Contract No.: CSD-AOA01-S-06-00068-000 

MPR Reference No.: 6309N 

Results from the 

Administration on 

Aging’s Third National 

Survey of Older 

Americans Act Program 

Participants 

Final Report 

March 12, 2008 

Jody Beauchamp 

Lisa Trebino 

Submitted to: Submitted by: 

Social & Scientific Systems, Inc. Mathematica Policy Research, Inc. 

12th Fl., 8757 Georgia Ave. 600 Maryland Ave., SW, Suite 550 

Silver Spring, MD 20910 Washington, DC 20024-2512 

U.S. Department of Health and Human Services Telephone: (202) 484-9220 

Administration on Aging Facsimile: (202) 863-1763 

Project Officer: Project Director: 

Gary Moore Jody Beauchamp 
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Chapter Page 

 EXECUTIVE SUMMARY......................................................................................... xiii 

I INTRODUCTION...........................................................................................................1 

A. OVERVIEW OF THE IMPORTANCE OF SERVICES PROVIDED BY
 

THE OLDER AMERICANS ACT PROGRAMS...................................................1 

B. ADMINISTRATION ON AGING PROGRAMS AND SERVICES......................3 

C. AoA PERFORMANCE MEASURES.....................................................................5 

D. PURPOSE AND OVERVIEW OF THIS REPORT................................................6 

II DESCRIPTION OF THE THIRD NATIONAL SURVEY ............................................9 

III DEMOGRAPHIC, SOCIOECONOMIC, AND HEALTH 

CHARACTERISTICS OF OAA TITLE III CLIENTS ................................................11 

A. OAA PROGRAM PARTICIPANTS ARE AMONG THE OLDEST OLD .........12 

B. OAA PROGRAM PARTICIPANTS ARE MUCH MORE LIKELY THAN 

OTHER OLDER AMERICANS TO BE FEMALE..............................................14 

C. OAA PROGRAMS ARE WELL-TARGETED TO AFRICANAMERICANS BUT SLIGHTLY LESS SO TO HISPANICS AND OTHER 

MINORITY GROUPS...........................................................................................16 

D. THE FRACTION OF OAA CLIENTS LIVING IN RURAL AREAS IS 

HIGHER THAN THAT OF OTHER OLDER ADULTS IN THE UNITED 

STATES.................................................................................................................18 

E. OAA HOME-DELIVERED-MEALS CLIENTS AND TRANSPORTATION 

SERVICES CLIENTS ARE MUCH MORE LIKELY THAN OTHER 

OLDER AMERICANS TO LIVE ALONE...........................................................19 

F. OAA PROGRAM PARTICIPANTS ARE MORE LIKELY THAN 

OTHERS IN THEIR AGE GROUP TO BE WIDOWED AND LESS 

LIKELY TO BE MARRIED .................................................................................21 

iii 

CONTENTS 
CONTENTS (continued) 

Chapter Page 

 III (continued) 

G. OAA PROGRAM PARTICIPANTS TEND TO HAVE LOWER LEVELS 

OF EDUCATIONAL ATTAINMENT THAN DO OTHER PEOPLE THEIR 

AGE .......................................................................................................................23 

H. OAA PROGRAM PARTICIPANTS ARE MORE LIKELY THAN OTHER 

OLDER AMERICANS TO BE LOWER INCOME .............................................24 

I. OAA PROGRAM PARTICIPANTS ARE LESS HEALTHY THAN 

OTHER OLDER AMERICANS ...........................................................................26 

J. OAA PARTICIPANTS HAVE HIGH RATES OF DIAGNOSED HEALTH 

CONDITIONS .......................................................................................................28 

K. OAA PARTICIPANTS WERE MORE LIKELY THAN OTHER OLDER 

AMERICANS TO HAVE TROUBLE WITH PHYSICAL FUNCTIONING......31 

IV THE OAA HOME-DELIVERED MEALS PROGRAM..............................................37 

A. USE OF THE OAA HOME-DELIVERED MEALS SERVICE...........................37 

B. IMPACT OF THE OAA HOME-DELIVERED MEALS SERVICE ...................40 

C. CLIENT-REPORTED SERVICE QUALITY IN THE OAA HOMEDELIVERED MEALS SERVICE.........................................................................43 

V THE OAA TRANSPORTATION SERVICES PROGRAM ........................................45 

A. ABILITY TO DRIVE AND ACCESS TO OTHER TRANSPORTATION 

AMONG OAA TRANSPORTATION SERVICES CLIENTS.............................45 

B. USE OF THE OAA TRANSPORTATION SERVICES PROGRAM..................47 

C. IMPACT OF THE OAA TRANSPORTATION SERVICES PROGRAM ..........51 

D. CLIENT-REPORTED SERVICE QUALITY IN OAA 

TRANSPORTATION SERVICES........................................................................53 

iv 
CONTENTS (continued) 

Chapter Page 

VI OAA CAREGIVER SUPPORT SERVICES................................................................57 

A. CHARACTERISTICS OF OAA CARE RECIPIENTS........................................57 

B. CHARACTERISTICS OF OAA CAREGIVERS .................................................64 

C. EMPLOYMENT AMONG OAA CAREGIVERS................................................66 

D. THE BURDENS AND REWARDS OF CAREGIVING AS REPORTED BY 

OAA CAREGIVER SUPPORT CLIENTS...........................................................69 

E. AMOUNT OF CARE PROVIDED BY THE OAA CAREGIVERS....................73 

F. USE OF THE OAA CAREGIVER SUPPORT SERVICES PROGRAM ............77 

G. IMPACT OF THE OF THE OAA CAREGIVER SUPPORT SERVICES 

PROGRAM............................................................................................................79 

H. CLIENT-REPORTED SERVICE QUALITY IN OAA CAREGIVER 

SUPPORT SERVICES ..........................................................................................80 

VII CONCLUSIONS AND RECOMMENDATIONS........................................................85 

 REFERENCES..............................................................................................................89
 

APPENDIX A ADMINISTRATION ON AGING PERFORMANCE 

MEASURES AND RELEVANT QUESTIONS FROM THE 

THIRD NATIONAL SURVEY .......................................................A.1 

APPENDIX B BRIEF DESCRIPTION OF THE HEALTH AND 

RETIREMENT STUDY ..................................................................B.1 

APPENDIX C THIRD NATIONAL SURVEY VARIABLE NAMES, 

DESCRIPTIONS, AND QUESTION TEXT...................................C.1 

v 
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TABLES 

Table Page 

I.1 AOA SERVICE REGIONS AND STATES IN EACH REGION .............................2 

I.2 NUMBER OF CLIENTS SERVED AND AMOUNT SPENT ON 

SELECTED OAA TITLE III PROGRAMS, 2005.....................................................4 

vii 
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FIGURES 

Figure Page 

I.1 MAP OF AOA SERVICE REGIONS ........................................................................2 

III.1 AGE DISTRIBUTION OF OAA PROGRAM PARTICIPANTS 

COMPARED TO THE U.S. 60+ POPULATION IN 2005, BY SERVICE 

CATEGORY.............................................................................................................13 

III.2 GENDER OF OAA PROGRAM PARTICIPANTS COMPARED TO THE 

U.S. 60+ POPULATION IN 2005, BY SERVICE CATEGORY............................15 

III.3 RACIAL COMPOSITION OF OAA PROGRAM PARTICIPANTS 

COMPARED TO THE U.S. 60+ POPULATION IN 2005, BY SERVICE 

CATEGORY.............................................................................................................16 

III.4 FRACTION OF OAA PROGRAM PARTICIPANTS LIVING IN RURAL 

AREAS IN 2005, BY SERVICE CATEGORY .......................................................19 

III.5 FRACTION OF OAA PROGRAM PARTICIPANTS COMPARED TO 

THE U.S. 60+ POPULATION WHO REPORTED LIVING ALONE IN 

2005, BY SERVICE CATEGORY...........................................................................21 

III.6 MARITAL STATUS OF OAA PROGRAM PARTICIPANTS 

COMPARED TO THE U.S. 60+ POPULATION IN 2005, BY SERVICE 

CATEGORY.............................................................................................................22 

III.7 HIGHEST EDUCATIONAL ATTAINMENT OF OAA PROGRAM 

PARTICIPANTS COMPARED TO THE U.S. 60+ POPULATION IN 

2005, BY SERVICE CATEGORY...........................................................................24 

III.8 ANNUAL HOUSEHOLD INCOME OF OAA PROGRAM 

PARTICIPANTS COMPARED TO THE U.S. 60+ POPULATION IN 

2005, BY SERVICE CATEGORY...........................................................................25 

III.9 SELF-REPORTED HEALTH STATUS OF OAA PROGRAM 

PARTICIPANTS COMPARED TO THE U.S. 60+ POPULATION IN 

2005, BY SERVICE CATEGORY...........................................................................27 

III.10 SELECTED HEALTH CONDITIONS AMONG OAA PROGRAM 

PARTICIPANTS COMPARED TO THE U.S. 60+ POPULATION IN 

2005, BY SERVICE CATEGORY...........................................................................29 

III.11 NUMBER OF REPORTED HEALTH CONDITIONS AMONG OAA 

PROGRAM PARTICIPANTS IN 2005, BY SERVICE CATEGORY ...................30 

ix 
FIGURES (continued) 

Figure Page 

III.12 REPORTED DIFFICULTIES WITH ACTIVITIES OF DAILY LIVING 

AMONG OAA PROGRAM PARTICIPANTS COMPARED TO THE U.S. 

60+ POPULATION IN 2005, BY SERVICE CATEGORY....................................32 

III.13 NUMBER OF DIFFICULTIES WITH ACTIVITIES OF DAILY LIVING 

AMONG OAA PROGRAM PARTICIPANTS AND US 60+ 

POPULATION .........................................................................................................33 

III.14 PRESENCE OF EARLY AND LATE ONSET ADL DIFFICULTIES 

AMONG OAA PROGRAM PARTICIPANTS COMPARED TO THE U.S. 

60+ POPULATION ..................................................................................................34 

III.15 REPORTED DIFFICULTIES WITH INSTRUMENTAL ACTIVITIES OF 

DAILY LIVING AMONG OAA PROGRAM PARTICIPANTS IN 2005, 

BY SERVICE CATEGORY.....................................................................................36 

IV.1 NUMBER OF DAYS PER WEEK CLIENTS RECEIVE ONE OR MORE 

HOME-DELIVERED MEALS ................................................................................38 

IV.2 AVERAGE NUMBER OF DAYS PER WEEK THAT CLIENTS 

RECEIVED ONE OR MORE HOME-DELIVERED MEALS, BY AoA 

REGION ...................................................................................................................39 

IV.3 TYPES OF FOODS USUALLY EATEN BY HOME-DELIVERED 

MEALS CLIENTS....................................................................................................40 

IV.4 PROPORTION OF DAILY FOOD THAT HOME-DELIVERED MEALS 

REPRESENT ............................................................................................................41 

IV.5 HOME-DELIVERED MEALS HELP CLIENTS TO.............................................42 

IV.6 OVERALL CLIENT-REPORTED SERVICE QUALITY IN THE HOMEDELIVERED MEALS..............................................................................................43 

IV.7 OTHER MEASURES OF SERVICE QUALITY WITH THE HOMEDELIVERED MEALS SERVICE............................................................................44 

V.1 ABILITY TO DRIVE AND ACCESS TO AN AUTOMOBILE AMONG 

TRANSPORTATION SERVICES CLIENTS .........................................................46 

V.2 NUMBER OF ONE-WAY TRIPS USED PER MONTH BY
 

TRANSPORTATION SERVICES CLIENTS .........................................................48 

x 
FIGURES (continued) 

Figure Page 

V.3 FRACTION OF CLIENT’S TRIPS REPRESENTED BY THE 

TRANSPORTATION SERVICE .............................................................................49 

V.4 TRANSPORTATION SERVICE USE BY THE TRANSPORTATION 

DISADVANTAGED ................................................................................................50 

V.5 USUAL DESTINATION WHEN USING THE TRANSPORTATION 

SERVICE..................................................................................................................51 

V.6 WHETHER THE TRANSPORTATION SERVICE ALLOWS THE 

CLIENT TO GET TO THEIR USUAL DESTINATION MORE OFTEN..............52 

V.7 OVERALL CLIENT-REPORTED SERVICE QUALITY IN THE 

TRANSPORTATION SERVICE .............................................................................53 

V.8 OTHER MEASURES OF SERVICE QUALITY IN THE 

TRANSPORTATION SERVICE .............................................................................54 

VI.1 AGE DISTRIBUTION OF THE CARE RECIPIENTS ...........................................58 

VI.2 GENDER OF CAREGIVER AND CARE RECIPIENT..........................................59 

VI.3 SUBJECTIVE HEALTH STATUS OF CARE RECIPIENTS, AS 

REPORTED BY THEIR CAREGIVER...................................................................59 

VI.4 MOST COMMON HEALTH CONDITIONS AMONG CARE 

RECIPIENTS, AS REPORTED BY THEIR CAREGIVER....................................61 

VI.5 NUMBER OF HEALTH PROBLEMS AMONG CARE RECIPIENTS.................62 

VI.6 REPORTED DIFFICULTIES WITH ACTIVITIES OF DAILY LIVING 

AMONG CARE RECIPIENTS, AS REPORTED BY THEIR CAREGIVER ........63 

VI.7 NUMBER OF REPORTED DIFFICULTIES WITH ACTIVITIES OF 

DAILY LIVING AMONG CARE RECIPIENTS, AS REPORTED BY 

THEIR CAREGIVER...............................................................................................64 

VI.8 RELATIONSHIP OF CAREGIVER TO THE CARE RECIPIENT........................65 

VI.9 TYPES OF ACTIVITIES WITH WHICH CAREGIVERS ASSIST.......................66 

VI.10 EMPLOYMENT STATUS OF CAREGIVERS, BY GENDER.............................67 

VI.11 EFFECTS OF CAREGIVING ON EMPLOYMENT ..............................................69 

xi 
FIGURES (continued) 

Figure Page 

VI.12 PERCENT OF CAREGIVERS REPORTING THAT CAREGIVING 

CREATED THEIR HEALTH PROBLEMS OR MADE PROBLEMS 

WORSE, BY TYPE OF PROBLEM........................................................................70 

VI.13 BIGGEST HARDSHIPS OF CAREGIVING (3 MOST COMMON 

RESPONSES)...........................................................................................................71 

VI.14 AVERAGE RATINGS OF COMMON BURDENS OF CAREGIVING................72 

VI.15 BIGGEST REWARDS OF CAREGIVING (3 MOST COMMON 

RESPONSES)...........................................................................................................73 

VI.16 DISTANCE THAT CAREGIVER LIVES FROM CARE RECIPIENT .................74 

VI.17 NUMBER OF HOURS OF CARE NEEDED BY CARE RECIPIENTS PER 

DAY..........................................................................................................................75
 

VI.18 HOURS OF CARE PER DAY GIVEN BY CAREGIVERS TO CARE 

RECIPIENTS, WEEKDAYS AND WEEKEND DAYS .........................................76 

VI.19 HOURS OF CARE PER WEEK PROVIDED BY CAREGIVERS TO 

CARE RECIPIENTS, BY EMPLOYMENT STATUS OF CAREGIVERS............77 

VI.20 SERVICES USED BY CAREGIVERS ...................................................................78 

VI.21 THE EFFECTS OF CAREGIVER SUPPORT SERVICES ON THE DAILY 

LIFE OF CAREGIVERS..........................................................................................79 

VI.22 OVERALL CLIENT-REPORTED SERVICE QUALITY IN CAREGIVER 

SUPPORT SERVICES .............................................................................................81 

VI.23 OVERALL REPORTED EASE OF GETTING CAREGIVER SUPPORT 

SERVICES................................................................................................................82 

VI.24 PERCENT OF CLIENTS WHO REPORTED HELPFULNESS OF 

CAREGIVER SUPPORT SERVICES .....................................................................83 

xii 
EXECUTIVE SUMMARY 

The Administration on Aging (AoA) strives to improve the quality of life for older 

Americans, in part by providing services to the most vulnerable elderly that allow them to 

maintain their independence and avoid institutionalization. To understand how the services it 

provides affect clients, the AoA began to survey participants in its Older Americans Act (OAA) 

Title III programs in 2003, covering a range of services and performance measures. The purpose 

of these surveys is to gauge the use, service quality, and impact of selected services funded by 

the OAA. This report documents findings from the Third National Survey of Program 

Participants conducted in 2005 of a representative sample of OAA clients, covering homedelivered meals, transportation services, and caregiver support services programs. 

Tabulations from the Third National Survey indicated that OAA programs tended to serve 

clients who were more vulnerable than the overall population of older Americans. Compared to 

a nationally representative sample of people age 60 and over in the United States, OAA homedelivered meals and transportation recipients were older and therefore more likely to be female 

and to live alone, but less likely to be married. OAA clients in these areas were also less 

educated, had lower incomes, were in worse health, and had worse physical functioning than 

other older Americans. Caregivers served by OAA were younger and less vulnerable than other 

OAA service recipients, but those they cared for were quite frail. Altogether, survey results 

indicated that OAA-supported home-delivered meals, transportation services, and caregiver 

support programs directly or indirectly provide services to those who might otherwise have been 

institutionalized or isolated, and assisted the frail and vulnerable elderly in maintaining their 

independence. 

The Third National Survey found that home-delivered meals, transportation, and caregiver 

services funded by the OAA were very well-liked by program participants. The AoA recently 

established new performance measures, to be effective in 2008, which seek to achieve at least 90 

percent of participants reporting service quality to be good, very good, or excellent. In the 2005 

Third National Survey, 94 percent of home-delivered meals clients, 98 percent of transportation 

services clients, and 94 percent of caregivers reported their satisfaction to be good, very good, or 

excellent. Client-reported service quality in specific aspects of each program was also quite 

high, indicating that the programs responded well to the needs of clients. 

