APPENDIX A

TITLE VI EVALUATION 

LOGIC MODEL

APPENDIX B

METHODS
1

Methods 

The Evaluation of the Administration for Community Living (ACL) Title VI Programs used a mixed 

methods approach to assess the impact of the Title VI programs on stakeholders, including elder 

program participants, caregivers of elders, grandparents raising grandchildren, elders caring for adult 

children with disabilities, and program staff. ICF used various data sources to describe and demonstrate 

the implementation of the Title VI programs and the outcomes across nutrition services, supportive 

services, and caregiver support services. As described in the final report, the evaluation design included 

two interconnected studies to assess the Title VI programs. 

Primary and secondary data collection and analysis approaches were designed to ensure the evaluation 

objectives were achieved. The evaluation addressed the following questions: 

• What is the context of the Title VI programs at the national and tribal levels? How do tribes operate 

their Title VI programs? 

• What are the outcomes and impacts of Title VI programs, nationally and by tribe or tribal groups? 

What is the effect of the Title VI programs on elders in the community, and are there differences 

nationally or by tribe/tribal group? 

• Do Title VI programs that rely only on Title VI funds have a different community impact than programs 

that receive money from other programs or agencies? 

Participatory Action Research (PAR) 

ICF used a PAR framework to ensure that the evaluation would be grounded in cultural context and to 

produce an evaluation design yielding more useful, meaningful, and accurate data. ICF prioritized a 

partnership with Title VI stakeholders to support the evaluation design and implementation, including 

the development of data collection approaches, instrument development and piloting, participant 

recruitment techniques, interpretation of data and analysis, and dissemination of evaluation findings. 

Ethical Considerations and Regulatory Review 

Office of Management and Budget (OMB) Clearance 

In 2017, ICF prepared, in consultation with ACL, an Evaluation of the ACL Title VI Programs OMB 

Information Collection Request package. The OMB package included standard forms; a comprehensive 

supporting statement; 60- and 30-day Federal Register notices (FRNs); and a list of attachments, such as 

data collection instruments. The summary statement described the objectives of the Evaluation of the 

ACL Title VI Programs, the evaluation questions being pursued, and the domains and/or data elements 

to be collected. The statement included clear descriptions of each data collection activity and 

instrument as well as burden estimates. The 60-day FRN was posted for public comment in the Federal 

The implementation study was designed to understand the extent of the Title VI programs’ 

implementation at the national and tribal levels, contextual factors that affect implementation, 

and barriers and facilitators to implementation. 

The outcomes study was designed to assess the program’s impact, including the proximal and 

distal outcomes outlined in the program logic model. 
2

Register. Comments were solicited over a 60-day period on the need for and proposed use of the study, 

respondent types, and annualized burden. No comments were received at the conclusion of the 60-day 

comment period. ICF then resubmitted the package, along with the 30-day FRN, to ACL for review and 

approval. ICF worked with the contracting officer’s representative to obtain necessary approvals and 

otherwise move through the approval chain for submission to OMB. OMB approval was received on 

February 5, 2018.1 

Institutional Review Board (IRB) Review and Approval 

To ensure the protection of human participants, including the confidentiality of data compiled and 

collected during the Evaluation of the ACL Title VI Programs, the ICF IRB reviewed and approved the 

evaluation data collection protocols and instruments prior to the collection of protected data. This 

review ensured compliance with the spirit and letter of U.S. Department of Health and Human Services 

regulations governing such projects. 

The ICF IRB is committed to protecting the rights, welfare, and privacy of individuals who participate in 

ICF-supported research and evaluation studies, as well as the confidentiality of the data collected. The 

IRB’s approach to protecting human subjects is guided by the ethical principles and guidelines outlined 

in the Belmont Report: respect for persons, beneficence, and justice. The ICF IRB (IRB00000954; expires 

July 12, 2023) complies with all requirements specified in the Code of Federal Regulations (45 CFR 46) on 

the protection of human subjects and has a Federalwide Assurance (FWA00000845). In addition to the 

federal regulations, the IRB takes into consideration any state or local laws regarding human subjects 

that may be more protective than the federal statutes. It is the responsibility of the IRB, as well as of the 

evaluation team, to ensure that these regulations and other applicable laws are followed in the conduct 

of ICF-supported research and evaluation. 

To ensure the protection of human participants in this evaluation, ICF undertook the following steps: 

1. Gave respondents the opportunity to refuse to answer questions, stop the focus group or 

interview, and leave the focus group at their discretion. 

2. Trained focus group moderators on their responsibility to maintain the privacy of respondents’ 

answers. ICF also instructed moderators not to disclose any information obtained during the 

focus group to any other individual outside of the evaluation team. 

3. Trained interviewers on their responsibility to maintain the privacy of respondents’ answers. ICF 

also instructed interviewers not to disclose any information obtained during the interview to 

any other individual outside of the evaluation team. 

4. Gave all focus group moderators and interviewers in-depth training on how to ask questions and 

respond appropriately, particularly regarding sensitive topics, to minimize the risk of emotional 

or mental distress or general discomfort related to the topics discussed. 

5. Trained focus group moderators to conduct focus groups in private locations with only the 

respondents, the moderator and the notetaker(s) present. 

6. Trained interviewers to conduct interviews in private locations with only the respondent and 

interviewer present. 

7. Trained the Evaluation Working Group (EWG) on human participants protection at the EWG inperson meeting prior to beginning data collection. 

8. Did not attribute comments made during the focus groups and interviews to any one respondent. 

1

 OMB No.: 0985-0059, Expiration Date: 02/28/2021. 
3

9. Kept focus group and interview digital recordings and notes in password-protected electronic 

files at ICF. 

10. Included only group-level analyses that fully protected the confidentiality of individual 

participants in all evaluation reports and publications that result from these data. 

 

ICF obtained ICF IRB approval for the Evaluation of the ACL Title VI Programs, including both the original 

protocol (approved on March 1, 2017) and the modified protocol (approved on February 9, 2018). ICF 

received continuing review approval on January 15, 2019, again on November 25, 2019, and, finally, on 

October 8, 2020. The submission to the IRB included a summary statement addressing the required key 

criteria for the IRB, previously outlined, and the evaluation protocol, including data collection 

instruments. Data collection did not begin until an ICF evaluation liaison had reviewed the informed 

consent form with all eligible respondents, including program staff, elders, and caregivers. All 

participants received a copy of the informed consent form, which emphasized that participation was 

voluntary and they had the right to stop participating at any time. The informed consent form also noted 

that all collected data would be kept private. Focus groups and interviews were audio recorded with 

participants’ permission.

Local-Level IRB Review and Approval 

In addition to the ICF IRB, ICF worked with each evaluation grantee to identify and obtain the local level 

approval(s) necessary to participate in the Evaluation of the ACL Title VI Programs through an IRB; 

institution at large; or other governing or advisory body, such as the tribal council. All evaluation 

grantees obtained a tribal resolution confirming their tribe’s commitment to participate in the 

evaluation as well as to share their Title VI data with ICF. All grantees received a copy of ICF’s 

(1) approved IRB package/application, (2) IRB approval letter, (3) summary page of IRB steps, 

(4) instruments and informed consents, and (5) summary of instruments by research question.

Data Security and Privacy 

ICF developed a data security and privacy plan that described the controls, policies, and procedures used 

to secure and ensure the privacy of the Evaluation of the ACL Title VI Program information assets. The 

plan detailed the controls designed to protect the collection, transfer, and storage of data from 

unauthorized access and ensure data confidentiality, integrity, and availability were not compromised. 

The plan was submitted to and approved by ACL on April 25, 2017. 

Data Sources 

QUALITATIVE DATA 

Primary Data—Program Staff Interviews 

The program staff focus groups and interviews assessed the nature, context, implementation, and 

management of Title VI programs; documented the challenges and barriers to program implementation; 

and gathered detailed information about the funding of activities (e.g., sole, blended, and how funds are 

leveraged). Data collected included Title VI program structure, resources, and activities; Title VI 

management structure; perceptions of met and unmet needs across Title VI service areas; barriers to 

Title VI services provision; and strengths and resources of the Title VI program. 
4

Primary Data—Elder Focus Groups and Interviews 

The elder focus groups and interviews assessed elders’ 

experiences and satisfaction with service delivery and 

program outcomes. Data collected included met and 

unmet needs; social connectedness and isolation; 

physical, mental, emotional, and spiritual health and 

wellness; independence and quality of life; and 

experiences with and perceptions of services. 

Primary Data—Caregiver Focus Groups and Interviews 

The caregiver focus groups and interviews assessed

caregivers’ experiences and satisfaction with service 

delivery and program outcomes. Data collected 

included linkages to needed services, provision of care, 

caregiver well-being (physical, mental, emotional, 

spiritual, quality of life, independence), community 

integration and social connectedness, and experiences 

with and perceptions of services. 

Primary Data—Caregiver Program Assessment 

The ICF team developed and conducted a caregiver 

program assessment, using an Excel workbook to catalog 

information related to grantees’ caregiver programs, 

including program participants, services provided, and 

program monitoring and evaluation. The caregiver 

program assessment was designed to support a 

thorough understanding of the Part C Caregiver Support 

Services program as it is implemented at the local level. 

Primary Data—Evaluation and Data Needs Assessment 

The ICF team developed and conducted an evaluation and data needs assessment, using an Excel 

workbook to catalog information related to grantees’ program stakeholders, goals and related outcomes 

and measures, service delivery, and evaluation and data support needs. Primarily designed to inform 

training and technical assistance provision, the evaluation and data needs assessment process 

supported understanding of the Title VI programs’ evaluation and data processes at the site level.

QUANTITATIVE DATA 

Secondary Data—n4a Title VI Program Survey 

The n4a Title VI program survey is collected and administered by the Scripps Gerontology Center 

(Scripps) approximately every 3 years. The survey gathers information from program staff about 

available services, service delivery, partnerships established to support service delivery, strategies for 

record keeping and budgeting, and challenges experienced with Title VI implementation. 

A Participatory Approach to Instrument 

Development 

ICF used a participatory approach to develop 

and identify data sources to address the Title VI 

evaluation questions that were culturally 

relevant and would reduce burden on 

participants. In partnership with the Title VI 

Evaluation Steering Committee, ICF developed 

original data collection instruments to collect 

primary qualitative data (i.e., focus groups and 

interviews of program staff, elders, and 

caregivers). The Steering Committee provided 

insight into focal areas for each instrument as 

well as reviewed each instrument for 

accessibility and cultural appropriateness. In 

addition, the Steering Committee helped 

identify relevant sources of secondary data 

(i.e., n4a Title VI Survey, National Resource 

Center on Native American Aging [NRCNAA] 

Elder Needs Assessment) to inform the 

evaluation while reducing the need for 

collecting additional primary data. 
5

Secondary Data—Title VI Program Performance Report (PPR) 

The Title VI PPR is maintained by the Administration on Aging/ACL. The PPR collects information on the 

number of clients and service units for Title VI nutrition, supportive, and caregiver support services 

delivered by each Title VI grant. 

Secondary Data—NRCNAA Elder Needs Assessment 

The Identifying Our Needs: A Survey of Elders assessment (NRCNAA Elder Needs Assessment) is 

administered by NRCNAA located at the Center for Rural Health at the University of North Dakota 

(UND). Cycle VI data were collected from April 2014 to March 2017; Cycle VII data were collected from 

April 2017 to March 2020. The NRCNAA Elder Needs Assessment includes information related to the 

health status of all elders receiving services through the Title VI programs and includes domains such as 

demographics, overall health and wellness, healthcare access, weight and physical activity, and social 

functioning. It also includes domains related to caregiving, including whether elders have a family 

caregiver, whether they are raising grandchildren, and what are their current and anticipated future 

need for caregiver services. 

Secondary Data—Title VI Grant Applications 

Title VI grant applications were used to collect information about plans for services for each Title VI 

grantee. The application gathers general information about the population served and plans for 

nutrition services, information/referral and assistance services, supportive services, and caregiver 

services. Grantees also describe their plans for coordinating between Title VI and Title III programs. 

Data Collection 

The Title VI evaluation spanned 5 years, beginning in 2016. Figure 1 presents the data collection timeline. 

Figure 1. Data Collection Timeline 
6

QUALITATIVE DATA 

Primary Data—Program Staff Interviews 

In the first and third years of the evaluation grantees’ engagement (2018 and 2020), ICF conducted 

semistructured telephone interviews with Title VI evaluation grantee program staff to improve 

understanding of the nature, context, implementation, and management of Title VI programs and how 

that may have changed over the Title VI program cycle. The first round of program staff interviews was 

conducted by telephone in February and March 2018. Program staff shared their perspectives on elders’ 

met and unmet needs, challenges and barriers to program implementation, funding of activities (e.g., 

supported solely by Title VI funds or by multiple funding sources), and strengths and resources of the 

program. To recruit participants, including the program director and additional program staff 

recommended by the program director, ICF evaluation liaisons sent an advance notification email to 

Title VI evaluation grantee program directors to inform them of the purpose of the interviews and the 

related procedures. Following this email, ICF evaluation liaisons contacted program staff to schedule the 

interviews. ICF evaluation liaisons were able to schedule and conduct 12 telephone interviews, one for 

each evaluation grantee program. In the case of seven evaluation grantees, the interviews were 

conducted with the program director only. In four cases, two respondents participated (e.g., a program 

director and other staff member), and in one case, the program director was the primary participant but 

the full Title VI program team also participated. The interviews lasted an average of 50 minutes. Data 

collection did not begin until the ICF evaluation liaison had reviewed the informed consent form with all 

participating program staff and all had agreed to participate. Interviews were audio recorded with the 

permission of the participants (all participants agreed to be recorded). Interviews were transcribed and 

stored as Word documents, along with the audio files, on a secure internal server. A thank-you email 

was sent to participants immediately following the interview. 

ICF planned to conduct the second round of program staff interviews in person during the third and final 

site visits in the spring of 2020. However, due to the COVID-19 pandemic and the need to ensure the 

safety of grantees and the evaluation team, the final site visits were canceled, and the interviews were 

rescheduled as telephone interviews, conducted in June 2020. ICF evaluation liaisons collaborated with 

program directors (1) to identify Title VI evaluation grantee program staff who were available and 

interested in participating and (2) to schedule the interviews. In June, the evaluation team conducted 11 

interviews via phone with Title VI program staff (in the case of the 12th grantee, the interview was not 

conducted because of recent program staff turnover). In most cases, ICF evaluation liaisons interviewed 

the Title VI program director and additional program staff, such as administrative assistants, outreach 

coordinators, and site managers; however, in the case of four grantees, only the program director was 

interviewed. The interviews lasted an average of 59 minutes. Data collection did not begin until the ICF 

evaluation liaison had reviewed the informed consent form with all participating program staff and all 

had agreed to participate. Interviews were audio recorded with the permission of the participants (all 

participants agreed to be recorded). Interviews were transcribed and stored as Word documents, along 

with the audio files, on a secure internal server. A thank-you email was sent to participants immediately 

following the interview. 

