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**AoA Update**

**Volume2, Issue****2 -Administration on Aging -****February 1997**

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**AoA Issues Report****on Native Americans’ Need for Services Community-Based CareLacking for Many Tribal Elders****1990 CensusCD-ROM’s On Aging Now Available********Nursing Home Survey ShowsHome Care Growth********Corporate Sector AidsSenior Meals Programs********AoA Releases Budget Request toCongress********Exercise Is EffectiveTreatment for Arthritis********National Aging InformationCenter Moves to AoA Headquarters********About AoA Update******

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**AoA Issues Report on Native Americans’ Needfor Services******Community-Based Care Lacking forMany Tribal Elders**

**T** he need for home andcommunity-based long-term care services in American Indian andAlaska Native communities is largely unmet, according to a reportrecently released by the Administration on Aging (AoA). Thereport, entitled "Home and Community-Based Long-Term Care inAmerican Indian and Alaska Native Communities," is based ona survey of 108 federally-recognized tribes, conducted in thespring of 1995, to learn more about the specific issues affectinghome and community-based long-term care in Indian country.

The report concludes thatwhile emergency medical care and congregate and home-deliveredmeals are frequently available, services such as case management;health promotion; alcohol, drug, and mental health services;transportation; and home maintenance only are available in somecases.

The need for home andcommunity-based long-term care services, however, is extensiveand largely unmet. This is particularly true in the areas ofalternative housing, including retirement villages, assistedliving, personal care boarding homes, group homes, short-termrehabilitation facilities, and intermediate and skilled nursingfacilities. While family and friends are important providers ofhome and community-based services, hospice care and otherservices that support family caregiving,  such as adult day care and respitecare, are rarely available.

The survey reports thatdespite an array of providers and funding sources for home andcommunity-based long-term care services, these are all fragmentedand insufficient to meet the need. Federal programs represent thegreatest source of funding for services, while tribes providesome financial support for virtually all services.

Survey respondentsidentified the tribes’ limited financial resources as amajor obstacle to developing programs and providing services. Lowfunding levels, little appreciation of local needs, limitedaccess to decision makers, and excessive regulations wereunanimously identified as barriers to continuing federal andstate-funded programs and to developing new ones. 

Bureaucratic procedureswere identified as the major barrier to using most services.Since there is no coordinated system of home and community-basedlong-term care services, elders often must meet differenteligibility criteria and complete separate applications for eachservice—a particularly difficult problem for those elderswith limited English language reading ability. In addition,elders’ lack of awareness about programs, uncertainty abouttheir eligibility, and the possible stigma attached to receivingcertain services are barriers that need to be addressed.

Some of the surveyrecommendations call for:

> - the Indian Health            Service to explore the possibility of a nationwide            Medicaid waiver;
- consistency in            legislation authorizing the various home and            community-based long-term care services; 
- coordination            among all agencies and programs involved in            delivering services; and
- training service            providers to work with elders, including social and            cultural considerations.

The AoA will work withother federal agencies and tribal organizations to explore waysto improve the range of home and community-based long-term careservices and access to them for American Indian and Alaska Nativeelders.

Copies of the report areavailable on the AoA web site at: http://www.aoa.dhhs.gov under"What’s New."

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**1990 Census CD-ROM’s On Aging NowAvailable**

A limited number ofCD-ROM’s of the 1990 Census Special Tabulation on Aging(STP-14) are available for Area Agencies on Aging (AAA’s)while the supply lasts. The STP-14 data, which has been sent toall of the State Units on Aging, covers such topics as self-carelimitation, marital status, living arrangements, education,earnings, poverty status, employment, mobility, and ability tospeak English.

A total of 483 populationand 228 housing tables are included. Most tables are for personsaged 60+, 65+, 75+, and 85+. The geographical levels coveredinclude national, regional, state, Planning and Service Area(PSA) and local. AAA’s will receive a CD-ROM which includesdata for the nation, their state, their PSA, and the local areasin their state.

The CD-ROM’s includethe Census Bureau software for accessing this data onPC-compatible computers, using MS-DOS. Macintosh users may accessthe data using general data-based software compatible with dBasefiles.

Requests for the CD-ROMmust be made in writing and received no later than Friday, March21. Priority will be based on the postmark or other writtenevidence of the date the request was sent. Requests should bemailed to:

Saadia Greenberg Office ofProgram Operations and Development Administration on Aging Room4280, Cohen Building Washington, DC 20201

Others interested inreceiving the CD-ROM’s may write to the above address andreceive copies, if they are available after requests from theAAA’s have been filled.

