DEPARTMENT 

of HEALTH 

and HUMAN 

SERVICES 

ADMINISTRATION 

ON AGING 

FY 2012 Online Performance Appendix 
 

 

 

 

 

 

 

 

 

 

 

 

 

Introduction 

The FY 2012 Online Performance Appendix is one of several documents that fulfill the 

Department of Health and Human Services’ (HHS) performance planning and reporting 

requirements. HHS achieves full compliance with the Government Performance and Results Act 

of 1993 and Office of Management and Budget Circulars A-11 and A-136 through the HHS 

agencies’ FY 2012 Congressional Justifications and Online Performance Appendices, the 

Agency Financial Report, and the HHS Summary of Performance and Financial Information 

(SPFI). These documents are available at http://www.hhs.gov/budget/. 

The FY 2012 Congressional Justifications and accompanying Online Performance Appendices 

contain the updated FY 2010 Annual Performance Report and FY 2012 Annual Performance 

Plan. The Agency Financial Report provides fiscal and high-level performance results. The 

HHS SPFI summarizes key past and planned performance and financial information. 

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From the Administration on Aging 

This submits the FY 2012 Online Performance Appendix (OPA) for the Administration on 

Aging. The OPA conforms with requirements of the Government Performance and Results Act 

of 1993, and provides additional detail for performance discussions presented in the 

accompanying FY 2012 budget request. The Administration on Aging (AoA) FY 2012 Online 

Performance Appendix demonstrates AoA’s commitment to providing high-quality, efficient 

services to the most vulnerable elders. Through effective program management, rigorous 

program evaluations and strategic investment of grant funds, AoA is systematically advancing its 

mission of developing a comprehensive, coordinated and cost-effective system of home and 

community-based services that helps older adults maintain their independence and dignity. 

AoA’s three performance measures: 1) improve program efficiency, 2) improve client outcomes 

and 3) target services to vulnerable populations support AoA’s key strategic goals to:

Empower older people, their families, and other consumers to make informed decisions 

about, and to be able to easily access, existing health and long-term care options. 

Enable seniors to remain in their own homes with high quality of life for as long as 

possible through the provision of home and community-based services, including 

supports for family caregivers. 

Empower older people to stay active and healthy. 

Ensure the rights of older people and prevent their abuse, neglect and exploitation. 

To the best of my knowledge, the performance data reported by the Administration on Aging in 

this FY 2012 Online Performance Appendix are accurate, complete and reliable. 

Kathy Greenlee 

Assistant Secretary for Aging 

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DEPARTMENT OF HE ALTH AND HUMAN SERVICES 

ADMINISTRATION ON AGING 

FY 2012 ANNUAL PERFORMANCE REPORT 

Introduction............................................................................................................................... i 

Overview of Performance .........................................................................................................1 

Performance Measurement Detail............................................................................................8 

Narrative by Activity ................................................................................................................8 

I . Health and Independence ...................................................................................................8 

Home and Community-Based Supportive Services ............................................................14 

Nutrition Services..............................................................................................................17 

Preventive Health Services ................................................................................................21 

Chronic Disease Self-Management Programs ....................................................................22 

Community Service Employment for Older Americans .....................................................23 

Native American Nutrition and Supportive Services..........................................................24 

Aging Network Support Activities.....................................................................................26 

II. Caregiver Services ...........................................................................................................27 

Family Caregiver Support Services....................................................................................27 

Native American Caregiver Support Services ....................................................................31 

Alzheimer’s Disease Supportive Services Program............................................................34 

Lifespan Respite Care........................................................................................................35 

III. Protection of Vulnerable Adults......................................................................................36 

Adult Protective Services State Demonstrations.................................................................36 

Long-Term Care Ombudsman Program.............................................................................37 

Prevention of Elder Abuse and Neglect .............................................................................41 

Elder Rights Support Activities .........................................................................................42 

Senior Medicare Patrol Program........................................................................................43 

IV. Consumer Information, Access & Outreach....................................................................45 

Aging and Disability Resource Centers..............................................................................45 

State Health Insurance Assistance Program .......................................................................46 

Community Living Assistance Services and Supports...........................................................47 

Program Innovations ..............................................................................................................48 

Agency Support for HHS Strategic Plan................................................................................49 

Summary of Full Cost .............................................................................................................54 

Summary of Findings and Recommendations from Completed Program Evaluations .......56 

Data Source and Validation Table .........................................................................................58 

National Survey Data ..............................................................................................................65 

Discontinued Performance Measures Table ..........................................................................66 

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List of Tables 

Table 1. Health and Independence ..............................................................................................8 

Table 2. Home and Community-Based Supportive Services .....................................................14 

Table 3. Nutrition Services.......................................................................................................17 

Table 4. Preventive Health Services .........................................................................................21 

Table 5. Native American Nutrition and Supportive Services ...................................................24 

Table 6. Family Caregiver Support Services.............................................................................27 

Table 7. Native American Caregiver Support Services .............................................................31 

Table 8. Alzheimer’s Disease Supportive Services Program.....................................................34 

Table 9. Lifespan Respite Care.................................................................................................35 

Table 10. Long-Term Care Ombudsman Program ....................................................................37 

Table 11. Prevention of Elder Abuse and Neglect.....................................................................41 

Table 12. Senior Medicare Patrol .............................................................................................43 

Table 13. Aging and Disability Resource Centers.....................................................................45 

Table 14. Community Living Assistance Services and Supports...............................................47 

Table 15. Link to HHS Strategic Plan........................................................................................50 

Table 16. Summary of Full Cost...............................................................................................54 

Table 17. Data Source and Validation Table.............................................................................58 

Table 18. Discontinued Measures.............................................................................................66 

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Overview of Performance 

AoA program activities have a fundamental common purpose which reflects the legislative intent 

of the Older Americans Act (OAA) and the AoA Mission: to develop a comprehensive, 

coordinated and cost-effective system of home and community-based services that helps elderly 

individuals maintain their health and independence in their homes and communities. To reflect 

this unified purpose, AoA has aggregated all budget line items into a single Government 

Performance and Results Act (GPRA) program, AoA’s Aging Services Program, for purposes of

performance measurement. 

The Aging Services Program’s fundamental purpose, in combination with the legislative intent 

that the National Aging Services Network actively participate in supporting community-based 

services with particular attention to serving economically and socially vulnerable elders, led 

AoA to focus on three measures: 1) improving efficiency; 2) improving client outcomes; and 

3) effectively targeting services to vulnerable elder populations. Each measure is representative 

of several activities across the Aging Services Program budget and progress toward achievement 

of the measure is tracked using a number of indicators. The efficiency measure and 

corresponding indicators are reflective of the Office of Management of Budget (OMB) 

requirements to measure efficiency for all program activities. The client outcome measure 

includes indicators focusing on consumer assessment of service quality and outcome indicators 

focusing on nursing home predictors, successful caregiver program operation and protection of 

the vulnerable elderly. The targeting measure and indicators focus on ensuring that States and 

communities serve the most vulnerable elders. Taken together, the three measures and their 

corresponding performance indicators are designed to reflect AoA’s strategic goals and 

objectives and in turn measure success in accomplishing AoA’s mission.

In addition to the basic performance measurement requirements of GPRA, which are discussed 

in detail below, and in recognition of this Administration’s enhanced emphasis on transparency

and accountability, AoA has taken several steps to improve the analysis and availability of 

performance information while also enhancing the rigor of program evaluations that are currently 

in development. To this end, AoA has: 

Expanded the availability of performance information via an on-line system that enables 

Aging Network professionals and the public to develop benchmarks and examine trends 

nationally and at the State level. 

Submitted public use data sets to the http://www.data.gov/ system. 

Further analyzed the results from the 2008 and 2009 National surveys to help inform 

decision makers. Results show: 

o AoA is effectively reaching those most at risk of institutionalization. 

o Service recipients report Title III services enable them to remain in their own 

homes. 

o Comparison of service recipients to the elderly US population 60 and older shows 

that Title III serves older people who are less healthy and have more limitations 

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than other older adults even after adjusting for demographic and socioeconomic 

differences between the groups. 

Tested through the Performance Outcomes Measurement Project (POMP) several 

methods for measuring the impact of services. Preliminary analysis for administrative 

data sets from four States, using Cox proportional hazards models, show a consistent 

lowering of the relative risk of nursing home placement with an increase in number of 

services utilized; and there was an increase in mean survival time in the community 

(i.e. months before placement) with increases in the total number of services used. 

Employed more rigorous program evaluation methods such as longitudinal data 

collection and experimental design. 

o The Title III-C Elderly Nutrition Services program evaluation employs a complex 

design that includes three major components and several subcomponents. The 

major components include a process study that surveys each level of the Aging 

Network on a large array of topics; a costs study that measures the actual cost of 

providing a meal by cost category (e.g. labor, food, overhead); and an individual 

outcome study. The individual outcome study will measure the program’s

success at meeting the legislative intent of the program (reduce hunger and social 

isolation while improving health and well-being of consumers). In addition, AoA 

and CMS have recently entered into an Inter-Agency Agreement that will enhance 

this evaluation to include prospective analysis of healthcare utilization and cost 

data of program participants compared to a matched group of seniors who do not 

participate in the program. 

o The evaluation of the Title III-E National Family Caregiver Support program will 

be the first for this OAA program. It is designed as a longitudinal study with a 

comparison group so that the effects of the five service categories can be 

measured over time. 

o AoA is working with AHRQ and research contractors to finalize a design for an 

evaluation of the Chronic Disease Self-Management program utilizing an 

experimental design and finalizing the design for an evaluation of Aging and 

Disability Resource Centers. 

Current Performance Information 

An analysis of AoA’s performance trends shows that through FY 2009 most indicators have 

steadily improved. It also points to some key observations about the potential of AoA and the 

National Aging Services Network in meeting the challenges posed by the growth of the 

vulnerable older adult population, the changing care preferences of aging baby boomers, the 

fiscal difficulties faced by State budgets, and the expanding needs of both the elderly and their 

caregivers. Below are some examples of these observations: 

OAA programs help older Americans who are severely disabled remain independent 

and in the community: Homebound older adults that have three or more impairments in 

Activities of Daily Living are at a high risk for nursing home placement. Measures of the 

Aging Network’s success at serving this vulnerable population is a proxy for success at 

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nursing home delay and diversion. In FY 2003, the Aging Network served home-delivered 

meals to 280,454 clients with three or more ADL impairments and by FY 2009 that number 

grew by 22% to 342,084 clients. Another approach to measuring AoA’s success is the newly

developed nursing home predictor score. The components of this composite score are 

predictive of nursing home placement based on scientific literature and AoA’s POMP which 

develops and tests performance measures. The components include such items as the percent 

of clients that are transportation disadvantaged and the percent of congregate meal clients 

that live alone. As the score increases, the prevalence of nursing home predictors in the 

OAA service population increases. In 2003, the nursing home predictor score was 46.57 and 

has increased to 61.0 in FY 2009. 

OAA programs are efficient: The National Aging Services Network is providing high 

quality services to the neediest elders and doing so in a very prudent and cost-effective 

manner; as an example, AoA has significantly increased the number of clients served per 

million dollars of AoA Title III funding. Without controlling for inflation, OAA programs 

have increased efficiency by nearly 40% between FY 2002 and FY 2009, serving 8,544 

clients per million dollars of AoA funding in FY 2009 compared to 6,103 clients served per 

million dollars of AoA funding in FY 2002. This increase in efficiency is understated since 

the purchasing power of a million dollars in 2009 is significantly less than in 2002 due to 

inflation. 

OAA programs build system capacity: OAA programs stay true to their original intent to 

“encourage and assist State agencies and Area Agencies on Aging to concentrate resources in 

order to develop greater capacity and foster the development and implementation of 

comprehensive and coordinated systems.” (OAA Section 301). This is evident in the 

leveraging of OAA funds with State/local or other funds (almost $3 in other funds for every 

dollar of OAA funds expended), as well as in the expansion of projects such as the Aging and 

Disability Resource Center initiative, which grew from 24 States to 45 States with 205 sites 

participating in this key program in FY 2009. 

OAA clients report that services contribute in an essential way to maintaining their independence 

and they express a high level of satisfaction with these services. In 2009, over 96% of 

transportation clients rated services good to excellent and 95% of caregivers rated services good 

to excellent. To help ensure the continuation of these trends in core programs, AoA makes 

extensive use of its discretionary funding to test innovative service delivery models for State and 

local program entities to attain measurable improvements in program activities. For example, 

AoA has worked with the Centers for Medicare & Medicaid Services and the Department of 

Veterans Affairs to better integrate funding for long-term care service delivery, eliminate 

duplication and improve access to services through Aging and Disability Resource Centers. 

Performance for FY 2012 

Federal support for Older Americans Act programs is not expected to cover the cost of serving 

every senior. For programs with the same funding levels in FY 2012 as FY 2010, performance 

would be expected to be similar or reduced because of inflationary factors. Funding level 

increases are requested for the Home and Community-Based Supportive Services Program, the 

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Family Caregiver Support Program and the Long Term Care Ombudsman Program and these 

programs are projecting modest increases in program performance. OAA programs have strong 

partnerships with State and local governments, philanthropic organizations, and private 

donations that contribute funds in greater proportions than OAA programs. Despite States only 

having to match these programs at 15% or 25% of their Federal allocation, States have normally 

leveraged resources of $2 or $3 per every Older Americans Act dollar. Regardless of the historic 

nature of State and local support for these programs, AoA expects a decline in performance for 

nutrition in FY 2012 compared to FY 2010. Substantial declines are projected to be largely 

attributable to declining leveraged funds, as State, local, and private budgets face economic 

hardships, along with inflation factors as previously noted. 

