04: 02/06      |     |
| staff participation    |                  |                   |     |
| for State Agencies     | FY 04: 10 States | FY 03: 02/05      |     |
|                        |                  |                   |     |
| **Measure 1.29**       | FY 03: 10 States | FY 02: 46 States  |     |
| Increase the number of |                  |                   |     |
| State agencies on      | FY 02: (New in   | FY 04: 02/06      |     |
| aging that provide     | 03)              |                   |     |
| caregiver services in  |                  | FY 03: 02/05      |     |
| all five service       | FY 04: 183.0     |                   |     |
| categories             |                  | FY 02: 142.0      |     |
|                        | FY 03: 183.0     |                   |     |
| **Measure 1.30**       |                  | FY 01: 143.8      |     |
| Increase the number of | FY 02: 183.0     |                   |     |
| home-delivered meals   |                  | FY 00: 143.4      |     |
| provided.              | FY 01: 179.0     |                   |     |
|                        |                  | FY 99: 134.6      |     |
| **Measure 1.31**       | FY 00: 155.0     |                   |     |
| Maintain the number of |                  | FY 98: 129.7      |     |
| congregate meals       | FY 99: 119.0     |                   |     |
| provided.              |                  | FY 04: 02/06      |     |
|                        | FY 04: 115.2     |                   |     |
| ####                   |                  | FY 03: 02/05      |     |
|                        | FY 03: 115.2     |                   |     |
| #### Measure 1.3       |                  | FY 02: 108.3      |     |
| 2 Transportation-Maint | FY 02: 115.2     |                   |     |
| ain the number of unit |                  | FY 01: 112.2      |     |
| s of service provided. | FY 01: 115.2     |                   |     |
|                        |                  | FY 00: 115.8      |     |
| **Measure 1.33**       | FY 00: 113.1     |                   |     |
| Information and        |                  | FY 99: 112.8      |     |
| Assistance: Maintain   | FY 99: 123.4     |                   |     |
| the number of units of |                  | FY 98: 114.1      |     |
| service provided.      | FY 04: 50.7      |                   |     |
|                        |                  | FY 04: 02/06      |     |
|                        | FY 03: 50.7      |                   |     |
|                        |                  | FY 03: 02/05      |     |
|                        | FY 02: 50.7      |                   |     |
|                        |                  | FY 02: 37.1       |     |
|                        | FY 01: 50.7      |                   |     |
|                        |                  | FY 01: 39.4       |     |
|                        | FY 00: 46.6      |                   |     |
|                        |                  | FY 00: 42.8       |     |
|                        | FY 99: 39.5      |                   |     |
|                        |                  | FY 99: 45.8       |     |
|                        | FY 04: 15.2      |                   |     |
|                        |                  | FY 04: 02/06      |     |
|                        | FY 03: 15.2      |                   |     |
|                        |                  | FY 03: 02/05      |     |
|                        | FY 02: 15.2      |                   |     |
|                        |                  | FY 02: 12.3       |     |
|                        | FY 01: 15.2      |                   |     |
|                        |                  | FY 01: 13.1       |     |
|                        | FY 00: 14.0      |                   |     |
|                        |                  | FY 00: 13.4       |     |
|                        | FY 99: 12.5      |                   |     |
|                        |                  | FY 99: 12.2       |     |
+------------------------+------------------+-------------------+-----+

**Program Performance Analysis for Years Prior to FY 2005**

In previous years, AoA presented measures for the community based
services program according to three categories: intermediate outcome
targeting measures, intermediate outcome system measures, and service
output measures. The analysis that follows maintains references to those
categories to allow for the conduct of analysis in the same context in
which the measures were originally presented in the plans for FY 2004
and prior years. This form of analysis will be maintained until GPRA
requirements for the reporting of program results are met for all fiscal
years prior to FY 2005.

In those plans, AoA established expectations for performance for the
various categories of measures.

-   **Intermediate outcome targeting measures.** Does the network target
    services to vulnerable elderly individuals and have there been
    improvements in the delivery of these services?

-   **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.?

####### Performance Measures Analysis---Intermediate Outcome Targeting Measures

In previous plans, AoA 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.

-   If AoA is to demonstrate that the network is targeting services to
    vulnerable individuals, then ***data should show that the percentage
    of clients who are poor, disabled, minorities and those in rural
    areas, is higher than the percentage of all elderly persons in the
    total population who fit these characteristics.***

####### Results for Intermediate Outcome Targeting Measures

For AoA targeting measures, the tables above indicate ***that the aging
services network effectively targets services to the vulnerable elderly
individuals in the Nation***.

-   **Poverty Targeting Measures:** Whereas 10% of all elderly over 60
    years old were poor, approximately 30% of aging services network
    clients were poor for all years reported.

-   **Minority Targeting Measure:** The percent of OAA clients who were
    minorities (20.5% in FY 2002) remains significantly higher than the
    total percent of all elderly minority individuals (16%).

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-   **Disability Targeting Measure:** National sample survey data show
    79% of clients receiving home delivered meals have limitations in
    Activities of Daily Living (ADL's) and 86% of clients receiving
    homemaker services have limitations in ADL's). **This data indicates
    that states, 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 (over 60%) receiving
    registered services are aged seventy-five and above. **This data
    indicates that states as a whole are successfully targeting
    registered services to elderly individuals aged seventy-five and
    above.**

-   **Caregiver Targeting Measure:** The caregiver program was
    implemented in FY 2001. States served significantly more caregivers
    in FY 2002 (439,000) than AoA had anticipated (250,000), so the
    ratio of caregivers served to elderly clients is also higher than
    anticipated. State agencies served 1.4 caregivers for every 10
    elderly individuals served in FY 2002.

**Performance Measures Analysis--- Intermediate Outcome
Efficiency/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 efficient.***

####### 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 services network are
    significant in total, almost doubling AoA funds for all years
    reported.***

2.  ***The leveraged funds substantially exceed the funding provided by
    AoA for home and community services to the elderly, particularly the
    disabled who required in-home services and adult day care.***

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 more
    than 40% of area agency staff are volunteers.***

-   **Leveraged Funding Measures:** For all years reported, FY 1997
    through FY 2002,

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-   funds leveraged by State and local agencies exceeded funds provided
    by AoA by almost 100%; and

-   approximately three-quarters of the funding that supported personal
    care, home-delivered meals, and adult day care combined, came from
    sources other than AoA.

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-   **Program Income Measure:** Data for all five fiscal years indicate
    that revenue generated by the aging services network (e.g.,
    voluntary contributions for meals) is a significant funding source,
    representing in over one-third of the amount provided by AoA each
    year, and at 44% in FY 2002 approached nearly half of the funding
    provided by AoA.

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-   **Senior Center Focal Point Measure:** Each year, over half of all
    senior centers participating in the program were community-service
    "focal points," and in FY 2002 that percentage rose to above 60%.

-   **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 all FYs 1997 through 2002.

-   **Caregiver Measure:** For the National Family Caregiver Support
    Program, our initial objective for the "system" has been to develop
    a well-rounded program that serves the various needs of caregivers
    as envisioned by the OAA. Performance by State agencies in providing
    services across all five caregiver service categories was
    significantly beyond AoA's expectations as 46 state units reported
    meeting that objective in FY 2002.

**Performance Measures Analysis - Service Output Measures**

The service output measures in former plans were used to track the level
of services that AoA and the other components of the network provide.

***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 sources through
the States.***

####### Results for Service Output Measures {#results-for-service-output-measures .unnumbered}

The data on outputs for FY 2002 appear to indicate that costs for
services may be rising at higher rates than anticipated, and that the
fiscal difficulties confronted by States may have affected program
outputs in FY 2002. The units of service provided in FY 2002 are
somewhat lower than the units provided in FY 2001 for the categories of
service tracked in earlier GPRA plans, including: home-delivered meals,
congregate meals, transportation services, and information and
assistance services. The number of home-delivered meals provided remains
high compared to levels provided only a few years ago, but it is lower
than the number reported for FY 2001, which was higher than for any of
the previous years presented in the table above. The service levels for
home-delivered meals and other services were not as great as AoA had
projected in its performance targets.

-   **Home Delivered Meals Output Measures: *The data reflects a modest
    decrease in the number of home-delivered meals provided in FY 2002,
    but not far off the FY 2001 level, which was highest number of meals
    provided in the past seven years***. We did not meet the higher
    targeted result, which we believe reflects three factors: 1) the
    difficulty of accurately targeting the number of meals that will be
    served in a given fiscal year, 2) cost increases (particularly fuel
    costs) associated with delivering the meals, and 3) fiscal
    difficulties encountered by state units on aging.

-   **Congregate Meals Output Measure:** FY 2002 data indicates that the
    network did not meet its target for congregate meals, and that the
    number of congregate meals served declined further.

-   **Transportation Output Measure:** The level of output performance
    for transportation service did not meet the FY 2002 target and
    declined for the third consecutive year.

-   **Information and Assistance Output Measures:** The level of output
    performance for information and assistance also did not meet, the FY
    2002 target.