Primary Data—Elder Focus Groups and Interviews 

During site visits held in April, May, and June 2018, ICF evaluation liaisons conducted focus groups and 

interviews with elders participating in the Title VI program to understand their experiences and 

satisfaction with service delivery. Before the site visits, ICF held a webinar presentation with grantee 

program staff to share the purpose of the visits and to coordinate the planning of the data collection 

activity. Elders were identified and recruited for the focus groups and interviews, with assistance from 
7

local Title VI program staff. During site visits, ICF evaluation liaisons conducted one or two focus groups 

and three to six interviews with elders receiving nutrition services (congregate or home-delivered meals) 

at each grantee program. The number of focus groups and interviews was determined by the size of the 

program. Local Title VI program staff provided elder participants with incentives, which varied across 

grantee programs (e.g., incentives often included a meal or a gift card). Data collection did not begin 

until the ICF evaluation liaison had reviewed the informed consent form with all participants and all 

agreed to participate. All interviews and focus groups were audio recorded and transcribed for analysis. 

As a backup data source, ICF evaluation liaisons took notes during the interviews and focus groups, and 

met to debrief after data collection activities to document the content and initial impressions of the 

findings. In all, ICF evaluation liaisons conducted 18 focus groups and 34 interviews. The focus groups 

lasted an average of 76 minutes, and the interviews lasted an average of 23 minutes. 

Primary Data—Caregiver Focus Groups and Interviews 

During site visits held in March, April, and May 2019, ICF evaluation liaisons conducted focus groups and 

interviews with caregivers participating in the Title VI program. The purpose of the data collection was 

to understand caregivers’ experiences with the Title VI program, including met and unmet needs related 

to spirituality; social connectedness and isolation; physical, mental, and emotional health and wellness; 

and independence and quality of life. Before the site visits, ICF held a webinar presentation with grantee 

program staff to share the purpose of the visits and to coordinate planning of the data collection 

activity. Caregivers were identified and recruited for the focus groups and interviews, with assistance 

from local Title VI program staff. During site visits, ICF evaluation liaisons conducted focus groups or

interviews with caregivers receiving caregiver services at each grantee program. Local Title VI program 

staff provided caregiver participants with incentives, which varied across grantee programs (e.g., 

incentives often included a meal or a gift card). Data collection did not begin until the ICF evaluation 

liaison had reviewed the informed consent form with all participants and all agreed to participate. All 

interviews and focus groups were audio recorded and transcribed for analysis. As a backup data source, 

ICF staff took notes during the interviews and focus groups, and met to debrief after data collection 

activities to document the content and initial impressions of the findings. In all, the team conducted 8 

focus groups and 11 interviews. The focus groups lasted an average of 56 minutes, and the interviews 

lasted an average of 20 minutes. Participants were primarily unpaid family caregivers; however, at one 

grantee site, the participants were formal, paid caregivers who also had experience as informal 

caregivers for their own families. Participants ranged in age from young adult to elder and included 

adults caring for their aging parents, husbands or wives caring for their spouse, siblings caring for 

another sibling, adults caring for a disabled family member, and grandparents caring for grandchildren. 

Primary Data—Evaluation and Data Needs Assessment 

Evaluation and data needs assessments were conducted in April, May, and June 2018, during year 1 site 

visits, through conversations with program directors and staff as well as direct program observation. In 

addition, programs provided examples of tracking and monitoring forms, including meal preparation 

tracking sheets, participation sign-in sheets, home-delivered meal and transportation mileage logs, and 

elder satisfaction surveys. 
8

Primary Data—Caregiver Program Assessment 

Caregiver program assessments were conducted through conversations with program directors and 

other program staff as well as through direct program observation during site visits held in March, April, 

and May 2019. 

QUANTITATIVE DATA 

Secondary Data—n4a Title VI Program Survey 

ICF, in consultation with Scripps and their IRB, prepared documents and established a process for 

evaluation grantees to receive their Title VI program survey data and to share that with ICF for the 

purpose of answering the Title VI evaluation questions. 

To access the Title VI program survey data for the 12 evaluation grantees, ICF undertook the 

following steps: 

1. Informed consent. In November 2017, ICF staff worked with Scripps to develop an informed 

consent letter to send to Title VI evaluation grantee program directors that explained the 

purpose of the evaluation, the risks and benefits of sharing data, who would have access to the 

data, and how the data would be stored and transferred. The letter was emailed to program 

directors in January 2018. 

2. Program data. In January 2018, Scripps sent a PDF version of each tribe’s completed 2016 Title 

VI survey to each of the 12 evaluation grantees. ICF staff then reached out to each of the 

grantees to answer any questions. 

3. Data access. ICF helped grantees share their 2016 data with the evaluation team. 

4. Data extraction. ICF extracted data for each grantee manually and consolidated the data in an 

Excel file, based on data cleaning and management plans. Following ethical procedures, only 

aggregated data for the overall evaluation sample was ever reported. 

In April 2018, ICF received the dataset for the 12 evaluation grantees’ Title VI program survey responses. 

Caregiver Program Assessment Topics 

• Overall caregiver program description, 

including participants, staff, and services 

provided

• History of the program 

• Community partnerships and collaborations 

• Program challenges and facilitators 

• Program monitoring and evaluation 

• Grantee questions/concerns 

Evaluation and Data Needs Assessment Topics

• Title VI program stakeholders, partners, and 

program staff 

• Local program planning, monitoring, and 

evaluation 

▪ Program goals, measures, or indicators 

▪ Data collection and management 

activities 

▪ Data use and dissemination 

▪ Program participant tracking 

• Grantee data support needs 
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Secondary Data—Title VI PPR 

ACL shared PPR Part A/B and Part C data by tribe for all Title VI grantees for 2010–2017 (average) and 

2018 with ICF for the evaluation. Data on the number of elders enrolled in nutrition and/or supportive 

services and caregivers receiving training were aggregated by grantee region or by type of funding (sole 

source vs. blended). 

In June 2019, ACL shared the Title VI Part A/B and C Performance Data Report for fiscal years 2010–

2017. ACL shared the Title VI Part A/B and C Performance Data Report for fiscal year 2018 with ICF in 

early 2020. 

Secondary Data—NRCNAA Elder Needs Assessment 

The NRCNAA Elder Needs Assessment data was used to conduct (1) an initial exploration of aggregated 

data in 2018 for the evaluation grantees as well as all Title VI grantees and (2) an in-depth analysis of 

disaggregated data for eight of the Title VI evaluation grantees in the final year of the evaluation. For the 

initial exploration, ICF traveled to UND in March 2018 to access the Cycle VI NRCNAA Elder Needs 

Assessment data. ICF also received a report of the Cycle VI and VII data from NRCNAA/UND, containing a 

table of survey questions with percentages and numbers of responses for the complete Title VI sample 

(all participating Title VI grantees). 

Prior to traveling to UND, ICF undertook the following steps to ensure data agreements and protections 

were in place: 

1. Tribal resolutions. ICF worked with each of the 12 evaluation grantees to secure a tribal 

resolution2to access their tribal-level NRCNAA Elder Needs Assessment data. ICF evaluation 

liaisons sent an advance notification email to Title VI evaluation grantee program directors to 

explain the purpose of the request for a tribal resolution. ICF evaluation liaisons followed this with 

one-on-one calls to each program director to address any questions or concerns related to data 

sharing and to identify the tribal resolution process for their tribe. To assist with the tribal 

resolution, ICF developed a resolution template that grantees had the option of using. The 

template clearly stated what data was requested, how the data would be used, and who would 

have access to the data. Tribal resolutions were received from each of the 12 evaluation grantees. 

2. Data use agreement (DUA). ICF established a DUA with NRCNAA/UND. The DUA described the 

purpose of the evaluation; the proposed use of the NRCNAA Elder Needs Assessment data; the 

access, transfer and storage of data; and how local-level approvals (e.g., tribal resolutions) were 

obtained. The DUA also affirmed that only aggregated data would be reported. 

3. Analysis plan. To guide the on-site analysis at NRCNAA/UND, ICF developed an analysis plan,

including data management, codebook, and codes prior to travel to UND. 

In winter 2019, ICF, in consultation with NRCNAA/UND and ACL, prepared documents and established a 

process for evaluation grantees to receive their disaggregated NRCNAA Elder Needs Assessment 

datasets and to share those with ICF for the purpose of answering the Title VI evaluation questions. 

To support grantees in obtaining their Cycle VI and Cycle VII data from NRCNAA/UND, ICF undertook the 

following steps to ensure data agreements and protections were in place: 

2

 In the case of the evaluation grantee serving Native Hawaiians, a signed certification from their corporate executive officer was 

submitted. 
10

1. Data custodian. Grantees identified the data custodian, a person in the tribe or program who 

would receive the data files. 

2. Tribal resolutions. Grantees worked with their tribal or governing council to complete a tribal 

resolution and data transfer agreement. The resolution and data transfer agreement clearly 

stated what data were requested, how the data would be used, and who would have access to 

the data. Grantees sent their signed tribal resolution and data transfer agreement via email to 

the NRCNAA/UND director. 

3. Program data. NRCNAA emailed the grantees’ Cycle VI and Cycle VII data to the identified data 

custodian. Grantees notified their ICF evaluation liaison when the data files were received. 

4. Data access. To securely share the data with ICF, ICF evaluation liaisons sent a secure file 

transfer link with instructions on use. 

5. Secure storage. ICF stored the data in a password-protected folder that only the evaluation 

team could access. 

By May of 2020, eight grantees had acquired signed tribal resolutions, received their NRCNAA Elder 

Needs Assessment data, and securely transferred their data to ICF for in-depth analysis. One grantee 

received their data from NRCNAA/UND but was unable to transfer the data to ICF because their tribal 

offices were closed due to the COVID-19 pandemic. The other three grantees were not able to obtain 

resolutions from their tribal councils due to disruptions from the pandemic. 

Secondary Data—Other 

In addition to Title VI program data, the evaluation relied on publicly available data sources (e.g., U.S. 

Census) to inform the analysis and interpretation of evaluation findings.

Data Analysis 

QUALITATIVE DATA 

Primary Data—Program Staff, Elder, and Caregiver Interviews and Focus Groups 

ICF’s approach to the qualitative analysis of interview data and focus group data included the 

following steps: 

1. Data capture and management. ICF managed a comprehensive data inventory in Excel to 

monitor and track the following for each grantee: dates of data collection activity, number of 

participants per data collection effort, number and type of data files (i.e., digital recordings, 

notes, transcripts), and steps and progress related to monitoring data quality. ICF reviewed 

transcripts and notes for completion and to minimize errors before the analysis process began. 

All data files and documents produced and/or collected before, during, and after data collection 

activities (e.g., interview and focus group notes, proprietary documents associated with a 

grantee, digital recordings, and transcripts) were stored in password-protected electronic files 

that only ICF project team members could access.

3 Audio recordings from each interview and 

focus group were transcribed and imported into the qualitative software package ATLAS.ti 

7.5.18, useful for facilitating the organization and management of textual data. The ICF team 

used this software to analyze the data for themes, patterns, and interrelationships relevant to 

the evaluation questions. 

3 See additional detail about security procedures in the section titled “Ethical Considerations and Regulatory Review.”
11

2. Codebook development. Codebook development was a multistep and iterative process 

involving the development and definition of codes and pretests to refine the codes and 

definitions. A draft codebook, with an initial set of deductive codes, was first developed based 

on the evaluation questions. Next, ICF reviewed the transcripts and developed summary memos 

to document initial impressions of the findings. This process helped to inform the development 

of new codes to capture unexpected issues and themes not included in the preliminary coding 

scheme. Upon completion of a revised codebook, team members separately coded a single 

transcript and then came together to discuss how they applied the codes to the document. 

Through these discussions, codes were added, removed, or refined to best capture emerging 

themes. This process was repeated several times through a similar review of a single transcript. 

Team members discussed code definitions or applications that they found confusing or 

disagreed on until all members had the same analytical understanding of the codes, as 

measured by sufficient intercoder reliability. 

3. Code application. Following codebook development, team members created their own 

Hermeneutic Unit (HU) in ATLAS.ti, to which they uploaded the transcripts and codebook. Team 

members applied the codes to the transcripts, using ATLAS.ti software, to facilitate data 

analysis. ICF team members coded at the level of a whole sentence or paragraph. 

4. Analysis and documentation of themes. Upon completing the coding process, ICF used ATLAS.ti 

to search for, retrieve, and classify the coded data. ICF produced output documents associated 

with each code and subcode. ICF used a thematic analysis approach in which each team 

member conducted an in-depth review of a set of output documents reflecting groupings of 

interrelated codes and subcodes. Next, each team member produced a comprehensive 

summary memo providing an assessment of key themes and relationships among themes for 

the assigned set of output documents. Following this process, team members met to discuss the 

analysis, findings, and themes, some of which were identified by a single analyst and some by 

multiple analysts. Team members then compiled and reduced the results of the output review in 

preparation for developing a triangulated approach to reporting featuring multiple data sources. 

Primary Data—Title VI Grant Applications and Evaluation and Data Needs Assessment 

ICF reviewed the Title VI grant applications as well as the evaluation and data needs assessment across 

the 12 grantees to identify both commonalities and areas of divergence among grantees. Findings were 

organized by topical area. 

Primary Data—Caregiver Program Assessment 

ICF reviewed the caregiver program assessment results to identify commonalities and areas of 

divergence among grantees. Findings were organized by topical area. 
12

QUANTITATIVE DATA 

Secondary Data—n4a Title VI Program Survey 

ICF developed a codebook with key questions from the survey that aligned with the evaluation plan and 

consolidated responses in one aggregated dataset containing recoded responses for all grantees. The 

recoded responses included both objective and descriptive answers. Table 1 includes a list of the 

selected survey questions used, along with a description of the data management approach for each. 

ICF conducted an initial descriptive analysis, including frequencies and means. Data cleaning (e.g., 

excluding invalid entries) and examination of missing data and out-of-range values were performed prior 

to data analysis. ICF conducted additional recoding and transformation of variables, and collapsed 

values into meaningful categories. Due to the survey having many items with multiple possible 

responses, ICF analyzed the data based on multiple response sets for the relevant questions. Therefore, 

percentage sums may add up to more than 100 percent. 

ICF used key n4a Title VI Program Survey indicators (see Table 1) to generate averages for the Title VI 

grantees as well as merged n4a Title VI Program Survey data to other program datasets (e.g., PPR, 

NRCNAA Elder Needs Assessment, other secondary data) to support impact analysis (see NRCNAA Elder 

Needs Assessment). 

Secondary Data—PPR

ICF used descriptive statistics to characterize the overall Title 

VI sample as well as the evaluation grantee sample. Review of 

the data for Part C identified extreme variances within and 

across grantees’ data, suggesting an overall lack of reliability. 

In consultation with ACL, the evaluation team determined to 

exclude Part C PPR data from data synthesis. Although some 

variances also were identified, averages for key data points 

(see Table 2) were reported and compared between 

evaluation grantees and overall Title VI grantees. 

ICF used key PPR indicators (see Table 2) to generate averages 

for the Title VI grantees as well as merged PPR data to other 

program datasets (e.g., n4a Title VI Program Survey, NRCNAA 

Elder Needs Assessment, other secondary) to support impact 

analysis (see NRCNAA Elder Needs Assessment). 

Secondary Data—Other 

Key secondary data indicators were used to generate 

averages for the eight Title VI evaluation grantees with 

disaggregated NRCNAA Elder Needs Assessment data and the 

overall Title VI sample using ZIP codes. These secondary 

indicators were merged to other program datasets (e.g., PPR, 

n4a Title VI Program Survey, NRCNAA Elder Needs 

Assessment) to support impact analysis. The NRCNAA Elder 

Needs Assessment disaggregated data analysis section 

describes the process for using the secondary data. Table 3 

details the publicly available data sources used. 