Performance Detail 

Taken as a whole, AoA’s performance measures and indicators form an interconnected system of

performance measurement akin to the three legs of a stool (efficiency, outcomes and targeting) 

holding up AoA’s mission and strategic goals that include:

1. Empower older people, their families, and other consumers to make informed decisions 

about, and to be able to easily access, existing health and long-term care options; 

2. Enable seniors to remain in their own homes with a high quality of life for as long as 

possible through the provision of home and community-based services, including 

supports for family caregivers; 

3. Empower older people to stay active and healthy through Older Americans Act services 

and the new prevention benefits under Medicare; 

4. Ensure the rights of older people and prevent their abuse, neglect and exploitation; and 

5. Maintain effective and responsive management. 

Below is a summary of each measure, its indicators and their relationship to AoA’s strategic

goals. 

Measure 1: Improve Efficiency 

Program efficiency is a necessary and important measure of the performance of AoA programs 

for two principal reasons. First, it is important to be a responsible steward of Federal funds. 

Second, the OAA intended Federal funds to act as catalyst in generating capacity for these 

program activities at the State and local levels. It is the expectation of the OAA that States and 

communities increasingly improve their capacity to serve elderly individuals efficiently and 

effectively with both Federal and State funds. 

Improvements in program efficiency support all of AoA’s Strategic Goals. Through optimal 

utilization of resources, improvements in program efficiency ensure that affordable and 

accessible community-based long-term care is available to promote the well-being of seniors and 

their family caregivers. 

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For FY 2012, there are four efficiency indicators for AoA program activities. Indicator 1.1 

addresses performance efficiency at all levels of the National Aging Services Network in the 

provision of home and community-based services, including caregiver services. Indicator 1.3 

demonstrates the efficiency of AoA in providing services to Native Americans. Indicator 1.5 

assesses the efficiency of the Senior Medicare Patrol program and Indicator ALZ.1 assesses 

more efficient program operation in the Alzheimer’s Disease Supportive Services Program

(ADSSP). 

A summary of program efficiency indicators for FY 2012 follows: 

Indicator 1.1: For Home and Community-based Services, including Nutrition Services, 

and Caregiver services, increase the number of clients served per million dollars of OAA 

funding. 

Indicator 1.3: Increase the number of units of service provided to Native Americans per 

thousand dollars of OAA funding. 

Indicator 1.5: SMP projects will increase the total dollar amount referred for further 

action. 

Indicator ALZ.1: Increase the percent of ADSSP grant funds dedicated to evidencebased programs. 

Measure 2: Improve Client Outcomes 

While improving efficiency, AoA is committed to maintaining quality and improving client 

outcomes. The FY 2012 performance budget includes eight core performance indicators 

supporting AoA’s commitment to improving client outcomes. AoA has multiple quality 

assessment indicators in this plan reflecting separate assessments provided by elders for services 

such as meals, transportation and caregiver assistance. Also, in developing the outcome 

indicators, AoA included measures to assess AoA’s fundamental outcomes: to keep elders at 

home and in the community, and to measure results important to family caregivers. The 

measures for the Ombudsman program focus on the core purposes of this program: advocacy on 

behalf of older adults. 

Although this measure supports all of AoA’s Strategic Goals, it is most strongly tied to Goal 2 to 

enable seniors to remain in their own homes with a high quality of life for as long as possible, 

Goal 3 to empower older adults to stay active and healthy, and Goal 4 to ensure the rights of 

older people and prevent their abuse, neglect and exploitation. 

A summary of the client outcome indicators for FY 2012 follows: 

Indicator 2.6: Reduce the percent of caregivers who report difficulty in getting services. 

Indicator 2.9a: 90% of home delivered meal clients rate services good to excellent. 

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Indicator 2.9b: 90% of transportation clients rate services good to excellent. 

Indicator 2.9c: 90% of National Family Caregiver Support Program clients rate services 

good to excellent. 

Indicator 2.10: Improve well-being and prolong independence for elderly individuals by 

increasing the index of Older Americans Act clients served who are at high-risk of 

nursing home placement. 

Indicator 2.11: Increase the percentage of transportation clients who live alone. 

Indicator 2.12: Decrease the number of complaints per long-term care facility. 

Indicator 2.13: Decrease the percentage of complaints for abuse, neglect and 

exploitation in nursing homes. 

Measure 3: Effectively Target Services to Vulnerable Elderly 

AoA believes that targeting is of equal importance to efficiency and outcomes because it ensures 

that AoA and the National Aging Services Network will focus their services on the neediest, 

especially when resources are scarce. Without targeting, efforts to improve efficiency and 

outcomes could result in unintended consequences whereby entities might attempt to focus their 

efforts toward individuals who are not the most vulnerable. Such an outcome would be 

inconsistent with the intent of the OAA, which specifically requires the network to target 

services to the most vulnerable elders. It would also be inconsistent with the mission of AoA, 

which is to help vulnerable elders maintain their independence in the community. To help 

seniors remain independent, AoA and the National Aging Services Network must focus their 

efforts on those who are at the greatest risk of institutionalization: older persons who are 

disabled, poor, and residing in rural areas. 

Effective targeting of OAA services supports AoA’s Strategic Goal 1 by ensuring access to longterm care options for the economically and socially vulnerable; Goal 2 by enabling the most 

vulnerable seniors to remain in their own homes with a high quality of life; Goal 3 by 

empowering those likely to experience health disparities to stay active and healthy through OAA 

services; and Goal 4 by ensuring the rights of vulnerable elders. Thus, AoA’s four indicators for 

effective targeting are crucial for ensuring that services are targeted to the most vulnerable client 

groups. 

Indicator 3.1: Increase the number of caregivers served. 

Indicator 3.2: Increase the number of older persons with severe disabilities who receive 

home-delivered meals. 

Indicator 3.3: The percentage of OAA clients served who live in rural areas is at least 

10% greater than the percent of all US elders who live in rural areas. 

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Indicator 3.4: Increase the number of States that serve more elderly living below the 

poverty level than the prior year. 

AoA has invested significant resources and continues to work with national partners including 

Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, and 

National Institute on Aging in the adoption of evidence-based programs at the community level 

which is reflected in our positive performance results. 

Aging Services Program – Performance Summary 

AoA has used a streamlined approach to performance measurement since FY 2005, by design. 

Most of the current performance indicators are cross-cutting and the established performance 

targets are usually dependent on multiple budget line items. The following table summarizes 

AoA’s performance measures and results from FY 2007 to FY 2012. 

Summary of Performance Targets and Results Table 

Fiscal 

Year 

Total 

Targets 

Targets with 

Results Reported 

Percent of Targets 

with Results 

Reported 

Total 

Targets 

Met 

Percent of 

Targets Met 

2007 16 16 100% 13 81% 

2008 14 14 100% 9 64% 

2009 15 15 100% 11 73% 

2010 15 NA NA NA NA 

2011 16 NA NA NA NA 

2012 16 NA NA NA NA 

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Performance Measurement Detail 

A detailed discussion of the Administration on Aging’s performance follows. Each budget 

activity will have a separate performance section, however, there will be some redundancy since 

most of the performance measures apply to or are impacted by multiple budget line items. 

Narrative by Activity 

I . Health and Independence 

Table 1. Health and Independence 

Measure 1.1: For Home and Community-based Services including Nutrition Services, and Caregiver services 

increase the number of clients served per million dollars of OAA funding. (Outcome) 

FY Target Result 

2012 8,650 Sep 30, 2013 

2011 8,350 Sep 30, 2012 

2010 7,742 Sep 30, 2011 

2009 8,422 8,544 

(Target Exceeded) 

2008 8,300 8,301 

(Target Met) 

2007 7,110 8,346 

(Target Exceeded) 

Measure 2.10: Improve well-being and prolong independence for elderly individuals by increasing the index of 

Older Americans Act clients served who are at high-risk of nursing home placement. (Outcome) 

FY Target Result 

2012 61 May 31, 2014 

2011 61 May 31, 2013 

2010 61 May 31, 2012 

2009 56 61 

(Target Exceeded) 

2008 54.5 60.6 

(Target Exceeded) 

2007 New in FY 2008 60.17 

(Target Not In Place) 

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Measure 3.3: The percentage of OAA clients served who live in rural areas is at least 10% greater than the percent 

of all US elders who live in rural areas. (Outcome) 

FY Target Result 

2012 Census + 10% Sep 30, 2013 

2011 30.5% Sep 30, 2012 

2010 30.5% Sep 30, 2011 

2009 30.5% 35.7% 

(Target Exceeded) 

2008 30.5% 35.1% 

(Target Exceeded) 

2007 30.5% 34.8% 

(Target Exceeded) 

Measure 3.4: Increase the number of States that serve more elderly living below the poverty level than the prior 

year. (Outcome) 

FY Target Result 

2012 28 Sep 30, 2013 

2011 28 Sep 30, 2012 

2010 30 Sep 30, 2011 

2009 28 32 

(Target Exceeded) 

2008 24 29 

(Target Exceeded) 

2007 20 24 

(Target Exceeded) 

Note: For presentation which ties to the budget AoA highlighted specific measures that are most directly related, 

however multiple performance outcomes are impacted by this program because AoA’s performance measures

(efficiency, effective targeting, and client outcomes) assess network-wide performance in achieving current strategic 

objectives. AoA outcome measures will be reviewed going forward to ensure continued effective measurement of 

program performance. 

Performance Narrative 

Performance measures for the Health and Independence cluster are focused on 

1) Improving Program Efficiency; 2) Improving Client Outcomes and Maintaining High Levels 

of Service Quality; and 3) Effectively Targeting Services to Vulnerable Populations. 

Performance Measure 1: Improve Program Efficiency 

Indicator 1.1: For Home and Community-based Services including Nutrition Services, 

and Caregiver services increase the number of clients served per million dollars of OAA 

funding. 

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Performance Results (Efficiency) 

For the past six years, AoA has achieved its efficiency performance targets. In FY 2009, the 

Aging Services Network served 8,544 clients per million dollars of OAA funding. 

Performance has trended upward (with the exception of a decline between 2007 and 2008) and 

performance targets (calculated as percentage increases over the FY 2002 baseline) have been 

consistently achieved. This reflects the success of ongoing initiatives to improve program 

management and expand options for home and community-based care. Medicare Part D, Aging 

and Disability Resource Centers (ADRCs), and increased commitments and partnerships at the 

State and local levels have all had a positive impact on program efficiency. 

Performance Targets (Efficiency) 

The target for FY 2012 is 8,650, slightly higher than the 2009 actual. The 2012 funding 

increases for Caregiver Support and Home and Community-Based Supportive Services will 

partially offset the stresses on the Aging Services network caused by State and local economic 

conditions. These stresses include layoffs and furloughs which reduce productivity and affect 

remaining staff, some of whom are less well equipped than their predecessors to achieve the 

prior results. 

Performance Measure 2: Improve Client Outcomes and Maintain a High Level of Service 

Quality 

The FY 2012 performance budget for Health and Independence includes two indicators 

supporting AoA’s goal of improving client outcomes and two indicators to monitor the continued 

high level of consumer-reported service quality. To AoA, these are the core performance 

outcome indicators for our programs. There is one overarching client outcome indicator that will 

be included in this section; the others will be included in the sections on Supportive Services and 

Nutrition Services. The client outcome indicator for FY 2012 follows: 

Indicator 2.10: Improve well-being and prolong independence for elderly 

individuals by increasing the index of Older Americans Act clients served who 

are at high-risk of nursing home placement: Composite index of nursing home 

predictors will increase. 

An increase in the nursing home predictor index means an increase in the 

frequency of nursing home predictors in the client population which is a strong 

proxy for nursing home diversion. 

The purpose of this measure is to demonstrate the success of Health and Independence related 

services, Caregiver Services and program innovations in developing tools that enable the Aging 

Services Network to delay or defer nursing home placement. 

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The components of the composite index of nursing home predictors are as follows: 

1. Increase the percentage of caregivers reporting that services help them provide 

care longer. 

Rationale: This variable from AoA's Annual National Surveys of OAA Service 

Recipients was validated as a nursing home predictor for the Family Caregiver 

Support Program by the Performance Outcome Measurement Project (POMP) 

grantees. 

2. Increase the percentage of transportation clients who are transportation 

disadvantaged. (Defined as unable to drive or use public transportation). 

Rationale: Data from the Third National Survey of OAA Service Recipients 

show that older persons receiving transportation services who are “transportation

disadvantaged” are more disabled and vulnerable and less likely to receive the 

information and assistance that they need. Specifically, they are more likely to 

exhibit Activities of Daily Living/Instrumental Activities of Daily Living 

(ADL/IADL) limitations; more likely to have stayed overnight in a hospital in the 

past year, more likely to have stayed overnight in a nursing home or rehabilitation 

facility and more likely to be socially isolated (all key predictors of nursing home 

placement; see Predicting Elderly People’s Risk for Nursing Home Placement,

Hospitalization, Functional Impairment and Mortality by Edward Alan Miller and 

William G. Weissert). They are also less likely to know how to contact their case 

manager and less likely to understand an explanation of their services. This 

subpopulation is more vulnerable to a loss of independence and less aware of 

service options. 