Finally, results from the Third National Survey indicated that OAA-funded services had a 

meaningful impact on the lives of clients. Ninety-three percent of home-delivered meals clients 

reported that the meals allowed them to continue to live in their own home, and 8 out of 10 said 

the service allowed them to eat a greater variety of food, eat healthier food, feel better, and feel 

less hungry. Nearly half of transportation services recipients (43 percent) relied on the service 

for almost all of their rides, and used the rides to go to medical appointments, run errands, and 

attend social events. Among caregivers, 54 percent said that receiving OAA-funded caregiver 

support services enabled the care recipient to live at home for a longer period of time. These 

impacts on the lives of clients show that the AoA is making substantial progress towards its 

mission and goal of providing needed support to allow vulnerable older adults to continue living 

in the community. 

xiii 
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I. INTRODUCTION 

A. OVERVIEW OF THE IMPORTANCE OF SERVICES PROVIDED BY THE OLDER 

AMERICANS ACT PROGRAMS 

Over the past three decades, state and federal policymakers have made concerted efforts to 

develop services and supports that allow older adults and those with disabilities to continue to 

live in the community. Programs such as Medicaid home and community-based services 

(HCBS) 1915c waivers and the Program of All-Inclusive Care for the Elderly (PACE) allow 

individuals who are eligible for nursing home level of care to continue living outside of 

institutional settings. Due to consumer preferences and legal decisions affirming the right of 

people with disabilities to live in their home or community settings, many states have begun to 

rebalance their long-term care systems towards community-based options. The Deficit 

Reduction Act of 2005 authorized the large-scale demonstration program, Money Follows the 

Person, to allow Medicaid funding that would normally be spent on nursing facility care to 

“follow the person” as he or she transitions out of institutions and into community life. 

Since its inception in 1965, the Older Americans Act (OAA), administered by the 

Administration on Aging (AoA), has provided funding for a variety of home and communitybased services to support aging individuals who want to remain in their homes or communities 

when disability or frailty occurs. These services are provided through the Aging Services 

Network, which consists of national organizations, 56 State Units on Aging, 655 Area Agencies 

on Aging (AAA), more than 240 tribal organizations, 29,000 community service provider 

organizations, and 500,000 senior volunteers (“U.S. Administration on Aging, Strategic Action 

Plan, 2007-2012,” Department of Health and Human Services, 2007).1 

The Strategic Action Plan can be accessed online at www.aoa.gov/about/strategic/ 

AoA%20Strategic%20Action%20Plan%202007-2012.pdf 

1 

1
The AoA is organized into regions, with the AoA office providing oversight and a regional 

office providing assistance to the AAAs and other organizations located in the states within its 

region (Figure I.1 and Table I.1). The geographic proximity and common demographics within 

each region may be useful for comparing the effectiveness and outcomes of AoA programs and 

services across the country. 

FIGURE I.1 

MAP OF AOA SERVICE REGIONS 

AoA Regions 

(Number of States) 

Region I (6) 

Regions II and III (8) 

Region IV (8) 

Region V (6) 

Region VI (5) 

Region VII (4) 

Region VIII (6) 

Region IX (4) 

Region X (4) 

2 
 

 

 

TABLE I.1 

AOA SERVICE REGIONS AND STATES IN EACH REGION 

Region States 

I Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island, and Vermont 

II and III2 New York, New Jersey, Puerto Rico, U.S. Virgin Islands, District of Columbia, Delaware, 

Maryland, Pennsylvania, Virginia, and West Virginia 

IV Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and 

Tennessee 

V Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin 

VI Arkansas, Louisiana, Oklahoma, New Mexico, and Texas 

VII Iowa, Kansas, Missouri, and Nebraska 

VIII Colorado, Montana, Utah, Wyoming, North Dakota, and South Dakota 

IX California, Nevada, Arizona, Hawaii, Guam, Mariana Islands, and American Samoa 

X Alaska, Idaho, Oregon, and Washington 

Source: AoA web page, www.aoa.gov/prof/aoaprog/nutrition/program_anniv/contact.asp. 

B. ADMINISTRATION ON AGING PROGRAMS AND SERVICES 

The Older Americans Act has funding streams for each of its program categories, or “titles.” 

Title III of the Older Americans Act funds most of the community-based services and supports to 

older Americans and their caregivers. For example, Title III-B funds access services 

(transportation, case management, and information and referral), in-home services (personal 

care, chore and homemaker assistance), and community services (adult day care and physical 

fitness programs). Title III-C2 funds home-delivered meals and related services to seniors who 

are homebound due to illness, disability, or geographic isolation. Support to caregivers of people 

ages 60 and older are funded under Title III-E.3 

2 While technically two regions, Regions II and III work together from an operational standpoint. 

3

 OAA also authorized caregiver support services to be provided to those over 60 who care for dependents 

under age 60, such as grandchildren or children with disabilities. 

3 
 

 

 

 

Although OAA Title III expenditures are small relative to the much larger sums spent by 

other federal programs for the elderly, such as Social Security, Medicare, and Medicaid, a large 

amount of services are provided to clients, particularly to those who are most frail and 

vulnerable. (Table I.2). Moreover, the services funded by OAA make a critical difference in the 

lives of older adults, frequently allowing them to continue to live on their own rather than enter 

institutions. For example: 

• More than 900,000 clients received approximately 140 million home-delivered meals 

in 2005, or approximately 150 meals per client annually. 

• More than 31 million one-way rides were funded in 2005. 

• 70,000 caregivers received OAA respite services in 2005, and each client received 

more than 100 hours of assistance on average. 

TABLE I.2 

NUMBER OF CLIENTS SERVED AND AMOUNT SPENT ON SELECTED 

OAA TITLE III PROGRAMS, 2005 

Service Units (FY 2005)a Clients (FY 2005) 

Title III Expenditures 

(FY 2005) 

Home-delivered meals 139,850,916 meals 938,463 $196,789,118 

Transportation services 31,332,847 rides — $67,595,431 

Caregiver-Counseling/ 

Support Groups/Training 583,790 sessions 157,128 $24,754,411 

Caregiver-Respite 7,563,110 hours 69,876 $114,282,396 

Caregiver- Access Assistance 988,696 contacts 283,461 $38,202,614 

Caregiver-Supplemental 971,714 units 40,658 $31,979,561 

Source:	 Home-delivered meals and transportation data found in the Fiscal Year 2005 U.S. Profile of OAA 

Programs (http://aoa.gov/PROF/agingnet/NAPIS/SPR/2005SPR/Profiles/us.pdf). AoA staff provided the 

caregiver support services data. 

a The guidelines to states for filling out the AoA State Program Reports indicate the definition of a unit for each 

service. Supplemental caregiver services are defined to be “services provided on a limited basis to complement the 

care provided by caregivers. Examples of supplemental services include, but are not limited to, home modifications, 

assistive technologies, emergency response systems, and incontinence supplies.” 

4 
 

C. AoA PERFORMANCE MEASURES 

In addition to measuring the number of clients served and dollar amounts spent, the AoA 

monitors other measures of performance that indicate the efficiency and quality of service 

delivery and the effectiveness of its programs in serving the most vulnerable populations. 

Performance measures are used to comply with the Government Performance Results Act 

(GPRA) of 1993 and to rate the agency’s performance in the Office on Management and 

Budget’s Program Assessment Rating Tool (PART) process. AoA has three performance 

measures: (1) improve efficiency, (2) improve client outcomes, and (3) effectively target services 

to vulnerable populations. Each of these measures has multiple performance indicators. For 

home and community-based services: 

• Efficiency indicators assess how many services are provided and at what cost, 

expressed as the number of clients served per million dollars of funds spent. 

• Client outcomes indicators include consumer-assessed service quality and how 

effective the services are in keeping elders in their homes. 

• Effective targeting indicators assess the program’s ability to serve those who are 

vulnerable, such as minorities, people with disabilities, and those who are poor or live 

in rural areas, even if these clients are harder to reach and could reduce the number of 

clients served overall (“Justification of Estimates for Appropriations Committees, 

Administration on Aging, Fiscal Year 2008,” Department of Health and Human 

Services, 2007).4 

AoA’s strategy to demonstrating improved program performance is to show evidence of 

improved efficiency, improved client outcomes, improved targeting, and maintenance of high 

service quality. 

4

 The 2008 Congressional Budget Justification notes that “...in an effort to improve efficiency and quality, 

entities could attempt to focus their efforts toward individuals who are easy to serve and easy to please. Instead, the 

targeting measure gauges AoA’s effectiveness in ensuring those receiving services are the most needy as envisioned 

by the OAA.” This document can be found online at: http://www.aoa.gov/about/legbudg/current_budg/docs/ 

AoA%20FY%202008%20CJ%20Final.pdf. 

5 
 

 

D. PURPOSE AND OVERVIEW OF THIS REPORT 

In 2005, the AoA conducted the Third National Survey of OAA Programs (henceforth, the 

Third National Survey) to assess how well it was improving client outcomes and targeting 

vulnerable clients. The survey (1) identified the quantity used of selected Title III program 

services by individual clients, (2) gauged the impact of service use on the lives of clients with a 

particular emphasis on the ability to maintain community living, and (3) assessed client-reported 

service quality. 

The Third National Survey is one of a number of data sources that the AoA uses to assess 

the effectiveness and impact of the programs and services it funds. Other data sources include 

the National Ombudsman Reporting System (NORS), State Program Reports (SPR), and the 

Performance Outcomes Measures Project (POMP). The Third National Survey, however, is the 

only data source that provides direct feedback to AoA from clients who receive OAA-funded 

services; it therefore provides uniquely valuable information about the extent to which the AoA 

is meeting its goals. Appendix A includes the agency’s performance measures that may be 

evaluated using data from the Third National Survey. 

This report documents findings from the Third National Survey that reflect individuals in 

home-delivered meals programs as well as those who receive transportation services and 

caregiver support services. More specifically, the report covers the following: 

• The survey and the sampling methodology (Chapter II) 

• A comparison of clients served by OAA programs in the three service categories— 

home-delivered meals, transportation services, and caregiver support services—to the 

entire elderly population in the United States (Chapter III)5 

5

 To make this comparison, we used the U.S. Census and other nationally representative survey data from the 

Health and Retirement Study, or HRS (see Appendix B for an overview of the data set). 

6 
• For each service, the quantity used by clients, the service quality reported by clients, 

clients for whom the service is most beneficial, and the impact of service use on client 

well-being (Chapters IV, V, and VI) 

• Overall themes that emerged from our analysis of the Third National Survey 

regarding the performance of AoA services vis-à-vis AoA goals (Chapter VII) 

7 
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II. DESCRIPTION OF THE THIRD NATIONAL SURVEY 

The Third National Survey follows two earlier surveys of OAA program participants. While 

the content and objectives of the three surveys are similar, the sample for the third is much larger, 

and some of the questions were revised. Because of the differences in question wording and 

sample sizes, the Third National Survey is the first that is suitable for a comprehensive analysis 

of OAA services and program participants. 

The survey was conducted by telephone between April 17 and June 25 of 2005 using 

computer-assisted telephone interviewing (CATI) technology.6

 A two-stage sample design was 

used, in which a sample of Area Agencies on Aging (AAA) were selected first, followed by a 

second stage selection of clients within each sampled AAA. In all, 310 AAAs of 649 total 

agencies were selected in the first stage, with a response rate of 88 percent. The 40 AAAs with 

the largest budgets were included in the sample, and the remainder were selected independently 

within strata based on agency budget size. 

For each AAA in the sample, clients were randomly sampled by service type (homedelivered meals, transportation, and caregiver services). The number of clients selected from 

each AAA was proportional to the number of clients served in that particular category by that 

agency. The “cooperation rate” was 82 percent.7 This report examines responses from 

participants in the following three survey samples: 

6 Westat (2007) provided information about the sampling methods and response and completion rates. All of 

the analyses conducted for this report use survey sampling weights calculated by Westat, which permit an estimation 

of program effects on all OAA clients in these service categories, rather than only those interviewed in the survey. 

7

 The cooperation rate was calculated by Westat (2007) as the sum of those who completed the interview plus 

those who were ineligible for survey participation divided by the sum of those people plus people who refused to 

complete the interview. 

9 
• 2,323 clients of home-delivered meals programs, who were asked about the number 

of meals received and consumed, the quality and taste of the food, and overall service 

quality. 

• 2,520 clients receiving transportation services, who were asked about the quantity of 

rides used, their destination when using the service, and about a variety of other 

topics regarding the timeliness and responsiveness of program staff to client needs. 

• 1,075 caregivers, who were asked about the care recipient and their caregiving role, 

the type and the amount of support they received from OAA programs, the impact of 

such support on their ability to provide quality care, and the recipient’s ability to 

continue to live in the community. While the caregiver is the direct beneficiary of 

OAA services, the characteristics of the care recipient are important determinants of 

the burden of caregiving. 

Data from and documentation of the Third National Survey and other AoA data sources are 

available on the new interactive AGing Interactive Database (AGID) at data.aoa.gov. The data 

used in this report were primarily taken from that website; Appendix C contains specific 

measures including variable label, question text, and the unweighted and weighted number of 

valid responses (i.e., responses provided by respondents that were not “don’t know” or “refuse to 

answer”) used in the analysis in this report. 

10 
 

 

III. DEMOGRAPHIC, SOCIOECONOMIC, AND HEALTH 

CHARACTERISTICS OF OAA TITLE III CLIENTS8
 

The AoA strives to serve vulnerable older adults, including people with disabilities, those 

who live in rural regions, and those who have low income (U.S. Department of Health and 

Human Services, 2007). Individuals in poor health or having a large number of limitations in 

functioning are also particularly vulnerable, as any new health problem may necessitate a move 

from one’s home. These vulnerable populations often have trouble accessing services. 

This chapter describes the demographic, socioeconomic, and health characteristics of the 

clients served by OAA home-delivered meals, transportation services, and caregiver support 

services, and compares them to the entire American population over age 60. These comparisons 

highlight that the characteristics of OAA clients vary quite a bit by the type of service they 

receive. For example, home-delivered meals and transportation services clients appear 

vulnerable in almost every way when compared to the American population over the age of 60— 

they tend to be older, have lower educational attainment and income, and be in poorer health 

than other elderly Americans. On the other hand, caregivers who receive support services from 

OAA look less vulnerable than other service recipients, but that is in large part due to program 

design; caregivers often assist people who are among the most vulnerable, even if they 

themselves are not. Indeed, unlike other OAA service recipients, caregivers are often under the 

age of 60 because they are assisting those who are older. Thus, along with highlighting the 

relative vulnerability of many OAA program participants, another intention of this chapter is to 

highlight the differences between caregivers and other OAA service recipients. Chapter VI will 

8

 Throughout the report, percentages are rounded to the nearest percent. This means that summed percentages 

that do not add to 100 percent are due to rounding. 

11 
 

look more closely at the vulnerability of the people that are assisted by OAA-supported 

caregivers. 

A. OAA PROGRAM PARTICIPANTS ARE AMONG THE OLDEST OLD 

In 2005, 16.8 percent of the nation’s population was age 60 or older.9 According to the U.S. 

Census, 26 percent of these individuals were ages 60 to 64, 37 percent were 65 to 74, 26 percent 

were 75 to 84, and 10 percent were ages 85 and older. Clients served by OAA home-delivered 

meals and transportation services programs were older on average than the American elderly 

population over the age of 60, as OAA clients tended to be among the oldest old (Figure III.1). 

Clients receiving home-delivered meals and transportation services were twice as likely as 

other older Americans to be 75 and older. Seven of 10 of these clients who were at least age 60 

were age 75 and older, compared to 36 percent at comparable ages in the U.S. population. 

Clients of home-delivered meals programs were slightly more likely to be younger than clients 

receiving transportation services. 

OAA caregivers were younger than clients receiving home-delivered meals and 

transportation services, reflecting the fact that caregivers are frequently children of care 

recipients and also differences in eligibility for Title III-E programs versus other OAA Title III 

programs. Caregiver support services can be provided for those under age 60 if they care for 

people age 60 and older, so it is not surprising that 41.5 percent of caregivers were younger than 

60. Despite this programmatic difference, a large fraction of caregivers are still among the oldest 

old; 24.0 percent were age 75 or older. The large proportion of caregivers at older ages means 

that many caregivers may themselves have health problems and frailty that accompany aging. 

9

 U.S. Census Bureau, Census 2006 Estimates (data for 2005). 

12 
 

 

 

 

 

FIGURE III.1
 

AGE DISTRIBUTION OF OAA PROGRAM PARTICIPANTS COMPARED TO THE U.S. 60+ POPULATION10 

IN 2005, BY SERVICE CATEGORY11 

0.0 

26.1 

37.5 

26.2 

10.2 

1.5 

5.3 

23.2 

40.3 

29.8 

0.1 

4.2 

27.8 

44.2 

23.8 

41.5 

11.9 

22.7 

19.8 

4.2 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

Under age 60 60 to 64 65 to 74 75 to 84 85 or older 

US Pop. 60+ Home-delivered meals Transportation Caregivers 

Source:	 Tabulations for the U.S. population provided by AoA staff based on data from the U.S. Census Bureau, 

Census 2006 Estimates (which includes data from 2000-2005). Data on OAA program participants from 

the Third National Survey of OAA Program Participants, 2005. 

The greater proportion of OAA program participants in older age groups relative to the 

national distribution of the population age 60 and older may explain many other differences 

between the socioeconomic and health characteristics of OAA participants and the overall 

population of older adults (discussed below). For example, as individuals age, they often 

experience changes in marital status after a spouse dies, living arrangements, wealth, and health. 

10 Note that the age distribution is only among the 60+ population so as to make the age ranges comparable to 

those served by OAA programs. Caregivers are often younger than 60 because the person they are caring for is over 

age 60, and therefore the caregiver is eligible for OAA caregiver support services. 