**Section 2: VULNERABLE OLDER AMERICANS**

**Program Description and Context**

Preventing the abuse, neglect and exploitation of older individuals in
institutional care settings as well as in their own homes and
communities is the legislative intent of Title VII of the Older
Americans Act. "Vulnerable Older Americans" is heavily weighted toward
representing the Ombudsman activities that are associated with
institutional care settings, but it also contains elements reflective of
performance on those activities associated with the protection of the
rights of elder individuals in their own homes.

The Long-Term Care Ombudsman program has as its mission to help States
to investigate and resolve complaints made by or on behalf of, residents
of long-term care facilities related to action, inaction or decisions
that may adversely affect the health, safely, welfare, or rights of
residents. Long-term care ombudsmen are necessary advocates for
residents of nursing homes, board and care homes, and adult care
facilities. The Prevention of Elder Abuse, Neglect and Exploitation
Program supports State and local efforts to train law enforcement
officers, medical professionals, social and adult protective services
workers and others in how to recognize and respond to such cases. It
also promotes public awareness campaigns.

Ombudsman responsibilities outlined in Title VII of the Older Americans
Act include:

-   Identifying, investigating and resolving complaints made by or on
    behalf of residents;

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-   Providing information to residents about long-term care services;

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-   Representing the interests of residents before governmental agencies
    and seeking administrative, legal and other remedies to protect
    residents;

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-   Analyzing, commenting on and recommending changes in laws and
    regulations pertaining to the health, safety, welfare and rights of
    residents;

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-   Educating and informing consumers and the general public regarding
    issues and concerns related to long-term care and facilitating
    public comment on laws, regulations, policies and actions; and

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-   Promoting the development of citizen organizations to participate in
    the program and providing technical support for the development of
    resident and family councils to protect the well-being and rights of
    residents.

The FY 2005 request for \$18.559 million is a decrease of \$0.885
million below the FY 2004 Conference level. Targeted program performance
improvement will result from improved program operations at the Federal,
State and local level.

Performance Measures Summary Table---Ombudsman Measures

+--------------------------+-----------------+-----------------+-----+
| **Performance Goals**    | **Targets**     | **Actual        | **N |
|                          |                 | Performance**   | ote |
|                          |                 |                 | s** |
+--------------------------+-----------------+-----------------+-----+
| **MEASURES FOR FY05 AND  | FY 05:          | FY 05: 09/06    | **  |
| BEYOND**                 | baseline + 4%   |                 | 6** |
|                          |                 | FY 04: 09/05    |     |
| **Measure 2.1: Improve   | FY 04:          |                 |     |
| Program Efficiency and   | baseline + 2%   | FY 03: 09/04    |     |
| Quality**                |                 |                 |     |
|                          | FY 03: (New in  | FY 02: 9,300    |     |
| **FULL COST %** FY05:    | 04)             | (baseline)      |     |
| 100%                     |                 |                 |     |
|                          | FY 05: 10       | FY 04: 02/06    |     |
| > FY04: 100%             | States          |                 |     |
| >                        |                 | FY 03: 02/05    |     |
| > FY03: 100%             | FY 04: 7 States |                 |     |
|                          |                 | FY 02: Not      |     |
| **Indicator 2.1:**       | FY 03: 5 States | applicable      |     |
| Increase number of       |                 |                 |     |
| complaints resolved or   | FY 02: (New in  | FY 04: 02/06    |     |
| partially resolved per   | 03)             |                 |     |
| million \$ of AoA        |                 | FY 03: 02/05    |     |
| funding.                 | FY 04: 75%      |                 |     |
|                          |                 | FY 02: 77.0%    |     |
| **Indicator 2.2**        | FY 03: 74%      |                 |     |
| Improve combined         |                 | FY 01: 76.7%    |     |
| resolution/ partial      | FY 02: 70%      |                 |     |
| resolution rate for      |                 | FY 00: 74.1%    |     |
| primary aging services   | FY 01: 70%      |                 |     |
| network States (States   |                 | FY 99: 74.3%    |     |
| and Territories)         | FY 00: 70%      |                 |     |
|                          |                 | FY 98: 70.6%    |     |
| **MEASURES FOR PRIOR     | FY 99: 71.48%   |                 |     |
| YEARS**                  |                 |                 |     |
|                          |                 |                 |     |
| Maintain a high combined |                 |                 |     |
| resolution / partial     |                 |                 |     |
| resolution rate for      |                 |                 |     |
| complaints in nursing    |                 |                 |     |
| homes.                   |                 |                 |     |
+--------------------------+-----------------+-----------------+-----+

Appropriated Funds: FY 2003 Enacted: \$18.559 Million

> FY 2004 Final Conference: \$19.444 Million

FY 2005 Budget Request \$18.559 Million

Full-Cost Budget: FY 2003 Enacted: \$24.747 Million

> FY 2004 Final Conference: \$25.658 Million

FY 2005 Budget Request \$24.899 Million

####### Performance Measures Analysis---Ombudsman Outcome Measures

With each succeeding year in the GPRA Program, AoA has sought to refine
and distill the measures that would succinctly, effectively and fairly
represent our stewardship in accomplishing the objectives of our
programs within available resources. The overriding goal of the
Ombudsman Program is to enable residents of long-term care facilities
and their families to be informed, "long-term care consumers" and to
facilitate the resolution of problems regarding care and conditions in
long-term care facilities. In measuring performance under the program
AoA focuses on the resolution of consumer complaints.

For the FY 2005 process, AoA has defined one performance measure with
two indicators to quantify performance under the measure. The measure is
to improve the efficiency and the quality of the program. The first
indicator combines both efficiency and results by linking the resolution
of complaints with AoA expenditures. The indicator is:

-   Increase number of complaints resolved or partially resolved per
    million \$ of AoA funding.

AoA's target for the combined measure is an aggressive one, which seeks
to increase the outcome efficiency of the program by four percent in
three years in the context of a stable budget request.

Reflecting the need also to track performance in complaint resolution
among the states, AoA has retained the following performance indicator
initiated in the FY 2003 budget process to foster improved performance
by committing to increase resolution rates for five program States
(States or Territories) that currently perform below the national
average.

-   Improve combined resolution/ partial resolution rate for primary
    aging services network States (States and Territories)

For FY 2005, AoA's target is aggressive, committing the Agency to double
the performance committed to for FY 2003. The target calls for
improvement in complaint resolution for 10 state agencies.

**Results for Ombudsman Outcome Measures**

For each of the years included in the table above, ***the network has
achieved a high combined resolution/partial resolution rate of nearly 80
percent***. For both FY 2001 and FY 2002, the rate has risen to over
75%.

**Section 3: SERVICES FOR NATIVE AMERICANS**

####### Program Description and Context

AoA's American Indian, Alaska Native, and Native Hawaiian Program --
Title VI of the OAA -- is responsible for serving as the Federal
advocate on behalf of older Native Americans, coordinating activities
with other Federal departments and agencies, administering grants to
Native Americans for home and community-based services, and collecting
and disseminating information related to the problems of older Native
Americans.

Under Title VI of the OAA, AoA annually awards grants to provide home
and community-based and nutrition services for American Indian, Alaska
Native and Native Hawaiian older adults living in the Title VI service
area. In 2003, grants were awarded to 241 American Indian and Alaska
Native tribal organizations representing nearly 300 tribes, and two
organizations serving Native Hawaiian elders.

In addition to nutrition services, the Title VI program funds home and
community-based services such as information and assistance,
transportation, chore services, homemaker services, health aide
services, outreach, family support, and legal assistance. \[There is
also a Native American Caregiver Support Program, established in the
2000 amendments to the OAA; however, the funding for this is included in
the community based services program.\]

For FY 2005, performance measurement has been consolidated into a single
efficiency measure that incorporates the total units of service reported
in several categories in prior years. Output measures used in previous
performance plans have been discontinued for reporting purposes. This
consolidation will still provide a direct budget to performance linkage
since AoA is not proposing to eliminate the existing performance
measures and indicators, instead, we will continue to separately assess
their efficiency and outcomes, which is how the budget and performance
linkage occurs. For presentation purposes, however, they will be
represented as indicators under a single, broader measure, just as we
currently do for Title III. This will achieve the secondary objective of
reducing the volume of documents HHS and OMB must manage and review in
this process.

