EVALUATION OF THE 

ACL TITLE VI PROGRAMS

– EXECUTIVE SUMMARY

BACKGROUND

The Administration for Community Living (ACL) supports home and community-based 

services for older American Indian, Alaska Native, and Native Hawaiian (AI/AN, NH) 

populations through funding from Title VI of the Older Americans Act.

In 2016, ACL contracted ICF, a public health consulting firm, to conduct the Evaluation 

of ACL’s AI/AN/NH Title VI grant program. This document presents a summary of the 

evaluation process, findings, and recommendations. For a more detailed report, please 

see The Evaluation of the ACL Title VI Programs – Final Report. 

THE EVALUATION

From 2016-2021, this first ever evaluation of the Title VI program collected and analyzed 

data on the program delivery and impact. The evaluation used a mixed methods, 

participatory action research design. Twelve Title VI grantees representing four Title VI 

regions and six states participated in the evaluation. 

Culturally Responsive

The evaluation used a participatory action research design centered on empowerment 

and community engagement. Title VI program staff and other stakeholders were active 

participants throughout, providing insight and recommendations on culturally based 

mechanisms of development and dissemination. This helped to ensure a culturally 

responsive and grounded evaluation. 

Methods 

The Evaluation of the ACL Title VI Programs included both the implementation study and 

the outcomes study, to assess the impact of the Title VI programs. The evaluation used 

both primary and secondary data collection.

▶ Primary data included interviews and focus groups with program staff, elders, 

and caregivers. 

▶ Secondary data included the National Resource Center on Native American 

Aging (NRCNAA) Elder Needs Assessment, n4a Title VI Program Survey, Program 

Performance Reports, and Title VI applications.

EVALUATION OF THE ACL TITLE VI PROGRAMS – EXECUTIVE SUMMARY 1
FINDINGS

1

The difference is even greater for elders from programs that provide a higher 

number of services compared to programs that provide fewer services.

▶ Title VI Evaluation grantees were similar to other Title VI grantees in important 

ways, including characteristics of the elders served and the number of elders 

participating in nutrition programs. Because of this, the evaluation grantees may be 

considered representative of all Title VI grantees.

▶ Most evaluation grantees (86%) rely on additional funding streams to support 

services and staffing for their Title VI programs.

▶ Meal programs are the focal point around which all other elder services are provided.

▶ Evaluation grantees reported significant confusion regarding what qualifies as a 

Title VI service.

▶ The range of Part C, Caregiver Support Services, provided varied considerably 

across the evaluation grantees. The most frequently provided service was 

information and assistance. None of the evaluation grantees were providing all of 

the required Part C services.

▶ Elders participating in Title VI services are older, have lower income, and are more 

likely to have difficulty with activities of daily living and instrumental activities of 

daily living than elders not using Title VI services.

▶ Elders using Title VI services reported 

an average of 36% fewer hospital visits 

(for all causes) and 10% fewer falls per 

person per year than elders not using 

Title VI services. This suggests that 

Title VI programs may be reducing 

healthcare costs. 

▶ Elders participating in Title VI services 

are almost 20% more likely to engage 

in cultural practices on a monthly 

basis compared to elders who do not 

participate in Title VI services.1

▶ Elders participating in Title VI services 

reported 35% more social activities per 

month than non-Title VI elders.1

▶ Receiving nutrition services is a positive 

predictor of elders’ mental well-being. 

Elders from grantees with overall high 

service provision for congregate and 

home-delivered meals report feeling 

happier compared to elders from lower 

service provision grantees. 

IMPACT OF TITLE VI

Title VI programs are serving 

elders most in need. 

Title VI elders are older, have 

lower income, are more likely 

to have difficulties with ADLs 

and IADLs.

Title VI programs 

provide opportunities for 

improved health. 

Title VI elders experience 

fewer hospitalizations and falls.

Title VI programs promote 

social and cultural 

connectedness. 

Title VI elders participate in 

more cultural practices and 

social activities.

EVALUATION OF THE ACL TITLE VI PROGRAMS – EXECUTIVE SUMMARY 2
RECOMMENDATIONS

In light of the evaluation findings, ACL should consider the following recommendations:

▶ To reduce confusion among grantees and increase the likelihood of grantees 

providing the full range of Title VI services, provide enhanced guidance and training 

and technical assistance for Title VI grantees, including: (1) developing plain language 

definitions and guidance for Title VI services and grant requirements, (2) promoting 

skill building by offering trainings for staff in various program roles (e.g., program 

director, finance, director, cook), (3) improving access to user friendly resources, and 

(4) creating opportunities for grantees to share and learn from one another.

▶ To facilitate collaboration and leveraging of limited resources, use the findings 

from the evaluation to build awareness in the field of the importance of Title VI and 

build/strengthen partnerships across programs with similar goals and outcomes.

▶ To better support the unique needs of caregivers, including grandparents raising 

grandchildren, implement a cross-site representative survey of caregivers to 

understand caregiver needs at the national level and how they vary by caregiver role. 

▶ To better understand the return on investment that Title VI provides, conduct a 

cost-benefit study identifying and monetizing all relevant program costs and benefits.

▶ To better understand the health outcomes impact on a broader scale, utilize the full 

disaggregated National Resource Center on Native American Aging elder needs 

assessment data to assess whether and how social and cultural participation relate to 

the experience of falls and hospitalizations among elders participating in Title VI, as 

well as whether these findings are consistent when all Title VI grantees are included.

▶ To better understand impact of Title VI on caregiver well-being and quality of life, 

conduct a caregiver study assessing the indicators of caregiver well-being and how 

those translates to better outcomes for elders.

EVALUATION OF THE ACL TITLE VI PROGRAMS – EXECUTIVE SUMMARY 3