11 While OAA home-delivered meals and transportation services programs usually serve the population ages 60 

and older, some respondents to the survey report being under age 60. Some of this is likely reporting error, but may 

also be attributable to individuals who are spouses of someone 60 and older (and are therefore eligible for Title III 

services) or adults with disabilities living in affordable housing where congregate meals are offered. 

13 
Hence, an older sample would be less likely than a younger one to be married, even though the 

two groups might have the same proportion of married individuals if observed at the same age. 

Similarly, the higher average age of OAA participants may explain why OAA home-delivered 

meals participants appear to be less healthy than all Americans over age 60. Differences 

between OAA participants and the overall population age 60 and older may also be due to cohort 

effects; that is, the educational attainment and income of younger cohorts are generally higher 

that in older cohorts. Hence, the large proportion of OAA caregivers younger than 60 likely 

explains part of why they reported having a higher level of education than did the population 

over age 60. 

Without a multivariate analysis that controls for age, we cannot know how much of the 

difference between OAA participants and the national population older than 60 is due to 

differences in the age distribution of the two populations. This is not to say that the differences 

between OAA participants and others are solely due to age differences, nor that OAA 

participants are not a very vulnerable population, regardless of their age. Rather, these caveats 

simply note that direct comparisons of the characteristics of OAA participants to other groups 

must be interpreted cautiously. 

B. OAA PROGRAM PARTICIPANTS ARE MUCH MORE LIKELY THAN OTHER 

OLDER AMERICANS TO BE FEMALE 

Because men have a shorter life expectancy than women, older populations are 

disproportionately female. Nationwide, among those age 60 and older, there are 130 women to 

every 100 men, implying that the population is 57 percent female (Figure III.2). Compared to 

the U.S. elderly population, clients of OAA services were much more likely to be female. 

The majority of clients in all three OAA service categories were female. Seventy-one 

percent of clients receiving home-delivered meals were female, corresponding to a female-to14 
 

 

 

male ratio of 244 women to every 100 men. Eighty-four percent of clients receiving 

transportation services were female (a female-to-male ratio of 506 to 100) and 76 percent of 

caregivers were female (a sex ratio of 312 females to 100 males). These sex ratios are about two 

to four times higher than the female-to-male ratio in the U.S. population age 60 and older. The 

larger fraction of females in the transportation and home-delivered meals samples is likely a 

result of the fact that the sample population is old relative to the general population; women are 

more likely to be caregivers than men, which explains the high percentage in the OAA client 

group. 

FIGURE III.2
 

GENDER OF OAA PROGRAM PARTICIPANTS COMPARED TO THE U.S. 60+ POPULATION12 IN 2005, 

BY SERVICE CATEGORY 

43.4 

56.6 

29.1 

70.9 

16.5 

83.5 

24.3 

75.7 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

Male	 Female 

US Pop. 60+ Home-delivered meals Transportation Caregivers 

Source:	 Tabulations for the U.S. population provided by AoA staff based on data from the U.S. Census Bureau, 

Census 2006 Estimates (which includes data from 2000-2005). Data on OAA program participants from 

the Third National Survey of OAA Program Participants, 2005. 

12 Estimates from the U.S. Census. 

15 
 

 

 

 

C. OAA PROGRAMS ARE WELL-TARGETED TO AFRICAN-AMERICANS BUT 

SLIGHTLY LESS SO TO HISPANICS 

The racial composition of OAA clients is roughly comparable to the racial composition of 

older adult population in the United States. Most OAA service clients were Caucasian (82 

percent of home-delivered-meals clients, 80 percent of transportation services clients, and 87 

percent of caregivers). Statistics from 2005 for the U.S. population indicate that 81 percent of 

individuals age 60 and older are white or Caucasian (Figure III.3). 

FIGURE III.3
 

RACIAL COMPOSITION OF OAA PROGRAM PARTICIPANTS COMPARED TO THE U.S. 60+ 

POPULATION IN 2005, BY SERVICE CATEGORY13
 

80.6 

8.5 6.6 

0.5 

3.2 

15.6 

4.7 3.5 

0.7 0.4 

80.2 

18.0 

5.8 

1.9 1.0 0.1 

86.7 

10.2 

3.5 

0.5 

3.0 

0.0 

82.4 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

White/Caucasian Black/African American Hispanic American Indian or Asian Native Hawaiian or 

Alaskan other Pacific Islander 

US Pop. 60+ Home-delivered meals Transportation Caregivers 

Source:	 Tabulations for the U.S. population provided by AoA staff based on data from the U.S. Census Bureau, 

Census 2006 Estimates (which includes data from 2000-2005). Data on OAA program participants from 

the Third National Survey of OAA Program Participants, 2005. 

13 Respondents were allowed to indicate more than one race; therefore, totals may sum to more than 100%. 

Native Hawaiian/Other Pacific Islander not reported because none of the samples had more than 0.5 percent in that 

category. Also, this category was not included in the Census data. 

16 
 

 

 

Although the majority of service clients were white, a sizeable fraction are in minority 

groups. Sixteen percent of home-delivered-meals clients, 18 percent of transportation services 

clients, and 10 percent of caregivers were African-American. By comparison, 9 percent of those 

age 60 and older in the U.S. in 2005 were African-American. The relatively larger proportion of 

OAA clients who are African American compared to the overall elderly population in the U.S. 

implies that OAA home-delivered meals and transportation services are well-targeted to AfricanAmericans. 

Compared to 7 percent of the U.S. population age 60 and older that was Hispanic in 2005, 5 

percent of those who receive home-delivered meals, 6 percent of those who receive 

transportation services, and 4 percent of caregivers were Hispanic. Therefore, the proportion of 

Hispanic clients served by OAA programs is about comparable to the proportion among all older 

Americans, but is slightly lower than the overall population age 60 and older. This difference in 

participation rates among African-Americans and Hispanics compared to overall population 

proportions suggests that one possible goal for future targeting may be to increase the focus on 

Hispanic clients, who may have a difficult time accessing services due to cultural or linguistic 

barriers.14 Hispanic clients served by OAA programs tend to be younger than other racial and 

ethnic groups (not shown), which means that as demographics change and recent Hispanic 

immigrants get older and more frail, there will be additional opportunities for AoA to target its 

services towards Hispanic populations. 15 

14 The Third National Survey was conducted in English and Spanish and attention was paid to facilitating 

interviews with Hispanic clients, so the smaller Hispanic population in the survey compared to the U.S. elderly 

population does not appear to be due to the language in which the survey was conducted. While the margin of error 

from the survey data does not rule out the fact that the proportion of the sample that is Hispanic is the same as in the 

U.S. elderly population, it also does not indicate that the proportion would be as much above the population 

proportion as was the case for African-Americans (either in absolute or percentage terms). 

15 Indeed, AoA recently announced a new partnership with the Alliance for Hispanic Health and Latino 

Communities to maximize the effectiveness of community interventions to improve the quality of life for older 

Hispanics. 

17 
 

 

 

 

The share of minority clients among OAA service clients varies in ways that are generally 

consistent with the racial composition of AoA regions (not shown). Regions IV, VI, and VII, 

which comprise states in the South, had the highest proportion of clients that were AfricanAmerican. Regions II, VI, and IX, which comprise New York, Texas, and southwestern states 

including California, had clients that were most likely to be Hispanic. 

D. THE FRACTION OF OAA CLIENTS LIVING IN RURAL AREAS IS HIGHER 

THAN THAT OF OTHER OLDER ADULTS IN THE UNITED STATES 

Despite the movement of the nation’s population toward cities and metropolitan areas, 

almost one-quarter of the population age 60 and over still lived in a rural area in 2005.16 People 

in rural areas often have a harder time obtaining social services, as they live further from 

administrative offices, senior centers, and other supports; moreover, they are often otherwise 

disadvantaged. Because of these difficulties, older adults living in rural areas are often more 

vulnerable, which is why the AoA has made a commitment to increase the proportion of rural 

clients served (Indicator 3.3, Appendix A). 

OAA program participants were much more likely to live in rural areas than the overall U.S. 

population age 60 and older.17 In fact, home-delivered meals and transportation services clients 

were more than twice as likely to live in a rural area than other older Americans. 56 percent of 

clients who received home-delivered meals and 55 percent of those who received transportation 

16 Estimates from the 2000 Census indicated that 22.6% of the 60+ population lived in a rural area in 2005 

(provided from AoA staff based on data from the American FactFinder system). Calculations from the 2005 

American Community Survey (ACS) indicated that this percentage was slightly higher, 24.4%. 

17 The percentage rural reported here used the definition of urban/rural adopted in the 2000 Census. This 

definition counts people who do not live in an unrbanized cluster or an urbanized area as rural residents. This differs 

from another commonly used measure to define rural residence, which relies on metropolitan statistical areas 

(MSAs). Unlike the MSA definition, the new urbanized definition identifies areas within MSAs that may not be 

urbanized. For this reason, the fraction rural is much higher under the urbanized definition than it is under the MSA 

definition for OAA program participants. For example, using the MSA definition, 35.7 percent of home-delivered 

meals clients, 37.2 percent of transportation services clients, and 25.8 percent of caregivers would be categorized as 

rural. However, in all of these cases, the percentage rural would still be higher than that in the overall elderly 

population using a similar definition of rural residence. 

18 
 

 

services lived in rural areas. Caregivers were slightly less likely to live in rural areas than other 

service recipients (45 percent lived in rural areas), but this is still a much higher fraction than in 

the U.S. population overall. These percentages indicate that OAA services are well-targeted to 

rural residents who might otherwise not have access to similar services. 

FIGURE III.4
 

FRACTION OF OAA PROGRAM PARTICIPANTS LIVING IN RURAL AREAS IN 2005,
 

BY SERVICE CATEGORY 

24.4 

56.05 55.24 

44.95 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

US Pop. 60+ Home-delivered meals Transportation Caregivers 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

E. OAA HOME-DELIVERED MEALS CLIENTS AND TRANSPORTATION 

SERVICES CLIENTS ARE MUCH MORE LIKELY THAN OTHER OLDER 

AMERICANS TO LIVE ALONE 

Older adults who live alone may be vulnerable to deteriorating health or institutionalization, 

especially if family and friends do not live nearby. These people may have difficulty getting to 

medical appointments and social gatherings if they are not able to drive themselves. Nationally, 

19 
 

26 percent of those age 60 and older in 2004 reported living alone.18 The fraction of OAA 

transportation services and home-delivered-meals clients living alone was substantially higher 

than in the national population, reflecting at least in part, the older average age of the sample 

(Figure III.5). 

According to the Third National Survey, 61 percent of home-delivered meals clients, 

reported living alone, as did 65 percent of transportation services clients. Reflecting the different 

focus of the caregiver support program compared to other services asked about in the survey, 

only 18 percent of caregivers lived alone. Among care recipients, 71 percent lived with their 

caregiver; of the remaining 29 percent who did not live in the same house as their caregiver, 61 

percent lived alone. Thus, even though the caregivers themselves were not generally vulnerable 

to the isolation associated with living alone, those that they cared for were. Females served by 

Title III programs were more likely to live alone than males (not shown); 38 to 50 percent of 

male program clients of home-delivered meals or transportation services reported living alone, 

compared to about two thirds (65 to 70 percent) of female clients. 

18 Calculations from the 2004 HRS, weighted to produce population estimates. Among those 65 and older 

population in 2004 (from the 2006 statistical profile on the AoA webpage): 30.1 percent of the non-institutionalized 

elderly lived alone, 38.4 percent of elderly women and 19.2 percent of elderly men. 

20 
 

 

FIGURE III.5
 

FRACTION OF OAA PROGRAM PARTICIPANTS COMPARED TO THE U.S. 60+ POPULATION WHO 

REPORTED LIVING ALONE IN 2005, BY SERVICE CATEGORY19
 

26.2 

60.7 

65.0 

17.7 17.4 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

US Pop. 60+ Home-delivered Transportation Caregivers Care recipients 

meals 

Source:	 Tabulations for the U.S. population from the 2004 Health and Retirement Study. Data on OAA program 

participants from the Third National Survey of OAA Program Participants, 2005. 

F. OAA PROGRAM PARTICIPANTS ARE MORE LIKELY THAN OTHERS IN 

THEIR AGE GROUP TO BE WIDOWED AND LESS LIKELY TO BE MARRIED 

As people age, especially women, they are more likely to become widowed. One-quarter of 

the U.S. population in 2004 age 60 and older was widowed. However, among those who are not 

widowed, most (62 percent) are married or partnered, another 10 percent are divorced or 

separated, and 3 percent were never married. Rates of widowhood were much higher among 

19 For home-delivered meals clients, transportation services clients, and caregivers, living alone was assessed 

from a question asking how many other people the participant lived with. For care recipients, the caregiver was first 

asked if he/she lived in the same house as care recipient. If not, an additional question of whether the care recipient 

lived alone was asked. 

21 
 

clients receiving home-delivered meals and transportation services than in the elderly population 

overall (Figure III.6). 

Among home-delivered meals clients, 24 percent were still married at the time of the survey, 

but the majority was either widowed (56 percent), or divorced or separated (14 percent). Six 

percent of clients were never married. Among transportation services clients, 17 percent were 

married, 60 percent were widowed, 16 percent were divorced or separated, and 8 percent had 

never married. 

FIGURE III.6
 

MARITAL STATUS OF OAA PROGRAM PARTICIPANTS COMPARED TO THE U.S. 60+ POPULATION IN
 

2005, BY SERVICE CATEGORY
 

61.5 

25.2 

9.3 

1.0 3.1 

24.2 

55.8 

12.6 

1.8 

5.6 

16.9 

59.6 

13.9 

2.1 

7.6 

73.2 

5.6 

11.4 

2.0 

7.9 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

Married Widowed Divorced Separated Never married 

US Pop. 60+ Home-delivered meals Transportation Caregivers 

Source:	 Tabulations for the U.S. population from the 2004 Health and Retirement Study. Data on OAA program 

participants from the Third National Survey of OAA Program Participants, 2005. 

The percentage of caregivers who were married was higher than the share among homedelivered meals and transportation services clients, and also higher than the share among the 

national elderly population. This finding reflects the fact the population of caregivers is younger 

22 
than these other groups and possibly that married individuals are more likely than unmarried 

individuals to assume caregiving responsibilities. Seventy-three percent of caregivers were 

married, only 6 percent were widowed, 13 percent were divorced or separated, and 8 percent had 

never married. 

G. OAA PROGRAM PARTICIPANTS TEND TO HAVE LOWER LEVELS OF 

EDUCATIONAL ATTAINMENT THAN DO OTHER PEOPLE THEIR AGE 

Home-delivered meals and transportation services clients had much lower levels of 

education than other people their age. Forty-one percent of home-delivered meals and 36 

percent of transportation services clients did not receive a high school diploma (Figure III.7). In 

the U.S. population ages 60 and older, 23 percent completed fewer than twelve years of 

schooling. At the other end of the spectrum, 21 percent of the U.S. population over 60 had a 

bachelor’s degree or higher, compared to 9 percent of home-delivered meals clients and 8 

percent of transportation services clients. Low levels of education are often associated with 

lower income and wealth, along with poorer health, so these less-educated OAA clients may be 

among the most vulnerable. 

Caregivers were more educated than home-delivered meals and transportation services 

clients. In part, this likely reflects cohort-related differences in educational attainment, as the 

caregiver sample was significantly younger than the other samples. Higher education levels 

among caregivers also points to the possibility that those with higher education may be better be 

able to take on the financial and emotional responsibilities that come with caregiving. The 

highest level of schooling completed was less than high school for 9 percent of caregivers and 

high school only for 29 percent. About 37 percent have some college education, or a trade or 

professional school education. Fully one-quarter have a college degree or more (12 percent have 

a bachelor’s degree, and 13 percent have more than a bachelor’s degree). 

23 
 

 

 

 

 

FIGURE III.7
 

HIGHEST EDUCATIONAL ATTAINMENT OF OAA PROGRAM
 

PARTICIPANTS COMPARED TO THE U.S. 60+ POPULATION IN 2005, BY SERVICE CATEGORY 

23.2 

35.9 

20.0 

12.5 

8.4 

40.7 

30.6 

20.2 

3.8 4.8 

35.6 34.9 

21.6 

4.1 3.9 

9.4 

28.5 

36.8 

12.1 13.1 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

Less than high school High school diploma or GED Some college Bachelor's degree More than bachelor's degree 

US Pop. 60+ Home-delivered meals Transportation Caregivers 

Source:	 Tabulations for the U.S. population provided by AoA staff using data on the highest educational 

attainment among the civilian non-institutionalized population from the U.S. Census Bureau Current 

Population Survey, 2005 Annual Social and Economic Supplement. Data on OAA program participants 

from the Third National Survey of OAA Program Participants, 2005. 

H. OAA PROGRAM PARTICIPANTS ARE MORE LIKELY THAN OTHER OLDER 

AMERICANS TO BE LOWER INCOME20 

It is likely that the low level of educational attainment among home-delivered meals and 

transportation services clients is partially responsible for the fact that most of these OAA clients 

had a very low household income. Most OAA clients lived in households with an income of less 

than $15,000 per year; two-thirds of home-delivered meals and transportation services clients fell 

into this range (Figure III.8). By comparison, 24 percent of households nationwide had an annual 

income of less than or equal to $15,000. Only about one-quarter of home-delivered meals and 

20 While the survey collected information that would allow for the calculation of poverty thresholds, these data 

were not available on the AoA AGID system at the time this report was written. Therefore, comparisons of 

household income are made as proxies to poverty status. 

24 
 

 

transportation services clients had annual household incomes between $15,001 and $30,000, 

about the same as in the older population overall (27 percent). 

Compared with the U.S. population age 60 and older, far fewer OAA participants were in 

the upper end of the income distribution. Twenty percent of older people nationwide have an 

annual household income of $30,001 to $50,000, and another 29 percent earn over $50,000 per 

year. Because the rates of living alone were much higher among OAA program participants than 

in the national population, it is difficult to compare the household income of the two groups 

without also considering the number of people in the household, as both the income earned and 

the amount necessary to support multiple household members will be different than supporting 

only one. 