Performance Measures Table---Native Americans Program

+---------------------------+----------------+------------------+-----+
| ### **Performance Goals** | #              | ### **Actu       | **N |
|                           | ## **Targets** | al Performance** | ote |
|                           |                |                  | s** |
+---------------------------+----------------+------------------+-----+
| **MEASURES FOR FY05 AND   | FY 05:         | FY 05: 02/07     | **  |
| BEYOND**                  | baseline + 4%  |                  | 6** |
|                           |                | FY 04: 02/06     |     |
| Measure 3.1 : Improve     | FY 04:         |                  |     |
| Program Efficiency        | baseline + 2%  | FY 03: 02/05     |     |
|                           |                |                  |     |
| **FULL COST %** FY05:     | (numbers in    | FY 02: 06/04     |     |
| 100%                      | thousands)     |                  |     |
|                           |                | FY 01: 230       |     |
| > FY04: 100%              | FY 04: 2,000   | (baseline)       |     |
| >                         |                |                  |     |
| > FY03: 100%              | FY 03: 1,850   | (numbers in      |     |
|                           |                | thousands)       |     |
| **Indicator 3.1:**        | FY 02: 1,850   |                  |     |
| Increase the number of    |                | FY 04: 02/06     |     |
| service units provided    | FY 01: 1,795   |                  |     |
| per thousand \$ of AoA    |                | FY 03: 02/05     |     |
| funding.                  | FY 00: 1,632   |                  |     |
|                           |                | FY 02: 1,667     |     |
| **MEASURES FOR PRIOR      | FY 99: 1,456   |                  |     |
| YEARS**                   |                | FY 01: 1,966     |     |
|                           | FY 04: 1,650   |                  |     |
| Initially increase and    |                | FY 00: 1,778     |     |
| then maintain units of    | FY 03: 1,650   |                  |     |
| service in the following  |                | FY 99: 1,680     |     |
| categories:               | FY 02: 1,650   |                  |     |
|                           |                | FY 04: 02/06     |     |
| > ***[Home-delivered      | FY 01: 1,583   |                  |     |
| > meals]{.underline}***   |                | FY 03: 02/05     |     |
| >                         | FY 00: 1,439   |                  |     |
| > ***[Congregate          |                | FY 02: 1,305     |     |
| > meals]{.underline}***   | FY 99: 1,322   |                  |     |
| >                         |                | FY 01: 1,440     |     |
| > ***[Transportation      | FY 04: 740     |                  |     |
| > Service                 |                | FY 00: 1,348     |     |
| > Units]{.underline}***   | FY 03: 732     |                  |     |
| >                         |                | FY 99: 1,290     |     |
| > ***[Information         | FY 02: 732     |                  |     |
| > &Referral Service       |                | FY 04: 02/06     |     |
| > Units]{.underline}***   | FY 01: 732     |                  |     |
| >                         |                | FY 03: 02/05     |     |
| > ***[In-home service     | FY 00: 665     |                  |     |
| > units]{.underline}***   |                | FY 02: 715       |     |
|                           | FY 99: 763     |                  |     |
| ***[Other                 |                | FY 01: 735       |     |
| services]{.underline}***  | FY 04: 747     |                  |     |
|                           |                | FY 00: 699       |     |
|                           | FY 03: 747     |                  |     |
|                           |                | FY 99: 702       |     |
|                           | FY 02: 747     |                  |     |
|                           |                | FY 04: 02/06     |     |
|                           | FY 01: 747     |                  |     |
|                           |                | FY 03: 02/05     |     |
|                           | FY 00: 679     |                  |     |
|                           |                | FY 02: 699       |     |
|                           | FY 99: 632     |                  |     |
|                           |                | FY 01: 659       |     |
|                           | FY 03: 970     |                  |     |
|                           |                | FY 00: 651       |     |
|                           | FY 02: 953     |                  |     |
|                           |                | FY 99: 633       |     |
|                           | FY 01: 953     |                  |     |
|                           |                | FY 03: 02/05     |     |
|                           | FY 00: 866     |                  |     |
|                           |                | FY 02: 833       |     |
|                           | FY 99: 742     |                  |     |
|                           |                | FY 01: 961       |     |
|                           | FY 03: 660     |                  |     |
|                           |                | FY 00: 929       |     |
|                           | FY 02: 650     |                  |     |
|                           |                | FY 99: 942       |     |
|                           | FY 01: 650     |                  |     |
|                           |                | FY 03: 02/05     |     |
|                           | FY 00: 591     |                  |     |
|                           |                | FY 02: 06/04     |     |
|                           | FY 99: 512     |                  |     |
|                           |                | FY 01: 776       |     |
|                           |                |                  |     |
|                           |                | FY 00: 682       |     |
|                           |                |                  |     |
|                           |                | FY 99: 702       |     |
+---------------------------+----------------+------------------+-----+

The FY 2005 Budget request for the Native American program is \$26.6
million, an increase of \$0.159 million over the FY 2004 Conference
level.

Appropriated Funds: FY 2003 Enacted: \$27.495 Million

> FY 2004 Final Conference: \$26.453 Million

FY 2005 Budget Request \$26.612 Million

Full-Cost Budget: FY 2003 Enacted: \$29.542 Million

> FY 2004 Final Conference: \$28.508 Million

FY 2005 Budget Request \$28.788 Million

######  {#section-11 .unnumbered}

###### Program Performance Analysis {#program-performance-analysis .unnumbered}

For FY 2005 and beyond, AoA will consolidate performance measurement for
this program into one program efficiency measure. Specifically, the
measure states that AoA will:

-   Increase the number of service units provided per thousand \$ of AoA
    funding.

In the context of stable funding for the program, AoA still proposes
relatively aggressive targets for the new efficiency measure. For FY
2005, AoA proposes to increase program efficiency by 4% over the FY 2001
base.

In analyzing program performance related to performance plans for
earlier years, the FY 2001 data for the Native American program, the
most recent complete data available for this program, indicate
successful results for all performance targets except for information/
referral services and congregate meals for that fiscal year. Units of
service rose for all of the service categories included in the plan.
Effectively, the data indicate that service provision overall remains
stable for this program.

Locally administered home and community-based programs and services are
an important component of the long-term care delivery system for this
program. Indian tribes have pursued the development of appropriate home
and community-based long-term care services to enable their elders to
remain as independent as possible in community settings of their choice.
Through 236 grants provided by AoA, a variety of in-home support
services were provided to tribes, tribal organizations and Native
Hawaiian organizations during FY 2001:

More than 61,000 older American Indians, Alaska Natives and Native
Hawaiians received a variety of in-home services including personal care
services, homemaker services, health aide services, case management
assistance, and family support.

Approximately 735,000 rides were provided to older Native American
adults to meal sites, medical appointments, grocery stores and other
destinations.

Nearly a million units of individual and family support services, such
as visitation and respite, were provided to elders and their families.
More than 650,000 units of information and assistance on issues dealing
with Social Security, food stamps, and other topics were provided to
elders and their families.

Recipients of rides were able to increase their access to programs and
services and maintain greater independence within their communities.
Recipients of information and assistance have increased information
about their right to receive Social Security, food stamps and other
services aimed at improving their health and standard of living.

####### Section 4: SENIOR MEDICARE PATROLS & TECHNICAL ASSISTANCE CENTERS

**Program Description and Context**

HHS, particularly the Centers for Medicare and Medicaid Services (CMS)
and the Office of Inspector General (OIG), has placed significant
emphasis on the identification and reduction of billions of dollars of
fraud and waste in the Medicare program. AoA works in partnership with
CMS, OIG, the Department of Justice, and other Federal, State, and local
partners to assist in this effort in a very specific way. Our role under
this partnership is to educate and inform older Americans how they can
play an important role in protecting the benefit integrity of the
Medicare and Medicaid programs. AoA's efforts under this initiative have
been funded through two sources.

Funding provided under the Health Insurance Portability and
Accountability Act (HIPAA) is used by State and local projects to:

-   train aging services network professionals to recognize and report
    potential instances of waste, fraud, and abuse;

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-   develop and disseminate consumer education materials to
    beneficiaries; and

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-   support technical assistance efforts designed to share and replicate
    common strategies and successful practices among federal, state and
    local officials, health care professionals, community service
    providers who serve older Americans, and beneficiaries and their
    families.

Appropriated funds provided on an annual basis are used to establish
innovative community-based projects that seek to utilize the skills and
expertise of retired professionals in educating older Americans
regarding how to help protect the benefit integrity of the Medicare and
Medicaid programs. As of FY 2002, AoA has cumulatively funded 57
community-based projects, known as "Senior Medicare Patrol Projects," in
52 jurisdictions (50 States, plus the District of Columbia and Puerto
Rico). These Senior Medicare Patrol Projects have recruited and trained
almost 40,000 retired professionals, such as doctors, nurses, teachers,
lawyers, accountants, and others to work in their communities, teaching
beneficiaries how to take an active role in protecting their Medicare
card numbers and their health care.

In FY 20005, many of the prior year performance measures have been
discontinued due to the need to reduce the total measures while
integrating efficiency measures for all programs. For the Senior
Medicare Patrol program, this has meant the focus on a single measure
that captures the compounded value of investment in prior years due to
the momentum of training activities. The measure is: "Improve Program
Efficiency" with the primary indicator at this time being to "Increase
the number of beneficiaries trained per million dollars of AoA funding."