Table 1. Selected Variables Used in the 

Quantitative Data Analysis From n4a Title VI 

Program Survey Data 

VARIABLE 

Number of Title VI Program Staff 

Individual Tribe Running the Program 

Title VI Program With Single Site 

Programs With Title VI as Single Funding Source 

Average Total Title VI Program Budget 

Table 2. Selected Variables Used in the 

Quantitative Data Analysis From PPR Data 

VARIABLE 

Number of Congregate Meals Served 

Number of Congregate Meal Clients 

Number of Home-Delivered Meals Served 

Number of Home-Delivered Meal Clients 

Number of Part C Services Served 

Number of Part C Clients 

Number of Part A/B Staff 

Number of Part C Staff 
13

Table 3. Secondary Data Sources and Use in the Title VI Evaluation 

DATA SOURCE EVALUATION PURPOSE 

Small Area Income and Poverty Estimates (SAIPE), 2017 Contextual data: Used to estimate evaluation 

grantees’ community poverty rates 

Local Area Unemployment Statistics (LAUS), 2017 Contextual data: Used to estimate evaluation 

grantees’ unemployment rates

CDC’s Bridged-Race Population Estimates, 2017

Contextual data: Used to estimate evaluation 

grantees’ proportion of American Indian/Alaska 

Native (AI/AN) population 

Florence et al. (2018). Medical costs of fatal and nonfatal falls in 

older adults. Journal of the American Geriatrics Society, 66(4), 

693–698

Cost savings estimation data: Used to estimate 

the average cost, by elder, of a fall 

HCUPnet, Healthcare Cost and Utilization Project. Agency for 

Healthcare Research and Quality, Rockville, MD

Cost savings estimation data: Used to estimate 

the average cost, by elder, of a hospitalization 

Secondary Data–NRCNAA Elder Needs Assessment 

The NRCNAA Elder Needs Assessment data was analyzed using two formats: (1) aggregated data analysis 

and (2) disaggregated data analysis. Although the aggregated data analysis (data by grantee) allowed the 

study of the evaluation grantees’ characteristics and how they compared to those of the overall Title VI 

grantees, the disaggregated data analysis allowed for more in-depth study of program outcomes and 

impact. Following are the steps ICF took to format the data for analysis. All data management, cleaning, 

preparation, and analysis were completed using SAS® 9.4. 

Aggregated Data Analysis (Data Exploration) 

Before the visit to UND, ICF reviewed the NRCNAA Elder Needs Assessment Cycle VI questionnaire and 

frequency tables to develop a codebook with key questions aligned to the evaluation plan, the cleaning 

and recoding steps needed for each question, and the analysis procedures to run while on site. During 

the visit in March 2018, ICF did an exploration of the aggregated data from the 12 evaluation grantees. 

ICF also undertook the following data management and cleaning steps according to the evaluation plan: 

1. ICF reviewed variables with no true missing values (a missing answer means “No” instead of 

“.”) and set them to “0”. This prevented miscounting responses and, consequently, 

generating misestimated rates. 

2. ICF reviewed all skip patterns relevant to the variables selected and applied a conditional 

code to guarantee the survey instructions were properly applied; for example, guaranteeing 

that only respondents who answered “Female” in the survey had valid responses relating to 

“Cervical Cancer.” 

3. ICF renamed and/or recoded all variables used for this analysis. This included changing some 

categorical variables to dichotomous (i.e., Yes/No) to allow further study of associations (as 

regression). In addition, multicategory variables were aggregated in smaller groups to match 

the literature and enable comparisons with other national datasets. 
14

4. ICF recoded numeric variables to categorical or dichotomous to facilitate further analysis. 

ICF also generated means from these numeric variables to better describe some of the 

sample subgroups. ICF planned the renaming and recoding of variables prior to the site visit, 

based on the review of key literature and data frequencies shared by UND. A list of the 

selected variables used in this report and initial data management are detailed in Table 4. 

Following the steps for data cleaning and management, ICF generated descriptive statistics (frequencies 

and means) of all the selected recoded variables (see Table 4). A comparison with the overall NRCNAA 

Elder Needs Assessment sample (which included 164 tribes) was done to explore how representative 

the evaluation grantee sample was to the overall Title VI grantee sample. For that purpose, only 

descriptive and aggregated-level data (summary format) was compared. All levels of data (raw, clean, 

and recoded) remained with NRCNAA/UND, per the DUA. 

ICF also revised frequency tables, generated and shared by NRCNAA/UND, containing evaluation 

grantees’ data and consolidated the variables of interest that did not need recoding. ICF used the 

aggregated tables to generate an average percentage for all evaluation grantees. Findings were 

presented in detail in the Evaluation of the ACL Title VI Programs Year 2 Interim Report.
15

Table 4. NRCNAA Elder Needs Assessment Data, Title VI Evaluation, Aggregated Indicators

NRCNAA ELDER NEEDS ASSESSMENT

SURVEY QUESTION DATA MANAGEMENT

Q1. Would you say your health in general is excellent, very 

good, good, fair, or poor? Merge "Poor" and "Fair" responses as "Mostly Unhealthy" 

Q5. Because of health or physical health problems that 

lasted more than 3 months, did you have any difficulty . . .?

Create new variable "Any Difficulty" that includes any report 

of activities of daily living (ADLs)

Q6. Because of health or physical problems that lasted 

longer than 3 months, did you have any difficulty . . .?

Create new variable "Any Difficulty" that includes any of the 

instrumental activities of daily living (IADLs)

Q34. Do you smoke tobacco now? Merge "Yes, some days" and "Yes, every day" to create 

"Current Smoker"

Q43. Please mark all that apply to your nutrition health.

Merge "I eat fewer than 2 meals per day"; "I eat few fruits, 

vegetables, or milk products"; "I have 3 or more drinks of 

beer, liquor, or wine almost every day" to create "Nutritional 

Inadequacy"4

Q44. Do you participate in cultural practices that include 

traditional food, music, and customs?

Create dichotomous variable: "No" = none of the time; "Yes"

= all other responses

Q45. How often do you get out and socialize (attend 

church/religious meetings, clubs, organizations you belong 

to or cultural activities/traditional ceremonies)?

Create dichotomous variable: "No" = none of the time; "Yes"

= all other responses

Generate average variable

Q53. During the past month, how much of the time were 

you a happy person?

Generate "Mostly Happy" by collapsing first three response 

options and "Mostly Not Happy" by collapsing latter three 

response options

Q59. Are you now using the following services? 

Generate groups: Title VI Direct Services: Q59HCB1–

Q59HCB25 except the ones below5

Title VI Indirect Services: home health services Q59HCB8, 

assisted living Q59HCB16, retirement communities 

Q59HCB17, nursing facilities Q59HCB18, gov’t-assisted 

housing Q59HCB19, shared housing Q59HCB20, adult 

daycare Q59HCB1, long-term care services Q59HCB25, legal 

services Q59HCB11 

Title VI All Services: Any of Q59HCB1– Q59HCB25

Q60–70. Demographic 

Employed in the past 12 months

Recode employment to “Yes” (employed in the past 

12 months); “No” (unemployed)

Q67. Ethnicity

Create dichotomous variable merging "Alaska Natives" and 

"Native Hawaiian" vs. merging "American Indian," "Other," 

and "Descendent"

Q68. Reside on reservation/trust land/Indian community No recode needed 

Q69. Enrolled member of federally recognized tribe No recode needed

4Given the association between excessive alcohol consumption and nutritional inadequacy, ICF included “I have 3 or more drinks

of beer, liquor, or wine almost every day" as part of the measure of “Nutritional Inadequacy”. Breslow, et al. (2010). Alcoholic 

beverage consumption, nutrient intakes, and diet quality in the US adult population, 1999-2006. Journal of the American Dietetic 

Association, 110(4), 551–562. https://doi.org/10.1016/j.jada.2009.12.026

Liangpunsakul S. (2010). Relationship between alcohol intake and dietary pattern: findings from NHANES III. World journal of 

gastroenterology, 16(32), 4055–4060. https://doi.org/10.3748/wjg.v16.i32.4055

5

ICF coded services most implemented by Title VI program staff as “direct services”. Services more commonly provided by 

partners were coded as “indirect services”.
16

Disaggregated Data Analysis (In-Depth Analysis) 

ICF analyzed disaggregated data for Cycle VI and VII of the NRCNAA Elder Needs Assessment survey for 

eight evaluation grantees.

6

ICF used similar steps for data cleaning and management as used for the 

aggregated data including reviewing true missing values and skip patterns and renaming/recoding some 

variables. In addition, the following steps were taken to prepare the data for analysis. 

1. Calculate levels of service provision for each grantee. 

To better understand how program characteristics impact elders’ health outcomes, ICF 

assessed each evaluation grantee in their level of service provision. A set of four 

dichotomous variables (1/0) were created to compare elders from grantees with high 

service provision (1) to other grantees (0). To do that, ICF used evaluation liaisons’ expertise 

about each grantee program and program data to create the following classifications: 

• Congregate Meal Provision: Aligned with Title VI regulations, grantees who offered 

congregate meals for 5 or more days per week were considered high service providers for 

congregate meals. 

• Home-Delivered Meal Provision: Grantees who served more than 120 meals per client 

annually, which represents the national Title VI average for meals per client, were 

considered high service providers for home-delivered meals. 

• Supportive Service Provision: Each supportive service tracked on the PPR was weighted, 

and grantees received a score based on the total number of supportive services they 

offered. The four grantees with the highest scores were considered high service providers 

for supportive services. 

• Overall Service Provision: ICF holistically assessed how grantees’ programs are delivered, 

considering the availability and comprehensiveness of Part A/B and C services. Three 

grantees, out of eight, were categorized as overall high service providers. 

2. Assign geographic representations (ZIP codes) for each grantee to enable linking of 

community-level indicators from secondary data. 

To better explore the community context in which elders live, ICF used secondary data 

relating to poverty, unemployment, AI/AN population, and rurality (see Table 3). To 

accomplish this, ICF first identified the most frequent ZIP codes reported by elders in the 

NRCNAA Elder Needs Assessment survey for each grantee. Then, ICF selected the ZIP codes 

that best represented the communities served by each grantee. For example, grantee X had 

15 ZIP codes reported by the elders from which ICF selected the 5 most frequent ZIP codes 

that best represented the communities served by this grantee based on evaluation liaisons’ 

knowledge about each grantee program. The liaisons also estimated what proportion of the 

grantee’s clients were from each ZIP code, based on program data shared by the grantee. 

These steps generated the following formula to estimate community-level indicators for this 

grantee (e.g., poverty rate): 

6

 Due to closures caused by the COVID-19 pandemic, four grantees were unable to complete the tribal resolution and data 

transfer process in time for analysis. 
17

Using this formula, ICF retrieved the selected ZIP codes from the secondary data and 

generated the community-level indicators for each grantee. 

3. Create a grantee-level dataset with service provision from other secondary, n4a Title VI 

Program Survey, PPR, and grant application variables. 

ICF generated a random identification number (ID) for each grantee, which was used to 

create a grantee-level dataset (one row per grantee). This dataset contained the variables 

generated in steps 1 and 2 in addition to key data points from the n4a Title VI program 

survey (see Table 1), PPR (see Table 2), and grant application data (for eligible service 

population). These data were used to further explore grantees’ program characteristics.

4. Merge the disaggregated data with grantee-level data by grantee ID. 

Finally, ICF added the associated grantee ID to each record in the disaggregated dataset to 

be able to merge with the grantee-level data by grantee ID. 

After data preparation, ICF completed three phases of analysis of the NRCNAA Elder Needs Assessment 

disaggregated data. 

Descriptive Phase 

ICF ran descriptive analyses (averages and frequencies) for the eight evaluation grantees with 

disaggregated data for each NRCNAA Elder Needs Assessment cycle (VI and VII). The analyses explored 

contextual variables, elder social demographic variables, elder health variables, service variables, and 

program variables (Section VI). The descriptive analyses for elder social demographic, elder health, and 

service variables were also compared to all Title VI NRCNAA Elder Needs Assessment data from the UND 

report, when available. 

Statistical Testing Phase 

To explore differences in NRCNAA Elder Needs Assessment indicators between subgroups of elders, ICF 

ran statistical tests. These tests were to determine whether differences between subgroups (see Table 

5) were significant (p < 0.05). Significance suggested a higher degree of confidence that the Title VI elder 

subgroups have better health and well-being compared to other subgroup of elders. For example, elders 

using Title VI services reported twice as much socialization per month compared to elders not using Title 

VI services. Because the difference was statistically significant, ICF has higher confidence that the 

difference was not due to chance. In this case, Title VI could be a key factor in the difference between 

these groups. 

Poverty Rate for Grantee X = (0.30*Poverty Rate(ZIPCode1) ) + (0.30* Poverty Rate(ZIPCode2)) 

+ (0.30* Poverty Rate(ZIPCode3)) + (0.05* Poverty Rate(ZIPCode4)) + (0.05* Poverty Rate(ZIPCode5)) 
18

Table 5. Groups Tested for Statistically Significant Differences in Their NRCNAA Elder Needs Assessment Data 

COMPARISON SUBGROUP 1 COMPARISON SUBGROUP 2 

Elders Using Any Title VI Services Elders Not Using Any Title VI Services 

Elders Using Congregate Meal Services Elders Not Using Congregate Meal Services 

Elders Using Home-Delivered Meal Services Elders Not Using Home-Delivered Meal Services 

Elders Using Supportive Services Elders Not Using Supportive Services 

Elders from Overall High Service Provision 

Grantees Elders Not from Overall High Service Provision Grantees 

Elders from High Congregate Meal Provision 

Grantees Elders Not from High Congregate Meal Provision Grantees 

Elders from High Home-Delivered Meal Provision 

Grantees Elders Not from High Home-Delivered Meal Provision Grantees 

Elders from High Supportive Service Provision 

Grantees Elders Not from High Supportive Service Provision Grantees 

AN/NH Elders* Non-AN/NH Elders* 

Elders from Single Funding Grantee* Elders NOT from Single Funding Grantee* 

* ICF tested for the overall sample of elders and separately tested for elders using any Title VI services, elders using congregate meals, elders 

using home-delivered meals, and elders using supportive services. 

ICF conducted chi-square tests (which compare differences between dichotomous variables) and t tests 

(which compare differences between means) for the following variables: 

• % Older Elders (> 70 years old) 

• % Low Income Elders (< $15,000 individual) 

• % Elders with Live Alone 

• % Elders with a Family Caregiver 

• % Elders that are a Primary Caregiver 

of Child(ren) 

• % Elders with any Hospitalizations in the 

Past Year 

• % Elders with any Falls in the Past Year 

• % Elders with any ADLs 

• % Elders with any IADLs 

• % Elders with Nutritional Inadequacy 

• % Elders with Eating Alone 

• % Elders with Health Condition 

Affecting Nutrition 

• % Elders with Income Affecting Nutrition 

• % Elders with Feel Unhealthy 

• % Elders with Feel Mostly Happy in the 

Past Month 

• % Elders with Feel Mostly Upset in the 

Past Month 

• % Elders with Caregiver Feels Supported 

• % Elders with Participate in Cultural Practices 

• % Elders with Socialize at Least Once a Month 

• Average Number of Individual 

Hospitalizations in the Past Year 

• Average Number of Individual Falls in the 

Past Year 

• Average Number of Individual ADLs 

• Average Number of Individual IADLs 

• Average Number of Socializations per Month 
19

Inferential Analysis Phase 

ICF conducted inferential analyses to test the association between the presence of Title VI services and 

elders’ physical, mental, and social outcomes (see Table 6). The measure of association provided 

additional evidence on the impact of Title VI on elders’ and their communities. 