FIGURE III.8
 

ANNUAL HOUSEHOLD INCOME OF OAA PROGRAM
 

PARTICIPANTS COMPARED TO THE U.S. 60+ POPULATION IN 2005, BY SERVICE CATEGORY Percent 

100 

90 

80 

70 

60 

50 

40 

30 

20 

10 

0 

11.2 12.4 

10.1 

17.1 

19.9 

29.4 

40.6 

26.1 

14.3 13.1 

4.2 

1.7 

41.5 

26.1 

12.7 13.6 

4.3 

1.9

4.3 

8.3 

12.4 

26.0 

23.6 25.4 

$10,000 or less $10,001 to $15,000 $15,001 to $20,000 $20,001 to $30,000 $30,001 to $50,000 $50,001 or more 

US Pop. 60+ Home-delivered meals Transportation Caregivers 

Source:	 Tabulations for the U.S. population provided by AoA staff based on 2005 total household income data 

from the U.S. Census Bureau, Current Population Survey, 2006 Annual Social and Economic Supplement. 

Data on OAA program participants from the Third National Survey of OAA Program Participants, 2005. 

25 
 

Caregivers had a much higher income than did other service clients, which reflects the fact 

that the former are not only younger but also that they have higher educational attainment and 

possibly the time and financial means to care for another person. Seventy-five percent of 

caregivers had an annual household income of $20,000 or more (Figure III.8). Despite having a 

relatively high income level on average, one-quarter of caregivers had an annual household 

income of $20,000 or less, and another quarter lived in households that had annual income 

between $20,001 and $30,000. Thus, while caregivers are in relatively better financial shape 

than other OAA program participants, a significant proportion is financially vulnerable. 

Furthermore, caregivers may also have the added financial burden supporting another person, 

meaning that their income might go partly to another person not residing in the household (which 

would not be reflected by these statistics). 

I. OAA PROGRAM PARTICIPANTS ARE LESS HEALTHY THAN OTHER OLDER 

AMERICANS 

As people age, their health declines due to adverse health events and worsening of health 

conditions, meaning that average self-rated health also begins to decline. Among those age 60 

and older in 2004, 10 percent said they were in excellent health; 28 percent, in very good health; 

32.6 percent, in good health; 20 percent, in fair health; and 9 percent said they were in poor 

health. OAA program participants, especially those receiving home-delivered meals, were not as 

healthy overall, compared with the older population nationwide (Figure III.9). 

26 
 

FIGURE III.9
 

SELF-REPORTED HEALTH STATUS OF OAA PROGRAM
 

PARTICIPANTS COMPARED TO THE U.S. 60+ POPULATION IN 2005, BY SERVICE CATEGORY 

10.1 

28.1 

32.6 

20.4 

8.8 

4.6 

10.8 

27.2 28.7 28.7 

5.6 

18.1 

30.7 29.3 

16.4 

12.1 

24.3 

35.4 

22.2 

5.9 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

Excellent Very good Good Fair Poor 

US Pop. 60+ Home-delivered meals Transportation Caregivers 

Source: Tabulations for the U.S. population from the 2004 Health and Retirement Study. Data on OAA program 

participants from the Third National Survey of OAA Program Participants, 2005. 

Very few home-delivered meals or transportation clients reported being in excellent or very 

good health. Only about 5 percent in both groups said their health was excellent; 11 percent of 

clients receiving home-delivered meals and 18 percent receiving transportation services said 

their health was very good. About one in three said their health was good, and one-quarter said 

their health was fair (29 percent). The remainder of clients reported being in poor health (29 

percent of home-delivered meals and 16 percent of transportation clients). The average selfrated health level among these groups (where 1 indicated poor health and 5, excellent health) was 

2.37 for clients receiving home-delivered meals and 2.69 for those receiving transportation 

services. The average for individuals age 60 and older nationwide was 3.1. 

Compared with clients receiving other OAA services, caregivers were healthier, reflecting 

their younger age and perhaps their higher socioeconomic status. Over one-third (36 percent) of 

27 
caregivers reported being in excellent or very good health, and another third (35 percent) said 

they were in good health. However, 22 percent said their health was only fair, and another 6 

percent reported being in poor health. The average self-rated health among caregivers was 3.1, 

the same as the average in the population nationwide. Although many of the caregivers were 

younger than other OAA participants (and therefore under 60), the distribution of health among 

caregivers was similar to that of the over-60 population across the nation. Since health declines 

with age, the fact that the health of caregivers is the same on average as an older group of 

Americans suggests that caregivers might be in relatively poor health for their age. 

J. OAA PARTICIPANTS HAVE HIGH RATES OF DIAGNOSED HEALTH 

CONDITIONS 

The poor self-rated health of OAA program participants provides a summary measure of 

their overall health status and functioning. In addition to being asked about their general health, 

clients were also asked whether they had any specific health conditions diagnosed by a doctor. 

Of the long list of diagnosed conditions that participants were asked about, 10 were cited by at 

least 25 percent of those receiving home-delivered meals and transportation services 

(Figure III.10). 

Almost 7 in 10 clients receiving home-delivered meals and transportation services were 

diagnosed with arthritis, hypertension or high blood pressure, or eye or vision problems. Almost 

half were diagnosed with high cholesterol. A high percentage also reported having been 

diagnosed with heart disease, diabetes, breathing or other lung problems, depression or anxiety, 

or hearing problems. The relative difference in self-rated health status between caregivers and 

the other two client groups is consistent with a lower rate of diagnosed health conditions among 

the former. Almost two-thirds of caregivers (64 percent) reported having back problems or 

arthritis, and 35 percent had cardiovascular conditions such as heart problems, hypertension, or a 

28 
 

 

Arthritis 

Breathing/lung problems 

Depression or anxiety 

Diabetes 

Eye or vision conditions 

Hearing problems 

Heart disease 

High cholesterol 

Hypertension 

Osteoporosis 

Stroke 

stroke (not shown). Other diagnosed health conditions among caregivers were minimal; fewer 

than 10 percent had breathing or other lung problems, diabetes, eye problems, or mental health 

issues. 

FIGURE III.10 

SELECTED HEALTH CONDITIONS AMONG OAA PROGRAM PARTICIPANTS COMPARED TO THE U.S. 

60+ POPULATION21 IN 2005, BY SERVICE CATEGORY 

66 

11 

19 

29 

58 

10 

69 

37 37 

32 

64 

38 

43 42 

69 

25 

21 

69 

32 

26 

30 

67 

32 

36 

48 

70 

25 

16 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

US Pop. 60+ Home-delivered meals Transportation 

Source:	 Tabulations for the U.S. population from the 2004 Health and Retirement Study. Data on OAA program 

participants from the Third National Survey of OAA Program Participants, 2005. 

While the categories and wording of the HRS questions vary slightly from those in the Third 

National Survey, HRS statistics provide some indication that the rates of diagnosis are much 

higher among OAA participants than other older Americans. For example, only 19 percent of 

21 The health conditions asked about in the 2004 HRS were sufficiently different (due to categorization of 

multiple conditions, different conditions, and different question wording) that the comparison to the National Survey 

data is not exact. We mean for these comparisons to only be illustrative, not definitive proof of health differences 

between the samples. In both the HRS and Third National Survey, a question asks whether the person has ever been 

diagnosed, which does not mean the condition is still present. This table only considers the most common health 

conditions out of a much larger list asked of OAA participants (contained in Appendix C). 

29 
 

HRS respondents over the age of 60 reported ever having been diagnosed with diabetes, 

compared to around 30 percent of transportation services and home-delivered meals respondents. 

Ten percent of HRS respondents reported ever having a stroke, compared to 16 and 21 percent of 

transportation services and home-delivered meals clients, respectively. 

FIGURE III.11
 

NUMBER OF REPORTED HEALTH CONDITIONS AMONG OAA
 

PROGRAM PARTICIPANTS IN 2005, BY SERVICE CATEGORY 

2.2 

11.7 

41.8 41.9 

1.6 2.4 

12.5 

46.4 

38.0 

1.5 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

0 1-2 3-5 6-10 11+ 

Number of Health Conditions 

Home-delivered meals Transportation 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

Given these rates of diagnosis for individual conditions, it is not surprising that the majority 

of home-delivered meals and transportation services clients have multiple health conditions 

(Figure III.11). Forty-two percent of home-delivered meals clients and 46 percent of 

transportation services recipients reported having three to five diagnosed conditions. About 40 

percent of these two client groups had 6 to 10 conditions. The large share of clients with 

multiple conditions suggests that OAA clients must manage multiple treatment regimens and 

30 
 

prescription medications, which can be difficult for the elderly as they begin to fail physically or 

cognitively. 

K. OAA PARTICIPANTS WERE MORE LIKELY THAN OTHER OLDER 

AMERICANS TO HAVE TROUBLE WITH PHYSICAL FUNCTIONING22 

As important as diagnosed health conditions for maintaining independence is the extent to 

which an older adult can perform basic functions, also known as activities of daily living 

(ADLs). Six activities are normally classified as ADLs: bathing or showering, dressing, eating, 

getting in and out of bed or a chair, toileting, and walking. Individuals who cannot perform these 

activities on their own or with an assistive device such as a walker or cane need help from 

another person. The AoA seeks to target its services to those with severe disabilities, which 

might include those who have a number of functional limitations (see Indicator 3.2, Appendix 

A). 

As shown in Figures III.12 and III.13, about one-quarter of clients receiving home-delivered 

meals said they did not have trouble with any ADLs, and another quarter reported only having 

difficulty with one ADL. Despite the proportion of clients with high functionality, a large share 

had difficulty walking (66 percent), bathing or showering (42 percent), getting in and out of a 

bed or chair (35 percent), or dressing (24 percent). Almost one third of clients had difficulty 

with at least three ADLs, indicating that this population needs a great deal of help to complete 

activities required for daily functioning. 

22 Questions in this section were not asked of caregivers. See Section VI of the report for a discussion of 

analogous information for care recipients. 

31 
 

FIGURE III.12
 

REPORTED DIFFICULTIES WITH ACTIVITIES OF DAILY LIVING 

AMONG OAA PROGRAM PARTICIPANTS COMPARED TO THE U.S. 60+ POPULATION IN 2005, BY
 

SERVICE CATEGORY 

7.2 9.4 

3.1 5.3 5.3 7.1 

41.8 

24.4 

8.0 

34.8 

16.1 

65.6 

23.0 

12.4 

5.5 

22.0 

9.3 

47.6 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

Bathing or Dressing Eating In/out of Toileting Walking 

showering bed/chair 

US Pop. 60+ Home-delivered meals Transportation 

Source:	 Tabulations for the U.S. population from the 2004 Health and Retirement Study. Data on OAA program 

participants from the Third National Survey of OAA Program Participants, 2005. 

Transportation services clients were less impaired than clients receiving home-delivered 

meals. Forty-four percent of the former reported not having any difficulties with ADLs, and 

one-quarter (24 percent) reported only having difficulty with one ADL. Still, a large proportion 

of clients said they had difficulty walking (48 percent), bathing or showering (23 percent), or 

getting in and out of a bed or chair (22 percent). A smaller fraction (17 percent) of transportation 

services clients than home-delivered meals clients had difficulty with three or more ADLs. 

Compared to national rates of functional limitations in people age 60 and older, OAA 

participants in 2005 were quite impaired. In the 2004 HRS, only 17.7 percent of older adults had 

difficulty with at least one ADL, meaning that about 8 in 10 people did not. Only 7 percent had 

32 
difficulty walking across the room, 9 percent had difficulty dressing, 7 percent had difficulty 

bathing or showering, 3 percent had difficulty eating, 5 percent had difficulty getting in and out 

of bed, and another 5 percent had trouble with toileting. It is likely that some of the differences 

between these low levels of functioning and the levels reported by OAA participants can 

explained by the fact that those receiving OAA services are relatively older than the U.S. 

population overall. 

FIGURE III.13
 

NUMBER OF DIFFICULTIES WITH ACTIVITIES OF DAILY 

LIVING AMONG OAA PROGRAM PARTICIPANTS AND US 60+ POPULATION
 

Percent 

100 

90 

80 

70 

60 

50 

40 

30 

20 

10 

0 

83.3 

8.6 

3.9 2.0 1.3 0.9 0.0 

24.9 

19.4 

13.6 

8.7 7.5 

2.6 

44.0 

24.4 

14.7 

7.7 5.1 3.0 1.0 

23.4 

0 1 2 3 4 5 6 

Number of Limitations 

US Pop. 60+ Home-delivered meals Transportation 

Source:	 Tabulations for the U.S. population from the 2004 Health and Retirement Study. Data on OAA program 

participants from the Third National Survey of OAA Program Participants, 2005. 

Katz and colleagues (1963) offer another perspective of impairment in their categorization 

of ADL difficulties, by whether they occur relatively early or late in a person’s functional 

decline. By this definition, early onset ADLs include dressing and personal hygiene; middle 

onset ADLs include toileting, transferring, and locomotion; and late onset ADLs include eating 

33 
 

and bed mobility. For this analysis, we categorized difficulty with dressing, bathing, toileting, 

and walking as early onset ADL difficulties, and the others as late onset ones. 

Home-delivered meals clients are more likely than transportation services clients to have 

both early and late onset ADL difficulties, but both have rates of onset that are much higher than 

the rates in the overall elderly population (Figure III.14). Seventy-three percent of those 

receiving meals had at least one difficulty with an early onset ADL, and 37 percent reported 

difficulty with a late onset ADL. Similar numbers for transportation services clients were 54 and 

25 percent. 

FIGURE III.14
 

PRESENCE OF EARLY AND LATE ONSET ADL DIFFICULTIES AMONG OAA PROGRAM 

PARTICIPANTS COMPARED TO THE U.S. 60+ POPULATION 

7.1 

16.2 

37.2 

72.6 

24.5 

53.7 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

Presence of late onset ADLs	 Presence of early onset ADLs 

US Pop. 60+ Home-Delivered Meals Transportation 

Source:	 Tabulations for the U.S. population from the 2004 Health and Retirement Study. Data on OAA program 

participants from the Third National Survey of OAA Program Participants, 2005. 

34 
 

Among those with at least one early onset ADL, 40 percent of home-delivered meals clients 

had only one difficulty and 30 percent had two ADL difficulties (not shown). This means that 

those with early onset ADL difficulties tended to not have problems with all four activities. 

Over half (55 percent) of transportation services clients with any early onset ADL difficulties 

had only one, and another 26 percent had two difficulties. Among those who have difficulty 

with at least one of the late-onset ADLs, most transportation and meals clients (85 and 88 

percent, respectively) only had difficulty with one (rather than both) of the late-onset ADLs. 

Instrumental activities of daily living (IADLs) are not necessary for functioning on a daily 

basis, but they are useful skills for independent living. They include activities such as preparing 

meals, performing light housework, and driving. As they did for ADLs, home-delivered meals 

and transportation services recipients reported high levels of difficulty with IADLs 

(Figure III.15). Only 17 percent of home-delivered meals clients and 33 percent of 

transportation services clients reported not having any trouble with IADLs. 

Home-delivered meals clients most often said that the following IADLs were difficult: going 

outside (55 percent), driving (53 percent), using public transportation (48 percent), performing 

light housework (47 percent), and preparing meals (45 percent). The very high rate of difficulty 

with going outside shows how important home-delivered meals are to these clients. 

Not surprisingly, transportation services clients had more difficulty driving an auto (48 

percent) and using public transportation (35 percent) than with other IADLs. Other than these 

two IADLs, transportation services clients reported the most difficulty with going outside (34 

percent) and light housework (28 percent). 

35 
o IADL limitations 

Drive an auto 

etting around inside 

Going outside 

Light housework 

Money or bills 

Prepare meals 

Prescription meds 

ublic transportation 

Use phone 

17.3 

53.0 

40.7 

55.4 

47.3 

27.0 

45.0 

21.2 

47.7 

10.8 13.5 

6.6 

34.5 

21.3 

17.5 

27.6 

33.7 

23.0 

47.6 

31.9 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

 

N

G

P

FIGURE III.1523 

REPORTED DIFFICULTIES WITH INSTRUMENTAL ACTIVITIES OF DAILY LIVING AMONG OAA 

PROGRAM PARTICIPANTS IN 2005, BY SERVICE CATEGORY 

Home-delivered meals Transportation 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

23 The HRS IADL categories are different enough from those in the Third National Survey to make a direct 

comparison implausible. 

36 
IV. THE OAA HOME-DELIVERED MEALS PROGRAM 

The OAA home-delivered meals program provides older adults who have health and/or 

mobility problems with nutritious food that might otherwise be beyond their reach. Seniors who 

have health problems, difficulty getting around, or are unable to drive may have trouble 

performing errands such as grocery shopping. Those who are financially strained may choose to 

eat unhealthy foods, or worse, skip meals in order to save money or pay for other important 

things such as prescription medications. OAA home-delivered meals make up a large, important 

part of the food consumed by program participants on delivery days, and recipients reported a 

high level service quality across all aspects of the program. 

A. USE OF THE OAA HOME-DELIVERED MEALS SERVICE 

Most home-delivered meals clients (73 percent) received at least one hot meal in the past 

week (not shown), and a full 49 percent received five hot meals in the past week. The mean 

number of hot meals received (among those receiving at least one meal) was 4.7 per week, or 

about one per weekday. About one in five clients (21 percent) received at least one frozen meal 

in the past week, and among those, most received one to five frozen meals. The average number 

of frozen meals received (among those receiving at least one meal) was 4.1. About one in 10 

clients (9 percent) received at least one bag meal in the past week, and the mean number of 

meals received by these individuals was 3.5. A much smaller share of clients (4 percent) 

received a nutritional supplement such as Boost or Ensure at least once in the past week. The 

average recipient in this group received 4.8 supplements. 

The majority of clients received home-delivered meals at least five days per week 

(Figure IV.1). Half of clients (51 percent) received home-delivered meals five days per week on 

average, 2 percent received meals 6 days each week, and 8 percent received them 7 days a week. 

