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**AoA Update**-See also:**BackIssues**

**Volume 3 Issue 1- Administration on Aging - January 1998**

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#### A Message from Jeanette C. Takamura, Assistant Secretary forAging AoA and HRSA Move to Improve Home and Community-Based Health Care andSocial Services For Older Persons and Their CaregiversOperation Restore Trust Grantees Live Up to Their Name 25 Years After Their Inception,  Nutrition Projects Continueto Grow and Change800 Number to Aid the Homeless Masthead

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### A Message from Jeanette C. Takamura, Assistant Secretary forAging 

*Dear Colleague,
As your new Assistant Secretary for Aging, it is an honor to have this opportunity toextend you heartfelt wishes for a very happy, healthy and successful new year! I amexcited about the many opportunities that lie ahead for AoA and the entire aging network,and certainly for our older Americans and their families. I look forward to renewing oldfriendships, establishing new ones across the national aging network and beyond, andworking to build on the successes of my predecessors and colleagues.

1998 will be an exciting and challenging year for the Administration on Aging, and forthose with whom we work and serve. The work we do will become more important than everbefore. We are now in the final stretch of the 20th century, during which the UnitedStates has reaffirmed its place as a world leader. This century has also set the stage forour own future as we enter the 21st century. Paramount to those changes is the rapidgrowth of the number of older persons. By the year 2030, there will be approximately 70million older persons in our country, more than twice their number in 1990. Along withthis will be an increased demand for home and community-based services, new variations forwhich will emerge over time. Thus, our ability to adapt will be important if we are tohave a comprehensive and coordinated system of home and community-based care in place. 

In light of the gift of longevity with which a growing majority of Americans arecurrently blessed, we must begin immediately to engage as a nation in ensuring that wehave an architecture for longevity in place. We must create a design for the future whichacknowledges long life as a reality and that is sensitive to the needs of current elders,who have done so much to make this nation great. And we must work together to ensure thatthis design recognizes the likely requirements and contributions of the largest cohort ofolder adults this world has yet to see--the baby boomers.

We must ready America for longevity. Greater emphasis must be placed on consumereducation and protection, on building public/private partnerships that recognize andaddress the diverse needs of population aging, and finally on testing and sharing bestpractices to determine what works and to identify costs and benefits. No one person ororganization can do this alone. AoA cannot do it alone. I welcome each of you to join mein preparing for a satisfying and secure destiny. Today’s older Americans and theirchildren and grandchildren, who are tomorrow’s older Americans, deserve no less.

With Warm Aloha,

Jeanette C. Takamura****Go Back to Contents MenuAoA and HRSA Move to Improve Home andCommunity-Based Health Care and Social Services For Older Persons and Their Caregivers
The Administration on Aging (AoA) and the Health Resources and Services Administration(HRSA) have signed a Memorandum of Understanding (MOU) designed to increase linkages andworking partnerships between the two agencies and their networks that will improve theeffectiveness of home and community-based health care and social service systems for theelderly and their caregivers.

The goals include:
- strengthening cooperative efforts to build effective community systems that are more      responsive to persons with Alzheimer’s disease and other dementias and their      caregivers;
- increasing access to and the availability of community-based services that respond to      the health care and supportive services needs of older persons who want to remain in their      own homes;
- enhancing the quality of care for the elderly by strengthening linkages between      HRSA’s health care and AoA’s social service communities and their networks; and
- formulating new avenues for sharing knowledge and training opportunities; and      collaborating in the administration of the Alzheimer Disease Demonstration Grant to States      Program (ADDGS).

The HRSA is one of eight agencies in the U.S. Public Health Service and the leadfederal agency in delivering health care services for underserved and vulnerablepopulations. Through its Bureau of Primary Health Care (BPHC), HRSA oversees both primaryand preventive health service programs for minority, underserved, and difficult-to-reachpopulations, including the elderly. It develops health care systems and tests new ways ofdelivering health care services to medically-underserved groups. 

The HRSA supports the delivery of primary health care services to more than 10 millionpersons in 685 health centers. The BPHC currently administers the ADDGS Program whichincludes 15 state grantees.