Table 6. Title VI Variables and Elders’ Outcomes Included in the Linear Regression Model 

TITLE VI VARIABLE ELDER OUTCOME 

Use of Any Title VI Service Any Hospitalizations in the Past Year 

Use of Congregate Meal Services Any Falls in the Past Year 

Use of Home-Delivered Meal Services Average Number of Individual Hospitalizations in the 

Past Year 

Use of Supportive Services Average Number of Individual Falls in the Past Year 

Grantees With Overall High Service Provision Feel Unhealthy 

Grantees With High Congregate Meal Provision Feel Mostly Upset in the Past Month 

Grantees With High Home-Delivered Meal Provision Feel Mostly Happy in the Past Month 

Grantees With High Supportive Service Provision Participate in Cultural Practices 

Grantees With Title VI as Single Funding Socialize at Least Once a Month 

Average Number of Socializations per Month 

Meal Inadequacy 

Eat Alone 

Health Affecting Nutrition 

ICF used linear and logistic regression to test whether Title VI-related indicators could predict the health 

outcomes of elders within the eight grantee sample. To better build the regression model, ICF 

accounted for key contextual data that could facilitate the association between Title VI variables and 

overall elder variables (e.g., grantee county poverty rate, grantee rurality, grantee proportion of older

elders [i.e., elders older than X age]). ICF used the following model for the inferential analysis: 

The regression results provided parameter estimates (or coefficients)—the change in the response (e.g., 

elder outcome) associated with a one-unit change of the predictor (e.g., Title VI variable); all other 

predictors held constant (controlling variables). For example, in testing whether grantees with overall 

high service provision was a predictor of the number of individual falls in the past year, ICF found a 

parameter estimate of -0.54. This indicates that an elder from an overall high service provision grantee 

may expect lower reports (0.54 less) in the number of falls per year compared to an elder not from high 

service provision grantees. 

Elder Outcome = Title VI Variables + Controlling Variables (Grantee County Poverty Rate, Grantee Rurality, Grantee 

Proportion of Older Elders) 
20

Cost Savings Analysis 

ICF conducted an exploratory analysis of potential cost savings associated with Title VI programs using a 

combination of program findings and publicly available data (see Table 4). 

ICF first identified statistically significant findings from the inferential analysis—elders using Title VI 

services reported fewer falls and hospitalizations compared to elders not using Title VI services (see 

Table 7). ICF then projected a scenario of 500 elders (proximal number of the national average of 

reported clients for congregate meals in the 2018 PPR) to calculate the expected differences in the 

number of reported hospitalizations and falls between a group of elders using any Title VI services and 

those not using any Title VI services. 

Table 7. Falls and Hospitalizations for Elders Using Title VI Services vs. Elders Not Using Title VI Services 

ELDER OUTCOME ELDERS USING ANY 

TITLE VI SERVICE 

ELDERS NOT USING 

ANY TITLE VI SERVICE DIFFERENCE 

Average Number of Individual 

Hospitalizations in the Past Year 0.85 1.22 0.37 fewer individual hospital visits 

Average Number of Individual 

Falls in the Past Year 0.99 1.09 0.10 fewer individual falls 

Number of Hospitalizations in 

the Past Year for 500 Elders 425 610 185 fewer hospitalizations 

Number of Falls in the Past Year 

for 500 Elders 495 545 50 fewer falls 

To quantify the differences in falls and hospitalizations into healthcare dollar savings, ICF researched the 

most up-to-date, publicly available national statistics on the cost of falls and hospitalizations among elders. 

• For hospitalizations, ICF generated a cost estimation for 2019 using HCUP,7 an online query system 

based on data from HCUP. In 2019, a hospital stay for younger elders (age 65–84 years) cost $14,997 

and for older elders (age 85 years or older) cost $11,601. 

▪ The NRCNAA Elder Needs Assessment Cycle VI data reported a national distribution of 

58 percent for younger elders to 42 percent for older elders, an approximate distribution of 

younger elders to older elders of 3:2. That is, for the 185 fewer hospitalizations in a group of 

500 elders using Title VI services compared to those not using Title VI services, 111 were from 

younger elders (i.e., three-fifths) and 74 were from older elders (i.e., two-fifths).

7

 Healthcare Cost and Utilization Project [HCUP], 2019 
21

▪ The difference in hospitalization costs between 500 elders using Title VI services and 500 elders 

not using Title VI services, in a 2:3 older elders to younger elders’ distribution, was $2,523,192. 

• For falls, ICF found that, in 2018, U.S. older elders reported 35.6 million falls and that the healthcare 

spending on older elder falls (excluding hospitalization cost) was approximately $42.5 billion 

annually.8 Thus, the cost of an individual fall was approximately $1,194. ICF took the following steps 

when estimating the fall cost: 

▪ The hospitalization cost associated with falls was removed from the calculations to avoid 

overlapping costs between the two measures. 

▪ The cost of an individual fall was adjusted to the December 2019 Consumer Price Index (CPI). 

The final cost of an individual fall was calculated to be $1,297. 

▪ The difference in the healthcare cost of falls between 500 elders using Title VI services and 500 

elders not using Title VI service was $64,853. 

To account for the cost of running a Title VI program, ICF subtracted the average Title VI funding award 

of $160,290 (Part A/B + Part C funds) for programs serving 401–500 elders from the total savings 

estimation. The estimated potential cost savings relating to falls and hospitalization is $2,427,755 for a 

program serving 500 elders. 

Triangulation 

Following preliminary analyses of qualitative and quantitative data, ICF conducted data triangulation to 

support synthesis and understanding of findings by key themes, connecting findings from qualitative and 

quantitative data for each relevant theme. This included reviewing common themes from the qualitative 

and quantitative data analysis to identify interconnecting themes as well as points in which the data 

diverges. ICF used the following triangulation process:

1. For each data source, ICF identified all major and minor themes, including subthemes. 

2. ICF conducted a crosswalk of all themes to the relevant evaluation question(s). 

3. ICF conducted cluster analysis, by evaluation question, grouping themes by affinity, to articulate 

findings, conclusions, and recommendations using a What/So What/Now What methodology: 

8 Florence, C. S., Bergen, G., Atherly, A., Burns, E., Stevens, J., & Drake, C. (2018). Medical Costs of Fatal and Nonfatal Falls in 

Older Adults. Journal of the American Geriatrics Society, 66(4), 693–698. https://doi.org/10.1111/jgs.15304

Hospitalization Cost Savings = (Difference in Number of Hospitalizations for Younger Elders 

[111] * Cost of a Younger Elder Hospitalization [$14,997]) + (Difference in Number of 

Hospitalizations for Older Elders [74] * Cost of an Older Elder Hospitalization [$11,601])

Fall Cost Savings = Difference in Number of Falls for 500 Elders (50) * Cost of an Elder Fall ($1,297)

Total Hospitalizations and Falls Cost Savings for 500 Elders = (Hospitalization Cost Savings for 500 

Elders [$2,523,192] + Fall Cost Savings for 500 Elders [$64,853]) – Average Title VI Funding for 

Grantees Serving 401–500 Elders [$160,290])
22

a. What are the grouped themes saying? (Findings)

b. So what do the findings suggest; why are they important? (Conclusions)

c. Now what are possible next steps? (Recommendations)

In the final year of evaluation, ICF facilitated two rounds of data triangulation, using the virtual whiteboard 

MURAL to facilitate the triangulation process and allow for real-time interactivity. A crosswalk of the data 

sources and evaluation questions used in the triangulation are detailed in Table 8. The first round included 

the ICF evaluation team and ACL. To ensure local perspective and insight, ICF facilitated a second 

triangulation process with evaluation grantees. Finally, ICF synthesized findings, conclusions, and 

recommendations from both rounds of triangulation. This process is presented in Figure 2. 

Figure 2. Title VI Evaluation Triangulation Process 

Table 8. Crosswalk of Evaluation Data Sources and Questions

QUESTION DATA SOURCE 

EVALUATION QUESTION 1: What is the context of the Title VI programs at the national and tribal levels? 

(How do tribes operate their Title VI programs?)

What are the program inputs, resources, and 

activities implemented through Title VI? 

n4a Title VI Program Survey 

PPR 

Title VI grant application 

Program staff interviews 

Evaluation and data needs assessment 

Caregiver program assessment 

To what extent are Title VI programs operated 

dependently or interconnected with other tribal 

elder programs? 

n4a Title VI Program Survey 

Program staff interviews 

Evaluation and data needs assessment 

What is the Title VI management structure? 

n4a Title VI Program Survey 

Title VI grant application 

Program staff interviews 

 
23

EVALUATION QUESTION 2: How are the Title VI programs implemented at the national and tribal levels?

How are nutrition, supportive, and caregiver support 

services provided through the Title VI programs?

n4a Title VI Program Survey

PPR

Title VI grant application

Evaluation and data needs assessment

Program staff interviews

Caregiver program assessment

What is the array of Title VI practices available to 

tribal elders? To caregivers?

n4a Title VI Program Survey

Title VI grant application

Evaluation and data needs assessment 

Program staff interviews 

Elder focus groups/interviews

Caregiver focus groups/interviews

Caregiver program assessment 

What are the program outputs of the Title VI service 

areas?

n4a Title VI Program Survey

NRCNAA Elder Needs Assessment

PPR

Program staff interviews

Elder focus groups/interviews

Caregiver focus groups/interviews

What are the challenges to implementing program 

activities?

n4a Title VI Program Survey

Program staff interviews

Evaluation and data needs assessment

Caregiver program assessment

How do Title VI programs address challenges to 

the program?

n4a Title VI Program Survey

Program staff interviews

Evaluation and data needs assessment

Caregiver program assessment

What are the facilitators of program implementation? 

What works well and under what conditions?

Program staff interviews

Data needs assessment (year 1)

Caregiver program assessment (year 2)

What are the met and unmet needs of consumers and 

program stakeholders? 

n4a Title VI Program Survey

Program staff interviews

Elder focus groups/interviews

Caregiver focus groups/interviews

Caregiver program assessment

How do Title VI programs use their funds to run 

their programs?

n4a Title VI Program Survey

Program staff interviews

How has Title VI program funding allowed Title VI 

programs to maintain certain levels of nutrition, 

supportive, and caregiver services?

n4a Title VI Program Survey

Program staff interviews

PPR

Caregiver program assessment 

How do Title VI programs leverage funds and 

resources to implement their programs?

n4a Title VI Program Survey

Program staff interviews

Evaluation and data needs assessment 

Caregiver program assessment
24

EVALUATION QUESTION 3: What are the outcomes and impacts of the Title VI programs, 

nationally and by tribe or tribal groups? (What is the effect of the Title VI programs on the elders in the 

community? Are there differences nationally or by tribe or tribal group?)

What are the characteristics of tribal elders reached 

through Title VI service areas? 

NRCNAA Elder Needs Assessment 

Program staff interviews 

Elder focus groups/interviews 

To what extent are elder and caregiver expectations 

met through the Title VI service areas? 

Program staff interviews 

Elder focus groups/interviews 

Caregiver focus groups/interviews 

To what extent do elders’ and caregivers’

experience vary by program inputs, resources, and 

management models? 

Program staff interviews 

Elder focus groups/interviews 

Caregiver focus groups/interviews 

To what extent do elders’ experiences vary by tribal 

and grantee demographic, geographical, and other 

tribal contexts? 

Elder focus groups/interviews 

NRCNAA Elder Needs Assessment 

How accessible are Title VI nutrition and supportive 

services? How did this change through the Title VI 

program? 

Program staff interviews 

Elder focus groups/interviews 

Evaluation and data needs assessment 

How accessible are caregiver support services? How 

did this change through the Title VI program? 

Program staff interviews 

Caregiver focus groups/interviews 

Evaluation and data needs assessment 

Caregiver program assessment 

EVALUATION QUESTION 4: What are the Title VI program outcomes for programs that rely solely or 

primarily on Title VI funds compared to cost-shared programs that receive a significant portion of their 

resources from other programs/agencies? (Do Title VI programs that rely only on Title VI funds have a 

different community impact than programs that have money from other programs or agencies?) 

What are the physical, emotional, mental, and 

spiritual outcomes of the Title VI program? 

• Are there differences in outcomes by Title 

VI grantee characteristics and 

management models? 

• Are funding structures associated with 

Title VI program outcomes?

NRCNAA Elder Needs Assessment 

Program staff interviews 

Elder focus groups/interviews 

Caregiver focus groups/interviews 

Evaluation and data needs assessment 

How has the Title VI program led to improved 

health outcomes, such as an increase in number of 

lives saved or number of elders returning from 

nursing homes? 

• How are Title VI program “costs” 

associated with outcomes? 

NRCNAA Elder Needs Assessment 

n4a Title VI Program Survey 

Title VI grant applications/funding 

PPR 

Program staff interviews 

Elder focus groups/interviews 

Caregiver focus groups/interviews 

Evaluation and data needs assessment 
25

Data and Analysis Limitations 

Findings should be interpreted in consideration of several limitations: 

• Although the evaluation identified comparable characteristics between the overall Title VI grantees 

and the 12 evaluation grantees, the evaluation grantees volunteered to participate in the evaluation 

and may not reflect a true diversity in program models. The evaluation grantees also included an 

oversample of AN/NH (i.e., 30% of NRCNAA Elder Needs Assessment Cycle VI) compared to the overall 

Title VI population (i.e., 9% of NRCNAA Elder Needs Assessment Cycle VI). Thus, the evaluation 

findings may not be generalizable to other Title VI programs or populations. 

• To not overly burden participants, ICF conducted a total of 18 elder focus groups, 34 elder interviews, 

8 caregiver focus groups, and 11 caregiver interviews. Although saturation in themes was reached, ICF 

did not involve all elders and caregivers, and elders and caregivers were not randomly selected. 

• Although in-person data collection is ideal, due to the COVID-19 pandemic, the final program staff 

interviews were conducted virtually. 

• The NRCNAA Elder Needs Assessment disaggregated data analysis was conducted from a sample of 8 

of the 12 evaluation grantees, further limiting the sample compared with the overall Title VI grantee 

population. The limited sample size may impact the power of the study to produce conclusive results 

because the data available to test the hypothesis was limited. 

• The NRCNAA Elder Needs Assessment data is a self-reported survey and many of the questions are 

left to the interpretation of the elders. Therefore, there may be reporting bias. 

• Although the NRCNAA Elder Needs Assessment provides important information about elders, it does 

not target other populations served by the Title VI program, such as caregivers. Although the 

assessment included some questions referring to caregivers (e.g., Are you a primary caregiver of 

grandchildren?), the survey administration targeted elders overall and the language was not tailored 

to address caregivers specifically. 

• ACL recently updated the Title VI PPR indicators and, in October 2020, unveiled a new data portal (Older 

Americans Act Performance System) to support increased accuracy and consistency in reporting across 

grantees. However, the PPR data used in this evaluation used the original reporting system, which is 

more vulnerable to reporting errors and, consequently, may generate unreliable data. 

• Data related to grantee funding source were inconsistent across data sources. This made it difficult to 

confidently assess the impact that different funding structures (e.g., Title VI as sole funding source vs. 

multiple sources of funding) had on program implementation and on elders’ experiences and outcomes. 

• The study of Title VI cost savings is limited to the secondary data available. The data used to generate 

the cost of a hospitalization (i.e., HCUP) exclude rehabilitation and long-term acute care 

hospitals from the sample, which may be important settings for elder inpatient care. 