37 
 

 

Four in five (80 percent) reported receiving only one meal on days when they did receive meals, 

but 10 percent reported receiving three or more meals per day.24 

FIGURE IV.1 

NUMBER OF DAYS PER WEEK CLIENTS RECEIVE ONE OR MORE HOME-DELIVERED MEALS 

8.2% 18.2% 

2.0% 

3.7% 

6.0% 

8.5% 51.4% 

2.1% 

0 1 2 3 4 5 6 7 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

The average number of days per week that meals are delivered to clients varies somewhat by 

AoA region (Figure IV.2). The lowest average is in Region VIII, where clients receive meals 

only three days per week on average. This is likely due to the vast size of these Mountain and 

Plains states in addition to the fact that they are largely rural. As a result, agencies may have to 

deliver fewer times per week. Regions II and III, which are concentrated in the East and MidAtlantic regions, have the highest number of days of meal delivery per week, each with more 

than four on average. 

24 Many of those in the 10 percent who reported 3 or more meals per day reported receiving 5 or 7 meals, 

which appear to be weekly deliveries, rather than meals delivered for a single day. 

38 
 

FIGURE IV.2 

AVERAGE NUMBER OF DAYS PER WEEK THAT CLIENTS RECEIVED ONE OR MORE HOMEDELIVERED MEALS, BY AoA REGION
 

3.6 

4.1 4.2 4.2 

4.0 4.0 

3.6 

3.0 

3.8 

3.6 

0 

1 

2 

3 

4 

5 

6 

7 

Days per week 

I II III IV	 V VI VII VIII IX X 

AoA region 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

The majority of clients reported that they usually ate all or most of the food that was 

delivered to them (Figure IV.3). Ninety-six percent of clients usually ate the meat, chicken, fish, 

or eggs provided; 95 percent of clients usually ate the fruit; and 95 percent usually ate the 

vegetables. Similarly high percentages were reported for the other types of food. Homedelivered meals clients seemed to be pleased enough with the taste of the food to usually eat it, 

an important measure of whether the service is useful to clients. Given food allergies and the 

range of food preferences, these rates of consumption are quite high. 

39 
FIGURE IV.3 

TYPES OF FOODS USUALLY EATEN BY HOME-DELIVERED MEALS CLIENTS 

94.8 92.0 94.6 

90.6 

87.1 

95.8 

85.3 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

Fruit Potatoes Vegetables Bread, cereal, Milk, cheese, Meat, Nuts, tofu, or 

rice, pasta, or yogurt chicken, fish, beans 

noodles, or or eggs 

tortillas 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

B. IMPACT OF THE OAA HOME-DELIVERED MEALS SERVICE 

The home-delivered meals program has had a great impact on the quantity and quality of 

food consumed. About 11 percent of clients reported eating more food on days when it was 

delivered (not shown). Almost two-thirds (64 percent) of clients reported eating the same 

amount of food on days when meals were delivered as on days when they were not, but 26 

percent reported that they ate less food on days when meals were delivered. This could mean 

that clients saved meals and ate them on days when they were not delivered or that the quality of 

food is high enough that clients can eat fewer food items on delivery days. 

40 
While quality may be the most salient feature of the meals, the amount of food is also not 

insignificant (Figure IV.4). On delivery days, about two in three clients said that the delivered 

food made up at least half of their food intake for the day. Another 29 percent said the meals 

were one-third to one-half of their total food intake, and only 6 percent said the meals were less 

than one-third of their daily intake. 

FIGURE IV.4 

PROPORTION OF DAILY FOOD THAT HOME-DELIVERED MEALS REPRESENT 

0.4% 5.5% 

29.4% 

39.7% 

24.9% 

Less Than One-Third Between One-Third And One-Half 

About One-Half More Than One-Half 

Other 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

The home-delivered meals program had large impacts on the lives of recipients 

(Figure IV.5). The measures in Figure IV.5 indicate that the meals have both improved the 

nutritional value of the food consumed and helped clients to maintain a higher quality of life. 

For instance, the majority of clients reported that the meals provided them with healthier food 

(82 percent) and allowed them eat a greater variety of foods (81 percent), to feel better (81 

percent), to maintain a healthy weight (79 percent), and to feel less hungry (79 percent). 

41 
Approximately 7 in 10 respondents reported that the meals helped to improve their health (73 

percent) or to maintain a special diet (72 percent). 

FIGURE IV.5 

HOME-DELIVERED MEALS HELP CLIENTS TO... 

Percent 

100 

90 

80 

70 

60 

50 

40 

30 

20 

10 

0 

Eat greater Eat Feel better Feel less Improve Keep a Maintain 

variety of healthier hungry health special diet healthy 

foods foods weight 

92.7 

81.1 81.7 80.6 78.9 

72.9 72.2 

79.0 

Continue to 

live in own 

home 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

One of the main goals of the AoA is to provide services to older adults that allow them to 

remain in their home (Strategic Objective 2.1, “U.S. Administration on Aging, Strategic Action 

Plan, 2007-2012,” U.S. Department of Health and Human Services, 2007). The home-delivered 

meals program appears to be very effective in achieving this goal; 93 percent of clients who 

received meals reported that the service allowed them to stay in their home. This rate did not 

differ much by whether the person lived alone or not, though the fraction was slightly higher 

among those who did not live with anyone else (not shown). Ninety-four percent of those who 

42 
lived alone and 91 percent of those who did not live alone reported that the meals allowed them 

to remain in their home. The fraction reporting that meals allowed them to continue to live at 

home did not vary by age or gender (not shown). 

C. CLIENT-REPORTED SERVICE QUALITY IN THE OAA HOME-DELIVERED 

MEALS SERVICE 

Given such high ratings of the food delivered and the impact of the home-delivered meals 

service, it is not surprising that service quality was also reported to be very high (Figure IV.6). 

Almost all clients (94 percent) rated the program good, very good, or excellent, which exceeds 

the new 2008 performance measure of 90 percent reporting service quality in those categories 

(Indicators 2.1 and 2.9a, Appendix A). Almost one-third (32 percent) said the program was 

excellent overall, and another 40 percent said the program was very good. Again, almost all 

home-delivered meals clients reported liking the meals (95 percent), and 91 percent would 

recommend the program to friends, neighbors, and relatives. 

FIGURE IV.6 

OVERALL CLIENT-REPORTED SERVICE QUALITY IN THE HOME-DELIVERED MEALS PROGRAM 

4.5% 1.1% 

32.0% 

39.9% 

22.5% 

Excellent Very Good Good Fair Poor 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

43 
26.2 

51.0 50.8 

39.6 

56.8 62.2 

90.2 

52.6 

36.9 36.8 

43.5 

33.3 

32.4 

8.6 

18.1 

9.9 10.6 14.1 

8.3 4.2 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

Way the food 

tastes 

Way the food 

smells 

Way the food 

looks 

Variety of 

foods 

Temperature 

of foods 

Time of 

arrival 

Person who 

delivers is 

friendly 

Service quality in particular features of the home-delivered meals service was also reported 

by recipients to be quite high (Figure IV.7). For example, 99 percent of clients reported that the 

delivery person was friendly all or most of the time, and 99 percent reported that they were 

satisfied with the time of delivery all, most, or some of the time. Service quality in other aspects 

of the program were similarly high. 

FIGURE IV.7 

OTHER MEASURES OF SERVICE QUALITY IN THE HOME-DELIVERED MEALS SERVICE 

All of the time Most of the time Some of the time 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

44 
 

 

 

V. THE OAA TRANSPORTATION SERVICES PROGRAM 

From routine trips to the grocery store, pharmacy, and doctors’ offices, to rides to the local 

senior center and other social settings, OAA transportation services help seniors to remain both 

independent and socially connected. These transportation services provide a large share of all 

rides received by clients in a given month. The service is particularly valuable to those who 

were otherwise transportation disadvantaged—that is, those who did not have a car, were not 

able to drive, or did not have access to public transportation. 

Clients were very satisfied with the transportation service overall, but there was some 

variation in the client-reported service quality with individual measures of service delivery. For 

example, one-quarter of clients said they were neither always nor usually notified when rides 

were cancelled.25 About the same fraction noted that the vans are not always easy for older 

adults to get in and out of, though this might expected for an older, frail population. Despite 

these complaints, the transportation service provided an invaluable opportunity to allow seniors 

the independence to get to their intended destinations without always relying on the help of 

friends and family 

A. ABILITY TO DRIVE AND ACCESS TO OTHER TRANSPORTATION AMONG 

OAA TRANSPORTATION SERVICES CLIENTS 

Most of the people who used the OAA transportation services were not able to drive 

themselves. Fewer than half (45 percent) of clients had a car in the household, and only half of 

those were able to drive (Figure V.1). Over half (55 percent) of clients did not have a car in the 

25 It is important to note that reservations are not a required component of service provision, and that some 

services provided in this category do not have a mechanism for notifying clients who use the route. This means that 

at least some fraction of the people who report not being notified of canceled rides were not using a service with a 

scheduled reservation. For example, clients who use a shuttle service that makes regular stops would not be notified 

if the service were delayed or canceled, since the service would not know which clients to contact. 

45 
 

household. The fraction without a car climbed to 70 percent among those who lived alone. 

Overall, 77 percent of clients could not regularly transport themselves by using a car in their 

household. 

FIGURE V.1 

ABILITY TO DRIVE AND ACCESS TO AN AUTOMOBILE AMONG
 

TRANSPORTATION SERVICES CLIENTS 

21.8% 

54.7% 

23.5% 

Household has car, client can drive 

Household has car, client cannot drive 

Household does not have car 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

The fraction of households without a car varied greatly by region (not shown), reflecting 

geographic differences in the availability of public transportation. Clients in Region VIII were 

the most likely to have a car they could drive (39 percent), while those in Regions II and IV were 

the least likely to have the same (14 percent). 

This regional variation also points to the possibility that some older people do not have cars 

because they can rely on public transportation. To widen our definition of “transportation 

disadvantaged,” we included people who did not have a car in their household, had a car in the 

household but could not drive it, and, for those who did not have a car, did not have access to 

public transportation or had difficulty using the system. Even allowing for the possibility of 

46 
 

public transportation use, 55 percent of transportation service clients were still transportation 

disadvantaged (not shown). 

B. USE OF THE OAA TRANSPORTATION SERVICES PROGRAM 

Clients who used transportation services tended to do so frequently, but the rate of use 

varied by whether a person was transportation disadvantaged and had whether the person had a 

car in their household.26 On average, the number of one-way trips per month among those who 

used the transportation service was 12.5, which is slightly more than one round-trip ride per 

week. One quarter of people who used transportation services took one round-trip ride or less 

per month, and another quarter took three to six round-trip rides monthly, one in five clients used 

between six and twelve rides, and one in three clients took more than 12 trips per month (not 

shown). 

The number of trips used per month varied by whether the client was transportation 

disadvantaged (Figure V.2). Those who were not transportation disadvantaged were much more 

likely to use fewer rides per month; 41 percent of those who were not transportation 

disadvantaged used the service for four or fewer one-way trips per month, compared to 32 

percent of those who were transportation disadvantaged. Those who were disadvantaged were 

much more likely to use the service for 11 or more rides per month. 

26 Note that whether these differences were statistically significantly different from zero was not tested for the 

purposes of this report. 

47 
 

4.8 

40.5 

24.7 

12.3 

6.7 

10.7 

1.9 

31.6 

26.8 

15.8 

10.8 

12.7 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

0 1-4 5-10 11-20 21-30 >30 

One-way trips per month 

Not transportation disadvantaged Transportation disadvantaged 

FIGURE V.2 

NUMBER OF ONE-WAY TRIPS USED PER MONTH BY TRANSPORTATION SERVICES CLIENTS 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

Transportation services represented a significant portion of all trips made by clients 

(Figure V.3). About half (53 percent) all clients who had at least one ride per month on average 

used the service for three quarters or more of all of their transportation needs. Forty-three 

percent relied on the transportation service for virtually all of their travel needs, indicating the 

importance of the service to an independent lifestyle. Only about one in five (22 percent) service 

users reported that they used the service only for a few of their trips. 

48 
 

FIGURE V.3 

FRACTION OF CLIENT’S TRIPS REPRESENTED BY THE TRANSPORTATION SERVICE 

14.3% 

11.3% 

21.8% 

43.0% 

9.6% 

Just a few About one-quarter About one-half About three-quarters Nearly all 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

Expanding the analysis to those who might have had the option of taking public 

transportation, we find that the number of rides used per month was higher among those who 

were transportation disadvantaged. About one-third (36 percent) of transportation-disadvantaged 

clients who used the service for at least one ride per month on average received more than 12 

rides per month, compared to only 27 percent of those who were not transportation 

disadvantaged (not shown). Only 20 percent of transportation-disadvantaged clients received 

two or fewer rides per month, compared to 29 percent of other clients. 

The transportation service represented a much higher fraction of rides for those who were 

transportation disadvantaged. About half (49 percent) of these clients who used at least one ride 

per month on average reported that they used the service for all of their rides, compared to only 

34 percent of those who were not similarly disadvantaged (Figure V.4). At the other end of the 

spectrum, 28 percent of those who were not disadvantaged used the service for only a few of 

their rides, a much higher fraction than those who were disadvantaged (17 percent). 

49 
 

 

 

FIGURE V.4 

TRANSPORTATION SERVICE USE BY THE TRANSPORTATION DISADVANTAGED27 

17.4 

28.4 

10.2 

13.4 12.7 

16.0 

9.8 9.1 

49.2 

33.7 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

Transportation-disadvantaged Not transportation-disadvantaged 

Just a few of all local trips About 1/4 of all local trips About 1/2 of all local trips 

About 3/4 of all local trips Nearly all local trips 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

Transportation services clients used the rides to get to a variety of destinations, ranging from 

religious services to medical appointments to work (Figure V.5). The most typical destinations 

included the offices of doctors and other health care providers (71 percent reported medical 

appointments as a usual destination when using the service). Many (39 percent) clients used the 

service to go shopping and to social settings, such as senior centers (42 percent), lunch programs 

(31 percent), and other events (27 percent). 

27 Note that whether these differences were statistically significantly different from zero was not tested for the 

purposes of this report. 

50 
 

Clubs or meetings 

Doctors/health care providers 

Friends or relatives 

Lunch program 

Religious services 

Senior center 

Shopping 

Social events 

Volunteer activities 

Work 

FIGURE V.5 

USUAL DESTINATION WHEN USING THE TRANSPORTATION SERVICE28 

12.3 

70.7 

8.3 

30.9 

5.9 

41.9 38.9 

26.9 

17.2 

1.7 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

C. IMPACT OF THE OAA TRANSPORTATION SERVICES PROGRAM 

For the majority of destinations, clients reported that the transportation service allowed them 

to get to their usual destination more often than they would have otherwise (Figure V.6). The 

only destinations and activities for which fewer than 50 percent of clients reported being able to 

get to more often were appointments with health providers, visit friends and relatives, and to go 

shopping. These activities might be those for which transportation-disadvantaged seniors may 

be assisted by family, neighbors, and friends, so the transportation service may be less necessary 

28 Respondents were allowed to select as many as were relevant, so the total across all categories sums to far 

more than 100 percent. 

51 
 

Clubs or meetings 

Doctors/health care providers 

Friends or relatives 

Lunch program 

Religious services 

Senior center 

Shopping 

Social events 

Volunteer activities 

Work 

FIGURE V.6 

WHETHER THE TRANSPORTATION SERVICE ALLOWS THE 

CLIENT TO GET TO THEIR USUAL DESTINATION MORE OFTEN29 

57.0 

39.7 42.3 

68.1 

55.4 

71.6 

43.3 

61.3 62.5 64.4 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

for these activities than for others. However, other activities such as lunch programs, visits to a 

senior, social events, volunteering, and work are important paths to social involvement. More 

than 60 percent of clients who used transportation services reported that all of these activities 

were ones they could get to more often because of the service. 

29 These questions only include people who report using the service (above), so sample sizes for some 

categories may be quite small. 

52 
 

D. CLIENT-REPORTED SERVICE QUALITY IN OAA TRANSPORTATION 

SERVICES 

As it has done for other service categories, the AoA has set a new performance goal for 

transportation service in 2008: at least 90 percent of those using the service will rank their 

overall service quality as good or higher (Indicators 2.2 and 2.9b, Appendix A). This goal was 

easily attained in 2005 (Figure V.7), when 98 percent of transportation services clients ranked 

the program good, very good, or excellent. 

FIGURE V.7 

OVERALL CLIENT-REPORTED SERVICE QUALITY IN THE TRANSPORTATION SERVICE 

34.9% 

0.5% 

1.7% 

13.3% 

49.7% 

Excellent Very Good Good Fair Poor 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

Clients were generally quite pleased with most aspects of the transportation service. When 

asked how often the transportation service had each of 13 positive attributes, at least 75 percent 

of clients said the service usually or always did (Figure V.8). 

53 
FIGURE V.8 

OTHER MEASURES OF SERVICE QUALITY IN THE TRANSPORTATION SERVICE30
 

 

 Percent 

100 

90 

80 

70 

60 

50 

40 

30 

20 

10 

0 

19.9 19.5 

6.1 9.6 8.0 

18.4 11.7 13.5 12.8 8.5 10.9 17.6 16.8 

72.3 70.5 91.8 78.7 86.5 74.0 81.6 79.9 80.5 87.3 

65.5 

62.8 

73.8 

Arrive on time

Comfortable vehicles

Drivers are polite

Measure of satisfaction 

Drivers offer help in/out of home

Drivers offer help in/out of van

Drivers pick up on time

Get number of rides needed

Get rides at days/times needed

Get to desired places

Have info. needed to schedule ride

Informed of cancelled rides

Rides don't take too long

Vans are easy to get in/out 

Usually Always Note: "Rides do not take too long" was actually phrased "rides take too long" in the survey, so we inverted the 

responses to correspond with the other measures of satisfaction 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

Some areas were ranked quite high: 92 percent of clients said that the drivers were always 

polite, and 87 percent said they always had the information they needed to schedule their rides. 