**Performance Measures Summary Table**--- Senior Medicare Patrol
Measures

+-----------------------+----------------+----------------------+-----+
| **Performance Goals** | **Targets**    | **Actual             | **N |
|                       |                | Performance**        | ote |
|                       |                |                      | s** |
+-----------------------+----------------+----------------------+-----+
| **MEASURE FOR FY05    | FY 05:         | FY 05: 02/06         |     |
| AND BEYOND**          | baseline + 5%  |                      |     |
|                       |                | FY 04: 02/05         |     |
| **Measure 4.1:        | FY 04:         |                      |     |
| Improve Program       | baseline + 3%  | FY 03: 02/04         |     |
| Efficiency**          |                |                      |     |
|                       | FY 03: 56,800  | FY 02: 31,000        |     |
| **Indicator 4.1:**    |                |                      |     |
| Improve elders        | FY 02: 54,800  | FY 03: 02/04         |     |
| trained funding       |                |                      |     |
| ratio.                | FY 01: 41,100  | FY 02: 57,061        |     |
|                       |                |                      |     |
| **FULL COST %** FY05: | FY 00: 17,125  | FY 01: 48,076        |     |
| 100%                  |                |                      |     |
|                       | FY 99: (new in | FY 00: 39,300        |     |
| > FY04: 100%          | 2000)          | trained              |     |
| >                     |                |                      |     |
| > FY03: 100%          | FY 04:         | FY 99: 13,700        |     |
|                       | 1,200,000      | (baseline) (a)       |     |
| **MEASURES FOR PRIOR  |                |                      |     |
| YEARS**               | FY 03: 600,000 | FY 04: 02/05         |     |
|                       |                |                      |     |
| **Measure 4.2**       | FY 02: 500,000 | FY 03: 02/04         |     |
| Increase the number   |                |                      |     |
| of trainers who       | FY 01: (new in | FY 02: 955,000       |     |
| educate beneficiaries | 2002)          |                      |     |
|                       |                | FY 01: 570,000       |     |
| **Measure 4.3**       | FY 04: 3,000   |                      |     |
| Increase the number   |                | FY 00: 350,000       |     |
| of beneficiaries who  | FY 03: 2,500   | (baseline) (b)       |     |
| are educated by the   |                |                      |     |
| volunteer trainers    | FY 02: 380     | FY 04: 02/05         |     |
|                       |                |                      |     |
| **Measure 4.4**       | FY 01: 280     | FY 03: 02/04         |     |
| Increase the number   |                |                      |     |
| of substantiated      | FY 00: 200     | FY 02: 2,708         |     |
| complaints generated  |                |                      |     |
| through AoA's         | FY 99: (new in | FY 01: 2,190         |     |
| activities (i.e.      | 2000)          |                      |     |
| complaint results in  |                | FY 00: 1,241         |     |
| some action taken).   |                |                      |     |
|                       |                | FY 99: 133           |     |
|                       |                | (baseline) (c)       |     |
+-----------------------+----------------+----------------------+-----+
| **Numbers for         |                |                      |     |
| training targets and  |                |                      |     |
| results, are          |                |                      |     |
| \"cumulative\" since  |                |                      |     |
| inception of the      |                |                      |     |
| projects -- including |                |                      |     |
| projects funded under |                |                      |     |
| the Health Insurance  |                |                      |     |
| Portability and       |                |                      |     |
| Accountability Act    |                |                      |     |
| (HIPAA) of 1996.**    |                |                      |     |
|                       |                |                      |     |
| (a) The cumulative    |                |                      |     |
|     total includes    |                |                      |     |
|     volunteers who    |                |                      |     |
|     were trained      |                |                      |     |
|     under HIPAA. The  |                |                      |     |
|     successor to this |                |                      |     |
|     effort was the    |                |                      |     |
|     \"Senior Medicare |                |                      |     |
|     Patrol\" project  |                |                      |     |
|     authorized by the |                |                      |     |
|     Omnibus           |                |                      |     |
|     Consolidated      |                |                      |     |
|     Appropriations    |                |                      |     |
|     Act of 1997       |                |                      |     |
|     (P. L. 104-209).  |                |                      |     |
|                       |                |                      |     |
| ```{=html}            |                |                      |     |
| <!-- -->              |                |                      |     |
| ```                   |                |                      |     |
| (b) Cumulative        |                |                      |     |
|     including         |                |                      |     |
|     beneficiaries     |                |                      |     |
|     educated under    |                |                      |     |
|     the authority of  |                |                      |     |
|     HIPAA.            |                |                      |     |
|                       |                |                      |     |
| ```{=html}            |                |                      |     |
| <!-- -->              |                |                      |     |
| ```                   |                |                      |     |
| (c) Baseline total is |                |                      |     |
|     cumulative        |                |                      |     |
|     including         |                |                      |     |
|     complaints        |                |                      |     |
|     substantiated     |                |                      |     |
|     under HIPAA.      |                |                      |     |
+-----------------------+----------------+----------------------+-----+

Trust Fund\*: FY 2003 Enacted: \$3.250 Million

> FY 2004 President's Budget: \$3.250 Million

FY 2005 Budget Request \$3.250 Million

> \* Mandatory

Full-Cost Budget: FY 2003 Enacted: \$12.798 Million

> FY 2004 Final Conference: \$12.804 Million

FY 2005 Budget Request \$12.861 Million

Performance Measures Analysis---Senior Medicare Patrol Program

#######  {#section-12 .unnumbered}

AoA elected to employ a set of fundamental results measures that reflect
the agency's commitment of educating and informing older Americans on
how to take an active role in their health care, thereby helping to
maintain the benefit integrity of the Medicare and Medicaid programs.

For the FY 05 GPRA Plan, AoA has introduced a new efficiency measure,
which combines the focus on training seniors to identify Medicare fraud
and abuse with the need to measure program efficiency for all program
activities. While the measures for prior years have been eliminated from
the plan, AoA will continue to track them internally.

-   **Beneficiaries Educated Per Million \$ of Funding Measure:** This
    outcome and efficiency measurement is directed toward increasing the
    number of beneficiaries who are educated by the volunteer trainers
    for a given dollar of Federal funding. This measure is new and thus
    we have only the baseline to report this year.

    Prior Year Results for the Senior Medicare Patrol Program

To demonstrate that the network is educating older Americans to take an
active role in their health care and protect the integrity of Medicare
and Medicaid services, the data should show an increase in the number of
trainers who educate beneficiaries, an increase in the number of
beneficiaries educated by volunteer trainers, and an increase in the
number of complaints that have been reported and acted upon as a result
of the AoA programs.

For the measures presented in the table above, the data indicates that
**the aging services network effectively educates and informs older
Americans on how to take an active role in their health care and
maintain the integrity of the Medicare and Medicaid systems.**

-   **Volunteers Trained Measure:** This measure is directed at
    increasing the number of volunteers trained by AoA's grantees, who
    in turn educate an increasing number of beneficiaries on how to take
    an active role in protecting their health care. In FY 1999, the
    Senior Medicare Patrol Projects were just beginning to develop their
    training activities and materials. However, by the end of FY 1999
    the project had trained 13,700 (on a cumulative basis) community
    volunteers under the HIPAA and Senior Medicare Patrol projects.
    During FY 2000 and beyond, materials and effective training
    strategies were more widely utilized by the grantees, which meant
    that we trained over 57,000 by FY 2002, one year earlier than
    planned.

> **The performance for FY 2002 exceeded the target, by reaching
> approximately 57,000 volunteers trained.** We do not anticipate that
> the grantees will train as many new volunteers during future years
> because the effort will build on the large pool of experienced
> volunteers who will continue to conduct sessions during those years.
> Also, because AoA wanted to focus on trained beneficiaries and their
> results, this measure was discontinued in the FY 2004 plan.

-   **Beneficiaries Educated Measure:** This measure is directed toward
    increasing the number of beneficiaries who are educated by the
    volunteer trainers. This measure was new in FY 2002. It is the
    beneficiaries, who have to learn to detect possible fraud, waste and
    abuse in the Medicare payments. AoA substantially exceeded its FY
    2002 target. The "trainers" trained over 950,000 beneficiaries for
    both HIPAA and the Senior Medicare Patrol projects.

-   **Inquiries Submitted and Acted Upon Measure:** This measure
    consists of the number of inquiries submitted by AoA's projects and
    volunteers to health care providers, Centers for Medicare and
    Medicaid Services (CMS), the OIG, and other appropriate sources that
    result in some action being taken. In FY 1999, this system of
    reporting was just beginning to be developed and AoA's projects
    started with a baseline of 133 cases (for both the HIPAA and Senior
    Medicare Patrol projects) that resulted in some sort of corrective
    action being taken. **In FY2002, actual performance indicates that
    the complaints generated through AoA's activities for which some
    action was taken exceeded the projected target: more than 2,700
    substantiated cases were generated.**

**Section 5: AOA INNOVATIONS AND DEMONSTRATIONS PROGRAM**

AoA's innovations and demonstrations program consists of model
demonstrations, applied research and national resource centers designed
to produce best practices, useful knowledge and systems improvements
that point policy makers and program administrators to well-reasoned
courses of action in the field of aging.