As the nation’s life expectancy continues to increase, there is a concomitantincrease in the number of persons with Alzheimer’s disease and other dementias whichrequire a blend of both medical and supportive services. The ADDGS Program hasdemonstrated that a blend of medical and social services is of great assistance in meetingthe needs of persons with Alzheimer’s disease and their caregivers.

The newly signed MOU sets the stage to expand the knowledge base created during the 15demonstrations (11 of which have been funded since 1992 and the remaining 4 since 1993) tomore communities and offers new opportunities to highlight best practice approaches forproviding assistance.
**Go Back to Contents MenuOperation Restore Trust Grantees Live Up to Their Name
Missouri’s Seniors Organized to Restore Trust (SORT) Project is building on thelessons learned from the aging network’s experiences during the Operation RestoreTrust demonstration. The consortia, made up of West Central Missouri organizations,including the District III Area Agency on Aging, Community Leaders Assisting the Insuredof Missouri, and the American Association of Retired Persons regional office, arecombining their own expertise and building on established working relationships with theMissouri Division on Aging, federal regional agencies and regional Medicare contractors toestablish a comprehensive program that uses retired professionals in the community toinform, educate, and counsel seniors, their families and the community-at-large abouthealth care waste, fraud, and abuse, and ways that they can prevent and detect it.

The project plans to train 140 retired professionals as key players to serve asentry-level, front-line SORT volunteers who will identify and refer potential cases andthose persons affected to SORT specialists for further action. In addition, the projectwill establish a corps of at least 50 trained specialists to provide education, advocacyand counseling regarding potential fraud and abuse. Project staff also will develop andimplement a comprehensive media campaign to educate older persons, particularly frailelders, their family and the public about suspected fraud and abuse in the Medicare andMedicaid systems and assist with volunteer recruitment.

In July, Health and Human Services Secretary, Donna E. Shalala, announced grantstotaling some $2 million for innovative projects that will help to combat fraud, waste,and abuse in the Medicare and Medicaid programs. The demonstration projects, administeredby the AoA, recruit and train volunteer retired professionals to work with Medicare andMedicaid beneficiaries in their own communities and in local senior centers to identifydeceptive health care practices such as overbilling, overcharging, or providingunnecessary or inappropriate services. 

The SORT project is one of 12 innovative projects awarded funds by the AoA as part ofthe two-year demonstration program. The Health Care Anti-Fraud, Waste and Abuse CommunityVolunteers Demonstration Projects, popularly known as the Harkin grants, are the result oflanguage authored by Senator Tom Harkin (D-Iowa), originally contained in the OmnibusConsolidated Appropriation Act of 1997. Project plans include development of trainingmanuals, Internet web sites, and statewide toll-free hot lines.

The work of the local projects complements the department’s success in expandinganti-fraud efforts, including Operation Restore Trust (ORT), and will help older Americansto have the information they need to identify and report potential fraudulent practices. 
**Go Back to Contents Menu 25 Years After Their Inception,  Nutrition Projects Continue to Grow and Change
October 1997 marked the 25th Anniversary of the Older Americans Act Nutrition Programs.As part of that celebration, the Administration on Aging recognized 25 meal projects fortheir responsiveness, creativity, fund-raising ability, volunteer contributions, andefficiency in providing nutrition services to older Americans. Among those recognized fortheir accomplishments were the Bozeman Senior Social Center of Bozeman, Montana and theSouthern Mississippi Area Agency on Aging.

Since it began in 1980, the Bozeman program has been growing to meet the needs of itselderly by having a cadre of volunteers who do all of the meal delivery. Participants alsoare involved with meal preparation and service, health clinics, educational seminars, athrift store, wood-working shop and assistance with community outreach programs in thearea. 

Meals are prepared at the site and served five days a week. Frozen meals are offered tothe homebound elderly on weekends while the local food bank offers 30 to 40 grocery bagsmonthly to low-income seniors along with their home-delivered meals, since many seniorsare reluctant to use the food bank on their own.

At the congregate sites, meals are served cafeteria style as well as hosted severaltimes a month when volunteer groups come in to help. 

The Bozeman Center now serves some 66,000 meals a year and has expanded by 5,000congregate and 5,000 home-delivered meals annually over the past five years.