On the other hand, individual measures of service quality pointed to possible areas for 

improvement. These areas tended to involve the consistency and timeliness of rides: 74 percent 

said that drivers always picked them up on time, 72 percent said that rides always arrived at their 

destination on time, and 63 percent said rides do not always take too long (meaning that more 

than one-third believed rides did take too long). 66 percent said they were always informed when 

rides were cancelled. Given that the most common destination is a medical provider’s office, 

30 “Rides do not take too long” was actually phrased “rides take too long” in the survey, so we inverted the 

responses to correspond with the other measures of satisfaction. 

54 
timely, consistent service is very important. There also seemed to be slight dissatisfaction with 

the ease of getting in and out of the vehicles and the comfort level in the vehicle, which may be 

important considerations for more frail elderly. 

The service quality reported by consumers was lower among those who were transportation 

disadvantaged; these people were less likely to report that the service “always” met their 

expectations on the above measures. However, these clients relied heavily on the service for 

most of their rides, so it is possible that the additional experience with the service also meant 

they had additional opportunities for problems to occur, making it less likely that the service 

“always” met their needs. We cannot, however, test this conjecture with the data we have. But 

even so, overall service quality reported by this group was still quite high, and the service may 

have a potentially greater impact on clients with fewer transportation alternatives. 

55 
PAGE IS INTENTIONALLY LEFT BLANK TO ALLOW FOR DOUBLE-SIDED COPYING 

 

 

VI. OAA CAREGIVER SUPPORT SERVICES 

Without informal and family caregiving, many older people would be forced to move into 

institutional settings as their physical and cognitive capabilities declined. Filling the role of a 

caregiver can be more than a full-time job and often brings financial, physical, and emotional 

strain. The services provided by OAA caregiver support programs are intended to mitigate these 

effects by offering information, assistance, and respite services to the people who provide care 

for the most vulnerable elderly. 

While caregivers were younger and healthier on average than the other two OAA service 

groups in the Third National Survey, they faced many burdens associated with their caregiving 

responsibilities, including the struggle to balance work and caregiving, to make time for their 

own needs, and to deal with health problems that arose or worsened because of caregiving. The 

caregiver support services helped these individuals cope with these burdens, and the majority 

reported high levels of service quality in most aspects of the program. The program also had an 

important impact on the lives of caregivers and care recipients; most indicated that the program 

allowed them to care for recipients longer and allowed their recipients to stay longer in their 

home. 

A. CHARACTERISTICS OF OAA CARE RECIPIENTS31 

Most care recipients in 2005 were among the oldest old; 36 percent were age 85 and older, 

and another 42 percent were 75 to 84 (Figure VI.1).32 This is a much older age distribution than 

31 All descriptions of care recipients are provided by their caregivers, who responded to the survey. 

32 The reauthorization in 2000 of the Older Americans Act included a provision to allow caregiver services to 

be provided to grandparents who are the primary caregivers of their grandchildren under 18, which has become 

increasingly common in the wake of dual-earner households and divorce. However, judging from the age 

distribution of care recipients, it is clear that this group was not included (at least in any significant way) in the 

National Survey in 2005. 

57 
FIGURE VI.1 

AGE DISTRIBUTION OF CARE RECIPIENTS 

1.5 

5.3 

23.2 

40.3 

29.8 

0.1 

4.2 

27.8 

44.2 

23.8 

41.5 

11.9 

22.7 

19.8 

4.2 

0.0 

5.1 

16.1 

42.4 

36.4 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

Under age 60 60 to 64 65 to 74 75 to 84 85 or older 

Home-delivered meals Transportation Caregivers Care recipients 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

in the previous two OAA client groups, meaning that caregivers are responsible for the oldest 

old, who are likely a frail and vulnerable population. 

Slightly more care recipients were female (61 percent), which is likely to reflect the fact that 

women more often live longer than men and therefore need the assistance of a caregiver (not 

shown). Although there were higher proportions of females among both caregivers and care 

recipients, only 41 percent of recipients were helped by a caregiver who was the same gender 

(Figure VI.2). Female caregivers were about equally likely to be assisting a male as a female. 

58 
 

 

FIGURE VI.2 

GENDER OF CAREGIVER AND CARE RECIPIENT 

2.5% 

21.8% 

38.2% 

37.6% 

Male caregiver, male care recipient Male caregiver, female care recipient 

Female caregiver, male care recipient Female caregiver, female care recipient 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

Care recipients were likely to be in fair or poor health, which is not surprising, given their 

age and the fact that they need someone else to help them with ADLs or IADLs (Figure VI.3). 

FIGURE VI.3 

SUBJECTIVE HEALTH STATUS OF CARE RECIPIENTS, AS REPORTED BY THEIR CAREGIVER 

4.1% 8.2% 

27.7% 

28.2% 

31.8% 

Excellent Very good Good Fair Poor 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

59 
 

About one in three (32 percent) caregivers said the person they took care of was in poor 

health, and 28 percent said the person was in fair health. Compared to home-delivered meals 

recipients (29 percent in poor health) and transportation services clients (16 percent in poor 

health), care recipients were most likely to be unhealthy.33 Considering that other OAA 

participants were much less healthy than the older population nationwide, care recipients were 

the least healthy. While 28 percent of caregivers said that the care recipient was in good health, 

only 12 percent said that the person was in very good or excellent health, a much smaller share 

than the 15 and 24 percent as self-reported by clients receiving meals and transportation services, 

respectively. 

As the subjective rating of the care recipient’s health would suggest, many care recipients 

had a number of health conditions (Figures VI.4 and VI.5). Rates of hypertension, arthritis, heart 

disease, and vision and hearing problems were similar to rates among transportation and meals 

services clients. However, care recipients had high rates of Alzheimer’s disease or dementia (58 

percent), depression or anxiety (60 percent), and stroke (36 percent). 

33 The health of care recipients was reported by their caregivers, whereas the health status of other survey 

participants was self-reported. It is not clear how this difference might bias the results presented here. 

60 
Alzheimer's/dementia 

Arthritis 

Breathing/lung problems 

Depression or anxiety 

Diabetes 

Eye or vision conditions 

Hearing problems 

Heart disease 

High cholesterol 

Hypertension 

Osteoporosis 

Stroke 

FIGURE VI.4 

MOST COMMON HEALTH CONDITIONS AMONG CARE RECIPIENTS, 

AS REPORTED BY THEIR CAREGIVER 

57.8 

64.1 

31.0 

60.3 

25.3 

64.3 

48.3 

43.0 

38.8 

63.9 

30.2 

36.4 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

61 
FIGURE VI.5 

NUMBER OF HEALTH PROBLEMS AMONG CARE RECIPIENTS 

0.5 

4.9 

34.8 

54.9 

4.8 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

0 1-2 3-5 6-10 11+ 

Number of health conditions 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

Approximately 55 percent of care recipients had 6 to 10 health problems, compared to about 

40 percent with 6 to 10 conditions in the other two client groups. Another 35 percent of care 

recipients had 3 to 5 conditions, and only about 6 percent had 2 or fewer problems, a much lower 

rate than among other participants. Thus, care recipients had more conditions to manage than 

did other program participants, probably explaining why they needed another person to help 

them on a regular basis. 

The activities that care recipients were most likely to need help with demanded a great deal 

from caregivers in terms of physical exertion (Figure VI.6). Almost 8 in 10 care recipients had 

difficulty bathing or showering (78 percent) and walking (78 percent). About two-thirds had 

62 
trouble dressing (67 percent) and getting in and out of chairs (63 percent), and over half (55 

percent) had difficulty toileting. 

FIGURE VI.6 

REPORTED DIFFICULTIES WITH ACTIVITIES OF DAILY LIVING 

AMONG CARE RECIPIENTS, AS REPORTED BY THEIR CAREGIVER 

77.5 

66.9 

28.2 

62.6 

54.9 

77.8 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

Bathing or Dressing Eating In/out of Toileting Walking 

showering bed/chair 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

Only 8 percent of care recipients did not have any trouble with ADLs (Figure VI.7). This is 

much lower than the share of clients receiving home-delivered meals and transportation services, 

25 and 44 percent of whom reported no difficulty with any ADLs. More than half of all care 

recipients had trouble with four or more ADLs, and one in five (20 percent) had difficulty with 

all six ADLs, compared to less than 3 percent in the other samples. The high rates of ADL 

difficulty imply that care recipients are a very vulnerable population who would not likely be 

able to perform ADLs without the regular assistance of a committed caregiver. 

63 
 

FIGURE VI.7 

NUMBER OF REPORTED DIFFICULTIES WITH ACTIVITIES OF 

DAILY LIVING AMONG CARE RECIPIENTS, AS REPORTED BY THEIR CAREGIVER 

8.2% 

20.1% 

11.7% 

9.3% 

25.9% 12.4% 

12.4% 

0 limitations 1 limitation 2 limitations 3 limitations 

4 limitations 5 limitations 6 limitations 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

B. CHARACTERISTICS OF OAA CAREGIVERS 

Caregivers of frail older individuals are usually family members or friends who informally 

take on the role of providing care to an ailing loved one; indeed, 41 percent of people receiving 

OAA-funded caregiver support services were spouses of the care recipient (Figure VI.8). 

Among those caring for their spouse, it was more likely that a wife was caring for her husband, 

as 66 percent of spouse caregivers were female (not shown). Almost the same fraction of 

caregivers was a daughter or daughter-in-law (40 percent). Almost four times as many 

caregivers were daughters (or daughters-in-law) than sons (or sons-in-law), reflecting the 

tendency for women than for men to be the more likely caretaker of parents. Only 10 percent of 

care recipients were assisted by family or friends who were not children or spouses. 

64 
FIGURE VI.8 

RELATIONSHIP OF THE CAREGIVER TO THE CARE RECIPIENT 

2.5% 7.0% 

40.7% 

10.0% 

39.7% 

Spouse Daughter/daugher-in-law 

Son/son-in-law Other relative 

Friend/neighbor/other non-relative 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

Given the high reported rates of difficulty in performing ADLs, it is not surprising that three 

out of four caregivers reported assisting care recipients with ADLs (Figure VI.9). Even more 

caregivers (89 percent) reported helping with household tasks such as paying bills, writing 

checks, cooking meals, doing laundry, or cleaning. Eighty-eight percent of caregivers reported 

arranging for care from others for the recipient. Almost all caregivers (96 percent) assisted with 

shopping trips or visits to the doctor’s office, and many (83 percent) helped to administer 

prescription medications and tended to other medical needs. 

65 
FIGURE VI.9 

TYPES OF ACTIVITIES WITH WHICH CAREGIVERS ASSIST 

72.3 

87.9 89.0 88.5 

95.8 

82.8 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

Activities of Arranging for Bills, checks, Meals, laundry, Shopping or Taking 

daily living care from others finances cleaning doctor's office medicines and 

other medical 

needs 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

C. EMPLOYMENT AMONG OAA CAREGIVERS 

Almost half (47 percent) of all caregivers served by AoA programs in 2005 were retired 

(Figure VI.10). About one in five (18 percent) were not working at all, and 12 percent were 

working part-time. The fraction of caregivers who reported being retired varied by gender; 66 

percent of men said they were retired compared to only 41 percent of women. It could be that 

women had either been out of the workforce for a long time or had never worked outside the 

home. Twenty-three percent of female caregivers—but only 6 percent of male caregivers—said 

they were not currently working (as opposed to retired). Female caregivers were twice as likely 

as men to be working part-time while caregiving (13 percent versus 6 percent). 

66 
FIGURE VI.10
 

EMPLOYMENT STATUS OF CAREGIVERS, BY GENDER 

22.5 23.6 

6.1 

13.2 

65.7 

40.6 

5.7 

22.6 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

Males Females 

Working full-time Working part-time Retired Not working 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

Females were more likely than males to have their participation in the labor force 

interrupted by the responsibilities of caregiving. Of the two-thirds of caregivers who said they 

were either not working or retired, 27 percent said they quit their job because of caregiving 

responsibilities (not shown). This effect was about twice as high among women than men; 30 

percent of women—but only 17 percent of men—reported that they had to quit work in order to 

keep up with their caregiving responsibilities. 

Those who continued to work while providing care to a friend or family member faced a 

variety of challenges, most of which centered around making enough time for both work and 

caregiving. Among caregivers who were working full- or part-time, 62 percent reported that 

caregiving interfered with their job at some point. Among those who said this, 36 percent said it 

always interfered, 52 percent said it sometimes interfered, and 13 percent said it rarely or never 

67 
 

interfered.34 In other words, caregiving responsibilities often interfered with the ability to hold a 

steady job. 

These types of effects on employment are shown in Figure VI.11. Almost all (93 percent) 

caregivers who held a full- or part-time job indicated that they had to deal with time conflicts. A 

majority indicated that they had to use time off (84 percent) or worked less than normal (59 

percent) in order to meet their responsibilities as a caregiver, suggesting that they may not have 

had time for their own needs. Four in 10 (40 percent) reported that they worked fewer hours in 

order to be a caregiver (possibly switching from full- to part-time work), while others took a less 

demanding job (27 percent) or lost a promotion (16 percent), which could have resulted in loss of 

current and future income. In addition to having a detrimental effect on career progression, any 

of these situations can have other long-term impacts, such as reduced retirement savings. 

34 The question wording allowed individuals who previously reported that caregiving interfered with their 

employment to say that it “rarely or never” interfered. Because “never” does not make sense in this context, we 

assume these responses are “rarely.” 

68 
 

Less demanding job 

Lost a promotion 

Lost employment fringe benefits 

Quit work or retire early 

Reduced working hours 

Taken a leave of absence 

Time conflicts 

Used time off 

Worked less than normal 

FIGURE VI.11 

EFFECTS OF CAREGIVING ON EMPLOYMENT35 

26.9 

16.4 19.6 

27.0 

40.0 

23.5 

92.5 

83.8 

58.6 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

D. THE BURDENS AND REWARDS OF CAREGIVING AS REPORTED BY OAA 

CAREGIVER SUPPORT CLIENTS 

Aside from demands on time, caregiving can also take a physical toll on caregivers. More 

than half (56 percent) of OAA caregivers who reported having at least one health problem 

indicated that these problem(s) had been created or worsened by caregiving responsibilities. The 

extent of this effect varied tremendously by the type of health problem (Figure VI.12). 

35 Note: Percentages are among those reporting working full- or part-time. 

69 
 

 

FIGURE VI.12
 

PERCENT OF CAREGIVERS REPORTING THAT CAREGIVING CREATED THEIR HEALTH
 

PROBLEMS OR MADE PROBLEMS WORSE, BY TYPE OF PROBLEM
 

56.3 54.9 

71.2 

48.8 

87.8 

33.3 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

Back problems and other

joint problems/arthritis

Heart problems/high blood

pressure/hypertension/stroke

Diabetes

Allergies/asthma/other

breathing and lung problems

Mental health problems

Eye problems 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

As shown in the figure, 88 percent of those who said they had a mental health condition said 

it was created or made worse by caregiving, as did 71 percent of those who said they had 

diabetes. Approximately 55 percent of those with back problems, arthritis, or heart problems 

said their condition was created or made worse by caregiving. While these effects were not 

clinically confirmed, they suggest that caregivers associate their role with serious health 

consequences. 

Along with the employment and health effects of caregiving, there are other consequences, 

such as stress on finances and relationships. Caregivers who participated in the survey were 

asked to identify the biggest hardship they experienced as a result of caregiving (Figure VI.13). 

70 
FIGURE VI.13
 

BIGGEST HARDSHIPS OF CAREGIVING (3 MOST COMMON RESPONSES)
 

37.6 

21.8 

9.6 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Creates stress Not enough time for self Not enough time for your family 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

By far, stress was the most common hardship, with 38 percent of respondents citing it as a 

problem. This could include time stress, financial stress, or stress on other relationships. The 

next most common hardship, cited by 22 percent of respondents, was not having enough time for 

oneself, while about 10 percent said that caregiving did not leave enough time for friends and 

family. 

Using a scale of 1 to 5 where 1 represented the lowest level of strain, stress, or burden, and 5 

represented the highest level, respondents were asked to report on their levels of physical strain, 

emotional stress, financial burden, and overall hardship brought on by their caregiving 

responsibilities. Emotional stress was ranked highest, while financial burden was ranked lowest 

(Figure VI.14). 

71 
 

FIGURE VI.14
 

AVERAGE RATINGS OF COMMON BURDENS OF CAREGIVING 

3.1 

3.5 

2.5 

3.0 

0.0 

1.0 

2.0 

3.0 

4.0 

5.0 

Mean level of strain, stress, or burden 

Physical strain Emotional stress Financial burden Hardship 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

The mean level of emotional stress reported was the highest of all forms of stress at 3.5, 

followed by physical stress at 3.1, then overall hardship at 3.0, and finally, financial stress, with 

an average rating of 2.5 on a five-point scale. In terms of the distribution of responses, 33 

percent rated the level of financial burden as a 1, compared to only 7 percent who ranked the 

level of emotional stress as a 1. 

While caregiving imposes several burdens on caregivers, it also has many rewards. 

Figure VI.15 shows the most commonly reported rewards. Topping the list was observing the 

effects of their help on the care recipient (45 percent of respondents). Another 39 percent 

reported that the greatest reward was caring for someone who had cared for them, such as a 

parent or a spouse. About 5 percent said that it was rewarding to help another family member. 

72 
FIGURE VI.15
 

BIGGEST REWARDS OF CAREGIVING (3 MOST COMMON RESPONSES)
 

44.6 

38.6 

4.5 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

Helping your care recipient Caring for someone who cared for Helping your other family 

you members 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

E. AMOUNT OF CARE PROVIDED BY THE OAA CAREGIVERS 

The burden of caregiving depends partly on the amount of time devoted by caregivers to 

their loved one. One aspect of the time commitment is the physical distance between the 

caregiver and the recipient. Even a daily round trip of an hour can become burdensome. This 

burden would increase with distance or if multiple trips per day were necessary. Figure VI.16 

presents the distribution of distances between the caregiver and the person they assist. 