Because these projects and other evaluation activities support the
fundamental program characteristics of the aging services network
programs, AoA does not establish a separate set of performance measures
for these activities. Rather, AoA's activity under this program
contributes to the accomplishment of broader measures presented under
the Community-Based Services Program and other AoA programs. The ability
of AoA and the network to achieve the service, outcome and systems
performance goals of the OAA programs relies in part on the projects and
activities carried out under this program category. Significant program
activity and improvements have their roots in such research and
development projects, including nutrition programs for the elderly, the
new caregiver program, and the long-term care ombudsman program.

Appropriated Funds: FY 2003 Enacted: \$56.034 Million

> FY 2004 Final Conference: \$58.686 Million

FY 2005 Budget Request \$48.716 Million

The resources requested in FY 2005 will be used to enhance the HHS
effort to: 1) create more balance in the long-term care service system
toward care in the community, 2) further AoA's efforts to deliver more
integrated services to older persons and their families, assist family
caregivers, and 3) continue to build partnerships with other agencies to
coordinate and integrate services. Because these activities support
AoA's other programs, particularly the community-based services program,
the costs of these programs have been distributed to the other program
in AoA's full cost analysis.

**Performance Analysis**

Examples of the community-based services measures supported by activity
under this program include:

-   Increase the number of people served per \$million of AoA funding
    with no decline in service quality.

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-   Increase the percent of caregivers reporting that services have
    ***"definitely"*** helped them provide care longer.

-   Decrease the number of caregivers reporting difficulties in dealing
    with agencies to obtain services.

-   Increase the number of home-delivered meal clients with 3 or more
    ADL limitations (nursing home eligible).

**Section 6: PROGRAM MANAGEMENT**

**Program Description and Context**

With the compelling need to reduce the number of performance measures,
AoA has eliminated the program management measure. As these measures are
also contained in the President's Management Agenda, their inclusion in
this plan would be duplicative.

To comply with GPRA Departmental Requirements to reduce the number of
performance measures, these measures will be tracked internally but
removed from the GPRA plan. AoA's management still views these measures
as valuable management tools and will continue to use them internally
even though they are not included in this plan.

Historically, AoA's performance measures for management activities
covered the following areas:

-   **Financial Management**

-   **Acquisitions/Grants Management/E-Government**

-   **Workforce Planning and Restructuring**

The areas covered and the measures employed track very closely with the
management priorities of OMB and HHS, they will be reported through
other measures, from FY 05 forward.

Appropriated Funds: FY 2003 Enacted: \$17.869 Million

> FY 2004 Final Conference: \$20.138 Million\*

FY 2005 Budget Request \$23.040 Million\*

\*Includes funding for the White House Conference on Aging.

The increase requested in FY 2005 is necessary to continue the support
of the President's Management Agenda and to carry out the Secretary's
"One Department" vision.

Performance Measures Summary Table---Program Management Measures

+------------------------+---------------------+---------------+-----+
| ###                    | ####### Targets     | ####### Actua | #   |
| #### Performance Goals |                     | l Performance | ### |
|                        |                     |               | ### |
|                        |                     |               |  No |
|                        |                     |               | tes |
+------------------------+---------------------+---------------+-----+
| ####### ME             | FY 02: Clean        | FY 02: Same   |     |
| ASURES FOR PRIOR YEARS | Opinion             | as 01         |     |
|                        |                     |               |     |
| **Measure 6.1**        | FY 01: Clean        | FY 01: Clean  |     |
| Results of most recent | Opinion             | Opinion       |     |
| CFO Audit of AoA       |                     |               |     |
| Financial Statements.  | FY 00: (New in FY   | FY 03: 100%   |     |
|                        | 01)                 |               |     |
| **Measure 6.2** A high |                     | FY 02: 100%   |     |
| percentage of AoA      | FY 03: 80%          |               |     |
|                        |                     | FY 04: 12/04  |     |
| hires will be based on | FY 02: 80%          |               |     |
| a formal AoA Workforce |                     | FY 03: 5.7 to |     |
| Plan.                  | FY 01: (New in FY   | 1             |     |
|                        | 02)                 |               |     |
| **Measure 6.3**        |                     | FY 02: 5.2 to |     |
| Increase the ratio of  | FY 04: 5.0 to 1     | 1             |     |
| employees to           |                     |               |     |
| supervisors.           | FY 03: 5.0 to 1     | FY 01: 4.3 to |     |
|                        |                     | 1             |     |
| **Measure 6.4**        | FY 02: (New in FY   |               |     |
| Decrease the average   | 03)                 | FY 04: 12/04  |     |
| grade of AoA career    |                     |               |     |
| employees              | FY 04: 12.2         | FY 03: 12.1   |     |
|                        |                     |               |     |
| **Measure 6.5**        | FY 03: 13.0         | FY 02: 12.3   |     |
| Increase the           |                     |               |     |
| percentage of          | FY 02: (New in FY   | FY 01: 13.5   |     |
| procurement dollars    | 03)                 |               |     |
| that are subjected to  |                     | FY 04:        |     |
| performance-based      | FY 04: 20%          |               |     |
| contracts.             |                     | FY 03: 10%    |     |
|                        | FY 03: 20%          |               |     |
| **Measure 6.6**        |                     | FY 02: 5%     |     |
| Increase the           | FY 02: 20%          |               |     |
| percentage of          |                     | FY 01: 0%     |     |
| discretionary grant    | FY 01: (New in FY   | (baseline)    |     |
| applications that are  | 02)                 |               |     |
| submitted and          |                     | FY 04:        |     |
| processed              | FY 04: +5%          |               |     |
| electronically,        |                     | FY 03: 12%    |     |
| including via the      | FY 03: 10%          |               |     |
| Internet.              |                     | FY 02: 10%    |     |
|                        | FY 02: (New in FY   |               |     |
| **Measure 6.7** AoA    | 03)                 | FY 01: 0%     |     |
| will have no material  |                     | (baseline)    |     |
| weaknesses identified  | FY 04: No           |               |     |
| in the Departmental    | weaknesses          | FY 04: 02/05  |     |
| top-down audit.        |                     |               |     |
|                        | FY 03: No           | FY 03: No     |     |
|                        | weaknesses          | weaknesses    |     |
|                        |                     |               |     |
|                        | FY 02: (New in FY   |               |     |
|                        | 03)                 |               |     |
+------------------------+---------------------+---------------+-----+

####### 

Consistent with AoA's effort to estimate the full cost of programs and
performance measures, the budget for program management for FY 2005 has
been allocated to the program activities presented in the previous
sections of this plan.

####### Results for Program Management Measures

**Financial Management** **Measures:** In FY 2001, AoA received a clean
opinion on the audit of its FY 2000 financial statements (balance
sheet), and in FY 2002 received a clean opinion on the audit of its
complete FY 2001 financial statements. To improve the efficiency of
financial audit processes and because the overwhelming majority of AoA
financial management activity is performed at the Department level, HHS
will not conduct separate audits of AoA accounts starting in FY 2003,
but will include AoA in "top-down" HHS audits. As a result, there will
no longer be opinions on AoA financial statements, and the clean opinion
measure will no longer be applicable. However, maintaining its
commitment to high quality financial management activity where AoA is
directly involved, ***AoA adopted a new performance measure that the
agency will have no material weaknesses cited in the HHS audit for AoA
financial management activity***. In the most recent top-down audit of
HHS financial statements (FY 2003), no material weaknesses were
identified for AoA financial management activity. To comply with
Departmental requirements to reduce the number of performance measures,
these measures will be tracked internally but removed from the GPRA
plan.

**Strategic Management of Human Capital Measures:** An extensive AoA
review of workforce and structural conditions found that improvements
were necessary and achievable in: 1) "delayering" the organization, 2)
grade structure, and 3) skill mix. To track its accountability for
implementing improvements, AoA included three performance measures
related to workforce planning and restructuring in its FY 2003 and FY
2004 GPRA performance plans. ***In FY 2002, one year ahead of the plan,
AoA met its FY 2003 targets and continued to make dramatic progress
towards these goals by increasing the employee to supervisor ratio for
the agency and by achieving a measurable reduction in the average grade
of employees during the next year and increasing the ratio of employees
to supervisors.***

Although ahead of our established goals for all of these measures, by FY
2005, AoA expects that at least for one measure, the average grade of
career employees, we may begin to experience a slight reversal, which is
expected to continue over the next two years. This is due to the
expected attrition of retirement age career staff and the need to
replace them with journeymen-level professionals in order to be able to
continue to function at our current level of service as we carry out the
important work on behalf of older Americans.

A minor note, but nevertheless a positive one has been that in each year
since the establishment of the Workforce Plan measure, 100% of all new
hires have been based on a formal AoA Workforce Plan. In addition, our
efforts at delayering have been fruitful as well: the ratio of employees
to supervisors has increased from 4.3 to 1 in FY 2001 and 5.2 to 1 in FY
2002 to 5.7 to 1 in FY 2003. Because so many of AoA's staff is made up
of contract employees rather than civil servants, however, the ratio
tends to understate the effective outcome and if total workforce were to
include contractors, the ratio of employees to supervisors would be 6.9
to 1 due to federal employees supervising contractor staff.