3. Increase percentage of congregate meal recipients who live alone. 

Rationale: Living alone is a predictor of nursing home placement (see Predicting 

Elderly People’s Risk for Nursing Home Placement, Hospitalization, Functional 

Impairment and Mortality by Edward Alan Miller and William G. Weissert) and 

congregate meal recipients who live alone exhibit numerous other characteristics 

that can make them more vulnerable to loss of independence. For example, data 

from the Second National Survey of OAA Service Recipients show that they are 

more nutritionally vulnerable. They are less likely to eat three meals a day; they 

are in poorer health; they are less likely to socialize; they are more likely to be 

low income; and they are more likely be 85 or older. Furthermore, they are more 

likely to utilize beneficial health promotion/disease activities offered at the meal 

site such as fitness activities and health screenings. 

4. Increase the percentage of home delivered meal recipients with 3+ IADL 

limitations. 

Rationale: Multiple IADL limitations is a predictor of nursing home placement. See 

Predicting Elderly People’s Risk for Nursing Home Placement, Hospitalization,

Functional Impairment and Mortality by Edward Alan Miller and William G. Weissert 

and the Urban Institute’s 2003 study entitled "Estimates of the Risk of Long Term Care -

Assisted Living and Nursing Home Facilities" available at 

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http://aspe.hhs.gov/daltcp/reports/2003/riskest.htm and data from the Third National 

Survey of OAA Service Recipients show that home-delivered meal recipients with three 

or more IADL limitations exhibit numerous other characteristics that make them 

vulnerable to loss of independence. For example, they are more likely to have ADL 

limitations; they are more like to exhibit numerous health conditions; they are more likely 

to be homebound; and they are more likely to suffer from food insecurity. Further, 

improved nutrition can help manage many of the diseases that they suffer from (e.g. heart 

disease, diabetes, and osteoporosis). 

AoA calculated the composite score using OAA Title III expenditures as reported in the State 

Program Report to weight the four components. 

Performance Results (Outcomes) 

This performance measure was first used in FY 2008 with the resulting score of 60.6 exceeding 

the target of 54.5. In 2009 the results showed continuous improvement with a resulting score of 

61.0. 

AoA believes that this composite index of nursing home predictors will continue to trend upward 

over the long-term at a more modest rate. The trend clearly has been showing a steady increase 

in the nursing home predictor index which is a strong proxy for nursing home diversion. 

Performance Targets (Outcomes) 

The performance target for FY 2012 is 61, the same as the FY 2009 actual. As indicated above, 

performance for this indicator has been steadily improving. However, AoA has observed 

declines in service levels due to States’ and other non-Federal resources’ fiscal challenges 

stemming from the economic downturn. For the short-term, we project performance will be 

relatively static, with long-term improvement anticipated. 

Performance Measure 3: Effectively Target Services to Vulnerable Elders 

There are three indicators for effective targeting of Health and Independence related services. 

Two indicators with broad applicability are included in this section and the other is included in 

the sections on Nutrition Services. The two FY 2012 indicators for Health and Independence 

follow: 

Indicator 3.3: The percentage of OAA clients served who live in rural areas is at least 

10% greater than the percent of all US elders who live in rural areas. 

Indicator 3.4: Increase the number of States that serve more elderly living below the 

poverty level. 

12 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Performance Results (Targeting) 

AoA achieved the performance targets for the two general targeting indicators for FY 2009 as 

follows: 

Indicator 3.3: The percentage of OAA clients served who live in rural areas is at 

least 10% greater than the percent of all US elders who live in rural areas. 

The FY 2009 target is calculated to be 30.5%. For FY 2009, 35.7% of OAA clients live 

in rural areas exceeding the performance target. Data reporting for this variable has 

fluctuated somewhat but targets have consistently been met or exceeded since at least 

2005. 

Indicator 3.4: Increase the number of States that serve more elderly living below the 

poverty level. 

The FY 2009 performance target was 28 States. Data for FY 2009 indicate that 32 States have 

increased the Title III clients in poverty, exceeding the FY 2009 performance target. Over the 

past five years there has been some annual fluctuation with performance. Performance targets 

have been met or exceeded since FY 2005. 

Performance Targets (Targeting) 

The performance target for Indicator 3.3 will remain at census +10% (30.5%) for FY 2011 and 

FY 2012. The performance targeting level is considered appropriate in that it places emphasis on 

providing services to rural elders, as required by the OAA, while acknowledging the needs of 

non-rural vulnerable older Americans. 

The performance targets for Indicator 3.4 are 28 States in FY 2011 and 28 States in FY 2012, 

lower than the FY 2009 actual. With the fiscal pressures being experienced by States, the targets 

may be overly optimistic. These targeted performance levels reflect the commitment of the 

aging network to provide services to low income elderly, a group that is especially vulnerable 

and tends to have more health problems and nutritional needs. 

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Home and Community-Based Supportive Services 

Table 2. Home and Community-Based Supportive Services 

Measure 1.1: For Home and Community-based Services including Nutrition Services, and Caregiver services 

increase the number of clients served per million dollars of OAA funding. (Outcome) 

FY Target Result 

2012 8,650 Sep 30, 2013 

2011 8,350 Sep 30, 2012 

2010 7,742 Sep 30, 2011 

2009 8,422 8,544 

(Target Exceeded) 

2008 8,300 8,301 

(Target Met) 

2007 7,110 8,346 

(Target Exceeded) 

Measure 2.9b: 90% of transportation clients rate services good to excellent. (Outcome) 

FY Target Result 

2012 90% May 31, 2014 

2011 90% May 31, 2013 

2010 90% May 31, 2012 

2009 90% 96.6% 

(Target Exceeded) 

2008 90% 96.7% 

(Target Exceeded) 

2007 New in FY 2008 96.1% 

(Target Not In Place) 

Measure 2.10: Improve well-being and prolong independence for elderly individuals by increasing the index of 

Older Americans Act clients served who are at high-risk of nursing home placement. (Outcome) 

FY Target Result 

2012 61 May 31, 2013 

2011 61 May 31, 2013 

2010 61 May 31, 2012 

2009 56 61 

(Target Exceeded) 

2008 54.5 60.6 

(Target Exceeded) 

2007 New in FY 2008 60.17 

(Target Not In Place) 

14 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Measure 2.11: Increase the percentage of transportation clients who live alone. (Outcome) 

FY Target Result 

2012 72% May 31, 2014 

2011 72% May 31, 2013 

2010 70% May 31, 2012 

2009 70% 72.4%* 

(Target Exceeded) 

2008 New in FY 2009 67.3% 

(Target Not In Place) 

2007 66% 

(Target Not In Place) 

* Based on upper range of confidence interval. 

Note: For presentation which ties to the budget AoA highlighted specific measures that are most directly related, 

however multiple performance outcomes are impacted by this program because AoA’s performance measures

(efficiency, effective targeting, and client outcomes) assess network-wide performance in achieving current strategic 

objectives. AoA outcome measures will be reviewed going forward to ensure continued effective measurement of 

program performance. 

Performance Narrative 

Performance measures for the Home and Community-Based Supportive Services are focused on 

1) Improving Program Efficiency; 2) Improving Client Outcomes and Maintaining High Levels 

of Service Quality; and 3) Effectively Targeting Services to Vulnerable Populations. 

Performance Measure 1: Improve Program Efficiency 

Indicator 1.1 includes persons receiving Home and Community-Based Supportive Services. 

A detailed discussion of this indicator’s performance can be found on pages 9-10. 

Performance Measure 2: Improve Client Outcomes and Maintain a High Level of Service 

Quality 

The FY 2012 performance plan includes three outcome indicators for Home and 

Community-Based Supportive Services. 

Indicator 2.9b: 90% of transportation clients rate services good to excellent. 

Indicator 2.10: Improve well-being and prolong independence for elderly individuals by 

increasing the index of Older Americans Act clients served who are at high-risk of 

nursing home placement. 

Indicator 2.11: Increase the percentages of transportation clients who live alone. 

15 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Indicator 2.10 is a composite index of nursing home predictors which cuts across all 

services. A detailed description of this indicator can be found under that section on pages 

10-12. Indicators 2.9b and 2.11 are discussed below. 

Performance Results (Outcomes) 

Performance data show that the FY 2009 performance target was achieved for the following 

indicators: 

Indicator 2.9b: 90% of transportation clients rate services good to excellent. 

Trend data indicates that performance has been consistently very high for this measure, ranging 

from 96% to 98% over the past four years. The performance of the Aging Services Network, in 

maintaining such high consumer-reported service quality, is particularly impressive when viewed 

in the context of annually improving program efficiency. 

Indicator 2.11: Increase the percentage of transportation clients who live alone. 

FY 2009 performance is 72.4%, exceeding the target. Living alone is a predictor of nursing 

home placement (see Predicting Elderly People’s Risk for Nursing Home Placement,

Hospitalization, Functional Impairment and Mortality by Edward Alan Miller and William G. 

Weissert). For FY 2008, 25.8% of the non-institutionalized U.S. population aged 60+ lived 

alone. The percentage of transportation service recipients living alone, who are among the most 

vulnerable to loss of independence, is nearly 3 times as great as the percentage in the general 

population. 

Performance Targets (Outcomes) 

For Indicator 2.9b, performance targets will remain at 90% for FY 2011 and FY 2012. Ninety 

percent is roughly the threshold for detecting statistically significant differences in this 

consumer-reported service quality indicator. 

For Indicator 2.11, the performance targets will remain at 72% for FY 2011 and FY 2012. 

As noted above, living alone is a key predictor of nursing home placement. AoA has examined 

the results for this indicator, looking at trends for the past 3 years. The performance has 

remained fairly constant. Since the results are already very impressive, we believe the amount of 

money expended for transportation is not sufficient to produce significant increases to the 

number of people who live alone and receive transportation. 

Performance Measure 3: Effectively Target Services to Vulnerable Elders 

Indicators 3.3 and 3.4 include persons receiving Home and Community-Based Supportive 

Services. A detailed discussion of these indicators’ performance can be found under the Health 

and Independence section on pages 12-13. 

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Nutrition Services 

Table 3. Nutrition Services 

Measure 1.1: For Home and Community-based Services including Nutrition Services, and Caregiver services 

increase the number of clients served per million dollars of OAA funding. (Outcome) 

FY Target Result 

2012 8,650 Sep 30, 2013 

2011 8,350 Sep 30, 2012 

2010 7,742 Sep 30, 2011 

2009 8,422 8,544 

(Target Exceeded) 

2008 8,300 8,301 

(Target Met) 

2007 7,110 8,346 

(Target Exceeded) 

Measure 2.9a: 90% of home delivered meal clients rate services good to excellent. (Outcome) 

FY Target Result 

2012 90% May 31, 2014 

2011 90% May 31, 2013 

2010 90% May 31, 2012 

2009 90% 91.1%* 

(Target Met) 

2008 90% 91.03%* 

(Target Met) 

2007 New in FY 2008 90.4% 

(Target Not In Place) 

* Based on the upper range of the survey confidence interval 

Measure 2.10: Improve well-being and prolong independence for elderly individuals by increasing the index of 

Older Americans Act clients served who are at high-risk of nursing home placement. (Outcome) 

FY Target Result 

2012 61 May 31, 2014 

2011 61 May 31, 2013 

2010 61 May 31, 2012 

2009 56 61 

(Target Exceeded) 

2008 54.5 60.6 

(Target Exceeded) 

2007 New in FY 2008 60.17 

(Target Not In Place) 

17 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Measure 3.2: Increase the number of older persons with severe disabilities who receive home-delivered meals. 

(Outcome) 

FY Target Result 

2012 271,000 Dec 31, 2013 

2011 297,000 Dec 31, 2012 

2010 325,000 Dec 31, 2011 

2009 378,613 342,084 

(Target Not Met) 

2008 364,590 349,934 

(Target Not Met) 

2007 350,568 359,143 

(Target Exceeded) 

Note: For presentation which ties to the budget AoA highlighted specific measures that are most directly related, 

however multiple performance outcomes are impacted by this program because AoA’s performance measures

(efficiency, effective targeting, and client outcomes) assess network-wide performance in achieving current strategic 

objectives. AoA outcome measures will be reviewed going forward to ensure continued effective measurement of 

program performance. 

Performance Narrative 

Performance measures for Nutrition Services are focused on 1) Improving Program Efficiency; 

2) Improving Client Outcomes and Maintaining High Levels of Service Quality; and 

3) Effectively Targeting Services to Vulnerable Populations. 

Performance Measure 1: Improve Program Efficiency 

Indicator 1.1 includes persons receiving Nutrition Services. A detailed discussion of this 

indicator’s performance can be found on pages 9-10. 

Performance Measure 2: Improve Client Outcomes and Maintain a High Level of Service 

Quality 

For FY 2011, there are two outcome indicators which directly relate to Nutrition 

Services: 

Indicator 2.9a: 90% of home-delivered meal clients rate services good to 

excellent. 

Indicator 2.10: Improve well-being and prolong independence for elderly individuals by 

increasing the index of Older Americans Act clients served who are at high-risk of 

nursing home placement. 

Indicator 2.10 is a composite index of nursing home predictors which cuts across all 

services. A detailed description of this indicator can be found under that section on 

pages 10-12. 

18 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Performance Results (Outcomes) 

FY 2009 performance data show that the FY 2009 performance target was achieved for the 

following indicator: 

Indicator 2.9a: 90% of home-delivered meal clients rate services good to excellent. 

Between 2003 through 2008, 90% - 94% of home delivered meal participants indicated high 

satisfaction with the meals. A target of 90% was established for subsequent years, as a threshold 

for indicating client reported high quality. The FY 2009 performance is 91.1%, based on the 

upper range of the confidence level. The currently ongoing program evaluation for the nutrition 

programs will provide additional information on service quality. 