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**NursingHome Survey Shows Home Care Growth**

For the first time sinceit began collecting data in 1973-1974, the National Nursing HomeSurvey, conducted by the National Center for Health Statistics,has noted a decline in the number of nursing homes and a virtualstabilization in the number of patients. 

The data, based on arandom sampling of 1,409 homes among the nation’s 16,700facilities, also found that while the number of homes hasdeclined, the number of average beds per facility has increasedfrom 75 per home in 1973 to 106 beds in 1995. Estimates indicatethat the homes had a total of 1.8 million beds and served morethan 1.5 million residents. 

The survey also noted that66 percent of the homes are operated for profit. However, therewas a 23 percent decrease since 1985 in the number of proprietaryhomes while voluntary nonprofit homes showed a 13 percentincrease. In 1995, slightly more homes were operated as a chain(54 percent) than were independently owned—the opposite ofthe 1985 survey results. With the increased number of homesoperated as part of a chain, there was a corresponding increasein the number of beds. Nursing homes operating as part of a chaincontained 55 percent of the total bed population and had anaverage bed size of 107.5 beds per home.

More than two-thirds ofall homes were certified by both Medicare and Medicaid. Only 4percent of the homes were not certified for either benefitprogram.

In 1995, there was anoverall occupancy rate of 87.4 percent down from 91-92 percentfor the first three surveys. The number of residents in 1995 hadonly increased 3.8 percent since 1985 compared with an increaseof 14.5 percent during the period from 1977 to 1985 and 21.1percent from 1973-74 to 1977.

Nearly 90 percent ofresidents were 65 and over and over 35 percent were 85 and older.Residents were predominately white--88 percent—and female--72.3 percent.

The ratio of residents 65and older in nursing homes to those in the general populationremained virtually unchanged from the first survey to the 1985survey, with about 50 of every 1,000 persons 65 and over residingin a nursing home. However, in 1995, this ratio was down to 41.3residents age 65 and over per 1,000 population 65 and over.

The small increase in thenumber of nursing home residents compared with previous surveys,along with the decrease in the ratio of residents to the generalpopulation, indicate that older Americans are not enteringnursing homes at the same rate as in previous years.

The rapid growth in thehome care industry, in part, as an effort to control health carecosts, has contributed to the fact that many older persons are nolonger going to nursing homes for care that they can, and preferto, receive at home. By 1994, about 11,000 home care and hospiceagencies were providing care to nearly 2 million patients.

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**CorporateSector Aids Senior Meals Programs**

January 7 marked theofficial kick-off of the ProjectMeal Foundation, under theauspices of the National Association of Meals Programs (NAMP).ProjectMeal is designed to enable meals programs providers andthe corporate sector to join hands so that meals programs can beexpanded to meet the needs of the estimated 4 million elderly whosuffer from food insecurity—the inability to afford, gainaccess to or prepare food. ProjectMeal also provides support forresearch into the special nutrition needs of older persons.

The NAMP is a membershiporganization representing congregate and home-delivered mealsprograms providers--three-quarters of whom receive funding underthe Administration on Aging’s Elderly Nutrition Program.

Reynolds Metals Company,the makers of Reynolds Wrap, has made a corporate commitment tocontinue its involvement with, and support to, NAMP programsnationwide. Reynolds has established a toll-free number(1-888-MEAL HELP) and announced the beginning of a joint searchfor 50,000 volunteers for NAMP-member programs.

Callers to the toll-freenumber, which was advertised in *USA Today*, will be giventhe name and phone number of the NAMP program nearest their homeand urged to become involved. Reynolds also distributed 50 newFord Aerostar vans to 50 previously- selected NAMP programsaround the nation.

Giant Food, Inc., agrocery store chain serving Washington, D.C., Virginia, Maryland,Delaware, New Jersey and Pennsylvania, has a special offer fornonprofit organizations. Organizations can purchase Fund RaiserCertificates from Giant at a 5 percent discount. The certificatesthen can be personalized with the organization’s name andsold at full price. The certificates can be used like money at aGiant supermarket and the nonprofit organization makes a 5percent profit. The certificates come in denominations of $5,$10, $20 and $25. For more information, call 1-888-496-4426.

Philip Morris has pledgeda grant to Citymeals on Wheels to feed all those seniors onwaiting lists for home-delivered meals in New York City for oneyear. In addition, the company has placed ads in the *New YorkTimes*, *The New Yorker*, and *New York Magazine*with the slogan, "It’s time we took something away fromseniors in need. The wait." The ads are designed to getothers involved in ending waiting lists for meals.

This March marks the 25thanniversary of the Nutrition Program for the Elderly which servessome 1 million congregate and home-delivered meals each day toolder Americans. 