AoA will continue to seek to maintain these significant improvements and
in the interest of reducing the number of measures in the AoA
performance plan, we will track future compliance with this objective
internally, but remove it from the GPRA Plan.

> **Acquisitions/Grants Management/E-Government Measures:** AoA has
> initiated work to apply the efficiencies of electronic transactions to
> one of its most significant operational activities, and will pursue
> the application to a second such activity within the next year. AoA
> has initiated work to apply e-government solutions to its grants
> processing efforts, and will work with State and local government
> entities to identify the feasibility of applying such technology to
> the submission of detailed program information requirements.

The grants application process is one of AoA's most significant workload
processes, and involves significant staff and related resources on the
part of AoA and potential grantees. Believing that electronic processes
offered a significant opportunity for improved efficiency for AoA and
its grantees, AoA has developed information technology that is allowing
grantees to apply for AoA funding electronically, including by way of
the Internet. To ensure the continued expansion of these electronic
process improvements, AoA has included a performance goal in its annual
GPRA performance plan that calls for the agency to increase the
percentage of discretionary applications that are submitted and
processed electronically in the first year of operation to 10 percent
from its FY 02 baseline; actual performance established that AoA
slightly exceeded this goal in FY 2003, with 12% of its discretionary
grants processed electronically.

AoA had also included a performance measure in GPRA performance plans
for the last three years to increase the use of performance-based
contracts in its procurement activities to 20 percent of its procurement
dollars. For the second year, while AoA was still unable to achieve this
objective due to technical government-wide requirements for contract
renewals. We did however manage to increase from our first year level of
5% to 10% in FY 2003. AoA does anticipate achievement of the objective
during FY 2004.

**III. APPENDICES to the PERFORMANCE PLAN**

Appendix A

**Linkages to HHS and AoA Strategic Plan**

Part 1 of this performance plan provides a summary presentation of the
linkage between the AoA Strategic Plan, the AoA GPRA performance plan
and the HHS Strategic Plan. The following chart is intended to provide a
more descriptive and definitive illustration of the detailed links
between individual AoA program activities and the detailed goals and
objectives in the HHS Strategic Plan.

+-----------------------------------------------------------------------+
| # **HHS Strategic Goa                                                 |
| l 1: Reduce the Major Threats to Health and Well-Being of Americans** |
+-----------------------------------------------------------------------+

+------------------------------+---------------------------------------+
| HHS Strategic Objective 1.1: |                                       |
| Reduce behavioral and other  |                                       |
| factors that contribute to   |                                       |
| the development of chronic   |                                       |
| diseases.                    |                                       |
+------------------------------+---------------------------------------+
| ## AoA Strategic Goal        | ## FY 2005 GPRA Performance Measures  |
+------------------------------+---------------------------------------+
| Goal 2: Increase the number  | 1.1, 1.2, 1.3                         |
| of older people who stay     |                                       |
| active and healthy.          |                                       |
+------------------------------+---------------------------------------+

  -----------------------------------------------------------------------
  **HHS Strategic Goal 6: Improve the Economic and Social Well-being of
  Individuals, Families, and Communities, Especially Those Most in Need**

  -----------------------------------------------------------------------

+-------------------------------+--------------------------------------+
| HHS Strategic Objective 6.2:  |                                      |
| Increase the Proportion of    |                                      |
| Older Americans Who Stay      |                                      |
| Active and Healthy            |                                      |
+-------------------------------+--------------------------------------+
| ## AoA Strategic Goal         | ## FY 2005 Performance Goal          |
+-------------------------------+--------------------------------------+
| Goal 1: Increase the number   | 1.1, 1.2, 1.3, 3.1                   |
| of older people who have      |                                      |
| access to an integrated array | 1.1, 1.2, 1.3                        |
| of services.                  |                                      |
|                               | 1.1, 1.2                             |
| Goal 2: Increase the number   |                                      |
| of older people who stay      | 2.1, 4.1                             |
| active and healthy.           |                                      |
|                               |                                      |
| Goal 3: Increase the number   |                                      |
| of families who receive help  |                                      |
| in their efforts to care for  |                                      |
| loved ones at home and in the |                                      |
| community.                    |                                      |
|                               |                                      |
| Goal 4. Increase the number   |                                      |
| of older people who benefit   |                                      |
| from programs that protect    |                                      |
| their rights and prevent      |                                      |
| elder abuse, neglect and      |                                      |
| exploitation.                 |                                      |
+-------------------------------+--------------------------------------+

+-------------------------------+--------------------------------------+
| HHS Strategic Objective 6.3:  |                                      |
| Increase the Independence and |                                      |
| Quality of Life of Persons    |                                      |
| with Disabilities including   |                                      |
| those with Long-Term Care     |                                      |
| Needs                         |                                      |
+-------------------------------+--------------------------------------+
| ## AoA Program                | ## Performance Goal                  |
+-------------------------------+--------------------------------------+
| Goal 1: Increase the number   | 1.1, 1.2, 1.3, 3.1                   |
| of older people who have      |                                      |
| access to an integrated array | 1.1, 1.2, 1.3                        |
| of services                   |                                      |
|                               | 2.1                                  |
| Goal 3: Increase the number   |                                      |
| of families who receive help  |                                      |
| in their efforts to care for  |                                      |
| loved ones at home and in the |                                      |
| community                     |                                      |
|                               |                                      |
| Goal 4. Increase the number   |                                      |
| of older people who benefit   |                                      |
| from programs that protect    |                                      |
| their rights and prevent      |                                      |
| elder abuse, neglect and      |                                      |
| exploitation.                 |                                      |
+-------------------------------+--------------------------------------+

APPENDIX B

Changes and Improvements over the Previous Year

AoA revised the FY 2005 plan in conformance with new formatting
instructions from HHS. In addition, there was a net decrease in
performance measures, new efficiency measures were added and new outcome
measures based on national survey data were introduced. We also
incorporated long-term performance measures from the AoA Strategic Plan
into the FY 2005 GPRA plan.

The major improvements to the plan occur in Section 1, the
Community-based Program and Section 5, AoA Innovation and Demonstration,
where we introduced new outcome performance measures which will
demonstrate both the effective contribution of the aging services
network to the HHS long-term care services "Rebalancing Initiative" and
the success of our service integration projects.