Performance Targets (Outcomes) 

Performance targets for this indicator will remain at 90% for FY 2011 and FY 2012. Ninety 

percent is roughly the threshold for detecting statistically significant differences in this 

consumer-reported service quality indicator. 

Performance Measure 3: Effectively Target Services to Vulnerable Elders 

There are three targeting indicators that relate directly to Nutrition Services as follows: 

Indicator 3.2: Increase the number of severely disabled clients receiving selected home and 

community-based services (home-delivered meals). 

Also, Indicators 3.3 and 3.4 include persons receiving Nutrition Services. A detailed discussion 

of the performance for Indicators 3.3 and 3.4 can be found under the Health and Independence 

section on pages 12-13. A discussion of performance for Indicator 3.2 follows. 

Performance Results (Targeting) 

FY 2009 performance data show that the FY 2009 performance target was not achieved for the 

following indicator: 

Indicator 3.2: Increase the number of severely disabled clients (defined as persons with 

three or more Activities of Daily Living (ADL) limitations) who receive selected (homedelivered meals) home and community-based services. 

The FY 2009 target was 378,613, a 35% increase over the FY 2003 baseline of 280,454. Actual 

performance for FY 2009 was 342,084. This performance indicator is a proxy for nursing home 

diversion since people with 3+ADL limitations are generally nursing home eligible. While this 

indicator did not achieve its FY 2009 performance target, this indicator is still performing at a 

level 22% higher than the 2003 baseline. The FY 2009 target turned out to be unrealistically 

high given the state of the economy which was not forecast at the time the target was set. 

19 
 

 

 

 

Performance Targets (Targeting) 

The FY 2012 target is 271,000. Fiscal and staffing constraints at the State and local level are 

expected to adversely impact performance through FY 2012. These fiscal constraints will be 

further amplified when Recovery Act funds are totally expended by the end of FY 2010. 

20 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Preventive Health Services 

Table 4. Preventive Health Services 

Output AB: The number of people served with health and disease prevention programs. (Developmental) 

FY Target Result 

2012 New in FY 2013 Baseline 

Note: For presentation which ties to the budget AoA highlighted specific measures that are most directly related, 

however multiple performance outcomes are impacted by this program because AoA’s performance measures

(efficiency, effective targeting, and client outcomes) assess network-wide performance in achieving current strategic 

objectives. AoA outcome measures will be reviewed going forward to ensure continued effective measurement of 

program performance. 

Performance Narrative 

AoA will monitor the performance of the Preventive Health programs utilizing annual state 

reports. Since AoA is promoting evidence-based programs, and States will have a variety of 

choices of health promotion and disease prevention systems this measure will illustrate the 

number of seniors impacted by services. 

Performance Measure Output AB: Number of People Provided Preventive Health Services 

Indicator Output AB: The number of people served with health and disease prevention 

programs. 

Performance Results 

This is a developmental indicator and results are expected to be available in late 2012. 

The baseline will be used to identify targets for 2013 and beyond. 

Performance Targets (Outcomes) 

Targets will be set for 2013 and subsequent years once baseline data is available. 

21 
 

 

Chronic Disease Self-Management Programs 

In FY 2009, 8,426 individuals with chronic conditions completed the CDSMP program. That 

number is projected to increase to 20,000 by FY 2012. Outcome measures and targets are under 

development. 

22 
 

 

 

 

 

 

 

 

 

 

 

Community Service Employment for Older Americans 

The outcome indicators below were developed and the data collected by the Department of 

Labor (DoL). Under the proposal to transfer SCSEP, AoA will work with all relevant parties to 

develop and refine performance measures, and collect performance data. 

Measure 

Average earnings in the second and third 

quarters after exit (Outcome) 

Most Recent PY 2010 

Result Projection 

PY 2008: 

$6,795 $6,590 

Percent of participants employed in the first 

quarter after exit (Outcome) 

PY 2008: 

48.1% 46.5% 

Percent of participants employed in the first 

quarter after exit still employed in the second 

and third quarters after exit (Outcome) 

PY 2008: 

71.1% 69.9% 

23 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Native American Nutrition and Supportive Services 

Table 5. Native American Nutrition and Supportive Services 

Measure 1.3: For Title VI Services, increase the number of units of service provided to Native Americans per 

thousand dollars of OAA funding. (Outcome) 

FY Target Result 

2012 300 Dec 31, 2013 

2011 300 Dec 31, 2012 

2010 300 Dec 31, 2011 

2009 277 317 

(Target Exceeded) 

2008 273 333 

(Target Exceeded) 

2007 264 312 

(Target Exceeded) 

Note: For presentation which ties to the budget AoA highlighted specific measures that are most directly related, 

however multiple performance outcomes are impacted by this program because AoA’s performance measures

(efficiency, effective targeting, and client outcomes) assess network-wide performance in achieving current strategic 

objectives. AoA outcome measures will be reviewed going forward to ensure continued effective measurement of 

program performance. 

Performance Narrative 

Native American Nutrition and Supportive Services provide grants to eligible tribal 

organizations to promote the delivery of home and community-based supportive services and 

nutrition services. The performance measurement strategy for this program aligns with the 

broader performance measurement strategy for Health and Independence services. 

Performance measures for Native American Nutrition and Supportive Services are focused on 

1) Improving Program Efficiency; 2) Improving Client Outcomes and Maintaining High Levels 

of Service Quality; and 3) Effectively Targeting Services to Vulnerable Populations. 

Performance Measure 1: Improve Program Efficiency 

For FY 2010, there is one efficiency indicator that directly relates to Native American Nutrition 

and Supportive Services: 

Indicator 1.3: For Title VI Services (nutrition, supportive services, caregiver 

services and other activities), increase the number of services provided per 

thousand dollars of OAA funding. 

24 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Performance Results 

In FY 2009, as in the prior five years, AoA achieved its efficiency performance target; the 

Title VI grantees provided 317 units of service per thousand dollars of OAA funding, exceeding 

the performance target of 277. 

When the performance target for FY 2009 was established, it was thought to be ambitious. 

Improved program efficiency was to be achieved through best practices. It was anticipated that 

program innovations would enhance operations throughout the Aging Services Network by 

establishing replicable information and access improvement strategies such as “single-entry 

points.”

However, the unanticipated occurred. After the enactment of the Medicare Prescription Drug 

Benefit, CMS sought the assistance of AoA and the Aging Services Network in providing 

information and assistance on this new benefit to Medicare recipients and their family members. 

As a result, the Aging Services Network experienced an influx of new service recipients as more 

people became aware of service options. 

Performance has consistently trended upward and performance targets (calculated as percentage 

increases over the FY 2002 baseline) have been consistently achieved over the past 5 years. 

Moreover, performance for FY 2006-FY 2008 showed substantial increases. Title VI grantees 

have shown impressive capacity to leverage additional funding to meet the increasing demand 

for services. 

Performance Targets (Efficiency) 

Due to the continued impact of the economic downturn, performance is expected to 

decline slightly to approximately 300 units of service provided per thousand dollars of 

OAA funding in 2012. This is similar to the decline between FY 2008 and FY 2009 and 

this trend is expected to continue for the next few years. 

25 
Aging Network Support Activities 

26 

Aging Network Support Activities provide ongoing support for the National Aging Services 

Network and AoA’s core service delivery programs. Specifically, the support activities

contribute to enhanced performance measurement for home and community-based services. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

II. Caregiver Services 

Family Caregiver Support Services 

Table 6. Family Caregiver Support Services 

Measure 1.1: For Home and Community-based Services including Nutrition Services, and Caregiver services 

increase the number of clients served per million dollars of OAA funding. (Outcome) 

FY Target Result 

2012 8,650 Sep 30, 2013 

2011 8,350 Sep 30, 2012 

2010 7,742 Sep 30, 2011 

2009 8,422 8,544 

(Target Exceeded) 

2008 8,300 8,301 

(Target Met) 

2007 7,110 8,346 

(Target Exceeded) 

Measure 2.6: Reduce the percent of caregivers who report difficulty in getting services. (Outcome) 

FY Target Result 

2012 30% May 31, 2014 

2011 30% May 31, 2013 

2010 30% May 31, 2012 

2009 35% 30% 

(Target Exceeded) 

2008 35% 32% 

(Target Exceeded) 

2007 35% 32.1% 

(Target Exceeded) 

Measure 2.9c: 90% of NFCSP clients rate services good to excellent. (Outcome) 

FY Target Result 

2012 90% May 31, 2014 

2011 90% May 31, 2013 

2010 90% May 31, 2012 

2009 90% 95.3% 

(Target Exceeded) 

2008 90% 95.4% 

(Target Exceeded) 

2007 New in FY 2008 93.8% 

(Target Not In Place) 

27 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Measure 2.10: Improve well-being and prolong independence for elderly individuals by increasing the index of 

Older Americans Act clients served who are at high-risk of nursing home placement. (Outcome) 

FY Target Result 

2012 61 May 31, 2014 

2011 61 May 31, 2013 

2010 61 May 31, 2012 

2009 56 61 

(Target Exceeded) 

2008 54.5 60.6 

(Target Exceeded) 

2007 New in FY 2008 60.17 

(Target Not In Place) 

Measure 3.1: Increase the number of caregivers served. (Outcome) 

FY Target Result 

2012 919,000 Sep 30, 2013 

2011 790,000 Sep 30, 2012 

2010 560,000 Sep 30, 2011 

2009 731,545 855,000 

(Target Exceeded) 

2008 762,000 675,243 

(Target Not Met) 

2007 1,000,000 731,545 

(Target Not Met but Improved) 

Note: For presentation which ties to the budget AoA highlighted specific measures that are most directly related, 

however multiple performance outcomes are impacted by this program because AoA’s performance measures

(efficiency, effective targeting, and client outcomes) assess network-wide performance in achieving current strategic 

objectives. AoA outcome measures will be reviewed going forward to ensure continued effective measurement of 

program performance. 

Performance Narrative 

Performance measures for Caregiver Services are focused on 1) Improving Program Efficiency; 

2) Improving Client Outcomes and Maintaining High Levels of Service Quality; and 

3) Effectively Targeting Services to Vulnerable Populations. 

Performance Measure 1: Improve Program Efficiency 

Indicator 1.1 includes persons receiving caregiver services. A detailed discussion of this 

indicator’s performance can be found on pages 9-10. 

28 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Performance Measure 2: Improve Client Outcomes and Maintain a High Level of Service 

Quality 

For FY 2012, the following indicators relate directly to Caregiver Services. 

Indicator 2.6: Reduce the percentage of caregivers reporting difficulty getting 

services. 

Indicator 2.9c: 90% of Family Caregiver Support clients rate services good to 

excellent. 

Indicator 2.10: Improve well-being and prolong independence for elderly individuals by 

increasing the index of Older Americans Act clients served who are at high-risk of 

nursing home placement. 

Indicator 2.10 is a composite index of nursing home predictors which cuts across all services. A 

detailed description of this indicator can be found under the Health and Independence section on 

pages 10-12. 

Indicators 2.6 and 2.9c are discussed below. 

Performance Results (Outcomes) 

FY 2009 performance data show that the performance target was achieved for the following 

quality indicators: 

Indicator 2.9c: 90% of NFCSP clients rate services good to excellent. 

This quality indicator for FY 2009 showed performance of 95.3% of caregivers rating services 

good to excellent. AoA anticipates that performance for this indicator will remain above 90% 

for subsequent years. 

While it is important to maintain high levels of service quality and to improve program 

efficiency and targeting, improving program outcomes is of paramount importance. 

Indicator 2.6: Reduce the percent of caregivers who report difficulty getting services. 

In FY 2003 the baseline of 64% was established. Ambitious performance targets of seven 

percentage point annual decreases were established at that time. The target for FY 2009 was 

35%. Performance in FY 2009 was 30% exceeding the target and showing a downward trend 

from the FY 2003 level. The successful maturation of the caregiver program and initiatives to 

improve access to service are responsible for this improvement. 

29 
 

 

 

 

 

 

 

 

 

 

 

 

Performance Targets (Outcomes) 

Performance targets for Indicator 2.6 are 30% for FY 2011 and FY 2012. With stresses 

on State and local budgets it is likely that some individuals will have to wait longer or 

may be denied services because of funding constraints. This target will be re-evaluated 

once the economy has improved. 

Performance targets for Indicator 2.9c will remain at 90% for FY 2011 and FY 2012. Ninety 

percent is roughly the threshold for detecting statistically significant differences in this 

consumer-reported quality indicator. 

Performance Measure 3: Effectively Target Services to Vulnerable Elders 

There is one targeting indicator for Caregiver Services. 

Indicator 3.1: Increase the number of caregivers served. 

Performance Results (Targeting) 

The FY 2009 performance target of 731,545 was exceeded. In FY 2009, 855,000 caregivers 

received services. 

Performance targets for FY 2008 and beyond were established using the marginal cost approach 

plus more realistic performance expectations consistent with current funding levels. Increasing 

the number of caregivers served is a critical component of AoA’s efforts to prolong the ability of

vulnerable elderly persons to live in their homes. Over 80% of caregivers receiving services 

report that the services have “helped them provide care longer” and over 43% of caregivers

report that without services their care recipients would be unable to maintain their current living 

arrangements. Unfortunately, the caregiver program which frequently relies on in-home services 

was affected by the economic stress at the state and local level, so we project that there will be a 

decline in caregivers served in FY 2010, with some rebounding expected by FY 2012 as a result 

of proposed budget increases. 