• Also, regarding the study of cost, ICF applied the average number of falls for all elders (i.e., 500); 

however, some elders might not report any falls per year, whereas others might report more than one. 
SECTION I. 

TITLE VI PROGRAM STAFF 

INTERVIEW GUIDE YEAR 1

APPENDIX B METHODS

THE EVALUATION OF THE ACL TITLE VI 

PROGRAMS DATA COLLECTION INSTRUMENTS
Form Approved

OMB No.: 0985-0059 

Expiration Date: 02/28/2021 

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it 

displays a currently valid OMB control number. The OMB control number for this project is 0985-0059. Public reporting burden for this collection of 

information is estimated to average 5 minutes per respondent, per year, including the time to review instructions. Send comments regarding this 

burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of Performance and 

Evaluation, Center for Policy and Evaluation, 330 C Street, SW, Rm 1229A, Washington DC, 20201.

Evaluation of the ACL Title VI Programs 

Title VI Program Staff Interview Guide 

Introduction and Informed Consent Statement 

Hi. My name is __________. 

Thank you for giving us this chance to discuss your Title VI Program. This discussion should 

take no more than 60 minutes of your time. We will do our best to stay on track. 

As you may remember, I work for ICF and we are helping the Administration on Aging conduct 

an evaluation of the Title VI Programs. Through this interview and others like it, we hope to get 

a better sense of how well the elders’ programs in our country are serving their communities.

You have been asked to participate because you are a staff person with an elders program in 

your community. We want to learn more about what these programs are doing for their 

communities and where they could use more help. 

There are no right or wrong answers. You are the expert on your Title VI program, and your 

opinions and thoughts are really important to us. You can choose not to answer any question for 

any reason. Your answers will not give you any benefits or change any benefits that you 

currently may be receiving. Your input will be used to help improve programs in tribal 

communities. 

This interview is strictly private; meaning information that identifies you will not be shared with 

anyone but study staff. To help with our notes, we also will audio tape the interview. We will 

keep the notes and tape records in locked files and only study staff will be allowed to see them. 

The information that we report will be grouped together with the results from all tribes and will 

not contain any information about you or your community. 

Participation in the interview is completely voluntary. You can refuse to participate with no 

penalty or negative results. You do not have to answer questions that you do not want to 

answer. You may choose to end the interview at any time, for any reason. 

Do you have any questions before we get started? 

Do you agree to participate in this interview? 

❑ Yes → Thank you. I am confirming you are willing to answer questions during this 

interview and will note your verbal consent. We also would like to record the 

discussion to make sure we don’t miss anything.

❑ No → Thank participant for their time.

Do I have your permission to turn on the audio recorder? 

❑ Yes → Thank you. Turn on recorder. 

❑ No → Thank you. I will refrain from recording the interview.
Form Approved

 OMB No.: 0985-0059 

Expiration Date: 02/28/2021

2 

First, I want to ask you a couple of questions to get some background information on 

your Title VI Program. As a reminder, these questions are about the services you provide 

under the Title VI Program.

1. How long have you been working for the Title VI program? 

a. What is your title? 

b. How long have you been in this role? 

2. Can you talk a little bit about your Title VI Program? What kinds of services are offered? 

a. Nutrition: education, meals, home delivery, etc. 

b. Supportive Services: transportation, home care, legal assistance, 

information/referral, etc. 

c. Caregiving: respite care, palliative care, grandparents program, 

information/referral, counseling, support groups, etc 

3. What are the greatest needs for your Elders? 

4. (If they have a Caregiver program) What are the greatest needs for Caregivers? 

5. What kinds of services do you most often refer people (Elders and Caregivers) to? 

6. Which services are the most used among Elders? Caregivers? 

I also want to understand how Title VI programs make ends meet for their programs in 

terms of staff, money, and other resources. 

7. Are there other sources of money that you use to supplement the Title VI funding? 

a. If YES→ where does the money come from? 

b. If NO→ do you feel like you are often trying to stretch the Title VI funding to go 

further each year? 

8. Which parts of the program do you have to supplement with money from another 

source? 

9. What about other resources? Volunteer time? Volunteered resources from other 

programs? 

10. Can you give an example of a group of people you couldn’t help because of resource 

limitations? 

Now we’re going to shift the conversation to talk more about the impact of the Title VI 

Program on the people it serves. 

11. How does your program build on the strengths of your culture and community? 
Form Approved

 OMB No.: 0985-0059 

Expiration Date: 02/28/2021

3 

12. Which aspects of your program do you think have the most impact on people? Why/in 

what way? 

13. What does your program do best for Elders? 

a. How does the program affect their physical, emotional, mental and/or spiritual 

wellbeing? 

14. What does your program do best for Caregivers? 

a. How does the program affect their physical, emotional, mental and/or spiritual 

wellbeing? 

15. What would happen if the Title VI program went away? 

a. What would the impact on the Elders? 

b. What would be the impact on caregivers? 

c. What impact on the Tribe/community? 

Now I’m going to ask you to think more about the management aspects of the Title VI 

Program. 

16. What are some of the challenges that you face with running this program? 

17. How do you manage all of the components of your program? 

18. If you had unlimited funds, what else would you like to do with your Title VI program? 

a. What would you change about your current program? 

b. What other kinds of programming would you like to have? 

19. Are there areas in which you could use more training? 

a. Implementation of best practices? 

b. Maintaining food safety standards? 

c. Grant management? 

d. Grant writing? 

e. Report writing? 

f. Data collection? 

g. Partnership development?

That wraps up my list of questions for you at this time. Do you have any questions for 

me? [ADDRESS ANY QUESTIONS]

• If no questions “Thank you again for taking the time to speak with me. We 

sincerely appreciate and value your input!”

• If you think of anything else after we get off the phone, please call me or email 

me. 
SECTION II. 

TITLE VI PROGRAM STAFF 

INTERVIEW GUIDE YEAR 3

APPENDIX B METHODS

THE EVALUATION OF THE ACL TITLE VI 

PROGRAMS DATA COLLECTION INSTRUMENTS
Form Approved

OMB No.: 0985-0059 

Expiration Date: 02/28/2021

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently 

valid OMB control number. The OMB control number for this project is 0985-0059. Public reporting burden for this collection of information is estimated to average 5 

minutes per respondent, per year, including the time to review instructions. Send comments regarding this burden estimate or any other aspect of this collection of 

information, including suggestions for reducing this burden, to Office of Performance and Evaluation, Center for Policy and Evaluation, 330 C Street, SW, Rm 1229A, 

Washington DC, 20201.

Evaluation of the ACL Title VI Programs 

Title VI Program Staff Interview Guide 

Introduction and Informed Consent Statement 

Hi. My name is __________. 

Thank you for giving us this chance to discuss your Title VI Program. This discussion should take no more 

than 60 minutes of your time. We will do our best to stay on track. 

As you may remember, I work for ICF and we are helping the Administration on Aging conduct an 

evaluation of the Title VI Programs. Through this interview and others like it, we hope to get a better 

sense of how well the elders’ programs in our country are serving their communities.

You have been asked to participate because you are a staff person with an elders program in your 

community. We want to learn more about what these programs are doing for their communities and 

where they could use more help. 

There are no right or wrong answers. You are the expert on your Title VI program, and your opinions 

and thoughts are really important to us. You can choose not to answer any question for any reason. 

Your answers will not give you any benefits or change any benefits that you currently may be receiving. 

Your input will be used to help improve programs in tribal communities. 

This interview is strictly confidential; meaning information that identifies you will not be shared with 

anyone but study staff. To help with our notes, we also will audio tape the interview. We will keep the 

notes and tape records in locked files and only study staff will be allowed to see them. The information 

that we report will be grouped together with the results from all tribes and will not contain any 

information about you or your community. 

Participation in the interview is completely voluntary. You can refuse to participate with no penalty or 

negative results. You do not have to answer questions that you do not want to answer. You may 

choose to end the interview at any time, for any reason. 

Do you have any questions before we get started? 

Do you agree to participate in this interview? 

❑ Yes → Thank you. I am confirming you are willing to answer questions during this 

interview and will note your verbal consent. We also would like to record the discussion 

to make sure we don’t miss anything.

❑ No → Thank participant for their time.

Do I have your permission to turn on the audio recorder? 

❑ Yes → Thank you. Turn on recorder. 

❑ No → Thank you. I will refrain from recording the interview.
Form Approved

OMB No.: 0985-0059 

Expiration Date: 02/28/2021

Evaluation of the ACL Title VI Programs 

Title VI Program Staff Small Group Interview Moderator Guide 

Questions Probes Time Guidelines 

Introduction of 

Moderator/Guests and 

Purpose of Interview/ Logistics 

Read Consent Form/Confirm 

Verbal Consent/ Confirm 

Permission to Audio Record 

5 minutes 

Opening Question 

1. Please tell us your first 

name and let us know 

how long you have been 

working for the Title VI 

program. 

▪ What is your title? 

▪ How long have you been in this role? 

5 minutes 

Introductory Question 

2. Can you talk a little bit 

about your Title VI 

program?

▪ In this Title VI cycle, what changes, if any, have you 

made to your program? Why/what led to those 

changes? 

▪ What kinds of services are offered? 

o Nutrition: education, meals, home delivery, 

etc. 

o Supportive Services: transportation, home 

care, legal assistance, information/referral, 

etc. 

o Caregiving: respite care, palliative care, 

grandparents program, information/referral, 

counseling, support groups, etc. 

10 minutes 

Transition Question 

3. What kinds of services do 

you most often refer 

people to? 

▪ What are the greatest needs for your Elders? For 

your Caregivers? 

o Intergenerational activities 

o Providing activities that reflect specific Tribal 

traditions or practices? 

o Chore services 

o Transportation 

▪ Which services are the most used among Elders? 

Caregivers? 

10 minutes 

Key Questions

4. Which aspects of your 

program do you think 

have the most impact on 

people? Why/in what 

way?

▪ What does your program do best for Elders? 

o How does the program affect their physical, 

emotional, mental and/or spiritual wellbeing? 

▪ What does your program do best for Caregivers? 

o How does the program affect their physical, 

emotional, mental and/or spiritual wellbeing? 

▪ How does the program build on the strengths of 

your community and culture? 

10 minutes 
Form Approved

OMB No.: 0985-0059 

Expiration Date: 02/28/2021

5. What would happen if 

the Title VI program 

went away?

▪ What would be the impact on the Elders? 

▪ What would be the impact on caregivers? 

▪ What impact on the Tribe/community? 

10 minutes 

6. We also want to 

understand how Title VI 

programs make ends 

meet for their programs in 

terms of staff, money, and 

other resources. 

▪ Are there other sources of money that you use to 

supplement the Title VI funding? 

o If so, where does the money come from? 

o If not, do you feel like you are often trying to 

stretch the Title VI funding to go further each 

year? 

▪ Which parts of the program do you have to 

supplement with money from another source? 

▪ What about other resources? Volunteer time? 

Volunteered resources from other programs? 

▪ Can you give an example of a group of people or 

person you couldn’t help because of resource 

limitations? 

10 minutes

7. What are some of the 

challenges that you face 

with running this 

program? 

▪ How do you manage all of the components of your 

program? 10 minutes 

8. If you had unlimited 

funds, what else would 

you like to do with you 

Title VI program? 

▪ What would you change about your current 

program? 

▪ What other kinds of programming would you like to 

have? 

5 minutes 

9. Are there areas in which 

you could use more 

training or support? 

▪ Such as for—

o Implementation of best practices?

o Maintaining food safety standards? 

o Grant management? 

o Partnership development?

5 minutes 

Ending Question 

10. Is there anything else 

that you want to share 

with us? Anything that 

we haven’t asked that 

we should have? 

5 minutes 

Total Time 85 minutes 
SECTION III. 

TITLE VI ELDER 

INTERVIEW GUIDE

APPENDIX B METHODS

THE EVALUATION OF THE ACL TITLE VI 

PROGRAMS DATA COLLECTION INSTRUMENTS
Form Approved

OMB No.: 0985-0059 

Expiration Date: 02/28/2021

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it 

displays a currently valid OMB control number. The OMB control number for this project is 0985-0059. Public reporting burden for this collection of 

information is estimated to average 5 minutes per respondent, per year, including the time to review instructions. Send comments regarding this 

burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of Performance and 

Evaluation, Center for Policy and Evaluation, 330 C Street, SW, Rm 1229A, Washington DC, 20201.

Evaluation of the ACL Title VI Programs 

Title VI Tribal Elders Interview – Informed Consent Form 

Purpose of the Study 

The Administration for Community Living (ACL) has hired ICF to find out how well the elders’

programs in our country are serving their communities. ICF will be talking to program leaders, 

elders, and caregivers to learn how the services in their communities help to make their lives 

better. We will also be looking for ideas to share with programs all over the country. In order to 

do this, we will be talking with elders’ program staff, elders, and caregivers to ask their ideas 

and thoughts. We will roll all of the ideas into a report which talks about the benefits and the 

best way to run elders programs. 

Description of Participation 

You have been asked to participate because your tribal elders program told us you are an elder who 

received some services from them. The interview will last about 1 hour. 

Here are some things we want you to know about the interview before agreeing and consenting to 

participate: 

Risk & Benefits 

Participating in this interview is unlikely to cause any problems for you in any way. You can choose 

not to answer any question for any reason. You can end the interview at any time. Your answers will 

not give you any benefits or change any benefits that you currently may be receiving. Your input will 

be used to help improve programs in tribal communities. 

Compensation 

If you agree to take part in this interview, you will receive [insert incentive]. 

Privacy 

We will be taking notes during the interview about what is said, but your name and answers will be 

kept private to the extent permitted by law. To help with our notes, we also will audio record the 

interview. We will keep the notes and audio record in locked files and only study staff will be allowed 

to see them. The information that we report will be grouped together with the results from all tribes 

and will not contain any information about you or your community. While not the focus of our 

questions, if you tell us about child or elder abuse or neglect, we have to report to the appropriate 

authority per tribal and state legal codes. 

Rights Regarding Decision to Participate 

Participation in the interview is completely voluntary. You can refuse to participate with no 

penalty or negative results. You do not have to answer questions that you do not want to 

answer. You may choose to end the interview at any time, for any reason. 

Contact Information 

If you have any concerns about your participation in this interview or have any questions about the 

evaluation, please contact the project manager, Gretchen Clarke, at gretchen.clarke@icf.com or 

(907) 747-7124, or contact the ACL Contract Officer Representative, Kristen Hudgins, at 

kristen.hudgins@acl.hhs.gov or (202) 795-7732. 
Form Approved

OMB No.: 0985-0059 

Expiration Date: 02/28/2021

2 

Voluntary Consent 

Before we begin the interview, I would like to get verbal consent to proceed. If you agree to take part 

in the interview, you are confirming that (1) this form has been read to you, (2) that you understand 

what it says, and (3) all of your questions have been answered. A copy of this form will be provided to 

you. 

Do you agree to participate in this interview? 

❑ Yes → Thank-you. I am confirming you are willing to answer questions during this 

interview and will note your verbal consent. We also would like to record the 

discussion to make sure we don’t miss anything.

❑ No → Thank participant for their time.

Do I have your permission to turn on the audio recorder? 

❑ Yes → Thank-you. Turn on recorder. 

❑ No → Thank-you. I will refrain from recording the session.

Do you have any questions for me before we begin? 

Pause for participant response. Answer any questions the respondent has. Proceed to 

conducting the interview using the Moderator Guide 
Form Approved

OMB No.: 0985-0059 

Expiration Date: 02/28/2021

3 

Evaluation of the ACL Title VI Programs 

Title VI Tribal Elder Interview Guide 

Introduction and Informed Consent Statement 

Hi. My name is __________. 