Summary of Changes to Plan

+-------------+--------------------------------------------------------+
| **Measures  | # **Changes**                                          |
| and         |                                                        |
| I           |                                                        |
| ndicators** |                                                        |
+-------------+--------------------------------------------------------+
| **Measure   | ## Design                                              |
| 1.1**       | ed in FY 05, includes indicators 1.1.1, 1.2, and 1.1.3 |
+-------------+--------------------------------------------------------+
| **Indicator | New efficiency measure in FY05                         |
| 1.1.1**     |                                                        |
+-------------+--------------------------------------------------------+
| Indicator   | ## No Change                                           |
| 1.1.2       |                                                        |
+-------------+--------------------------------------------------------+
| **Indicator | Efficiency Measure, Discontinued Measure 1.13 in FY04, |
| 1.1.3**     | Reinstated as 1.1.3 in FY05                            |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
| **Measure   | ## Designed in FY 05, includes indicators 1.2.1-1.2.7  |
| 1.2**       |                                                        |
+-------------+--------------------------------------------------------+
| **Indicator | New outcome measure in FY05                            |
| 1.2.1**     |                                                        |
+-------------+--------------------------------------------------------+
| **Indicator | New outcome measure in FY05                            |
| 1.2.2**     |                                                        |
+-------------+--------------------------------------------------------+
| **Indicator | New outcome measure in FY05                            |
| 1.2.3**     |                                                        |
+-------------+--------------------------------------------------------+
| **Indicator | New outcome measure in FY05                            |
| 1.2.4**     |                                                        |
+-------------+--------------------------------------------------------+
| **Indicator | New outcome measure in FY05                            |
| 1.2.5**     |                                                        |
+-------------+--------------------------------------------------------+
| **Indicator | New outcome measure in FY05                            |
| 1.2.6**     |                                                        |
+-------------+--------------------------------------------------------+
| **Indicator | New outcome measure in FY05                            |
| 1.2.7**     |                                                        |
+-------------+--------------------------------------------------------+
|             | #                                                      |
+-------------+--------------------------------------------------------+
| **Measure   | ## Designed in FY05, includes Indicators 1.3.1--1.3.2  |
| 1.3**       |                                                        |
+-------------+--------------------------------------------------------+
| Indicator   | No Change                                              |
| 1.3.1       |                                                        |
+-------------+--------------------------------------------------------+
| Indicator   | No Change                                              |
| 1.3.2       |                                                        |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
| Measure     | Discontinued in FY05                                   |
| 1.14        |                                                        |
+-------------+--------------------------------------------------------+
| Measure     | Discontinued in FY05                                   |
| 1.15        |                                                        |
+-------------+--------------------------------------------------------+
| Measure     | Discontinued in FY04                                   |
| 1.16        |                                                        |
+-------------+--------------------------------------------------------+
| Measure     | Discontinued in FY05                                   |
| 1.17        |                                                        |
+-------------+--------------------------------------------------------+
| Measure     | Discontinued in FY05                                   |
| 1.18        |                                                        |
+-------------+--------------------------------------------------------+
| Measure     | Discontinued in FY05                                   |
| 1.19        |                                                        |
+-------------+--------------------------------------------------------+
| Measure     | Discontinued in FY05                                   |
| 1.20        |                                                        |
+-------------+--------------------------------------------------------+
| Measure     | Discontinued in FY05                                   |
| 1.21        |                                                        |
+-------------+--------------------------------------------------------+
| Measure     | Discontinued in FY05                                   |
| 1.22        |                                                        |
+-------------+--------------------------------------------------------+
| Measure     | Discontinued in FY05                                   |
| 1.23        |                                                        |
+-------------+--------------------------------------------------------+
| Measure     | Discontinued in FY05                                   |
| 1.24        |                                                        |
+-------------+--------------------------------------------------------+
| Measure     | Discontinued in FY05                                   |
| 1.25        |                                                        |
+-------------+--------------------------------------------------------+
| Measure     | Discontinued in FY05                                   |
| 1.26        |                                                        |
+-------------+--------------------------------------------------------+
| Measure     | Discontinued in FY05                                   |
| 1.27        |                                                        |
+-------------+--------------------------------------------------------+
| Measure     | Discontinued in FY05                                   |
| 1.28        |                                                        |
+-------------+--------------------------------------------------------+
| Measure     | Discontinued in FY05                                   |
| 1.29        |                                                        |
+-------------+--------------------------------------------------------+
| Measure     | Discontinued in FY05                                   |
| 1.30        |                                                        |
+-------------+--------------------------------------------------------+
| Measure     | Discontinued in FY05                                   |
| 1.31        |                                                        |
+-------------+--------------------------------------------------------+
| Measure     | Discontinued in FY05                                   |
| 1.32        |                                                        |
+-------------+--------------------------------------------------------+
| Measure     | Discontinued in FY05                                   |
| 1.33        |                                                        |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
| **Measure   | **Designed in FY05, includes Indicator 2.1.1**         |
| 2.1**       |                                                        |
+-------------+--------------------------------------------------------+
| **Indicator | ## New Efficiency measure in FY04                      |
| 2.1.1**     |                                                        |
+-------------+--------------------------------------------------------+
| Measure 2.2 | Discontinued in FY04 -- converted to efficiency        |
|             | measure                                                |
+-------------+--------------------------------------------------------+
| Measure 2.3 | Discontinued in FY05                                   |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
| **Measure   | **Designed in FY05, includes Indicator 3.1.1**         |
| 3.1**       |                                                        |
+-------------+--------------------------------------------------------+
| **Indicator | **New efficiency measure in FY04**                     |
| 3.1.1**     |                                                        |
+-------------+--------------------------------------------------------+
| Measure 3.2 | Discontinued in FY05                                   |
+-------------+--------------------------------------------------------+
| Measure 3.3 | Discontinued in FY05                                   |
+-------------+--------------------------------------------------------+
| Measure 3.4 | Discontinued in FY05                                   |
+-------------+--------------------------------------------------------+
| Measure 3.5 | Discontinued in FY05                                   |
+-------------+--------------------------------------------------------+
| Measure 3.6 | Discontinued in FY04                                   |
+-------------+--------------------------------------------------------+
| Measure 3.7 | Discontinued in FY04                                   |
+-------------+--------------------------------------------------------+
| Measure 3.8 | Discontinued in FY04                                   |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
| ##          | **Designed in FY05, includes Indicator 4.1.1**         |
| Measure 4.1 |                                                        |
+-------------+--------------------------------------------------------+
| **Indicator | **New efficiency measure in FY04**                     |
| 4.1.1**     |                                                        |
+-------------+--------------------------------------------------------+
| Measure 4.2 | Discontinued in FY05                                   |
+-------------+--------------------------------------------------------+
| Measure 4.3 | Discontinued in FY05                                   |
+-------------+--------------------------------------------------------+
| Measure 4.4 | Discontinued in FY05                                   |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
| Measure 6.1 | Discontinued in FY05                                   |
+-------------+--------------------------------------------------------+
| Measure 6.2 | Discontinued in FY04                                   |
+-------------+--------------------------------------------------------+
| Measure 6.3 | Discontinued in FY05                                   |
+-------------+--------------------------------------------------------+
| Measure 6.4 | Discontinued in FY05                                   |
+-------------+--------------------------------------------------------+
| Measure 6.5 | Discontinued in FY05                                   |
+-------------+--------------------------------------------------------+
| Measure 6.6 | Discontinued in FY05                                   |
+-------------+--------------------------------------------------------+
| Measure 6.7 | Discontinued in FY04                                   |
+-------------+--------------------------------------------------------+

**APPENDIX C**

Partnerships and Coordination

To administer the programs established under the Older Americans Act,
AoA works in close partenership with State Units on Aging, Area Agencies
on Aging, Tribal governments, State Ombudsman and numerous service
providers.

To effectively administer OAA programs, it is also important to
collaborate with other Federal Departments and other agencies within
HHS. Some current examples of these collaborations are:

-   **Aging "One- Stop Shop" Centers**: In partnership with the Centers
    for Medicare and Medicaid Services (CMS), AoA is working to
    establish Aging "One-Stop Shop" Centers which will serve as visible
    resources where people can obtain information about long-term care
    services options.

-   **Systems Change and Rebalancing**: AoA is working with CMS, the
    Office of the Assistant Secretary for Planning and Evaluation (ASPE)
    and other HHS agencies on efforts to help States redirect and
    integrate their systems of care to respond to older people's
    preference for care in the community.

-   **Steps to a Healthier US**: AoA is working with the Centers for
    Disease Control (CDC), the Health Resources and Services
    Administration (HRSA), the Administration for Children and
    Families(ACF) and the Agency for Healthcare Research and Quality
    (AHRQ) on the Department's Steps to a Healthier US initiative. This
    initiative will seek to both enhance personal responsibility for
    lifestyle choices Americans make and social responsibility to ensure
    that policy makers support programs that foster healthy behaviors
    and prevent disease.

-   **Nursing Home Quality of Care**: AoA and CMS have partnered to
    involve the Long-Term Care Ombudsman program in the CMS Nursing Home
    Quality Indicators initiative. The AoA/CMS partnership capitalizes
    on the vast experience of the over 8,000 certified volunteer
    ombudsman by training them to educate and advise consumers about how
    to use the quality measures in making long-term care facility
    placement decisions.

-   **Nutrition**: AoA works with the U.S. Department of Agriculture
    (USDA) and within HHS, the Office of Public Health and Science on
    Dietary Reference Intakes (DRIs), which includes the well-known
    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; and the HHS Dietary Reference
    Intake Steering Committee.

-   **Transportation**: 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 and the Federal
    Transit Administration are partnering to disseminate information on
    "promising practices " in coordinated transportation services for
    the elderly and conduct regional technical assistance sessions for
    State governments.

-   **REACH 2010**: 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.

-   **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.

-   **Caregiver Training**: 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.

-   **Promoting Greater Balance in Long-Term Care**: During FY 2001, AoA
    played a major role in advancing HHS' initiative to help States
    implement the Supreme Court's Olmstead decision. AoA joined the
    Department's internal Olmstead work group comprised of CMS, Office
    for Civil Rights (OCR), ASPE, Substance Abuse and Mental Health
    Services Administration (SAMHSA), and Administration for
    Developmental Disabilities (ADD) in developing the Real Choice
    Systems Change (RCSC) Grants which provided States with \$70 million
    dollars to make their systems of long-term care more consumer
    directed and focused on home and community-based care. Since that
    time we have continued to make additional RCSC funding available to
    States. In FY 2003, AoA partnered with CMS to fund the Aging and
    Disability Resource Center grant program designed to assist states
    in streamlining access to Long-Term Care. As part of the RCSC
    initiative, AoA also 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.

-   **Consumer Direction**: AoA is partnering with ASPE, CMS and the
    Robert Wood Johnson Foundation to launch the Cashing and Counseling
    Next Steps Initiative. This program builds on the success of the an
    earlier HHS initiative, the Cash & Counseling Program. Under the
    Cash and Counseling model, consumers are given the option to have
    direct control over how their Medicaid resources are spent. This
    includes the right to hire, supervise and fire their direct care
    workers.