Performance Targets (Targeting) 

The performance target for Indicator 3.1 is 919,000 for FY 2012. This is consistent with the 

FY 2012 budget request and expected economic conditions. 

30 
 

 

 

 

 

 

 

 

 

 

 

 

 

Native American Caregiver Support Services 

Table 7. Native American Caregiver Support Services 

Measure 2.6: Reduce the percent of caregivers who report difficulty in getting services. (Outcome) 

FY Target Result 

2012 30% May 31, 2014 

2011 30% May 31, 2013 

2010 30% May 31, 2012 

2009 35% 30% 

(Target Exceeded) 

2008 35% 32% 

(Target Exceeded) 

2007 35% 32.1% 

(Target Exceeded) 

Measure 2.9c: 90% of NFCSP clients rate services good to excellent. (Outcome) 

FY Target Result 

2012 90% May 31, 2014 

2011 90% May 31, 2013 

2010 90% May 31, 2012 

2009 90% 95.3% 

(Target Exceeded) 

2008 90% 95.4% 

(Target Exceeded) 

2007 New in FY 2008 93.8% 

(Target Not In Place) 

Measure 3.1: Increase the number of caregivers served. (Outcome) 

FY Target Result 

2012 919,000 Sep 30, 2013 

2011 790,000 Sep 30, 2012 

2010 560,000 Sep 30, 2011 

2009 731,545 855,000 

(Target Exceeded) 

2008 762,000 675,243 

(Target Not Met) 

2007 1,000,000 731,545 

(Target Not Met but Improved) 

31 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Note: For presentation which ties to the budget AoA highlighted specific measures that are most directly related, 

however multiple performance outcomes are impacted by this program because AoA’s performance measures

(efficiency, effective targeting, and client outcomes) assess network-wide performance in achieving current strategic 

objectives. AoA outcome measures will be reviewed going forward to ensure continued effective measurement of 

program performance. 

Performance Narrative 

The Native American Caregiver Support Services program provides grants to eligible tribal 

organizations to promote the delivery of services that assist Native American family and 

informal caregivers. The performance measurement strategy for this program aligns with the 

performance measurement strategy for Family Caregiver Support Services program. 

Performance measures for the Native American caregivers are focused on 

1) Improving Program Efficiency; 2) Improving Client Outcomes and Maintaining High Levels 

of Service Quality; and 3) Effectively Targeting Services to Vulnerable Populations. 

Performance Measure 2: Improve Client Outcomes and Maintain a High Level of 

Service Quality 

Outcome and Service Quality information is obtained specifically for the Title VI program 

through comprehensive, multileveled program evaluations. The evaluation conducted by 

Mathematica Policy Research Inc. (1993-1995) found that the service quality results reported by 

the Native American Service recipients are comparable to the service quality reported by Title III 

nutrition participants. While there are no on-going data sources specifically for Title VI 

outcomes and service quality, Native Americans participate in the National Surveys conducted 

for Title III services and the following outcome indicators are considered annual proxies for 

Native American indicators. 

Caregiver Difficulty Reduction: Decrease the percentage of caregivers reporting 

difficulties in dealing with agencies to obtain services (Indicator 2.6). 

Caregiver Quality Assessment: 90% of caregivers rate National Family Caregiver 

Support Program services good to excellent (Indicator 2.9c). 

A detailed discussion of these indicators can be found under the Family Caregiver 

Support Services section on pages 29-30. 

32 
 

 

 

 

 

 

 

Performance Measure 3: Effectively Target Services to Vulnerable Elders 

Indicator 3.1: Increase the Number of Caregivers Served: As part of the caregiver 

program implementation it is essential that the National Aging Services Network 

reach out to caregivers. FY 2009 data indicate that 855,000 caregivers received 

services, including 26,500 Native American caregivers. 

A detailed discussion of this indicator’s performance can be found under the Family 

Caregiver Support Services section on page 30. 

33 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Alzheimer’s Disease Supportive Services Program

Table 8. Alzheimer’s Disease Supportive Services Program

Measure ALZ.1: Percent of ADSSP grant funds dedicated to implementing evidence-based programs. (Outcome) 

FY Target Result 

2012 60% Dec 31, 2013 

2011 60% Dec 31, 2012 

2010 New in FY 2011 Dec 31,2011 

2009 64% 

(Target Not In Place) 

2008 59% 

(Target Not In Place) 

Note: For presentation which ties to the budget AoA highlighted specific measures that are most directly related, 

however multiple performance outcomes are impacted by this program because AoA’s performance measures

(efficiency, effective targeting, and client outcomes) assess network-wide performance in achieving current strategic 

objectives. AoA outcome measures will be reviewed going forward to ensure continued effective measurement of 

program performance. 

Performance Measure Output ALZ.1: Percentage of Funds Used for Evidence-based 

Programs 

Performance Narrative 

AoA is promoting evidence-based systems to assist caregivers serving people with Alzheimer’s

disease, and grantees have a variety of systems to implement. This measure will enable AoA to 

track the transition to the new ways of doing business which are expected to improve client 

outcomes. 

Indicator ALZ.1: Percent of ADSSP grant funds dedicated to implementing evidencebased programs. 

Performance Results 

This is a new indicator with no prior performance target. Baseline results indicate that 59% of 

funds are currently used in evidence-based programs. 

Performance Targets (Outcomes) 

The FY 2012 target is 60% of funds which represents growth toward the goal of greater 

application of evidence-based programs as more evidence-based options become available. 

Since this is a competitive discretionary grant program, grantees change periodically and the 

proportion of grantees that are evidence-based could fluctuate. 

34 
Lifespan Respite Care 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 9. Lifespan Respite Care 

Output AE: Increase the number of caregivers served as a result of Lifespan Respite Care. (Developmental) 

FY Target Result 

2012 New in FY 2013 

2011 Baseline 

Note: For presentation which ties to the budget AoA highlighted specific measures that are most directly related, 

however multiple performance outcomes are impacted by this program because AoA’s performance measures

(efficiency, effective targeting, and client outcomes) assess network-wide performance in achieving current strategic 

objectives. AoA outcome measures will be reviewed going forward to ensure continued effective measurement of 

program performance. 

Performance Narrative 

The intent of the Lifespan Respite Care program is to expand and enhance respite care services 

to family members, improve coordination of respite care, and reduce family caregiver strain. 

Grantees are provided broad discretion for implementation strategies, while this indicator can be 

used to measure the impact from disparate approaches. 

Performance Measure Output AE: Increase the number of caregivers served with Respite 

Care. 

Indicator Output AE: Increase the number of caregivers served as a result of Lifespan 

Respite Care. 

Performance Results 

This is a developmental indicator and preliminary results are expected to be available late 

in FY 2011. The baseline will be used to identify targets for 2013 and beyond. 

Performance Targets (Outcomes) 

Targets will be set for 2013 and subsequent years once baseline data is available. 

35 
 

 

 

 

III. Protection of Vulnerable Adults 

Adult Protective Services State Demonstrations 

There is currently no consistent, national data set for reporting. Adult Protective Services State 

Demonstrations will help identify best practices in reporting on these activities. An evaluation of 

the demonstration projects will be designed to develop and test appropriate methods of 

addressing elder abuse, neglect and exploitation. 

36 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Long-Term Care Ombudsman Program 

Table 10. Long-Term Care Ombudsman Program 

Measure 1.2: For Title VII Services, increase the number of Ombudsman complaints resolved or partially resolved 

per million dollars of AoA funding. (Outcome) 

FY Target Result 

2010 Retire 

2009 11,346 8,227 

(Target Not Met) 

2008 11,439 10,089 

(Target Not Met) 

2007 11,811 10,801 

(Target Not Met but Improved) 

Measure 2.7: Improve the Ombudsman complaint resolution rates. (Outcome) 

FY Target Result 

2010 Retire 

2009 32 23 

(Target Not Met) 

2008 30 24 

(Target Not Met) 

2007 15 35 

(Target Exceeded) 

Measure 2.12: Decrease the number of complaints per LTC facility. (Outcome) 

FY Target Result 

2012 3.2 Sep 30, 2013 

2011 3.9 Sep 30, 2012 

2010 4.06 Sep 30, 2011 

2009 New in FY 2010 3.4 

(Target Not in Place) 

2008 4.06 

(Target Not In Place) 

2007 4.28 

(Target Not In Place) 

37 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Measure 2.13: Decrease the percentage of complaints for Abuse, Gross Neglect and Exploitation in nursing homes. 

(Outcome) 

FY Target Result 

2012 18.5% Sep 30, 2012 

2011 19.5% Sep 30, 2012 

2010 20% Sep 30, 2011 

2009 New in FY 2010 20.44% 

(Target Not In Place) 

2008 20.18% 

(Target Not In Place) 

2007 21.63% 

(Target Not In Place) 

Note: For presentation which ties to the budget AoA highlighted specific measures that are most directly related, 

however multiple performance outcomes are impacted by this program because AoA’s performance measures

(efficiency, effective targeting, and client outcomes) assess network-wide performance in achieving current strategic 

objectives. AoA outcome measures will be reviewed going forward to ensure continued effective measurement of 

program performance. 

Performance Narrative 

Performance measurement for the Long-Term Care Ombudsman Program focuses on 

1) Improving Client Outcomes and 2) Maintaining High Levels of Service Quality. These 

programs, which focus on the prevention of elder abuse and neglect in institutional settings, are 

targeted to the most vulnerable elder Americans. 

Changes in Measures 

The two FY 2009 performance measures, Indicator 1.2 and Indicator 2.7 have been replaced 

because they do not capture the current program focus. In recent years, the Ombudsman 

program has been employing a more proactive approach to head off problems and lessen the 

need for complaints. An increased emphasis has been placed on training, consultations and 

regular (quarterly) facility visits. 

This approach is yielding positive results. The average number of complaints per facility is 

declining and while the total number of complaints declines, complaints for abuse and neglect in 

nursing homes are declining at a faster rate. 

To capture this change in program emphasis, AoA introduced two new performance measures. 

Indicator 2.12: Decrease the average number of complaints per Long-Term Care 

facility. 

Indicator 2.13: Decrease the percentage of complaints for Abuse, Gross Neglect and 

Exploitation in nursing homes. 

38 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

It is important to note that complaint resolution will always be of paramount importance. 

However, over the past several years, complaints have been resolved or partially resolved at a 

rate of, on average, 77%. The percentage of complaints not resolved in a satisfactory manner 

ranges from 5.66% to 6.72% over 6 years with roughly 3% withdrawn, 8% determined no action 

needed and 5% referred to other agencies. AoA will continue to monitor the complaint 

resolution rate to assure it remains at the current high level of performance. 

Performance Measure 1: Improve Program Efficiency 

For FY 2010 and beyond, the efficiency measure has been replaced by an additional outcome 

measure. 

Performance Results (Efficiency) 

The FY 2009 performance target was not achieved for this indicator. The FY 2009 target was 

11,346 complaints resolved or partially resolved per million dollars of OAA funding. Actual 

2009 performance was 8,227. Several States that reported declines in complaints and resolutions 

had layoffs and staff furloughs reducing efficiency and productivity. In addition, total 

expenditures and grants from State and local funders declined affecting local ombudsman 

productivity as well. As noted above, current program efforts are focused on minimizing 

complaints by increased facility visitation and consultations. This measure does not reflect the 

current program focus and has been discontinued. 

Performance Measure 2: Improve Client Outcomes and Maintain a High Level of Service 

Quality 

The FY 2009 measure for the Ombudsman program assesses the efforts of States to improve the 

successful resolution of complaints by residents of nursing homes and other institutions. 

Indicator 2.7: Improve Ombudsman complaint resolution rates. 

This measure is subject to much State by State fluctuation and, while complaint resolution is of 

paramount importance, some States are solving complaints at such a high rate, improvement for 

them is unrealistic. This indicator, along with Indicator 1.2 is being discontinued. See above for 

discussion of new indicators. 

Performance Results (Outcomes) 

The FY 2009 performance target of 32 was not met. FY 2009 data indicates that the 

Ombudsman complaint resolution rates improved in 23 States. While the total number of 

complaints is declining, some States are improving their resolution rates even as the focus shifts 

to prevention. However, establishing annual targets is unrealistic given that improvement rates 

vary from year to year. Further, this measure is inconsistent with the current focus on 

prevention. 

39 
 

 

 

 

 

 

 

 

 

 

 

Performance Targets (Outcomes) 

For new Indicator 2.12, decrease the number of complaints per LTC facility, the FY 2012 target 

is 3.2. 

For new Indicator 2.13, decrease the percentage of complaints for Abuse, Gross Neglect and 

Exploitation in nursing homes and the FY 2012 target is 18.5%. 

AoA has chosen ambitious targets for 2012 due to the request for increased Federal funding in 

FY 2012. 

Performance Measure 3: Effective Targeting to Vulnerable Elders 

Since the Ombudsman Program is already targeted to a vulnerable population and serves a 

prevention purpose, a formal targeting measure is not applicable. However, the frequency of 

visits to facilities by Ombudsmen is an effective indicator and was discussed by the Institute of 

Medicine (IOM) as a measure of program effectiveness in the 1995 evaluation of the program. 

In FY 2009, 80% of the 16,653 nursing facilities nationwide received at least quarterly visits not 

in relation to a complaint from the Ombudsman Program. 

40 
Prevention of Elder Abuse and Neglect 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 11. Prevention of Elder Abuse and Neglect 

Output U: Elder Abuse prevention non-OAA service expenditures ($ in thousands). 