As you may remember, I work for ICF and we are helping the Administration on Aging find out 

how well the elders’ programs in our country are serving their communities. ICF will be talking to 

program leaders, elders, and caregivers to learn how the services in their communities help to 

make their lives better. We will also be looking for ideas to share with programs all over the 

country. 

You have been asked to participate because your tribal elders program told us you are an elder 

who received some services from them. This discussion should take no more than 60 minutes 

of your time. We will do our best to stay on track. 

There are no right or wrong answers. You are the expert on your experiences, and your 

opinions and thoughts are really important to us. You can choose not to answer any question for 

any reason. Your answers will not give you any benefits or change any benefits that you 

currently may be receiving. Your input will be used to help improve programs in tribal 

communities. 

This interview is strictly private; meaning information that identifies you will not be shared with 

anyone but study staff. To help with our notes, we also will audio tape the interview. We will 

keep the notes and tape records in locked files and only study staff will be allowed to see them. 

The information that we report will be grouped together with the results from all tribes and will 

not contain any information about you or your community. 

Participation in the interview is completely voluntary. You can refuse to participate with no 

penalty or negative results. You do not have to answer questions that you do not want to 

answer. You may choose to end the interview at any time, for any reason. 

Do you have any questions before we get started? 

Do you agree to participate in this interview? 

❑ Yes → Thank-you. I am confirming you are willing to answer questions during 

this interview and will note your verbal consent. We also would like to record the 

discussion to make sure we don’t miss anything.

❑ No → Thank participant for their time.

Do I have your permission to turn on the audio recorder? 

❑ Yes → Thank-you. Turn on recorder. 

❑ No → Thank-you. I will refrain from recording the interview.
Form Approved

OMB No.: 0985-0059 

Expiration Date: 02/28/2021

4 

First, I want to ask you a couple of questions to get a better understanding of the 

services you receive from your Title VI Program.

1. How long have you been receiving Title VI services? 

2. Can you tell me a little bit about the services you get through the program? (Probe for: 

meals, transportation, supportive services such as home care and legal assistance, 

nutrition education, exercise services, chore services) 

3. What do you like best about the services you receive through the program? (e.g., don’t 

have to cook; don’t have to worry about having enough money for food; feel more 

independent; someone to talk to/ask for help; helps me to feel safe in my home, a place 

to practice my culture) 

4. Which service is the most helpful to you? 

a. Does that service make it easier for you to live in your home? 

5. What else do you wish the program had? 

6. If you could change something about the program, what would that be? 

Now we’re going to shift the conversation to talk more about the impact the program has 

for you. 

7. Can you talk a little bit about the different ways the program helps you? 

a. How has the program helped you stay connected to traditional American Indian, 

Alaska Native, Native Hawaiian (AI/AN/NH) ways of life (e.g., foods, spirituality, 

language, music)? 

b. Are there other ways that the program helps you feel connected to your 

community? 

c. How does the program help you get around your house or community? 

d. How does the program help with your day-to-day activities? 

e. How does the program help you to stay in the community? 

f. How does the program help you to be healthier? 

g. How does the program help contribute to your quality of life? 

8. What is the best/most important thing the program has done for you? 

a. If you were telling someone else about the program, what would be the first thing 

you would tell them about? 

b. Do you think the program makes a difference in people’s lives? Can you share 

an example? 
Form Approved

OMB No.: 0985-0059 

Expiration Date: 02/28/2021

5 

9. What would happen if you didn’t have this program? Probe for: 

a. Meals—have fewer meals/cold meals 

b. Nutrition—eat less healthy meals 

c. Chances to socialize/visit with others—feel isolated/lonely 

d. Getting out of the house—feel isolated/lonely 

e. Transportation to places I couldn’t otherwise get to

f. Chore services 

g. Mental/Emotional—more depressed/anxious/worried 

That wraps up my list of questions for you at this time. Do you have any questions for 

me? [ADDRESS ANY QUESTIONS]

• If no questions “Thank you again for taking the time to speak with me. We 

sincerely appreciate and value your input!”

• If you think of anything else after we get off the phone, please call me or email 

me. 
SECTION IV. 

TITLE VI ELDER 

FOCUS GROUP GUIDE

APPENDIX B METHODS

THE EVALUATION OF THE ACL TITLE VI 

PROGRAMS DATA COLLECTION INSTRUMENTS
Form Approved

OMB No.: 0985-0059 

Expiration Date: 02/28/2021

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it 

displays a currently valid OMB control number. The OMB control number for this project is 0985-0059. Public reporting burden for this collection 

of information is estimated to average 5 minutes per respondent, per year, including the time to review instructions. Send comments regarding 

this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to [title], [address, city, 

state, zip].

Evaluation of the ACL Title VI Programs 

Title VI Tribal Elders Focus Group – Informed Consent Form 

Purpose of the Study 

The Administration for Community Living (ACL) has hired ICF to find out how well the elders’ programs 

in our country are serving their communities. ICF will be talking to program leaders, elders, and 

caregivers to learn how the services in their communities help to make their lives better. We will also be 

looking for ideas to share with programs all over the country. In order to do this, we will be talking with 

elders’ program staff, elders, and caregivers to ask their ideas and thoughts. We will roll all of the ideas 

into a report which talks about the benefits and the best way to run elders programs. 

Description of Participation 

You have been asked to participate because your tribal elders program told us you are an elder who received 

some services from them. The focus group will last 2 hours. 

Here are some things we want you to know about the focus group before agreeing and consenting to 

participate: 

Risk & Benefits 

Participating in this focus groups is unlikely to cause any problems for you in any way. You can choose not to 

answer any question for any reason. You can leave the focus group at any time. Your answers will not give you 

any benefits or change any benefits that you currently may be receiving. Your input will be used to help 

improve programs in tribal communities. 

Compensation 

If you agree to take part in this focus group, you will receive [insert incentive]. 

Privacy 

Everyone in the focus group will be asked not to share the names of those who participated or what was said, 

but we cannot guarantee that everyone will keep the discussion private. We will be taking notes during the 

focus group about what is said, but your name and answers will be kept private to the extent permitted by 

law. To help with our notes, we also will audio tape the focus group. We will keep the notes and tape records 

in locked files and only study staff will be allowed to see them. The information that we report will be grouped 

together with the results from all tribes and will not contain any information about you or your community. 

While not the focus of our questions, if you tell us about child or elder abuse or neglect, we have to report to 

the appropriate authority per tribal and state legal codes. 

Rights Regarding Decision to Participate 

Participation in the focus group is completely voluntary. You can refuse to participate with no penalty or 

negative results. You do not have to answer questions that you do not want to answer. You may choose 

to leave the focus group at any time, for any reason. 

Contact Information 
Form Approved

OMB No.: 0985-0059 

Expiration Date: 02/28/2021

If you have any concerns about your participation in this focus group or have any questions about the 

evaluation, please contact the project manager, Gretchen Clarke, at gretchen.clarke@icf.com or (907) 747-

7124, or contact the ACL Contract Officer Representative, Kristen Hudgins, at kristen.hudgins@acl.hhs.gov or 

(202) 795-7732. 

Voluntary Consent 

Before we begin the focus group, I would like to get verbal consent to proceed. If you agree to take part in the 

focus group, you are confirming that (1) this form has been read to you, (2) that you understand what it says, 

and (3) all of your questions have been answered. A copy of this form will be provided to you. 

Do you agree to participate in this focus group? 

❑ Yes → Thank-you. I am confirming you are willing to answer questions during this 

focus group and will note your verbal consent. We also would like to record the 

discussion to make sure we don’t miss anything.

❑ No → Thank participant for their time.

Do I have your permission to turn on the audio recorder? 

❑ Yes → Thank-you. Turn on recorder. 

❑ No → Thank-you. I will refrain from recording the session.

Do you have any questions for me before we begin? 

Pause for participant response(s). Answer any questions the respondents have. Proceed 

to conducting the focus group using the Moderator Guide 
Form Approved

OMB No.: 0985-0059 

Expiration Date: 02/28/2021

Evaluation of the ACL Title VI Programs 

Title VI Tribal Elder Focus Group Moderator Guide 

 

Questions Probes Time Guidelines 

Introduction of 

Moderator/Guests and 

Purpose of Focus Group/ 

Logistics 

5 minutes 

Read Consent Form/Confirm 

Verbal Consent/Confirm 

Permission to Audio Record 

5 minutes 

Opening Question 

1. Please tell us your first 

name and let us know 

how long you have been 

using Title VI services. 

5 minutes 

Introductory Question 

2. Can you tell me a little bit 

about the services you 

get through the program?

Provide examples of services specifically provided by the 

program: 

▪ Meals 

▪ Transportation 

▪ Supportive services 

o Home care, legal assistance, 

information/referral, etc. 

▪ Nutrition education 

▪ Exercise classes 

▪ Chore services 

10 minutes 

Transition Questions 

3. What do you like best 

about the services you 

receive through the 

program? 

▪ Don’t have to cook/can get a hot meal

▪ Don’t have to worry about not having enough money 

for food 

▪ Feel more independent/Don’t have to rely on others 

as much 

▪ Get out and see people 

▪ Someone to talk to/ask for help/ask to explain things 

▪ Stay connected to community/tribe 

▪ Helps me to feel safe in my home 

10 minutes 

Key Questions

4. Which service is the most 

helpful to you?

▪ Does that service make it easier for you to live in your 

home? 10 minutes 

5. What else do you wish 

that the program had? 10 minutes 

6. If you could change 

something about the 

program, what would that 

be?

10 minutes 
Form Approved

OMB No.: 0985-0059 

Expiration Date: 02/28/2021

7. What would happen if you 

didn’t have this program? 

Components to talk about: 

▪ Meals – have fewer meals/cold meals 

▪ Nutrition-eat less healthy meals 

▪ Chances to socialize/visit with others-feel 

isolated/lonely 

▪ Exercise classes—be less healthy 

▪ Getting out of the house—feel isolated/lonely 

▪ Transportation to places I couldn’t get otherwise

▪ Chore services 

▪ Mental/Emotional - More 

depressed/anxious/worried 

15 minutes 

8. Can you talk a little bit 

about the different ways 

that the program helps 

you? 

▪ How has the program helped you stay connected to 

traditional American Indian, Alaska Native, Native 

Hawaiian (AI/AN/NH) ways of life (food choices, 

spirituality, language, music and so on) 

▪ Are there other ways that the program helps you feel 

connected to your community? 

▪ I can talk to someone if I have a problem or if I think 

someone is trying to take advantage of me 

▪ How does the program help you get around your 

house or community? 

▪ How does the program help with your day-to-day 

activities? 

▪ Help you to stay in the community 

▪ Help you to be healthier 

▪ Contributed to your quality of life

15 minutes 

9. What is the best/most 

important thing that the 

program has done for 

you? 

▪ If you were telling someone else about the program, 

what would be the first thing you would tell them 

about? 

▪ Do you think the program makes a difference in 

people’s lives? Can you share an example?

15 minutes 

Ending Question 

10. Thank you so much for 

sharing your stories with 

us today. Is there 

anything that we have 

missed? Is there 

anything that you came 

wanting to say that you 

didn’t get a chance to?

5 minutes 

Total Time 120 minutes 
SECTION V. 

TITLE VI CAREGIVER 

FOCUS GROUP GUIDE

APPENDIX B METHODS

THE EVALUATION OF THE ACL TITLE VI 

PROGRAMS DATA COLLECTION INSTRUMENTS
Form Approved

OMB No.: 0985-0059 

Expiration Date: 02/28/2021 

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it 

displays a currently valid OMB control number. The OMB control number for this project is 0985-0059. Public reporting burden for this collection of 

information is estimated to average 5 minutes per respondent, per year, including the time to review instructions. Send comments regarding this 

burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of Performance and 

Evaluation, Center for Policy and Evaluation, 330 C Street, SW, Rm 1229A, Washington DC, 20201.

Evaluation of the ACL Title VI Programs 

Title VI Tribal Caregivers Focus Group – Informed Consent Form 

Purpose of the Study 

The Administration for Community Living (ACL) has hired ICF to find out how well the elders’

programs in our country are serving their communities. ICF will be talking to program leaders, 

elders, and caregivers to learn how the services in their communities help to make their lives 

better. We will also be looking for ideas to share with programs all over the country. In order to 

do this, we will be talking with elders’ program staff, elders, and caregivers to ask their ideas 

and thoughts. We will roll all of the ideas into a report which talks about the benefits and the 

best way to run elders programs. 

Description of Participation 

You have been asked to participate because your tribal elders program told us you are a caregiver 

who received some services from them. The focus group will last 2 hours. 

Here are some things we want you to know about the focus group before agreeing and consenting to 

participate: 

Risk & Benefits 

Participating in this focus groups is unlikely to cause any problems for you in any way. You can 

choose not to answer any question for any reason. You can leave the focus group at any time. Your 

answers will not give you any benefits or change any benefits that you currently may be receiving. 

Your input will be used to help improve programs in tribal communities. 

Compensation 

If you agree to take part in this focus group, you will receive [insert incentive]. 

Privacy 

Everyone in the focus group will be asked not to share the names of those who participated or what 

was said, but we cannot guarantee that everyone will keep the discussion private. We will be taking 

notes during the focus group about what is said, but your name and answers will be kept private to 

the extent permitted by law. To help with our notes, we also will audio tape the focus group. We will 

keep the notes and tape records in locked files and only study staff will be allowed to see them. The 

information that we report will be grouped together with the results from all tribes and will not contain 

any information about you or your community. While not the focus of our questions, if you tell us 

about child or elder abuse or neglect, we have to report to the appropriate authority per tribal and 

state legal codes. 

 

Rights Regarding Decision to Participate 

Participation in the focus group is completely voluntary. You can refuse to participate with no 

penalty or negative results. You do not have to answer questions that you do not want to 

answer. You may choose to leave the focus group at any time, for any reason. 

Contact Information 
Form Approved 

OMB No.: 0985-0059 

Expiration Date: 02/28/2021 

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it 

displays a currently valid OMB control number. The OMB control number for this project is 0985-0059. Public reporting burden for this collection of 

information is estimated to average 5 minutes per respondent, per year, including the time to review instructions. Send comments regarding this 

burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of Performance and 

Evaluation, Center for Policy and Evaluation, 330 C Street, SW, Rm 1229A, Washington DC, 20201.

If you have any concerns about your participation in this focus group or have any questions about the 

evaluation, please contact the project manager, Gretchen Clarke, at gretchen.clarke@icf.com or 

(907) 747-7124, or contact the ACL Contract Officer Representative, Kristen Hudgins, at 

kristen.hudgins@acl.hhs.gov or (202) 795-7732. 

Voluntary Consent 

Before we begin the focus group, I would like to get verbal consent to proceed. If you agree to take 

part in the focus group, you are confirming that (1) this form has been read to you, (2) that you 

understand what it says, and (3) all of your questions have been answered. A copy of this form will be 

provided to you. 

Do you agree to participate in this focus group? 

❑ Yes → Thank-you. I am confirming you are willing to answer questions during this 

focus group and will note your verbal consent. We also would like to record the 

discussion to make sure we don’t miss anything. 

❑ No → Thank participant for their time.

Do I have your permission to turn on the audio recorder? 

❑ Yes → Thank-you. Turn on recorder. 

❑ No → Thank-you. I will refrain from recording the session.

Do you have any questions for me before we begin? 