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**AoAReleases Budget Request to Congress**

Acting Assistant Secretaryfor Aging, Robyn I. Stone, announced release of theAdministration on Aging’s (AoA) fiscal year 1998 budgetrequest to Congress. The request provides some $838 million forprograms serving older Americans and their caregivers.

The Acting AssistantSecretary said that, "This budget request acknowledges thedemand for effective, appropriate and efficiently deliveredservices to a growing number of older Americans, in particularthe vulnerable and frail.

"Our budget requestaddresses those needs by preserving the strengths and successesof the Older Americans Act, and by focusing our attention on thepriority areas of home and community-based care, consumerprotections and consumer education."

FY 1998 Budget Request

***Program Request******(dollars in thousands)***

| Supportive        Services and Senior Centers                      | $291,375.                   |
|---------------------------------------------------------------------|-----------------------------|
| Congregate        Meals*                                           | 359,810.                    |
| Home-Delivered        Meals                                        | 110,064.                    |
| In-Home        Services for the Frail Elderly                      | 9,263.                      |
| Health        Promotion                                            | 15,623.                     |
| Research,        Training & Discretionary Programs             | 4,000.                      |
| Grants        to Indian Tribes
(Indian Tribes)

(Native Hawaiians) | 16,057.
(14,451.)

(1,606.) |
| Alzheimer’s        Initiative**                               | 8,000.                      |
| Protection        of Vulnerable Older Americans ***                | 9,181.                      |
| (Ombudsman        Programs)                                        | (        4,449.)           |
| Federal        Administration                                      | 14,795.                     |
| **TOTAL**                                                           | **$838,168.**               |

Senior Community ServiceEmployment Program**** $440,200.

* Total nutrition fundingremains the same; the shift reflects current state trends to meetprogram needs.

**Funded through HealthResources and Services Administration in FY 1997.

***Ombudsman services andelder abuse programs funded through Supportive Services in FY1997.

****Transfer from theDepartment of Labor to theAoAupon reauthorization of the Older Americans Act.

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**ExerciseIs Effective Treatment for Arthritis******

A recent study, funded bythe National Institute on Aging, suggests that people withosteoarthritis of the knee who exercise have less pain, reduceddisability, and improved physical performance.

The Fitness Arthritis and SeniorsTrial results compared improvement measurements in people whoparticipated in moderate intensity aerobic exercise or moderateresistance exercise with those in a health education program. Theresults showed a modest, but consistent, improvement in painrelief, disability, and physical performance for those who tookpart in the exercise programs compared to those who attended thehealth education program.

Seniors in aerobictraining participated for 1 hour, 3 days a week, with warm-upcalisthenics and stretching followed by walking. Resistancetraining participants used dumbbells and cuff weights tostrengthen major muscles in the upper and lower body. The studyresults were published in the January 1, 1997, issue of the *Journalof the American Medical Association*. 

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**NationalAging Information Center Moves to AoA Headquarters**

The National AgingInformation Center (NAIC), created in 1995 as a service of theAdministration on Aging (AoA), has moved from Bethesda, Marylandto the AoA headquarters in Washington, D.C.

The NAIC was establishedby the Older Americans Act Amendments of 1992 as a means ofmeeting the needs of America’s aging society through datacollection and information sharing about current approaches topractice and policy. The NAIC has served as the central source ofa range of materials on aging and statistical data about thenation’s elderly. The NAIC will continue to provide a linkto:

> - a bibliographic            data base of AoA-supported products and other            aging-related materials;
- materials for            aging program planners and practitioners; and
- Census Bureau            reports on the demographic, health, social, and            economic status of older Americans.

The NAIC’s move isthe result of budget cuts to the AoA’s Older Americans ActTitle IV Discretionary program. Because of its importance to theaging network and those who reply on its services, the NAIC willcontinue to operate on a limited basis, within the AoA.

NAIC’s new addressis:

**National AgingInformation CenterAdministration on Aging330 Independence Ave., S.W. Room 4656Washington, DC 20201**

**(202)619-7501FAX:(202) 401-7620Internet WebSite:****http://www.ageinfo.org**

****AoA Update

**Robyn I.Stone**Acting Assistant Secretary for Aging

**JudySatine**Director, Executive Secretariat

**JuneB. Faris**Editor

**AoAUpdate**Administrationon AgingU.S. Department ofHealth & Human ServicesWashington, DC 20201

(202)619-0724TDD: (202) 401-7575 FAX: (202) 260-1012E-mail: AoA_ESEC@Ban- Gate.AoA.DHHS.GOVInternet Web Site: http://WWW.AoA.DHHS.Gov