FY Target Result 

2012 $20,000 Sep 30, 2013 

2011 New in FY 2012 Sep 30, 2012 

2010 New in FY 2012 Sep 30, 2011 

2009 $19,365 

Note: For presentation which ties to the budget AoA highlighted specific measures that are most directly related, 

however multiple performance outcomes are impacted by this program because AoA’s performance measures

(efficiency, effective targeting, and client outcomes) assess network-wide performance in achieving current strategic 

objectives. AoA outcome measures will be reviewed going forward to ensure continued effective measurement of 

program performance. 

Performance Narrative 

The prevention of Elder Abuse and Neglect program provides State formula grants for training 

and education, promoting public awareness of elder abuse, and supports State and local elder 

abuse prevention coalitions and multi-disciplinary teams. With the expanded focus on Elder 

Justice, this funding stream which has operated for several years will become an important 

component of AoA’s Elder Justice activities. Information, training, and technical assistance for 

this program are provided through the Elder Rights Support Activities. 

Performance Measure: Indicator Output U: Increase the elder abuse prevention non-OAA 

expenditures ($ thousands). 

Performance Results 

This is a new indicator for 2012. 

Performance Targets 

In FY 2009 $19,365,000 of funds from state and local entities were reported to enhance the 

approximately $5 million of OAA funds. The FY 2012 target is $20,000,000, which is highly 

ambitious given the current fiscal constraints faced by State and local governments. 

41 
 

 

 

 

 

Elder Rights Support Activities 

Elder Rights Support Activities provide on-going support for the National Aging Services 

Network and AoA’s core programs protecting vulnerable adults. The support activities 

contribute to enhanced performance across the Protection of Vulnerable Adults programs. 

42 
 

 

 

 

 

 

 

 

 

 

 

Senior Medicare Patrol Program 

Table 12. Senior Medicare Patrol 

Measure 1.4: For Senior Medicare Patrol, increase the number of beneficiaries trained per million dollars of AoA 

funding. (Outcome) 

FY Target Result 

2010 Discontinued 

2009 41,230 26,600 

(Target Not Met) 

2008 49,600 36,479 

(Target Not Met) 

2007 48,980 39,216 

(Target Not Met) 

Measure 1.5: SMP projects will increase the total dollar amount referred for further action. (Outcome) 

FY Target Result 

2012 $5,000,000 Sep 30, 2012 

2011 $4,000,000 Sep 30, 2012 

2010 $2,500,000 Sep 30, 2011 

2009 New in FY 2010 $3,762,448 

2008 $2,345,299 

(Target Not In Place) 

Note: For presentation which ties to the budget AoA highlighted specific measures that are most directly related, 

however multiple performance outcomes are impacted by this program because AoA’s performance measures

(efficiency, effective targeting, and client outcomes) assess network-wide performance in achieving current strategic 

objectives. AoA outcome measures will be reviewed going forward to ensure continued effective measurement of 

program performance. 

Performance Narrative 

This program serves an important role in the Department’s efforts to prevent or identity

healthcare fraud in the Medicare and Medicaid programs. The SMP program has documented 

nearly $106 million in savings to Medicare, Medicaid, program beneficiaries, and others since its 

inception in 1997, excluding any deterrent effect. During that same period, the program has 

educated over 2.8 million beneficiaries through the work of 19,467 volunteers who contributed a 

combined 543,805 hours of their time to preventing, detecting and reporting suspected incidents 

of fraud and educating and training community members about fraud prevention. The efficiency 

measure noted below is a direct measure of potential fraudulent or inaccurate claims identified 

by SMP program participants. 

Performance Measure 1: Improve Program Efficiency 

For FY 2012, there is one efficiency indicator for the Senior Medicare Patrol Program. 

43 
 

 

 

 

 

 

 

 

 

 

 

 

 

Indicator 1.5: SMP projects will increase the total dollar amount referred for further 

action. 

This indicator, replacing Indicator 1.4, is new in FY 2010. 

Performance Results (Efficiency) 

The FY 2009 performance target for Indicator 1.4 was not achieved. In FY 2009, Senior 

Medicare Patrols reported training 26,600 beneficiaries per million dollars of funding. 

A new reporting system was implemented in FY 2007 and since that time the number of seniors 

trained has declined substantially. In FY 2010, AoA is starting a performance evaluation of the 

SMP to better understand current program performance and identify more suitable performance 

measures. 

Performance Targets (Efficiency) 

Indicator 1.4 has been replaced by Indicator 1.5. The total number of beneficiaries trained will 

fluctuate from year to year (1.4) and is subject to economic downturns and other program 

initiatives. Indicator 1.5 which measures the dollar amount, referred for further action, should 

show steady increase as the program continuing to successfully mature. 

The performance target for FY 2012 is $5 million. 

44 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IV. Consumer Information, Access & Outreach 

Aging and Disability Resource Centers 

Table 13. Aging and Disability Resource Centers 

LTC.2: Percent of individuals who indicate ADRC information and counseling contribute to informed decision 

making. (Developmental) 

FY Target Result 

2012 New in FY 2013 Baseline 

Note: For presentation which ties to the budget AoA highlighted specific measures that are most directly related, 

however multiple performance outcomes are impacted by this program because AoA’s performance measures

(efficiency, effective targeting, and client outcomes) assess network-wide performance in achieving current strategic 

objectives. AoA outcome measures will be reviewed going forward to ensure continued effective measurement of 

program performance. 

Performance Narrative 

The performance measurement for Aging and Disability Resource Centers (ADRCs) focuses on 

the key intent of this program which is to aid individuals in making informed decisions about 

alternatives to institutional care, and enabling individuals with disabilities to remain in the 

community. ADRCs will be a key component in transforming States’ long-term care supports 

and services programs. 

Performance Measure LTC.2: Informed decision making through ADRC 

Indicator LTC.2: Percent of individuals who indicate ADRC information and 

counseling contribute to informed decision making. 

Performance Results 

This is a developmental indicator and results are expected to be available in late 2012. 

The baseline will be used to identify targets for 2013 and beyond. 

Performance Targets (Outcomes) 

Targets will be set for 2013 and subsequent years once baseline data is available. 

45 
 

 

 

 

State Health Insurance Assistance Program 

In grant year 2006, the total number of clients reached by SHIPs was 3.4 million. In grant year 

2007, the number was 4.2 million. In grant year 2008, the number was 5.2 million. As part of 

the proposed reassignment to AoA, further performance measures on the SHIPs program will be 

established and reported in future submissions. 

46 
 

 

 

 

 

 

 

 

 

 

 

Community Living Assistance Services and Supports 

Table 14. Community Living Assistance Services and Supports 

CL.1: Increase the number of individuals enrolled in CLASS to 7.7 million by 2015. (Output) 

FY Target Result 

2012 Baseline 

Performance Narrative 

The Community Living Assistance Services and Supports (CLASS) is a self-funded, voluntary 

insurance program. Participants pay a premium and those who meet benefit eligibility 

requirements can receive a cash benefit to purchase long-term services and supports. Based on 

estimates from the Congressional Budget Office, an expected 7.7 million individuals will sign up 

by 2015. 

NOTE: This output projection is derived from the Congressional Budget Office’s estimates prior

to the passage of the Affordable Care Act. It is subject to change based on the actuarial 

projections that accompany the benefit plan designed by the Secretary. 

Performance Measure Output CL.1: 

Indicator Output CL.1: Increase the number of individuals enrolled in CLASS 

to 7.7 million by 2015. 

Performance Results 

This is a new indicator. 

Performance Targets (Outcomes) 

The FY 2012 data will serve as a baseline for future targets. 

47 
 

 

 

 

 

 

 

 

 

Program Innovations 

The knowledge generated through Program Innovations grants helps to ensure that AoA’s core

programs maintain and improve performance. Program Innovations support program 

performance for AoA’s core Health and Independence, Caregiver Services, and Protection of 

Vulnerable Adults programs. Program Innovation demonstration projects contribute to 

successful core program performance. New demonstrations being tested in this venue in FY 

2012 will have accompanying performance measures or evaluation plans to ensure that the 

efficacy of these demonstrations can be assessed. 

48 
 

 

 

 

 

Agency Support for HHS Strategic Plan 

All five of AoA’s strategic goals holistically support the HHS Strategic Plan goals.

HHS Goal 1, Transform Health Care, is supported by all five of AoA’s strategic goals. One key

example of AoA’s support in this area is its joint collaboration with the Centers for Medicare & 

Medicaid Services (CMS) to inform older Americans about available Federal and State benefits 

available under Medicare and Medicaid, including the Low Income Subsidy program (LIS), 

Medicare Savings Program (MSP), and Medicare Part D, and assistance to individuals in 

applying for benefits through state and local networks. Another example of AoA’s strong role in

supporting the transformation of health care within the nation is the use of AoA’s Aging and 

Disability Resource Center and Home and Community-Based Services programs to promote the 

creation and integration of highly visible and trusted one-stop shops in every community where 

people with disabilities of all ages and incomes can turn for information on the full range of 

long-term support options; options counseling to assess and understand their needs, assistance in 

making informed decisions about appropriate long-term service and support choices; streamlined 

access to public long-term care programs and benefits; and assistance with person-centered care 

transitions to ensure they end up in the settings that best meet their individual needs and 

preferences and avoid unnecessary institutionalization. 

HHS Goal 2, Advance Scientific Knowledge and Innovation, is supported by three of AoA’s

strategic goals. In particular, through the evaluation, analysis and performance measurement and 

ongoing implementation of the Home and Community Based Supportive Services, Nutrition 

Services, Preventive Health Services, Family Caregiver Support Services and Program 

Innovations programs, AoA strengthens HHS’s capacity and ability to foster innovation and 

shared solutions (HHS Objective 2.B), as well as increase the nation’s understanding of what

works in human service and public health practice by developing evidence-based programs in 

prevention and Alzheimer’s care through the translation of science into practice (HHS 

Objective 2.D.). 

HHS Goal 3, Advance the Health, Safety and Well-Being of the American People, is supported 

by all five of AoA’s strategic goals. On average more than ninety-five percent of AoA’s annual

program budget is dedicated to home and community-based services that help older adults and 

individuals with disabilities maintain their independence and dignity, preserve their health, 

prevent their abuse and neglect, and avoid unnecessary institutionalization and remain in their 

own homes and communities with a high quality of life for as long as possible. Through these 

efforts AoA assists HHS in promoting the economic and social well-being of individuals, 

families and communities (HHS Objective 3.B), improving the accessibility and quality of 

supportive services for people with disabilities and older adults (HHS Objective 3.C), promoting 

prevention and wellness (HHS Objective 3.D), and protecting and empowering American’s

health and safety during and following emergencies (HHS Objective 3.F). Support for Aging 

and Disability Resource Centers demonstrate AoA’s commitment to improving access to

services for all Americans (HHS Objective 3.C). 

HHS Goal 4, Increase Efficiency, Transparency, and Accountability of HHS Programs, is 

supported by three of AoA’s strategic goals. AoA is improving performance by focusing on 

49 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No No No No

program integrity, responsible stewardship of resources, and using data to improve the 

department’s performance and sustainability across all programs (HHS Objectives, 4.A, 4.C, 

4.D); and by fighting fraud and eliminating improper payments in the Medicare and Medicaid 

programs through the Senior Medicare Patrol (SMP) program (HHS Objective 4.B). Through 

the SMP program seniors receive increased awareness and understanding of healthcare programs 

to protect themselves from the economic and health-related consequences of Medicare and 

Medicaid fraud, error and abuse, as well as help to resolve beneficiary complaints of potential 

fraud in partnership with state and national fraud control and consumer protection entities, 

including Medicare contractors, state Medicaid fraud control units, state attorneys general, the 

HHS Office of Inspector General (OIG) and CMS. 

HHS Goal 5, Strengthen the Nation's Health and Human Service Infrastructure and Workforce, 

is supported by four of AoA’s strategic goals. While the AoA does not have a specific 

workforce program that directly supports this goal, AoA does indirectly support the investment 

and strengthening of the nation’s health and human services workforce through the

implementation and ongoing development of its programs. In particular AoA seeks to strengthen 

the human services and health workforce to provide person-centered, consumer directed care in 

all health and long-term care settings, as well as strengthen the capacity and increase the quality 

and supply of informal caregivers to assist older adults and individuals with disabilities to remain 

in the community. 

The table below shows the alignment of AoA's strategic goals with HHS Strategic Plan goals. 