Pause for participant response(s). Answer any questions the respondents have. Proceed 

to conducting the focus group using the Moderator Guide 
Form Approved 

OMB No.: 0985-0059 

Expiration Date: 02/28/2021 

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it 

displays a currently valid OMB control number. The OMB control number for this project is 0985-0059. Public reporting burden for this collection of 

information is estimated to average 5 minutes per respondent, per year, including the time to review instructions. Send comments regarding this 

burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of Performance and 

Evaluation, Center for Policy and Evaluation, 330 C Street, SW, Rm 1229A, Washington DC, 20201.

Evaluation of the ACL Title VI Programs 

Title VI Tribal Caregiver Focus Group/Interview Moderator Guide 

Questions Probes Time Guidelines 

Introduction of 

Moderator/Guests and 

Purpose of Focus Group/ 

Logistics 

5 minutes 

Read Consent 

Form/Confirm Verbal 

Consent/ Confirm 

Permission to Audio 

Record 

5 minutes 

Opening Question 

1. Please tell us your first 

name and how long you 

have been using Title VI 

(or local program name) 

services. 

5 minutes 

Introductory Question 

2. Tell me a little bit about 

the services you get as a 

caregiver. 

Provide examples of services specifically provided 

by the program: 

▪ Information 

▪ Counselling 

▪ Education 

▪ Support group 

▪ Respite care 

▪ Grandparent support

10 minutes 

Transition Questions

3. What do you like about 

the caregiver program? 

▪ Why is that? What about that service makes you 

say that? 

▪ Can you give me an example or tell a story about it? 

10 minutes 

Key Questions

4. How does the program 

help you as a caregiver?

▪ How does the program help you with stress, time, 

resources, etc.? 

▪ How/does the program ease mental overload? 

▪ How/does the program improve your quality of life? 

▪ How/does the program improve the quality of life of 

the person you care for? 

▪ Are there other ways that the program helps you 

feel connected to your community? 

10 minutes 

5. What else do you wish 

the program had for 

caregivers? 

▪ What other types of information might be valuable 

to you as a caregiver? 

▪ What other types of services might you want to 

receive?

10 minutes 

6. If you could change 

something about the 

program for caregivers, 

what would that be? 

10 minutes 
Form Approved 

OMB No.: 0985-0059 

Expiration Date: 02/28/2021 

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it 

displays a currently valid OMB control number. The OMB control number for this project is 0985-0059. Public reporting burden for this collection of 

information is estimated to average 5 minutes per respondent, per year, including the time to review instructions. Send comments regarding this 

burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of Performance and 

Evaluation, Center for Policy and Evaluation, 330 C Street, SW, Rm 1229A, Washington DC, 20201.

7. What would happen to 

you as a caregiver if you 

didn’t have this program?

Components to talk about: 

▪ Employment 

▪ Stress 

▪ Difficulty with providing care 

▪ Chances to socialize/visit with others 

▪ Getting out of the house, etc. 

▪ Not be able to continue providing care 

▪ Not be able to provide as good care

10 minutes 

8. If you were telling a friend 

about the experiences 

you’ve had as a caregiver 

with the program, what 

would you would tell 

them? 

10 minutes 

Ending Question 

9. Thank you so much for 

sharing your stories with 

us today. Is there 

anything that we have 

missed? Is there 

anything that you came 

wanting to say that you 

didn’t get a chance to?

5 minutes 

Total Time 90 minutes 
APPENDIX B METHODS

THE EVALUATION OF THE ACL TITLE VI 

PROGRAMS DATA TABLES

SECTION VI. 

DATA TABLES
1 

Table 1. Title VI Evaluation Quantitative Analysis: 

Descriptive Phase Results 

COMMUNITY CONTEXT Title VI Evaluation Grantees 

(N = 13)1

All National Tribes 

(N = 489)2

Community Poverty Rate3 13.3 15.6 

Community Unemployment Rate4 5.7 12.3 

Communities in CHSDA5 88% 84% 

Communities' Alaska Native/Native 

Hawaiian (AN/NH) Population6

10% 11% 

Grantees in Rural Communities6 70% 69%

EVALUATION GRANTEES’ 

PROGRAM CONTEXT 2010–2017 Average 2018

Average Number of Clients Served in the 

Elder Program (Part A/B)7

557 522

Average Number of Congregate Meal 

Clients7

193 189

Average Number of Home-Delivered Meal 

Clients7

134 76

Average Number of Clients Served in the 

Elder Program (Part C)7

247 237

Average Number of Services Provided in 

the Elder Program (Part A/B)7

43,099 42,597 

Average Number of Congregate Meals 

Provided7

9,764 9,250 

Average Number of Home-Delivered 

Meals Provided7

12,533 11,770 

Average Number of Services Provided in 

the Elder Program (Part C)7

1,666 1,505 
2

Title VI Evaluation Grantees

Average Number of Services per Elder 

Program Client (Part A/B)7, 8

80

Average Number of Services per Elder

Program Client (Part C)8

6

Average Cost of Elder Program Service 

(Part A/B)8

$5

Average Cost of Elder Program Service 

(Part C)8

$35

Individual Tribe Running Elder Program9 53%

Elder Programs With Single Site9 86%

Elder Programs With Title VI as Single 

Funding Source9

38%

Mean Eligible Population Receiving 

Services10 1,756

Median Eligible Population Receiving 

Services10 489

Average Full-Time Staff7 3 4

ELDERS' DEMOGRAPHIC,

HEALTH STATUS, AND SERVICE USE 

INFORMATION

Cycle VI Cycle VII

Evaluation Grantees

(1,010 Survey

Responses)

All Title VI 

Grantees

Evaluation Grantees

(1,176 Survey Responses)

N % % N %

Younger Elder (55–69 years old) 500 50 58 607 52

Older Elder (> 70 years old) 455 45 42 505 43

Male 315 31 39 377 32

Female 672 67 61 778 66

Low Income (< $15,000 individual

income11)

306 30 47 275 23

Employed 277 27 31 325 28
3 

ELDERS' DEMOGRAPHIC, 

HEALTH STATUS, AND SERVICE USE 

INFORMATION 

Cycle VI Cycle VII 

Evaluation Grantees 

(1,010 Survey 

Responses)

All Title VI 

Grantees

Evaluation Grantees 

(1,176 Survey Responses)

N % % N %

AN/NH 308 30 9 373 32

Health Insurance—Government12 787 78 87 963 82

Health Insurance—Tribal13 483 48 72 215 18

Health Insurance—None 11 1 18 65 6 

Live Alone 223 22 29 314 27

Have a Family Caregiver 371 37 34 322 27

Primary Caregiver of Child(ren) 72 7 10 80 7 

Any Hospitalization in the Past Year 236 23 25 250 21

Average Individual Hospitalizations in the 

Past Year 0.83 N/A14 1.20 

Any Falls in the Past Year 350 35 3910 467 40

Average Number of Individual Falls in the 

Past Year 0.94 N/A14 1.13 

Any Activity of Daily Living (ADL) 316 31 N/A14 393 33

Average Number of Individual ADLs 0.69 N/A14 0.67 

Any Instrumental Activity of Daily Living 

(IADL) 400 40 N/A14 479 41

Average Number of Individual IADLs 0.90 N/A14 0.88 

Any Long-Term Care Needs15 364 36 40 437 37

Nutritional Inadequacy16 405 40 N/A14 444 38

Eating Alone 238 24 18 262 22
4

ELDERS' DEMOGRAPHIC, 

HEALTH STATUS, AND SERVICE USE 

INFORMATION 

Cycle VI Cycle VII 

Evaluation Grantees 

(1,010 Survey 

Responses)

All Title VI 

Grantees

Evaluation Grantees 

(1,176 Survey Responses)

N % % N %

Health Affecting Nutrition17 453 45 N/A14 508 43

Income Affecting Nutrition 213 21 11 159 14

Feel Overall Unhealthy18 319 32 34 372 32

Feel Mostly Happy in the Past Month 843 83 82 935 80

Feel Mostly Upset in the Past Month 83 8 9 86 7

Caregiver Feels Supported 140 14 67 151 13

Participate in Cultural Practices 614 61 73 822 70

Socialize at Least Once a Month 909 90 85 977 83

Average Socializations per Month 8.7 N/A14 7.5 

Now Using Congregate Meals 206 20 17 118 10

Would Use Congregate Meals 382 38 18 441 38

Now Using Home-Delivered Meals 314 31 15 274 23

Would Use Home-Delivered Meals 189 19 35 230 20

Now Using Information and 

Referral/Assistance 108 11 5 80 7 

Would Use Information and 

Referral/Assistance 259 26 20 211 18

Now Using Case Management 54 5 4 38 3 

Would Use Case Management 169 17 14 203 17

Now Using Transportation 204 20 10 173 15
5 

ELDERS' DEMOGRAPHIC, 

HEALTH STATUS, AND SERVICE USE 

INFORMATION 

Cycle VI Cycle VII 

Evaluation Grantees 

(1,010 Survey 

Responses)

All Title VI 

Grantees

Evaluation Grantees 

(1,176 Survey Responses)

N % % N %

Would Use Transportation 343 34 32 420 36

Now Using Caregiver Program 60 6 6 67 6 

Would Use Caregiver Program 355 35 29 428 36

Now Using Respite Care 14 1 2 16 1 

Would Use Respite Care 188 19 16 240 20

Now Using Supportive Services19 14 1 N/A14 16 1 

Would Use Supportive Services19 622 62 N/A14 674 57

1

 Community estimations based on counties served by the Title VI evaluation grantees as presented in Appendix B (Methods). 

2

 Number of nationwide counties that include federally recognized tribal lands based on legal (reservation and off-reservation trust land areas) 

and statistical tribal areas: https://www.bia.gov/tribal-leaders-directory. 

3

 Small Area Income and Poverty Estimates (SAIPE), 2017. 

4

 Local Area Unemployment Statistics (LAUS), 2017. 

5

 Contract Health Service Delivery Areas (CHSDA). 

6

 CDC bridged-race population estimates, 2017. 

7

 Program Performance Report (PPR) data. 

8

 Calculated using 2018 PPR and 2018 n4a Title VI Program Survey. Review Appendix B (Methods) for details. 

9

 n4a Title VI Program Survey. 

10 As reported in the evaluation grantees’ Title VI grant applications.

11 Proxy of Census poverty threshold for individuals > 65 years old: https://www.census.gov/library/publications/2020/demo/p60-270.html. 

12 Medicare, Medicaid, Veterans Affairs. 

13 Indian Health Service, Alaska Native Health Organization, Indian Health/Tribal Insurance. 

14 Calculations not available in the Elder Needs Assessment Aggregate Tribal Data Report. 

15 “Moderate,” “Moderately severe,” or “Severe.”

16 Meal inadequacy responses “yes” to at least one of the following: “I eat fewer than 2 meals

per day,” “I eat few fruits or vegetables or milk products,” and “I have 3 or more drinks of beer, liquor, or wine almost every day.”

17 Health affecting nutrition responses “yes” to at least one of the following: “I have an illness or condition that made me change the kind 

and/or amount of food I eat,” “I have tooth or mouth problems that make it hard for me to eat,” “Without wanting to, I have lost or gained 10 

pound in the last 6 months,” and “I am not always physically able to shop, cook, and/or feed myself.”

18 General health fair or poor. 

19 Supportive services include home repair/modification, legal assistance, personal care, and senior center programs.
6

Table 2. Title VI Evaluation Quantitative Analysis: Statistical Testing Phase Results—

Elders’ Service Use

ELDERS’ CHARACTERISTICS

ELDERS’ SERVICE USE

Any Title VI Services Congregate Meals Services Home-Delivered Meals Services Supportive Services

Elders Using Elders Not Using Elders Using Elders Not Using Elders Using Elders Not Using Elders Using Elders Not Using

% Older Elders (> 70 years old) 58.01 37.6 59.52 43.8 59.33 41.0 57.84 40.3

% Low Income Elders (< 

$15,000 individual) 30.21 23.1 44.32 23.7 26.5 25.6 27.1 25.2

% Elders with Live Alone 28.3 28.0 27.0 28.2 26.1 28.7 27.8 28.3

% Elders with Have Family 

Caregiver 34.61 24.5 47.42 26.1 31.7 27.2 32.0 26.7

% Elders that are Primary 

Caregiver of Child(ren) 6.6 7.4 3.5 7.5 7.8 6.9 6.7 7.2

% Elders with any 

Hospitalization in the Past Year 26.11 19.5 37.62 20.2 21.4 22.2 25.1 20.7

% Elders with any Falls in the 

Past Year 44.81 38.3 61.22 38.4 38.5 41.4 42.0 40.2

% Elders with any Activity of 

Daily Living (ADL)

38.81 30.3 59.62 30.6 29.2 34.7 36.0 32.5

% Elders with any Instrumental 

Activity of Daily Living (IADL)

46.11 37.7 72.92 37.2 35.03 42.5 42.6 40.1

% Elders with Nutritional

Inadequacy 42.61 35.0 51.72 36.2 43.83 36.0 40.7 36.3

% Elders with Eating Alone 27.71 19.2 28.0 21.7 27.73 20.6 27.24 20.4

% Elders with Health Conditions

Affecting Nutrition 51.41 38.5 65.32 40.8 43.4 43.2 50.24 40.5
7

ELDERS’ CHARACTERISTICS

ELDERS’ SERVICE USE

Any Title VI Services Congregate Meals Services Home-Delivered Meals Services Supportive Services 

Elders Using Elders Not Using Elders Using Elders Not Using Elders Using Elders Not Using Elders Using Elders Not Using 

% Elders with Income Affecting 

Nutrition 16.1 12.1 20.32 12.8 12.8 13.8 16.3 12.4 

% Elders with Feel Unhealthy 36.31 29.1 53.42 29.3 31.0 32.0 32.9 31.3 

% Elders with Feel Mostly 

Happy in the Past Month 81.7 82.3 69.82 82.8 85.4 80.2 84.3 80.3 

% Elders with Feel Mostly Upset 

in the Past Month 7.8 7.3 10.4 7.1 7.4 7.5 7.6 7.4 

% Elders with Participate in 

Cultural Practices 78.81 64.8 63.6 70.7 83.43 65.8 85.24 64.0

% Elders with Socialize at Least 

Once a Month 84.7 82.3 70.32 84.6 89.83 81.1 90.34 80.3 

Average Number of Individual 

Hospitalizations in the Past Year 0.9

1 1.2 1.02 1.1 0.83 1.2 0.84 1.2 

Average Number of Individual 

Falls in the Past Year 1.01 1.1 1.2

2 1.0 0.93 1.1 0.94 1.1 

Average Number of Individual 

ADLs 0.661 0.69 0.82 0.7 0.63 0.7 0.64 0.7 

Average Number of Individual 

IADLs 0.861 0.88 1.02 0.9 0.83 0.9 0.84 0.9 

Average Number of 

Socializations per Month 9.61 7.2 6.52 8.3 10.93 7.3 10.44 7.2 

1

 Difference between elders using any Title VI services and elders not using any Title VI services was statistically significant (p < .05). 

2

 Difference between elders using congregate meal services and elders not using congregate meal services was statistically significant (p < .05). 

3

 Difference between elders using home-delivered meal services and elders not using home-delivered meal services was statistically significant (p < .05). 