73 
FIGURE VI.16
 

DISTANCE THAT CAREGIVER LIVES FROM CARE RECIPIENT 

71.3% 

20.5% 

6.2% 

2.0% 

In The Same House Less Than 20 Minutes Away 

Between 20 And 60 Minutes Away One or more hours away 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

The majority of care recipients lived close to their caregivers, including 71 percent who 

lived in the same house. Only about 8 percent lived more than 20 minutes away from their 

caregiver. So, time is not a burden for most caregivers. However, the close proximity of 

caregiver and recipient may have been precipitated by a health event or by the need to move to 

be closer to a family member’s home or an assisted-living facility. 

While the driving distance to the recipient of care may not be particularly burdensome for 

caregivers served by OAA programs, the number of hours of care needed by the recipient per 

day was quite high (Figure VI.17). About half of care recipients (49 percent) needed more than a 

half day of care per day, while the remainder needed less than a half day. A large part of the 

time was concentrated at the extremes: 42 percent of care recipients needed 19 to 24 hours of 

care per day, while at the other end of the spectrum, 34 percent needed 6 or fewer hours each 

day. It can be very difficult to provide care for another person for more than half a day while 

holding a full-time job, as reflected in responses about the burden of caregiving. 

74 
FIGURE VI.17
 

NUMBER OF HOURS OF CARE NEEDED BY CARE RECIPIENTS PER DAY
 

33.9% 

42.0% 

17.2% 6.9% 

0 to 6 7 to 12 13 to 18 19 to 24 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

Among care recipients who did not live in the same house as their caregiver, approximately 

6 in 10 (61 percent) lived alone (not shown). Among care recipients who did not live alone, only 

11 percent could be left alone in their home for an entire day. Most required full-time care; 65 

percent of care recipients required a caregiver all of the time, and another 24 percent needed 

caregiver for at least part of the day. 

The amount of time a care recipient needs care may differ from the amount of time that a 

caregiver provides it, if the caregiver is unable to devote as much time as needed or shares the 

caregiving responsibility with another person. The time devoted by caregivers to care recipients 

was concentrated at either end of the distribution, likely reflecting the needs of the recipient 

(Figure VI.18). A large fraction provided virtually full-time care, but many provided six or 

fewer hours per day. 

75 
 

FIGURE VI.18 

HOURS OF CARE PER DAY GIVEN BY CAREGIVERS TO CARE RECIPIENTS, 

WEEKDAYS AND WEEKEND DAYS 

0 to 6 7 to 12 13 to 18 19 to 24 

35.6 

17.3 

12.4 

34.6 

31.6 

17.0 

8.6 

42.7 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Weekdays Weekend days 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

More care was provided on weekends than weekdays. This could mean that caregivers who 

worked were able to devote more time to the care recipient on the weekend, or it might reflect 

the fact that paid caregiving support received by individuals during the week was not available 

on the weekend, at which time family or friend caregivers would take over. 

The number of hours of care provided per week was correlated with whether or not the 

caregiver was working (Figure VI.19). Those who were retired or not working were much more 

likely to provide full-time care (168 hours per week) than those who were either working part- or 

full-time. For example, 38 percent of those who were retired and 34 percent of those not 

working provided round-the-clock care, compared to only 9 percent of those working part-time 

76 
and 5 percent of full-time workers. Caregivers who worked at all were more likely to provide 60 

or fewer hours of care per week, compared to those who were not working. Even so, 60 hours of 

care per week is quite a lot for people who have a job, and providing full-time care is 

burdensome, even for those who are not working. 

FIGURE VI.19
 

HOURS OF CARE PER WEEK PROVIDED BY CAREGIVERS TO CARE RECIPIENTS, 

BY EMPLOYMENT STATUS OF CAREGIVERS 

1.5 0.9 2.7 2.1 

45.3 

40.9 

14.1 14.2 

26.4 

23.4 23.0 

20.3 21.8 

25.8 

22.2 

29.8 

5.0 

9.0 

38.0 

33.6 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

Working full-time Working part-time Retired Not working 

0 1-30 31-90 91-167 168 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

F. USE OF THE OAA CAREGIVER SUPPORT SERVICES PROGRAM 

The OAA reauthorization in 2000 acknowledged the burden on caregivers by establishing 

the National Family Caregiver Support Program (NFCSP). The Third National Survey provides 

insight into which caregiving services provided by OAA programs are used the most by and are 

most useful to caregivers (Figure IV.20). 

77 
Resource information 

Respite care 

Caregiving training 

Assistive devices 

mergency response systems 

Home modifications 

Specialized equipment 

Nutritional supplements 

FIGURE VI.20 

SERVICES USED BY CAREGIVERS 

78.4 

53.2 

35.2 

26.5 

18.3 16.2 15.8 

10.4 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

E

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

Caregivers used resource information more than they used any other service; 78 percent of 

caregivers reported receiving information about services for managing the burdens of caregiving 

(Figure VI.19). Next in line was respite care, which was used by slightly more than half of all 

caregivers (53 percent). About one-third of caregivers (35 percent) received training in some 

aspect of caregiving, and about one-quarter (27 percent) received assistive devices, which could 

include a walker, a special toileting device, or other equipment. Services used less frequently 

included emergency response systems, home modifications, nutritional supplements, and 

specialized equipment. It is noteworthy that the overall use of services by caregivers depends 

not only on whether or not the clients decided to “take up” the services offered, but also on 

78 
90.8 

76.7 

82.6 

77.9 

57.9 

62.2 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

Care recipient

benefits from

caregiver services

Clearer

understanding of

how to get the

services needed

Easier to care for

care recipient

Feel less stress

Know more about

care recipient's

condition/illness

More time for

personal activities 

whether services were offered in the first place. The preceding rates of use are likely to reflect 

variation in both of these factors. 

G. IMPACT OF THE OF THE OAA CAREGIVER SUPPORT SERVICES PROGRAM 

Caregiver support services affected the lives of caregivers and care recipients in meaningful 

and diverse ways (Figure VI.21). Nine out of 10 caregivers (91 percent) reported that the 

services they offered were beneficial to the care recipient. Eight in 10 caregivers (83 percent) 

said that the services they themselves received made it easier to care for another person. Support 

services also allowed about three-quarters (77 percent) of caregivers to better understand how to 

obtain resources and how feel less stress associated with their role, both of which allowed 

caregivers to function more effectively. 

FIGURE VI.21 

THE EFFECTS OF CAREGIVER SUPPORT SERVICES ON THE DAILY LIFE OF CAREGIVERS 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

79 
Most caregivers believed that the support services they received allowed them to be a better 

caregiver; 72 percent said that the services helped a lot, and another 23 percent said they helped a 

little (not shown). Only 5 percent said the services did not help, and almost no caregivers (less 

than one percent) said the services made things worse. Caregivers also reported that the support 

services increased the length of time that they could perform their duties; 51 percent said this 

was definitely the case, and another 34 percent said they thought it was so (not shown). 

One of the AoA goals is to increase the percent of caregivers who report that services help 

them care longer for older individuals (Indicator 2.5, Appendix A). While a single measure 

cannot answer whether this fraction will increase over time, the National Survey results indicated 

very high baseline responses to this question. About half of caregivers (54 percent) said that 

caregiver support services enabled the care recipient to live at home for a longer period of time. 

H. CLIENT-REPORTED SERVICE QUALITY IN OAA CAREGIVER SUPPORT 

SERVICES 

Overall satisfaction levels with caregiver support services were very high (Figure VI.22). 

The vast majority of caregivers (94 percent) reported that the OAA services they received were 

good, very good, or excellent. Thus, in 2005, the caregiver program exceeded AoA’s new 2008 

performance target, which is at least 90 percent of clients ranking the service as good to excellent 

(Indicators 2.3 and 2.9c, Appendix A). 

80 
FIGURE VI.22
 

OVERALL CLIENT-REPORTED SERVICE QUALITY IN CAREGIVER SUPPORT SERVICES 

4.1% 2.3% 

47.6% 

27.2% 

18.9% 

Excellent Very Good Good Fair Poor 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

Because caregiver support services come in a variety of forms that may not all be known to 

clients, one concern is that caregivers may have difficulty identifying and getting the services 

available to them. While slightly more than half of caregivers (51 percent) did not report 

difficulty in accessing services, others did (Figure VI.23). 

81 
 

 

FIGURE VI.23
 

OVERALL REPORTED EASE OF GETTING CAREGIVER SUPPORT SERVICES 

50.6% 

20.6% 

13.3% 

7.7% 

7.8% 

Not difficult at all A little difficult Somewhat difficult Difficult Very difficult 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

About one in three caregivers (34 percent) said that they found the process of obtaining 

services a little or somewhat difficult, and 16 percent found it difficult or very difficult. The 

extent of difficulty differed little by type of service received (not shown). These numbers point 

to an area for improvement in AoA programs if they are to meet the performance goal in this 

category (Indicator 2.6, Appendix A). 

The majority of caregivers reported that the services they received were helpful 

(Figure IV.24). About 9 out of 10 (89 percent) of those who received respite services said they 

helped a lot, while almost all of the rest (10 percent) said they at least helped a little. Even in 

information services, the category with the fewest number reporting that the services helped a 

lot, 70 percent said this information helped a lot, and another 24 percent said it helped a little. 

For all four major types of caregiver services, at least 95 percent of clients reported that the 

services were helpful. 

82 
 

FIGURE VI.24
 

PERCENT OF CLIENTS WHO REPORTED HELPFULNESS OF CAREGIVER SUPPORT SERVICES 

88.9 

72.3 70.3 

76.7 

10.1 

26.3 

24.2 

20.2 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent 

Respite care services Caregiving training Information about Other types of assistance 

resources 

They helped a lot They helped a little 

Source: Tabulations from the Third National Survey of OAA Program Participants, 2005. 

83 
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VII. CONCLUSIONS AND RECOMMENDATIONS 

OAA program participants appear to be more vulnerable than other Americans age 60 and 

older in almost every area—marital status, living situation, income, education, self-rated health, 

diagnosed health conditions, and functional limitations. Some of the difference between OAA 

participants and other elderly Americans is likely a result of the age difference between the two 

groups; OAA participants tend to be among the oldest old even though the programs can serve 

anyone age 60 and older. Indeed, serving the oldest old may be quite appropriate, given that 

AoA strives to serve clients who are the most vulnerable. 

OAA program participants used the home-delivered meals, transportation, and caregiver 

support services intensively, and they reported that the services are quite helpful in allowing 

them to maintain their independence and remain in their homes. Overall client-reported service 

quality in each of these three programs was quite high. Client-reported service quality for more 

specific measures such as the taste of food or the politeness of drivers—was also high for most 

measures. 

There was, however, room for improvement in a few areas. For instance, people of Hispanic 

origin may not be proportionately served to the same degree as African-Americans, although the 

fraction of Hispanic OAA clients is about the same as that in the U.S. population age 60 and 

older. As the Hispanic population continues to grow, additional emphasis on reaching this group 

may be important, and the AoA has already begun to establish partnerships with groups like the 

Alliance for Latino Health in order to reach the most vulnerable among this population. 

In terms of service delivery, most measures of use, impact, and client-reported service 

quality were quite high, although there remains room for improvement in some areas. For 

example, one-quarter of clients who received transportation services identified that the vans were 

85 
 

 

 

difficult to get in and out of at least some of the time. Older adults are likely have physical 

problems that would make it difficult to get in and out of any vehicle, and evidence from this 

report showed that OAA clients tended to have much higher rates of difficulty with activities of 

daily living than others in their age group. Even so, drivers may want to provide additional 

assistance to clients who appear to be having the most difficulty.36 

Similarly, even though service delivery in transportation is already high quality and threequarters of clients are notified when rides are cancelled, roughly one-quarter of respondents said 

that they were not usually or always notified of canceled rides.37 Many older adults rely on 

transportation to get to medical appointments, and the cancellation of rides without warning may 

lead to fees for missed appointments, or worse, additional health problems from delayed care. 

Improving notification of cancelled rides could improve service quality even more than the 

current level. 

Finally in terms of caregiver support, almost half of the caregivers reported having trouble 

accessing services at least to some degree. Aging Disability Resource Centers (ADRCs) are 

currently piloting projects that are geared toward increasing consumer ease of access or 

removing barriers to applying for services. The ADRCs focus on providing information and 

assistance to individuals in applying for community-based services, and are developing webbased resource databases, providing on-line access to applications and forms, and developing online decision support tools to help consumers tailor information to their situation. In addition, 

ADRCs are working to reduce the number of interactions required for consumers and to shorten 

36 There was an additional question that asked about whether the driver assisted clients, but this question about 

assistance to other passengers, and not the client him or herself. Future revisions to the National Survey will attempt 

to better gauge service quality on this and other measures. 

37 The question related to transportation services did not ask clients specifically whether the rides that were 

canceled were reserved rides. 

86 
the time from intake to eligibility determination. The expected result of these efforts will 

ultimately help caregivers in identifying and accessing additional resources and services. 

The results in this report indicate that overall performance of and reported service quality 

within each of the programs is quite high, and the AoA is already making changes to address 

some of the specific issues raised by clients. AAAs may also want to consider using the results 

in this report to make changes where possible to improve their performance and service delivery. 

In future National Surveys, it will be possible to observe trends over time and hence areas where 

services improve or decline. In particular, additional surveys will allow for comparisons of 

actual to target AoA performance measures, many of which aim for sustained improvements in 

service delivery and impact. 

87 
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REFERENCES 

Katz, S., A.B. Ford, R.W. Moskowitz, et al. “Studies of Illness in the Aged: The Index of ADL.” 

Journal of the American Medical Association, vol. 185, 1963, pp. 914-919. 

U.S. Department of Health and Human Services. “U.S. Administration on Aging, Strategic 

Action Plan, 2007-2012.” Washington, DC: DHHS, 2007. Available at 

[www.aoa.gov/about/strategic/AoA%20Strategic%20Action%20Plan%202007-2012.pdf]. 

Accessed September 17, 2007. 

U.S. Department of Health and Human Services. “Justification of Estimates for Appropriations 

Committees, Administration on Aging, Fiscal Year 2008.” Washington, DC: DHHS, 2007. 

Available at [www.aoa.gov/about/legbudg/current_budg/docs/AoA%20FY%202008% 

20CJ%20Final.pdf]. Accessed September 17, 2007. 

Westat. “AoA Third National Survey: Technical Documentation.” Rockville, MD: Westat, 

2007. 

89 
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APPENDIX A 

ADMINISTRATION ON AGING PERFORMANCE MEASURES AND RELEVANT 

QUESTIONS FROM THE THIRD NATIONAL SURVEY
 
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Performance Measure 

Third National Survey Variable Name/ 

Question Text 

Statistics from the 2005 

National Survey 

Improving Client Outcomes 

Indicator 2.1: Maintain high 

client satisfaction with homedelivered meals. 

HMRATE (HNR38): How would [you/NAME 

OF PARTICIPANT] rate the home-delivered 

meals program overall? 

Excellent: 32.0% 

Very good: 39.9% 

Good: 22.5% 

Indicator 2.2: Maintain high 

client satisfaction with 

transportation services. 

TRRATE (TR24): Next, how would [you/NAME 

OF PARTICIPANT] rate the transportation 

service that [you/s/he] received? 

Excellent: 49.7% 

Very good: 34.9% 

Good: 13.3% 

Indicator 2.3: Maintain high 

client satisfaction among 

caregivers of elders. 

CGRATE (CG20): Overall, how would 

[you/NAME OF CAREGIVER] rate the 

caregiver support services that have been 

provided? 

Excellent: 47.6% 

Very good: 27.2% 

Good: 18.9% 

Indicator 2.5: Increase percent of 

caregivers who report that 

services help them care longer for 

older individuals. 

CGCARLG (CG19): Have these caregiver 

services enabled [you/NAME OF CAREGIVER] 

to provide care for [CARE RECIPIENT] for a 

longer time than would have been possible 

without these services? 

54.4% 

Indicator 2.6: Reduce the percent 

of caregivers who report 

difficulty in getting services. 

CGDIFF (CG21): How difficult has it been for 

[you/NAME OF CAREGIVER] to get services 

from agencies for [CARE RECIPIENT]? 

Not at all difficult: 50.6% 

A little difficult: 20.6% 

Somewhat difficult: 13.3% 

Difficult: 7.7% 

Very difficult: 7.8% 

Indicator 2.9a: 90% of homedelivered meal clients rate 

services good to excellent. 

HMRATE (HNR38): How would [you/NAME 

OF PARTICIPANT] rate the home-delivered 

meals program overall? 

94.4% 

Indicator 2.9b: 90% of 

transportation clients rate services 

good to excellent. 

TRRATE (TR24): Next, how would [you/NAME 

OF PARTICIPANT] rate the transportation 

service that [you/s/he] received? 

97.9% 

Indicator 2.9c: 90% of NFCSP 

clients rate services good to 

excellent. 

CGRATE (CG20): Overall, how would 

[you/NAME OF CAREGIVER] rate the 

caregiver support services that have been 

provided? 

93.6% 

Effective Targeting 

Indicator 3.2: Increase the 

number of severely disabled 

clients who receive selected home 

and community-based services. 

Difficulties with three or more activities of daily 

living (ADLs) 

Note: The State Program Reports (SPRs) are now 

better geared to assess this measure of 

performance, and will be used in budget 

justification from Fiscal Year 2009 and onward. 

Home-delivered meals: 32.6% 

Transportation services: 16.8% 

Care recipients: 70.8% 

Source:	 Performance measures were taken from the Administration on Aging’s 2008 Justification of Estimates for 

Appropriations Committees. Statistics about performance measures in 2005 calculated from data in the 

Third National Survey of Program Participants in 2005. 