Table 15. Link to HHS Strategic Plan 

HHS Strategic Goals 

AoA Goal 

1: 

Empower 

older 

people, 

their 

families, 

and other 

consumers 

to make 

informed 

decisions 

about, and 

to be able 

to easily 

access, 

existing 

health and 

long-term 

care 

options 

AoA Goal 

2: Enable 

seniors to 

remain in 

their own 

homes with 

a high 

quality of 

life for as 

long as 

possible 

through the 

provision of 

home and 

communitybased 

services, 

including 

supports for 

family 

caregivers 

AoA Goal 

3: 

Empower 

older 

people to 

stay active 

and 

healthy 

through 

Older 

Americans 

Act 

services 

and the 

new 

prevention 

benefits 

under 

Medicare 

AoA Goal 

4: Ensure 

the rights 

of older 

people and 

prevent 

their abuse, 

neglect and 

exploitation 

AoA Goal 

5: Maintain 

effective 

and 

responsive 

management 

1 Transform Health Care Transform 

Health Care 

1.A: Make coverage more secure for those 

who have insurance, and extend affordable 

coverage to the uninsured 

X 

50 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No No No

No No No

No No No No No

No No No No No

No No

No No No No No

No No

No No No No No

No

HHS Strategic Goals 

AoA Goal 

1: 

Empower 

older 

people, 

their 

families, 

and other 

consumers 

to make 

informed 

decisions 

about, and 

to be able 

to easily 

access, 

existing 

health and 

long-term 

care 

options 

AoA Goal 

2: Enable 

seniors to 

remain in 

their own 

homes with 

a high 

quality of 

life for as 

long as 

possible 

through the 

provision of 

home and 

communitybased 

services, 

including 

supports for 

family 

caregivers 

AoA Goal 

3: 

Empower 

older 

people to 

stay active 

and 

healthy 

through 

Older 

Americans 

Act 

services 

and the 

new 

prevention 

benefits 

under 

Medicare 

AoA Goal 

4: Ensure 

the rights 

of older 

people and 

prevent 

their abuse, 

neglect and 

exploitation 

AoA Goal 

5: Maintain 

effective 

and 

responsive 

management 

1.B Improve health care quality and patient 

safety X X 

1.C Emphasize primary and preventive care 

linked with community prevention services X X 

1.D Reduce the growth of health care costs 

while promoting high-value, effective care X X X X X 

1.E Ensure access to quality, culturally 

competent care for vulnerable populations X X X X X 

1.F Promote the adoption of health 

information technology 

2 Advance Scientific Knowledge and 

Innovation Advance Scientific Knowledge 

and Innovation 

2.A Accelerate the process of scientific 

discovery to improve patient care 

2.B Foster innovation at HHS to create 

shared solutions X X X 

2.C Invest in the regulatory sciences to 

improve food and medical product safety 

2.D Increase our understanding of what 

works in public health and human service 

practice 

X X X 

3 Advance the Health, Safety and WellBeing of the American People Advance the 

Health, Safety and Well-Being of the 

American People 

3.A Ensure the safety, well-being, and 

healthy development of children and youth 

3.B Promote economic and social well-being 

for individuals, families and communities X X X X 

51 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No

No No No

No No No No No

No No No

No No

No No No

No No No

No No No

No

HHS Strategic Goals 

AoA Goal 

1: 

Empower 

older 

people, 

their 

families, 

and other 

consumers 

to make 

informed 

decisions 

about, and 

to be able 

to easily 

access, 

existing 

health and 

long-term 

care 

options 

AoA Goal 

2: Enable 

seniors to 

remain in 

their own 

homes with 

a high 

quality of 

life for as 

long as 

possible 

through the 

provision of 

home and 

communitybased 

services, 

including 

supports for 

family 

caregivers 

AoA Goal 

3: 

Empower 

older 

people to 

stay active 

and 

healthy 

through 

Older 

Americans 

Act 

services 

and the 

new 

prevention 

benefits 

under 

Medicare 

AoA Goal 

4: Ensure 

the rights 

of older 

people and 

prevent 

their abuse, 

neglect and 

exploitation 

AoA Goal 

5: Maintain 

effective 

and 

responsive 

management 

3.C Improve the accessibility and quality of 

supportive services for people with 

disabilities and older adults 

X X X X 

3.D Promote prevention and wellness X X 

3.E Reduce the occurrence of infectious 

diseases 

3.F Protect Americans’ health and safety

during emergencies, and foster resilience in 

response to emergencies 

X X 

4 Increase Efficiency, Transparency, and 

Accountability of HHS Programs Increase 

Efficiency, Transparency, and 

Accountability of HHS Programs 

4.A Ensure program integrity and 

responsible stewardship of resources X X X 

4.B Fight fraud and work to eliminate 

improper payments X X 

4.C Use HHS data to improve the health and 

well-being of the American people X X 

4.D Improve HHS environmental, energy, 

and economic performance to promote 

sustainability 

X X 

5 Strengthen the Nation's Health and 

Human Service Infrastructure and 

Workforce Strengthen the Nation's Health 

and Human Service Infrastructure and 

Workforce 

5.A Invest in the HHS workforce to meet 

America’s health and human services needs 

today and tomorrow 

X X X X 

52 
No No No No

No No No No No

No

No No No No No

HHS Strategic Goals 

AoA Goal 

1: 

Empower 

older 

people, 

their 

families, 

and other 

consumers 

to make 

informed 

decisions 

about, and 

to be able 

to easily 

access, 

existing 

health and 

long-term 

care 

options 

AoA Goal 

2: Enable 

seniors to 

remain in 

their own 

homes with 

a high 

quality of 

life for as 

long as 

possible 

through the 

provision of 

home and 

communitybased 

services, 

including 

supports for 

family 

caregivers 

AoA Goal 

3: 

Empower 

older 

people to 

stay active 

and 

healthy 

through 

Older 

Americans 

Act 

services 

and the 

new 

prevention 

benefits 

under 

Medicare 

AoA Goal 

4: Ensure 

the rights 

of older 

people and 

prevent 

their abuse, 

neglect and 

exploitation 

AoA Goal 

5: Maintain 

effective 

and 

responsive 

management 

5.B Ensure that the Nation’s health care

workforce can meet increased demands X 

5.C Enhance the ability of the public health 

workforce to improve public health at home 

and abroad 

5.D Strengthen the Nation’s human services

workforce X X X X 

5.E Improve national, state, and local 

surveillance and epidemiology capacity 

53 
Summary of Full Cost 

Table 16. Summary of Full Cost 

Summary of Full Cost 

(Budgetary Resources in Millions) 

Administration on Aging 

HHS Strategic Goals & Objectives FY 2010 to 2015 FY 2010 FY 2011 FY 2012 

1 Transform Health Care 85.158 55.160 54.908 

1.A Make coverage more secure for those who have insurance, and 

extend affordable coverage to the uninsured 76.960 46.960 46.960 

1.B Improve health care quality and patient safety 8.198 8.200 7.948 

1.C Emphasize primary and preventive care linked with community 

prevention services - - -

1.D Reduce the growth of health care costs while promoting highvalue, effective care - - -

1.E Ensure access to quality, culturally competent care for 

vulnerable populations - - -

1.F Promote the adoption of health information technology - - -

2 Advance Scientific Knowledge and Innovation - - -

2.A Accelerate the process of scientific discovery to improve patient 

care -

2.B Foster innovation at HHS to create shared solutions - - -

2.C Invest in the regulatory sciences to improve food and medical 

product safety - - -

2.D Increase our understanding of what works in public health and 

human service practice - - -

3 Advance the Health, Safety and Well-Being of the American 

People 2,313.885 2,314.104 2,159.055 

3.A Ensure the safety, well-being, and healthy development of 

children and youth - - -

3.B Promote economic and social well-being for individuals, 

families and communities 2,068.239 2,068.428 1,779.659 

3.C Improve the accessibility and quality of supportive services for 

people with disabilities and older adults 224.620 224.650 348.370 

3.D Promote prevention and wellness 21.026 21.026 31.026 

3.E Reduce the occurrence of infectious diseases - - -

3.F Protect Americans’ health and safety during emergencies, and

foster resilience in response to emergencies - - -

54 
HHS Strategic Goals & Objectives FY 2010 to 2015 FY 2010 FY 2011 FY 2012 

4 Increase Efficiency, Transparency, and Accountability of HHS 

Programs 33.203 32.730 37.293 

4.A Ensure program integrity and responsible stewardship of 

resources 19.976 19.979 24.543 

 

4.B Fight fraud and work to eliminate improper payments 13.227 12.751 12.750 

4.C Use HHS data to improve the health and well -being of the 

American people - - - 

4.D Improve HHS environmental, energy, and economic 

performance to promote sustainability - - - 

5 Strengthen the Nation's Health and Human Service 

Infrastructure and Workforce - - - 

5.A Invest in the HHS workforce to meet America’s health and

human services needs today and tomorrow - - - 

5.B Ensure that the Nation’s health care workforce can meet

increased demands - - - 

5.C Enhance the ability of the public health workforce to improve 

public health at home and abroad - - - 

5.D Strengthen the Nation’s human services workforce - - - 

5.E Improve national, state, and local surveillance and epidemiology 

capacity - - - 

Total 2,432.246 2,401.994 2,251.256 

55 
Summary of Findings and Recommendations from Completed Program 

Evaluations 

AoA’s program evaluation activities are complementary to AoA’s performance measurement

strategy. Just as with measures of program performance, evaluations are designed to gather 

information on targeting, efficiency and client outcomes as well as other program specific topics 

of interest. In contrast to performance measures that are collected annually, program evaluation 

is periodic and gathers a greater range of data and far more detail at all levels of the Aging 

Network (States, Tribes, Area Agencies on Aging, local service providers and consumers) than is 

feasible for performance measurement. Program evaluations also use methods such as 

comparison groups, longitudinal data collection and experimental design to ensure sufficient 

rigor and enable outcomes to be attributed to the program under study. 

Multiple evaluation activities are currently underway. The evaluation of the Title III-E National 

Family Caregiver Support program will be the first for this program. It is designed as a 

longitudinal study with a comparison group so that the effects of the program’s five service

categories can be measured over time. Evaluation of the Title III-C Elderly Nutrition Services 

program utilizes a complex design that includes three major components and several 

subcomponents. The major components of this evaluation include a process study that surveys 

each level of the Aging Network on a large array of topics; a costs study that measures the actual 

cost of providing a meal by cost category (e.g. labor, food, overhead); and an individual outcome 

study. The individual outcomes study will measure the program’s success at meeting the

legislative intent of the program (reduce hunger and social isolation while improve health and 

well-being of consumers). In addition, AoA and CMS have reached an Inter-Agency Agreement 

that will enhance this evaluation by including prospective analysis of healthcare utilization and 

cost data of program participants compared to a matched group of seniors who do not participate 

in the program. Further, AoA is working with the Agency for Healthcare Research and Quality 

and a research firm to finalize a design framework for an evaluation of the AoA funded Chronic 

Disease Self-Management program utilizing an experimental design. The contract for this 

evaluation framework is scheduled to be completed by June 2011. Under the Affordable Care 

Act, section 4202, CMS is evaluating community based interventions for older adults. AoA is a 

member of the federal work group planning these evaluations. The CDSMP is included in the 

environmental scan being conducted by the CMS contractor for this evaluation. While no final 

decisions have been made, it is likely that the final evaluation will include CDSMP. Finally, 

AoA is implementing an evaluation of the Aging and Disability Resource Centers. A detailed 

methodology including sampling frame and data collection tools are being finalized. The 

overarching research questions focus on how well ADRCs are meeting the needs of older adults 

and people with disabilities as compared with non-ADRC long-term services and support 

systems. The evaluation will include both a process and an outcome evaluation. The process 

evaluation includes surveys at the state and local project levels. The outcome evaluation 

includes multiple study components and will make within state comparisons of ADRC consumer 

outcomes to AAA and Center for Independent Living (CIL) consumer outcomes. Matching 

ADRC and non-ADRC communities within states will control for variation in state policies, 

availability of support services, community factors and population characteristics. AoA is 

engaging the disability community, as their participation in the evaluation is essential. Federal 

partners include, the Department of Health and Human Services’ Office on Disability, Centers 

56 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

for Medicaid and Medicare Services and National Institute on Disability and Rehabilitation 

Research as well as the Department of Education’s Rehabilitation Services Administration.

In recognition of the Administration’s guidance on transparency and accountability AoA has 

taken several steps to improve the analysis and availability of performance information while 

also enhancing the rigor of program evaluations that are currently in development. For example, 

in the Brief released July 2010 “Aging in Place: Do Older Americans Act Title III Services

Reach Those Most Likely to Enter a Nursing Home” AoA used two nationally recognized, peer

reviewed comprehensive studies that identify predictors of nursing home placement. The 

responses from the 2009 National Survey of a random sample of Older Americans Act service 

recipients were analyzed to determine the frequency of having these key predictors. These key 

predictors were also analyzed for the 60 and older US population using the Health Retirement 

survey respondents as a comparison group. The results showed that AoA is effectively reaching 

those most at risk of institutionalization and that Title III plays an important role in helping 

elderly adults remain in the community. The results of this brief are posted on the AoA website 

at http://www.aoa.gov/AoARoot/Program_Results/docs/AoA-issue1_Nursing%20Homes.pdf. 

Further analysis of these data sets in combination with emerging research and other national data 

sets are planned until the results of the performance of the nutrition and caregiver evaluations are 

available. 

57 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Data Source and Validation Table 

Table 17. Data Source and Validation Table 

Agency Macro Program: Health and Independence 

Measure Data Source Data Validation 

1.1 State Program 

Report data is 

annually 

submitted by 

States. 

The web-based submissions include multiple data checks for consistency. 

Multi-year comparison reports are reviewed by AoA and State staff. AoA 

staff follow-up with States to assure validity and accuracy. After revisions, 

States certify the accuracy of their data. 

3.3 

3.4 

2.10 State Program 

Report and 

National Survey. 

This is a composite measure that utilizes data from multiple sources. One 

source is the State Program Report. Another source is the National Survey. 

State Program Report data is annually submitted by States. The web-based 

submissions include multiple data checks for consistency. Multi-year 

comparison reports are reviewed by AoA and State staff. AoA staff 

follow-up with States to assure validity and accuracy. After revisions, 

States certify the accuracy of their data. The National Survey draws a 

sample of Area Agencies is used to obtain a random sample of clients 

receiving selected services. Trained staff administers telephone surveys. 

Results are analyzed and compared to client population to assure 

representative sample. 

Agency Program: Home and Community-Based Supportive Services 

Measure Data Source Data Validation 

1.1 

2.11 

State Program 

Report data is 

annually 

submitted by 

States. 