4

 Difference between elders using supportive services and elders not using supportive services was statistically significant (p < .05).
8

Table 3. Title VI Evaluation Quantitative Analysis: Statistical Testing Phase Results—Grantee 

Level of Service Provision

ELDERS’ CHARACTERISTICS

GRANTEE LEVEL OF SERVICE PROVISION AMONG ALL ELDERS1 GRANTEE LEVEL OF SERVICE PROVISION AMONG ELDERS USING SERVICES2

Overall High 

Service Provision 

Grantees (HSPG)3

Congregate Meals 

HSPG

Home-Delivered 

Meals HSPG

Supportive 

Services HSPG Overall HSPG Congregate Meals HSPG

Home-Delivered 

Meals HSPG

Supportive 

Services HSPG

Elders 

From 

HSPG

Elders 

Not

From 

HSPG

Elders 

From 

HSPG

Elders 

Not

From 

HSPG

Elders 

From 

HSPG

Elders 

Not

From 

HSPG

Elders 

From 

HSPG

Elders 

Not

From 

HSPG

Elders 

From 

HSPG

Elders 

Not

From 

HSPG

Elders 

From 

HSPG

Elders 

Not

From 

HSPG

Elders 

From 

HSPG

Elders 

Not

From 

HSPG

Elders 

From 

HSPG

Elders 

Not

From 

HSPG

% Older Elders (> 70 years old) 53.24 39.0 51.95 36.7 51.06 40.0 35.17 58.3 65.68 46.1 66.2 51.0 60.0 58.5 36.4 67.1

% Low Income Elders (< 

$15,000 individual) 25.5 26.0 29.95 20.1 20.86 28.5 27.9 22.9 23.38 40.8 45.9 42.2 37.0 54.0 37.99 22.3

% Elders with Live Alone 27.0 29.1 28.6 27.4 23.0 28.3 25.9 29.7 27.2 30.1 24.2 30.6 27.1 24.5 28.6 27.4

% Elders with Have a Family 

Caregiver 29.6 27.1 30.1 25.7 32.66 25.8 28.1 28.4 32.4 38.0 45.5 50.0 53.3 43.4 31.8 29.6

% Elders that are Primary 

Caregiver of Child(ren) 6.2 7.8 7.7 6.2 5.4 8.4 6.5 7.8 6.6 6.6 3.0 4.0 1.7 5.7 6.1 7.0

% Elders with any 

Hospitalization in the Past Year 22.8 21.3 22.6 21.16 25.66 20.2 21.5 22.6 25.9 26.4 37.9 37.3 45.0 31.5 33.79 21.4

% Elders with any Falls in the 

Past Year 38.54 43.3 39.6 42.2 35.36 45.5 42.8 38.1 40.4

8 51.8 60.0 62.8 53.310 71.7 58.29 35.1

% Elders with any Activity of 

Daily Living (ADL)

31.6 34.9 34.1 32.5 31.8 35.2 35.97 30.3 34.28 45.9 65.2 51.9 60.0 58.2 50.59 29.6

% Elders with any Instrumental 

Activity of Daily Living (IADL)

41.1 40.5 41.9 39.2 41.9 40.4 45.77 34.4 41.58 52.9 77.3 67.3 78.3 69.1 63.49 33.5
9

ELDERS’ CHARACTERISTICS

GRANTEE LEVEL OF SERVICE PROVISION AMONG ALL ELDERS1 GRANTEE LEVEL OF SERVICE PROVISION AMONG ELDERS USING SERVICES2

Overall High 

Service Provision 

Grantees (HSPG)3

Congregate Meals 

HSPG 

Home-Delivered 

Meals HSPG 

Supportive 

Services HSPG Overall HSPG Congregate Meals HSPG 

Home-Delivered 

Meals HSPG 

Supportive 

Services HSPG 

Elders 

From 

HSPG 

Elders 

Not

From 

HSPG 

Elders 

From 

HSPG 

Elders 

Not

From 

HSPG 

Elders 

From 

HSPG 

Elders 

Not

From 

HSPG 

Elders 

From 

HSPG 

Elders 

Not

From 

HSPG 

Elders 

From 

HSPG 

Elders 

Not

From 

HSPG 

Elders 

From 

HSPG 

Elders 

Not

From 

HSPG 

Elders 

From 

HSPG 

Elders 

Not

From 

HSPG 

Elders 

From 

HSPG 

Elders 

Not

From 

HSPG 

% Elders with Nutritional 

Inadequacy 36.2 39.1 38.7 36.6 35.2 39.1 34.87 41.7 42.3 42.9 54.6 48.1 48.3 52.7 39.6 42.6 

% Elders with Eating Alone 24.1 20.9 23.4 20.8 24.4 20.9 19.17 26.5 30.4 23.5 24.2 32.7 30.0 25.5 23.8 28.7 

% Elders with Health Conditions 

Affecting Nutrition 44.9 41.9 43.7 42.6 47.86 39.9 40.8 46.4 50.4 52.9 63.6 67.3 73.3 58.2 63.79 43.5 

% Elders with Income Affecting 

Nutrition 15.2 12.2 15.45 10.9 13.0 12.6 14.6 12.2 15.0 17.7 21.2 19.2 21.7 16.4 24.89 12.6 

% Elders with Feel Unhealthy 28.64 34.3 29.7 24.6 30.0 34.0 31.2 32.5 31.98 42.9 50.0 57.7 46.7 61.8 36.3 31.3 

% Elders with Feel Mostly 

Happy in the Past Month 85.04 78.5 85.35 76.2 85.46 77.9 78.47 85.4 85.4

8 76.1 78.811 58.0 73.3 66.0 77.29 87.4 

% Elders with Feel Mostly Upset 

in the Past Month 7.4 7.5 7.3 7.7 5.9 8.5 107 4.2 7.3 8.4 12.3 8.0 13.8 7.4 12.09 5.7 

% Elders with Participate in 

Cultural Practices 86.24 56.7 79.65 56.8 80.26 57.6 67.17 63.7 90.0

8 61.8 63.6 63.5 73.310 52.7 83.2 86.1 

% Elders with Socialize at Least 

Once a Month 92.64 75.6 89.3 74.8 89.76 75.7 81.7 85.1 94.28 70.0 77.3 61.5 78.310 60.0 86.1 92.2 

Average Number of Individual 

Hospitalizations in the Past Year 0.8

4 1.3 0.85 1.5 0.76 1.4 1.37 0.8 0.78 1.1 0.811 1.2 0.610 1.2 1.29 0.7 
10

ELDERS’ CHARACTERISTICS

GRANTEE LEVEL OF SERVICE PROVISION AMONG ALL ELDERS1 GRANTEE LEVEL OF SERVICE PROVISION AMONG ELDERS USING SERVICES2

Overall High 

Service Provision 

Grantees (HSPG)3

Congregate Meals 

HSPG 

Home-Delivered 

Meals HSPG 

Supportive 

Services HSPG Overall HSPG Congregate Meals HSPG 

Home-Delivered 

Meals HSPG 

Supportive 

Services HSPG 

Elders 

From 

HSPG 

Elders 

Not

From 

HSPG 

Elders 

From 

HSPG 

Elders 

Not

From 

HSPG 

Elders 

From 

HSPG 

Elders 

Not

From 

HSPG 

Elders 

From 

HSPG 

Elders 

Not

From 

HSPG 

Elders 

From 

HSPG 

Elders 

Not

From 

HSPG 

Elders 

From 

HSPG 

Elders 

Not

From 

HSPG 

Elders 

From 

HSPG 

Elders 

Not

From 

HSPG 

Elders 

From 

HSPG 

Elders 

Not

From 

HSPG 

Average Number of Individual 

Falls in the Past Year 0.84 1.3 0.9

5 1.3 0.86 1.3 1.27 0.9 0.88 1.3 0.911 1.6 0.810 1.3 1.19 0.9 

Average Number of Individual 

ADLs 0.6

4 0.8 0.65 0.7 0.66 0.7 0.7 0.7 0.58 0.8 0.711 0.8 0.610 0.9 0.79 0.6 

Average Number of Individual 

IADLs 0.84 0.9 0.855 0.9 0.856 0.9 0.97 0.8 0.8

8 1.0 0.911 1.1 0.810 1.0 1.09 0.8 

Average Number of 

Socializations per Month 10.94 5.8 10.0

5 5.5 9.86 6.1 6.2 10.7 12.28 5.7 8.211 4.4 12.210 6.7 5.69 12.5 

1

 Test compared elders from HSPGs with elders not from HSPGs, regardless of Title VI service use. 

2

 Test was performed between elders using Title VI services from HSPGs and elders using Title VI services not from HSPGs. 

3

 Level of service provision was based on comprehensiveness of services provided by grantees, detailed in Appendix B.

4

 Difference statistically significant (p < .05) between elders from overall HSPGs and elders not from overall HSPGs, regardless of whether the elder used the service or not. 

5 Difference statistically significant (p < .05) between elders from HSPGs for congregate meals and elders not from HSPGs for congregate meals, regardless of whether the elder used the service or not. 

6

 Difference statistically significant (p < .05) between elders from HSPGs for home-delivered meals and elders not from HSPGs for home-delivered meals, regardless of whether the elder used the service or not. 

7

 Difference statistically significant (p < .05) between elders from HSPGs for supportive services and elders not from HSPGs for supportive services, regardless of whether the elder used the service or not. 

8

 Difference statistically significant (p < .05) between elders from overall HSPGs and elders not from overall HSPGs that are using any Title VI Service. 

9

 Difference statistically significant (p < .05) between elders from HSPGs for supportive services and elders NOT from HSPGs for supportive that are using supportive services.

10 Difference statistically significant (p < .05) between elders from HSPGs for home-delivered meals and elders not from HSPGs for home-delivered meals that are using home-delivered meals services. 

11 Difference statistically significant (p < .05) between elders from HSPGs for congregate meals and elders not from HSPGs for congregate meals that are using home-delivered meals services. 
11

Table 4. Title VI Evaluation Quantitative Analysis: Inferential Analysis Phase Results 

ELDERS’ OUTCOMES

GRANTEES’ SERVICE PROVISION LEVEL1 ELDERS’ USE OF TITLE VI SERVICES2

Overall High 

Service 

Provision 

Grantee (HSPG)3

Congregate 

Meals HSPG 

Home-Delivered 

Meals HSPG 

Supportive 

Services HSPG 

Using Any Title 

VI Services 

Using 

Congregate 

Meal Services 

Using HomeDelivered Meal 

Services 

Using 

Supportive 

Services 

 (Parameter Estimate)4

Number of Elders 

Reporting any 

Hospitalizations in 

the Past Year 

0.0914 N/A5 N/A 0.0686 N/A 0.1255 N/A N/A 

Average Number of 

Individual 

Hospitalizations in 

the Past Year 

-0.0703 -0.2788 0.0964 0.0877 -0.0351 -0.0326 -0.0259 -0.0328 

Number of Elders 

Reporting any Falls in 

the Past Year 

N/A N/A -0.2438 0.1900 0.1008 0.2172 N/A N/A 

Average Number of 

Individual Falls in the 

Past Year 

-0.5439 -0.2974 -1.2436 0.0654 N/A 0.1435 -0.0229 N/A 

Number of Elders 

Reporting Feeling 

Unhealthy 

-0.1238 N/A -0.2466 N/A 0.0315 0.2351 N/A N/A 

Number of Elders 

Reporting Feeling 

Mostly Upset in the 

Past Month 

0.0838 N/A N/A 0.0527 N/A N/A N/A N/A 

Number of Elders 

Reporting Feeling 

Mostly Happy in the 

Past Month 

N/A 0.0859 0.1083 N/A N/A -0.14316 N/A N/A 
12

ELDERS’ OUTCOMES

GRANTEES’ SERVICE PROVISION LEVEL1 ELDERS’ USE OF TITLE VI SERVICES2

Overall High 

Service 

Provision 

Grantee (HSPG)3

Congregate 

Meals HSPG 

Home-Delivered 

Meals HSPG 

Supportive 

Services HSPG 

Using Any Title 

VI Services 

Using 

Congregate 

Meal Services 

Using HomeDelivered Meal 

Services 

Using 

Supportive 

Services 

 (Parameter Estimate)4

Number of Elders 

Reporting 

Participating in 

Cultural Practices 

0.2628 0.1181 N/A 0.1331 0.0694 N/A 0.078 0.1327 

Number of Elders 

Reporting Socializing 

at Least Once a 

Month 

0.1998 0.1036 0.1992 0.0747 N/A -0.1444 N/A 0.0581 

Average 

Socializations per 

Month 

0.1383 0.2490 -0.2535 -2.3997 0.0936 -0.5086 0.8451 0.6082 

Number of Elders 

Reporting Nutritional 

Inadequacy 

-0.1406 N/A -0.2036 -0.1242 0.0887 0.1778 0.0829 0.6149 

Number of Elders 

Reporting Eating 

Alone 

N/A N/A N/A N/A 0.0639 N/A N/A N/A 

Number of Elders 

Reporting Health 

Conditions Affecting 

Nutrition 

N/A N/A N/A N/A 0.1211 0.2492 N/A 0.0814 

1

 Categories of grantee service provision are not mutually exclusive. 

2

 Categories of elders’ use of Title VI services are not mutually exclusive.

3 Based on a comprehensive assessment of evaluation grantee’s level of service provision, detailed in Appendix B. 

4  (parameter estimate) is the value in the regression equation for predicting the dependent variable (elders’ outcomes) from the independent variable (grantees’ service 

provision level or elders’ use of Title VI service). Where the  is presented in the table, the test of the relationship was statistically significant (p < .05; df = 1). Measure of 

prediction was controlled for by county poverty rate, rurality, and grantee percentage of elders more than 70 years old. 

5

 N/A = Not statistically significant (p > .05). 
APPENDIX C

TITLE VI STAKEHOLDER 

ENGAGEMENT ACTIVITY TABLE
1

Table C1. Title VI Evaluation Stakeholder Engagement and Technical Assistance Activities 

2017 2018 2019 2020 2021

Engagement Activity Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1

Steering Committee 

Webinars & Calls X X X X X X 

Steering Committee 

E-letters X X X X X X 

Evaluation Grantee 

Quarterly Calls X X X X X X X X X X X 

In-Person Site Visits X X 

Evaluation Working 

Group (EWG) 

Webinars 

X X X X X X 

EWG In-Person 

Meetings X X X X

*

All Title VI Trainings 

& Webinars X X X X X 

*

The 2020 EWG in-person meeting was converted to a virtual meeting due to the COVID-19 pandemic.
2

Steering Committee webinars and calls were an opportunity to share evaluation 

updates as well as to gather insight and guidance from stakeholders on evaluation 

activities, including data collection and participant recruitment. 

Steering Committee e-letters provided evaluation updates, such as emerging themes 

from data collection along with opportunities for stakeholders to provide input and 

recommendations on evaluation activities.

Evaluation grantee quarterly calls were an opportunity to further understand grantees’ 

evolving evaluation capacity and questions about local program evaluation as well as to 

provide tailored technical assistance.

In-person site visits were an opportunity to continue to build relationships with 

grantees, understand the cultural context of Title VI programs and the populations they 

serve, and provide intensive training and technical assistance to build evaluation 

capacity.

EWG webinars were designed to build familiarity, understanding, and capacity for 

evaluation at the local program level, with trainings on topics including incorporating 

evaluation into local programming.

EWG in-person meetings provided an opportunity to continue to build collaborative 

relationships with the evaluation grantees as well as offer interactive and hands-on 

learning on a variety of evaluation topics, including how to use evaluation for program 

monitoring and improvement.

All Title VI trainings and webinars were an opportunity to build the evaluation capacity 

of all Title VI program grantees and their partners in the aging community.