**Appendix D**

**Data Verification, Validation and Other Data Issues**

**AoA has continued to make progress in the two data initiatives
highlighted originally in the FY 2002 performance plan. AoA and State
agencies engaged in a formal assessment effort that has resulted in the
certification of NAPIS data months earlier than originally anticipated.
AoA has initiated a process to revise routine information collection
activities to reduce reporting burden, improve timeliness and
reliability of data, and incorporate reporting for the National Family
Caregiver Support Program into the standard data collection process; OMB
approval of proposed modifications is being pursued in FY 2003. AoA
continues to focus on the assessment of quality through the consumer,
where it counts the most, at the community level, through the
Performance Outcome Measures Project. AoA conducted national surveys of
performance outcomes in the past year, and incorporated these results
into the new outcome measures and into the analysis included in this
plan. Follow-up surveys featuring larger sample sizes will be conducted
this year.**

AoA and the aging services network face a significant challenge in
obtaining data to measure performance for programs of this kind. All
levels of the aging services network, from AoA through the state and
area agencies on aging to local centers and service providers, know well
the challenge of producing client and service counts by critical program
and client characteristics for a program which ***coordinates*** service
delivery through approximately 29,000 local providers. Many OAA program
services do not require a one-time registration for service on the part
of clients; eligible clients may obtain services on an ad hoc and
irregular basis. This makes the tracking of services to individuals and
the generation of "unduplicated" counts of clients a very difficult task
at the local level, particularly if local entities lack information
technology that simplifies client and service record-keeping and
information management. Federal and State reviews of data provided under
NAPIS suggest that significant limitations in the adequacy of
information infrastructure at the local level inhibit their ability to
routinely and consistently produce the data that are required by law for
the Older Americans Act programs and form the basis for many of AoA's
GPRA performance measures. Extensive and repeated Federal and State
efforts to provide technical assistance and to isolate and correct
common data problems have been helpful for local areas in the majority
of States and for most data elements required by the OAA through NAPIS.
Nevertheless, much remains to be done to ensure that local service
providers and area agencies have the capacity to reliably provide
important data without excessive burden.

######### Technical Assistance, Standard Software Packages, Electronic Edits

AoA and the State units on aging have long recognized the effects that
local capacity limitations could have on the generation of reliable data
for programs and services of this type, and have taken significant steps
to support local entities in producing the NAPIS data. There are at
least two commercial packages now available to States and local entities
to assist them in the preparation of the NAPIS data. These packages have
fostered far greater consistency in the data generated for NAPIS than
was possible in the early years of implementation. AoA developed an
extensive set of electronic edits for all data elements, which are
applied to the electronic submissions of State entities. AoA contractors
work with State data administrators to correct data elements that fail
electronic edits to ensure that data meet standard logic checks.
Following standard electronic checks, knowledgeable AoA regional and
central office staff conduct extensive reviews of edited data for
"reasonableness," to ensure that significant value changes from one year
to another reflect program circumstances and not the limitations of the
program data. These processes have been extremely slow, burdensome and
time consuming, and they must be modified. AoA and State agency
representatives continue to investigate ways to streamline the data
verification and validation process without compromising data quality.

Despite the data challenges that the network is addressing and the
time-consuming validation processes that remain in place at the present
time, AoA and the network have been able to certify NAPIS data on an
increasingly more timely basis. The actions of AoA and its state and
local partners have reduced the time required to make data available for
performance measurement.

**Appendix E -- Full Cost Tables**

Full Cost Table 1

Performance Program Area

## Community Based Services Program

+-----------------+----------------+----------------+----------------+
| **Full Costs &  | #              | #              | #              |
| Annual          |                |                |                |
| Measures**      | # FY 2003      | # FY 2004      | # FY 2005      |
|                 |                |                |                |
| **(\$ in        |                |                |                |
| Millions)**     |                |                |                |
+-----------------+----------------+----------------+----------------+
| Full Cost\*     |                |                |                |
+-----------------+----------------+----------------+----------------+
| Measure 1.1,    | \$1,303.220    | \$1,310.198    | \$1,313.229    |
| 1.2, 1.3        |                |                |                |
|                 |                |                |                |
| Incorporates:   |                |                |                |
|                 |                |                |                |
| Efficiency      |                |                |                |
| Indicators      |                |                |                |
| 1.1.1, 1.1.2,   |                |                |                |
| 1.1.3;          |                |                |                |
|                 |                |                |                |
| Client          |                |                |                |
| Assessment      |                |                |                |
| Indicators      |                |                |                |
| 1.2.1, 1.2.2,   |                |                |                |
| 1.2.3, 1.2.4,   |                |                |                |
| 1.2.5, 1.2.6,   |                |                |                |
| 1.2.7, and      |                |                |                |
| Targeting       |                |                |                |
| Indicators      |                |                |                |
| 1.3.1, 1.3.2.   |                |                |                |
+-----------------+----------------+----------------+----------------+

\*The sum of full costs of performance measures may not equal the full
cost of performance program area, to the extent the program has elements
for which there are no current measures.

Full Cost Table 2

## Performance Program Area 

## Vulnerable Older Americans - Ombudsman Measures

+-----------------+----------------+----------------+----------------+
| **Full Costs &  | #              | #              | #              |
| Annual          |                |                |                |
| Measures**      | # FY 2003      | # FY 2004      | # FY 2005      |
|                 |                |                |                |
| **(\$ in        |                |                |                |
| Millions)**     |                |                |                |
+-----------------+----------------+----------------+----------------+
| Full Cost\*     |                |                |                |
+-----------------+----------------+----------------+----------------+
| Measure 2.1     | 24.747         | 25.658         | 24.899         |
|                 |                |                |                |
| Incorporates    |                |                |                |
| Efficiency      |                |                |                |
| Indicators 2.1. |                |                |                |
| and 2.2.        |                |                |                |
+-----------------+----------------+----------------+----------------+

\*The sum of full costs of performance measures may not equal the full
cost of performance program area, to the extent the program has elements
for which there are no current measures.

Full Cost Table 3

Performance Program Area

## Native Americans Program

+-----------------+----------------+----------------+----------------+
| **Full Costs &  | #              | #              | #              |
| Annual          |                |                |                |
| Measures**      | # FY 2003      | # FY 2004      | # FY 2005      |
|                 |                |                |                |
| **(\$ in        |                |                |                |
| Millions)**     |                |                |                |
+-----------------+----------------+----------------+----------------+
| Full Cost\*     |                |                |                |
+-----------------+----------------+----------------+----------------+
| Measure 3.1     | \$29.542       | \$28.508       | \$28.788       |
|                 |                |                |                |
| Incorporates    |                |                |                |
| Efficiency      |                |                |                |
| Indicator 3.1   |                |                |                |
+-----------------+----------------+----------------+----------------+

\*The sum of full costs of performance measures may not equal the full
cost of performance program area, to the extent the program has elements
for which there are no current measures.

Full Cost Table 4

Performance Program Area

## Senior Medicare Patrols & Technical Assistance Centers

+-----------------+----------------+----------------+----------------+
| **Full Costs &  | #              | #              | #              |
| Annual          |                |                |                |
| Measures**      | # FY 2003      | # FY 2004      | # FY 2005      |
|                 |                |                |                |
| **(\$ in        |                |                |                |
| Millions)**     |                |                |                |
+-----------------+----------------+----------------+----------------+
| Full Cost\*     |                |                |                |
+-----------------+----------------+----------------+----------------+
| Measure 4.1     | \$12.798       | \$12.804       | \$12.861       |
|                 |                |                |                |
| Incorporates    |                |                |                |
| Efficiency      |                |                |                |
| Indicator       |                |                |                |
|                 |                |                |                |
| 4.1             |                |                |                |
+-----------------+----------------+----------------+----------------+

\*The sum of full costs of performance measures may not equal the full
cost of performance program area, to the extent the program has elements
for which there are no current measures.

## Summary of Full Cost Performance Program Areas

+-----------------+----------------+----------------+----------------+
| **Full Costs &  | #              | #              | #              |
| Annual          |                |                |                |
| Measures**      | # FY 2003      | # FY 2004      | # FY 2005      |
|                 |                |                |                |
| **(\$ in        |                |                |                |
| Millions)**     |                |                |                |
+-----------------+----------------+----------------+----------------+
| Full Cost\*     |                |                |                |
+-----------------+----------------+----------------+----------------+
| Community Based | \$1,303        | \$1,310        | \$1,313        |
| Services        |                |                |                |
| Program         |                |                |                |
+-----------------+----------------+----------------+----------------+
| Vulnerable      | \$25           | \$26           | \$25           |
| Older           |                |                |                |
| Americans -     |                |                |                |
| Ombudsman       |                |                |                |
| Measures        |                |                |                |
+-----------------+----------------+----------------+----------------+
| Native          | \$30           | \$29           | \$29           |
| Americans       |                |                |                |
| Program         |                |                |                |
+-----------------+----------------+----------------+----------------+
| Senior Medicare | \$13           | \$13           | \$13           |
| Patrols &       |                |                |                |
| Technical       |                |                |                |
| Assistance      |                |                |                |
| Centers         |                |                |                |
+-----------------+----------------+----------------+----------------+
| AoA Total Full  | \$1,370        | \$1,377        | \$1,380        |
| Cost            |                |                |                |
+-----------------+----------------+----------------+----------------+

\*The sum of full costs of performance measures may not equal the full
cost of performance program area, to the extent the program has elements
for which there are no current measures.