Seniors are drawn to the programs thanks to a Sunday noon meal served once a month,pancake suppers served four times a year, and offering the center as a meeting place formany senior and health-related groups. With its new senior day care center program andenlarged space, the center plans to offer wellness programs and to expand the area fordining and fitness classes.

The Southern Mississippi Area Agency on Aging, commonly known as "Southern,"under the leadership of Director Jane Kennedy, has been a major catalyst in developing theElderly Nutrition Program (ENP) at the community level. Begun in 1972 as one of the nineoriginal model projects to pioneer the ENP, "Southern" now produces nearly halfa million meals a year with a budget of $1.2 million. Southern first launched and then setthe pace for public/private partnerships in the Mississippi aging network, demonstratingthat "such alliances benefit both the private sector and the public good." 

While the ENP is set up as a congregate meals program, Southern quickly identified anincreasing need for home-delivered meals and began to build alliances at the communitylevel to leverage resources to support both nutrition components. As federal funds becamemore limited in the late 1970’s, Southern sought and received local government andprivate funds that exceeded a 100 percent matching ratio, which remains today, forsupportive and nutrition services. One county, termed the most economically depressed inthe state and 1 of the 10 poorest in the nation, provided matching funds of 160 percent,showing that support will spring even from the poorest areas when there is a need inone’s own community and that need is made known.

Because some home-delivered meals routes were as long as 120 miles and volunteersupport was scarce, Southern began to concentrate on improving the service management,quality, accountability and cost effectiveness of home-delivered meals. It did so byapproaching Mississippi’s statewide ENP food service contractor and asking thecompany to explore the feasibility of frozen foods, meals packaging options, andalternative delivery systems. The contractor refused.

Needless to say, the contractor was no match for Southern’s persistence, and in afew months the food contractor was in the frozen food production and delivery business.

By the spring of 1991, Southern and the statewide contractor had entered into acollaborative partnership whereby the contractor was producing and delivering five-packfrozen meals once a week to 600 of Southern’s homebound-meals participants in threecounties. The pilot project realized a savings of $6,400 over the initial six-monthperiod. By 1997, the frozen meals had grown to 1,600 a day with the contractor nowproviding 4,000 ENP frozen meals a day across the state. 
**In the fall of 1993, the contractor developed an automated data collection system toelectronically track and verify the delivery of meals to homes. The program, copyrightedas "Common Bonds" and marketed separately, was tested in Southern’sdistrict in 1994 and fully implemented in the spring of 1995.

In March 1996, Southern and the contractor entered the final phase of its automatedfrozen meals delivery when they were linked by modem so that meal orders and any changesin the participant data file made at the AAA office could be recorded electronically atthe vendor office, providing for routing adaptation and updated invoice reconciliation.

Southern uses the dependable delivery system to full advantage by sending regularhealth promotion newsletters along with the meals. Last spring, Southern initiated abreakfast program and a fee-for-service program. Plans are in place for the statewidecontractor to create a new frozen breakfast meal for select seniors in Southern’sservice area as well as frozen lunch meals for elderly and disabled persons interested inpurchasing them.
**Go Back to Contents Menu800 Number to Aid the Homeless 
The U.S. Department of Housing and Urban Development (HUD) has set up a toll-freehotline to put people in touch with local agencies and shelters that can help thehomeless. The toll-free number also will give callers an opportunity to learn how they canhelp the homeless and end homelessness in their community through conversations with localagency and shelter personnel.

HUD estimates that on any given night some 600,000 people are homeless. HUD also willdistribute 300,000 wallet-sized cards with the toll-free number and 10 suggestions on waysto end homelessness. The number is: 1-800-HUD-1010.
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AoA Update

**Jeanette C. Takamura**Assistant Secretary for Aging

**Judy Satine**Director, Executive Secretariat

**June B. Faris**Editor

**AoA Update**Administration on AgingU.S. Department of Health & Human ServicesWashington, DC 20201(202) 619-0724TDD: (202) 401-7575 FAX: (202) 260-1012E-mail: [email protected]Internet Web Site: http://WWW.AoA.DHHS.Gov

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