The web-based submissions include multiple data checks for consistency. 

Multi-year comparison reports are reviewed by AoA and State staff. AoA 

staff follow-up with States to assure validity and accuracy. After revisions, 

States certify the accuracy of their data. 

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Measure Data Source Data Validation 

2.9b National Survey AoA’s national survey uses a range of quality assurance procedures to

validate data on OAA participants and services which covers all the steps 

in the survey process. The surveys have consistently achieved a 

cooperation rate of over 80% for the sampled Area Agencies on Aging and 

over 90% for the sample of clients who are currently participating in OAA 

programs. These high cooperation rates occur because of several important 

steps in the quality assurance process, including intensive follow-up to 

contact and interview as many service participants as possible, and calling 

back at times that are convenient for respondents. After the surveys are 

complete, range and consistency checks and edits, in conjunction with the 

CATI software applications, ensure that only correct responses appear in 

the data files. The data is weighted during three post-survey steps to 

ensure accuracy. This includes using the inverse of the probability of 

selection to weight the sample of agencies and clients, adjusting for any 

non-response patterns and bias that might otherwise occur, and poststratification of control totals to ensure consistency with official 

administrative records. 

2.10 State Program 

Report and 

National Survey. 

This is a composite measure that utilizes data from multiple sources. One 

source is the State Program Report. Another source is the National Survey. 

State Program Report data is annually submitted by States. The web-based 

submissions include multiple data checks for consistency. Multi-year 

comparison reports are reviewed by AoA and State staff. AoA staff 

follow-up with States to assure validity and accuracy. After revisions, 

States certify the accuracy of their data. The National Survey draws a 

sample of Area Agencies is used to obtain a random sample of clients 

receiving selected services. Trained staff administers telephone surveys. 

Results are analyzed and compared to client population to assure 

representative sample. 

Agency Program: Nutrition Services 

Measure Data Source Data Validation 

1.1 

3.2 

State Program 

Report data is 

annually 

submitted by 

States. 

The web-based submissions include multiple data checks for consistency. 

Multi-year comparison reports are reviewed by AoA and State staff. AoA 

staff follow-up with States to assure validity and accuracy. After revisions, 

States certify the accuracy of their data. 

59 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Measure Data Source Data Validation 

2.9a National Survey AoA’s national survey uses a range of quality assurance procedures to

validate data on OAA participants and services which covers all the steps 

in the survey process. The surveys have consistently achieved a 

cooperation rate of over 80% for the sampled Area Agencies on Aging and 

over 90% for the sample of clients who are currently participating in OAA 

programs. These high cooperation rates occur because of several important 

steps in the quality assurance process, including intensive follow-up to 

contact and interview as many service participants as possible, and calling 

back at times that are convenient for respondents. After the surveys are 

complete, range and consistency checks and edits, in conjunction with the 

CATI software applications, ensure that only correct responses appear in 

the data files. The data is weighted during three post-survey steps to 

ensure accuracy. This includes using the inverse of the probability of 

selection to weight the sample of agencies and clients, adjusting for any 

non-response patterns and bias that might otherwise occur, and poststratification of control totals to ensure consistency with official 

administrative records. 

2.10 State Program 

Report and 

National Survey. 

This is a composite measure that utilizes data from multiple sources. One 

source is the State Program Report. Another source is the National Survey. 

State Program Report data is annually submitted by States. The web-based 

submissions include multiple data checks for consistency. Multi-year 

comparison reports are reviewed by AoA and State staff. AoA staff 

follow-up with States to assure validity and accuracy. After revisions, 

States certify the accuracy of their data. The National Survey draws a 

sample of Area Agencies is used to obtain a random sample of clients 

receiving selected services. Trained staff administers telephone surveys. 

Results are analyzed and compared to client population to assure 

representative sample. 

Agency Program: Preventive Health Services 

Measure Data Source Data Validation 

AB State Program 

Report data is 

annually 

submitted by 

States. 

AoA in FY 2010 received clearance from OMB to obtain additional 

information about clients who are provided services through preventive 

health funding. States will start collecting this data October 2010 as a new 

addition to the State Program Report. The first results from 2012 and 

2013 will be used to develop the baseline for future years. The web-based 

submissions include multiple data checks for consistency. Multi-year 

comparison reports are reviewed by AoA and State staff. AoA staff 

follow-up with States to assure validity and accuracy. After revisions, 

States certify the accuracy of their data. 

60 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Agency Program: Native American Nutrition and Supportive Services 

Measure Data Source Data Validation 

1.3 Title VI Reporting 

System, Budget 

amounts as 

appears in the 

Congressional 

Justification 

Annual reports submitted by grantees, reviewed by AoA staff who followup with questions. Tribal officials certify report is accurate. AoA staff 

review record keeping system during regular on-site monitoring. 

Agency Macro Program: Caregiver Services 

Agency Program: Family Caregiver Support Services 

Measure Data Source Data Validation 

1.1 State Program 

Report data is 

annually 

submitted by 

States. 

The web-based submissions include multiple data checks for consistency. 

Multi-year comparison reports are reviewed by AoA and State staff. AoA 

staff follow-up with States to assure validity and accuracy. After 

revisions, States certify the accuracy of their data. 

2.6 

3.1 

2.9c National Survey AoA’s national survey uses a range of quality assurance procedures to

validate data on OAA participants and services which covers all the steps 

in the survey process. The surveys have consistently achieved a 

cooperation rate of over 80% for the sampled Area Agencies on Aging 

and over 90% for the sample of clients who are currently participating in 

OAA programs. These high cooperation rates occur because of several 

important steps in the quality assurance process, including intensive 

follow-up to contact and interview as many service participants as 

possible, and calling back at times that are convenient for respondents. 

After the surveys are complete, range and consistency checks and edits, in 

conjunction with the CATI software applications, ensure that only correct 

responses appear in the data files. The data is weighted during three postsurvey steps to ensure accuracy. This includes using the inverse of the 

probability of selection to weight the sample of agencies and clients, 

adjusting for any non-response patterns and bias that might otherwise 

occur, and post-stratification of control totals to ensure consistency with 

official administrative records. 

61 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Measure Data Source Data Validation 

2.10 State Program 

Report and 

National Survey. 

This is a composite measure that utilizes data from multiple sources. One 

source is the State Program Report. Another source is the National 

Survey. State Program Report data is annually submitted by States. The 

web-based submissions include multiple data checks for consistency. 

Multi-year comparison reports are reviewed by AoA and State staff. AoA 

staff follow-up with States to assure validity and accuracy. After 

revisions, States certify the accuracy of their data. The National Survey 

draws a sample of Area Agencies is used to obtain a random sample of 

clients receiving selected services. Trained staff administers telephone 

surveys. Results are analyzed and compared to client population to assure 

representative sample. 

Agency Program: Native American Caregiver Support Services 

Measure Data Source Data Validation 

2.6 State Program 

Report data is 

annually 

submitted by 

States. 

The web-based submissions include multiple data checks for consistency. 

Multi-year comparison reports are reviewed by AoA and State staff. AoA 

staff follow-up with States to assure validity and accuracy. After 

revisions, States certify the accuracy of their data. 

3.1 

2.9c National Survey AoA’s national survey uses a range of quality assurance procedures to

validate data on OAA participants and services which covers all the steps 

in the survey process. The surveys have consistently achieved a 

cooperation rate of over 80% for the sampled Area Agencies on Aging 

and over 90% for the sample of clients who are currently participating in 

OAA programs. These high cooperation rates occur because of several 

important steps in the quality assurance process, including intensive 

follow-up to contact and interview as many service participants as 

possible, and calling back at times that are convenient for respondents. 

After the surveys are complete, range and consistency checks and edits, in 

conjunction with the CATI software applications, ensure that only correct 

responses appear in the data files. The data is weighted during three postsurvey steps to ensure accuracy. This includes using the inverse of the 

probability of selection to weight the sample of agencies and clients, 

adjusting for any non-response patterns and bias that might otherwise 

occur, and post-stratification of control totals to ensure consistency with 

official administrative records. 

62 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Agency Program: Alzheimer’s Disease Supportive Services Program

Measure Data Source Data Validation 

ALZ.1 AoA Grants 

submissions 

As part of grantees’ request for funds from ADSSP, the grantees report the 

amount of funds that are used for specific Alzheimer’s activities. The

percent of ADSSP grant funds dedicated to implementing evidencedbased programs is calculated from the grantees’ submissions.

Agency Program: Lifespan Respite Care 

Measure Data Source Data Validation 

AE TBD Lifespan Respite grantees have been meeting to discuss and identify the 

data collection mechanism for this measure. We expect to complete this 

activity in FY 2011. 

Agency Macro Program: Protection of Vulnerable Adults 

Agency Program: Long-Term Care Ombudsman Program 

Measure Data Source Data Validation 

2.12 

2.13 

National 

Ombudsman 

Reporting System 

State Program Report data is annually submitted by States. Multi-year 

comparison reports are reviewed by AoA. AoA staff follow-up with States 

to assure validity and accuracy. 

Agency Program: Prevention of Elder Abuse and Neglect 

Measure Data Source Data Validation 

U State Program 

Report data is 

annually 

submitted by 

States. 

The web-based submissions include multiple data checks for consistency. 

Multi-year comparison reports are reviewed by AoA and State staff. AoA 

staff follow-up with States to assure validity and accuracy. After 

revisions, States certify the accuracy of their data. 

Agency Program: Senior Medicare Patrol Program 

Measure Data Source Data Validation 

1.5 SMP state 

program directors 

submit data 

semiannually to 

HHS OIG. 

Program data is reviewed by SMP Resource Center for input 

discrepancies; follow-up as needed to ensure validity and accuracy. OIG 

reviews SMP performance report submissions, validating documentation 

of savings reported. 

63 
 

 

 

 

Agency Macro Program: Consumer Information, Access & Outreach 

Agency Program: Aging and Disability Resource Centers 

Measure Data Source Data Validation 

LTC.2 Semi-annual 

reporting tool 

AoA in conjunction with its partner has been meeting to discuss and 

identify the data collection mechanism for this measure. 

Agency Macro Program: Community Living Assistance Services and Supports 

Measure Data Source Data Validation 

CL.1 CLASS 

enrollment 

software 

CLASS enrollment software and auditing processes are currently under 

development. 

64 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

National Survey Data 

AoA’s national survey employs a range of quality assurance procedures to guarantee the 

validity of data on OAA participants and services. These quality assurance procedures cover 

all steps in the survey process, from the development of the samples of agencies and service 

recipients, to the computer-assisted telephone interviewing (CATI) editing that occurs during 

the survey, and the post-survey weighting of the data to assure that the sample is truly 

representative of the universe of clients and services. 

Senior statisticians have designed a sample of agencies and service recipients that ensure an 

accurate representation of OAA programs, and the project staff focus their attention on 

achieving a high response rate, which maximizes the survey’s precision. The surveys have

consistently achieved a cooperation rate of over 80% for the sampled Area Agencies on Aging 

and for the sample of clients who are currently participating in OAA programs. These high 

cooperation rates occur because of several important steps in the quality assurance process, 

including intensive follow-up to contact and interview as many service participants as possible, 

calling back at times that are convenient for respondents. 

After the surveys are complete, range and consistency checks and edits, in conjunction with the 

CATI software applications, ensure that only correct responses appear in the data files. Also, the 

statisticians weight the data during three important post-survey steps to ensure accuracy. First, 

the sample of agencies and clients is weighted using the inverse of the probability of selection. 

Second, there is an adjustment for any non-response patterns and bias that might otherwise 

occur. Third, the data are post-stratified to known control totals to ensure consistency with 

official administrative records. 

65 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Discontinued Performance Measures Table 

Table 18. Discontinued Measures 

Agency Macro Program: Protection of Vulnerable Adults 

Agency Program: Long-Term Care Ombudsman Program 

Measure 1.2: For Title VII Services, increase the number of Ombudsman complaints resolved or partially resolved 

per million dollars of AoA funding. (Outcome) 

FY Target Result 

2010 Discontinued 

2009 11,346 8,227 

(Target Not Met) 

2008 11,439 10,089 

(Target Not Met) 

2007 11,811 10,801 

(Target Not Met but Improved) 

Measure 2.7: Improve the Ombudsman complaint resolution rates. (Outcome) 

FY Target Result 

2010 Discontinued 

2009 32 23 

(Target Not Met) 

2008 30 24 

(Target Not Met) 

2007 15 35 

(Target Exceeded) 

Measure Data Source Data Validation 

1.2 

2.7 

National Ombudsman Reporting System State Program Report data is annually 

submitted by States. Multi-year comparison 

reports are reviewed by AoA. AoA staff 

follow-up with States to assure validity and 

accuracy. 

66 
 

 

 

 

 

 

 

 

 

 

 

 

Agency Program: Senior Medicare Patrol Program 

Measure 1.4: For Senior Medicare Patrol, increase the number of beneficiaries trained per million dollars of AoA 

funding. (Outcome) 

FY Target Result 

2010 Discontinued 

2009 41,230 26,600 

(Target Not Met) 

2008 49,600 36,479 

(Target Not Met) 

2007 48,980 39,216 

(Target Not Met) 

Measure Data Source Data Validation 

1.4 SMP state program directors submit data 

semiannually to HHS OIG. 

Program data is reviewed by SMP Resource 

Center for input discrepancies; follow-up as 

needed to ensure validity and accuracy. OIG 

reviews SMP performance report submissions, 

validating documentation of savings reported. 

67