A.3 
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APPENDIX B 

BRIEF DESCRIPTION OF THE HEALTH AND RETIREMENT STUDY
 
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The Health and Retirement Study (HRS) is a nationally representative longitudinal dataset 

of the United States population over the age of 50. It is administered by the University of 

Michigan Institute for Social Research and is funded by the National Institute on Aging. The 

HRS contains a range of measures on physical and mental health, health insurance coverage, 

financial status (including innovative methods for measuring income and assets), family support 

systems, labor market status, and retirement planning. 

The survey began in 1992, when it interviewed non-institutionalized sample members who 

were born between 1931 and 1941, as well as their spouses. These participants have been reinterviewed every other year since, most recently in 2006. Other cohorts have been added as the 

sample has aged, and the oldest old were included beginning in 1996, when the HRS merged 

with another similar data set, AHEAD. In recent years, more than 20,000 sample members have 

participated in each interview. While the initial survey sampled only those not in institutions, 

participants are followed as they move into nursing homes or other facilities. One additional 

caveat is that the interviews are only conducted in English and Spanish, meaning that groups 

who cannot complete the interviews in one of those languages are not included in the study and 

will therefore be under-represented. Using the sampling weights provided by the study (which 

are benchmarked to the March Current Population Survey of the relevant year), one can obtain 

estimates about the U.S. older population on a range of dimensions. 

The tabulations in this report consider individuals ages 60 and over using the RAND-HRS 

dataset from 2004. The RAND data provide consistent measures across all waves of the HRS. 

This dataset, along with the raw HRS data files, are free and publicly available at 

http://hrsonline.isr.umich.edu. 

B.3 
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APPENDIX C 

THIRD NATIONAL SURVEY VARIABLE NAMES, 

DESCRIPTIONS, AND QUESTION TEXT 
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Variable 

Name 

Variable 

Description Question Text Sample Size38 

Demographics, Socioeconomic, and Health Status39 

HDM, TS, CG: 

AGEC 

CR: CGPAGE 

Age HDM, TS, CG: (DE2UPDATE): What is [your/NAME OF 

PARTICIPANT’s/NAME OF CAREGIVER’s] date of 

birth? [AGEC constructed from this information] 

CR: (CG63B): What is {CARE RECIPIENT’s} date of 

birth? [CGPAGE constructed from this information] 

HDM: 2,318 [983,276] 

TS: 2,516 [303,269] 

CG: 1,063 [580,510] 

CR: 1,064 [580,805] 

DERAC01 ­

DERAC06 

Race (DE5): What is [your/his/her] race? [CODE ALL THAT 

APPLY] 

HDM: 2,240 [946,562­

946,563] 

TS.: 2,430 [291,277] 

CG: 1,052 [579,188] 

DEHISP Hispanic (DE4): [Are you/is NAME OF PARTICIPANT/NAME OF 

CAREGIVER] Spanish, Hispanic, or Latino? 

HDM: 2,302 [977,150] 

TS: 2,493 [301,162] 

CG: 1,073 [589,854] 

DEGENDR 

DELIVWI 

Gender 

Living 

situation 

(DE1): ASK IF NOT OBVIOUS: What is [your/NAME 

OF PARTICIPANT’s/NAME OF CAREGIVER’s] 

gender? 

(DE8): Does anyone else live with [you/NAME OF 

PARTICIPANT/NAME OF CAREGIVER]? 

Note: This question was asked to all HDM, TS, and CG 

respondents. For the CR sample, it was only asked to 

respondents whose caregiver was not living in the same 

house. This question was used to ascertain whether or not 

participants lived alone. 

HDM: 2,323 [985,760] 

TS: 2,520 [304,185] 

CG: 1,053 [577,462] 

CR: 1,075/590,714 

HDM: 2,316 [982,568] 

TS: 2,506 [302,535] 

CG: 1,068 [586,491] 

CR: 301 [167,992] 

DEMARST Martial 

status 

(DE9): What is [your/his/her] marital status? HDM: 2,312 [981,541] 

TS: 2,506 [302,831] 

CG: 1,069 [586,863] 

38 Sample size indicates the number of valid (non-missing and not ‘don’t know’ or ‘refused’) responses. First 

number is unweighted number of survey responses, bracketed number indicates the weighted count of AoA service 

recipients. “HDM” denotes home-delivered meals sample, “TS” denotes transportation services sample, “CG” 

denotes caregivers and “CR” denotes care recipients. 

39 Questions in this section were asked of all respondents in the surveys where the sample size is indicated, 

unless otherwise noted. If the sample size is not indicated for a particular group (HDM, TS, CG, or CR), the 

question was not asked to or about that group. 

C.3 
 

 

 

 

 

 

 

 

 

 

 

Variable 

Name 

Variable 

Description Question Text Sample Size38 

DEEDUC Education (DE3): What is [your/NAME OF PARTICIPANT/s/NAME 

OF CAREGIVER’s] highest level of education? 

HDM: 2,302 [976,399] 

TS: 2,502 [302,055] 

CG: 1,072 [588,770] 

DEINAB Income (DE10): Which category best describes [your/NAME OF HDM: 1,737 [733,842] 

DEINBEL PARTICIPANT’s/NAME OF CAREGIVER’s] total 

DEINABOV household annual income during the year 2004? TS: 1,861 [223,344] 

CG: 913 [494,448] 

HNR, TR: Health HDM, TS: (PF2): Has a medical doctor told [you/NAME HDM: 2,243-2,312 

PFDISA- Conditions OF PARTICIPANT] that [you have/s/he has] had any of [952,992-985,760 ] 

PFDISP the following?: Arthritis, Breathing/lung problems, 

Depression or anxiety, Diabetes, Eye or vision conditions, TS: 2,466-2,509 [279,924­

CG: CGDISBB Hearing problems, Heart disease, High cholesterol, 304,186] 

Hypertension, Osteoporosis, Cancer, Stroke, Anemia, 

Kidney disease, Alzheimer’s or dementia, Seizures/brain CG: 450 [250,159] 

disorder, Parkinsons, Skeletal. 

CG: (CG35B): What is that problem, condition, or 

disability? (back problems and other joint 

problems/arthritis, heart problems/high blood 

pressure/hypertension/stroke, diabetes, allergies/asthma, 

other breathing and lung problems, other illness, mental 

health, eye problems, other 

Note: For HDM and TS, this question was asked to all 

respondents. For CG, the specific health condition 

questions were only asked to those who reported having 

any health condition. 

HDM, TS: Self-rated HDM, TS: (PF1): In general, would [you/NAME OF HDM: 2,284 [970,037] 

PFHLTH health status PARTICIPANT] say [your/his/her] health is: excellent, 

very good, good, fair, or poor? TS: 2,485 [300,067] 

CG: 

CGHEALTH CG: (CG66): In general, would [you/NAME OF CG:1,072 [586,074] 

CAREGIVER] say [your/his/her] health is: excellent, very 

CR: good, good, fair, or poor? CR: 1,062 [583,849] 

CGCRHL 

CR: (CG54): In general, would [you/NAME OF 

CAREGIVER] say [CARE RECIPIENT’s] health is: 

excellent, very good, good, fair, or poor? 

PFBATH, ADL HDM, TS: [Do you/Does NAME OF PARTICIPANT]... HDM: 2,315-2,318 

PFDRES, difficulties ...(PF10) have difficulty when taking a bath or shower? [982,547-983,728 ] 

PFEAT, ...(PF11) have difficulty when dressing? 

PFBED, ...(PF13) have difficulty eating? TS: 2510-2,519 [303,176­

PFWC, ...(PF9) have difficulty getting in or out of bed or a chair? 304,094] 

PFWALK ...(PF14) have difficulty using the toilet or getting to the 

toilet? 

...(PF12) have difficulty when walking? 

C.4 
 

 

 

 

Variable Variable 

Name Description Question Text Sample Size38 

PFDRIVE, 

PFDFIN, 

PFDFOU, 

PFCLEN, 

PFDLR, 

PFMEAL, 

PFTKDG, 

PFUSEBUS, 

PFFONE 

IADL 

difficulties 

HDM, TS: [Do you/Does s(he) ] 

...(PF20): have difficulty driving an automobile? 

...(PF7): have difficulty getting around inside the home? 

...(PF8): have difficulty going outside the home, for 

example, to shop or visit a doctor’s office? 

...(PF17): have difficulty doing light housework, such as 

washing dishes or sweeping a floor? 

...(PF15): have difficulty keeping track of money or bills? 

...(PF16): have difficulty preparing meals? 

...(PF18): have difficulty taking the right amount of 

prescribed medicine at the right time? 

...(PF21B): If public transportation is available, have 

difficulty using this transportation? 

...(PF19): have difficulty using the telephone? 

HDM: 2,286-2,321 

[971,356-984,762] 

 Public transportation: 984 

[425,810] 

TS: 2,463-2,519 [298,229­

304,034 ]

 Public transportation: 

1,053 [131,059] 

Note: Question about public transportation was only 

relevant to those who reported having public transportation 

available. 

C.5 
 

 

 

 

 

Variable 

Variable Name Description Question Text Sample Size 

HMHOT Number of 

hot meals 

received in 

(HNR2): What is the total number of hot meals 

[you/NAME OF PARTICIPANT] received in the past 

week? 

2,323 [973,759] 

past week 

Home-Delivered Meals40 

HMFROZE Number of 

frozen meals 

received in 

past week 

(HNR3): What is the total number of frozen meals 

[you/NAME OF PARTICIPANT] received in the past 

week? 

2,323 [970,322] 

HMBAG Number of 

bag suppers 

received in 

past week 

(HNR4): What is the total number of bag suppers 

[you/NAME OF PARTICIPANT] received in the past 

week? 

2,323 [966,138] 

HMSUPP Number of 

nutritional 

supplements 

received in 

past week 

(HNR5): What is the total number of nutritional 

supplements, such as Boost or Ensure, [you/NAME OF 

PARTICIPANT] received in the past week? 

2,323 [961,298] 

HMDAYSWK Number of 

days each 

week client 

receives 

meals 

(HNR7): How many days each week [do you/does s/he] 

receive home-delivered meals? 

2,269 [961,366] 

HMDAYSPST Number of 

days in the 

past week 

client eats 

1+ homedelivered 

meal 

(HNR8): How many days in the past week did 

[you/NAME OF PARTICIPANT] eat one or more homedelivered meal? 

2,288 [969,628] 

HMMEALS Number of 

meals eaten 

on days of 

homedelivered 

meals 

(HNR9): Please tell me, on the days [you eat/s/he eats] 

home-delivered meals, how many meals [do you/does 

s/he eat]? 

2,263 [960,897] 

40 All questions in the home-delivered meals survey were asked of all respondents. Variations in sample size 

are due to people responding that the question did not apply, they did not know the answer, or refused to answer the 

question. 

C.6 
 

 

Variable 

Variable Name Description Question Text Sample Size 

HMNOEAT Number of (HNR10): On the days [you don’t/NAME OF 2,196 [936,849] 

meals eaten PARTICIPANT doesn’t] eat home-delivered meals, how 

on days many meals [do you/does s/he eat]? 

without 

homedelivered 

meals 

HMDYNOFD Whether (HNR11): Now think about the days when [you don’t/s/he 2,210 [939,180] 

eats doesn’t] eat a home-delivered meal. [Do you/Does s/he 

more/less on eat] about the same amount of food, more food, or less 

the days food? 

when 

doesn’t get 

homedelivered 

meals 

HMPORTN How much (HNR12): Think about the amount of food [you eat/s/he 2,103 [887,692] 

of total food eats] from the home-delivered meal. On the days [you 

consumed eat/NAME OF PARTICIPANT eats] a home-delivered 

do home- meal, what portion of all the foods [you eat/s/he eats] in a 

delivered day does this meal represent? 

meals 

represent on 

the days 

received 

HMEATFRT, Usually eat When [you eat/he eats] the home-delivered meal, [do 

HMEATPOT, you/does s(he)] usually eat... 

HMEATVEG, ...(HNR15): the fruit that is provided? 2,289 [971,970] 

HMEATPBRD, ...(HNR17): the potatoes that are provided? 2,289 [970,368] 

HMEATDAR, ... (HNR19): other than potatoes... the vegetables that are 2,285 [970,601] 

HMEATMET, provided? 

HMEATBNS ... (HNR21): the bread, cereal, rice, pasta, noodles, or 2,282 [968,351] 

tortillas that are provided? 

... (HNR23): or drink the milk, cheese, or yogurt that are 2,279 [968,214] 

provided? 

... (HNR25): the meat, chicken, fish, or eggs that are 2,290 [971,993] 

provided? 

... (HNR27): the nuts, tofu, or beans if they are provided? 2,263 [960,403] 

HMRATE How rates (HNR38): How would [you/NAME OF PARTICIPANT] 2,308 [979,404] 

HDM rate the home-delivered meals program overall? 

program 

overall 

HNRRECOM Whether (HNR39): Would [you/s/he] recommend this program to 2,313 [980,822] 

would [your/his/her] friends, neighbors, and relatives? 

recommend 

the program 

to others 

C.7 
 

 

 

Variable Name 

Variable 

Description Question Text Sample Size 

HNRLIKE Whether (HNR37): [Do you/Does NAME OF PARTICIPANT] 2,267 [/962,801] 

person likes like the home-delivered meals [you get/s/he gets]? 

meals 

HMTASTES, Other [Are you/is s/he] satisfied... 

HMSMELLS, measures of ...(HNR30): with the way the food tastes? 2,293 [973,837] 

HMLOOKS, satisfaction ... (HNR31): with the way the food smells? 2,011 [847,819] 

HMVARITY, ... (HNR32): with the way the food looks? 2,109 [890,281] 

HMTEMP, ... (HNR33): with the way the variety of the food? 2,285 [967,863] 

HMONTIME, ... (HNR34): that the hot foods are hot and the cold foods 2,034 [854,485] 

HNRFRND are cold? 

... (HNR35): that [your/NAME OF PARTICIPANT’s] 2,263 [959,138] 

meals arrive about the time [you expect/s/he expects] 

them to? 

... (HNR36): that the person who delivers the meals is 2,268 [961,882] 

friendly and respectful? 

HMVARFD, Home- Do home-delivered meals help [you/NAME OF 

HMVR2FD, delivered PARTICIPANT]... 

HMSPECDT, meals help ...(HNR40): eat healthier foods? 2,284 [968,834] 

HMWEIGHT, clients to... ...(HNR41): eat a greater variety of foods? 2,300 [/975,704] 

HMFLBTR, ...(HNR42): follow the special diet that is prescribed by 1,569 [674,309] 

HMFLBR2, [your/his/her] doctor or dietician? 

LESSHGRY, ...(HNR43): achieve or maintain a healthier weight? 2,263 [960,709] 

HMSTATHM ...(HNR44): improve [your/NAME OF 2,278 [960,013] 

PARTICIPANT’s] health? 

...(HNR45): feel better? 2,286 [970,807] 

...(HNR46): feel less hungry? 2,267 [962,105] 

...(HNR47): do home-delivered meals help [you/NAME 2,270 [964,415] 

OF PARTICIPANT] continue to live in [your/his/her] 

home? 

C.8 
 

 

 

 

Transportation Services41 

Variable Variable 

Name Description Question Text Sample Size 

TRDRIVE Does 

household 

(TR29): [Do you/Does NAME OF PARTICIPANT] ever 

drive that car? 

1,113 [137,578] 

have a 

car?/If so, 

can 

participant 

drive? 

Note: This question was only asked to respondents who 

said there was a car in working condition in the household 

(answered yes to TR28) 

TRMONTH Number of 

one-way 

trips used 

per month 

(TR5): About how many local one-way trips a month [do 

you/does NAME OF PARTICIPANT] make using this 

service? For example, if [you go/s/he goes] to the 

doctor’s office and then [come/comes] back using this 

service, that counts as 2 one-way trips. 

2,004 [222,117] 

Note: 470 respondents were noted to have a ‘Not 

Applicable’ answer to this question because they used less 

than one trip per month on average. 

TRPROP Fraction of 

all of 

client’s oneway trips 

performed 

by 

transportati 

on service 

(TR6): In an average month, would [you/NAME OF 

PARTICIPANT] say [you rely/s/he relies] on this 

transportation services for: just a few of [your/his/her] 

local trips, about 1/4 of all [your/his/her] local trips, 

about 1/2 of all [your/his/her] local trips, about 3/4 of all 

[your/his/her] local trips, or nearly all of [your/his/her] 

local trips? 

1,844 [221,201] 

Note: 516 respondents were noted to have a ‘Not 

Applicable’ answer to this question because they used the 

service for less than one ride per month on average. 

TRACT01 – 

TRACT10 

Usual 

destination 

of 

transportati 

on services 

(TR25): [Do you/Does NAME OF PARTICIPANT] use 

[your/his/her] transportation service to get to: 

...work? 

...doctors and health care providers? 

...shopping? 

...volunteer activities? 

...senior center? 

...lunch program? 

...friends, neighbors, and relatives? 

...social events and recreation activities? 

...clubs and meetings? 

...religious services? 

2,519 [304,031] 

2,517 [303,794] 

2,514 [303,215] 

2,508 [302,709] 

2,514 [303,362] 

2,514 [303,274] 

2,513 [303,375] 

2,515 [303,808] 

2,513 [303,378] 

2,518 [303,805] 

41 Questions in the transportation services survey were asked of all respondents unless otherwise noted. Other 

variations in sample size are due to people responding that the question did not apply, they did not know the answer, 

or refused to answer the question. 

C.9 
 

 

 

 

 

 

 

Variable Variable 

Name Description Question Text Sample Size 

TRACTB01 – Whether 

TRACTB10 transportati 

on allows 

participant 

to go to 

places more 

(TR25B): Because of the transportation service, [do 

you/does NAME OF PARTICIPANT] go to ___ more 

often? 

...work 

...doctors and health care providers 

...shopping 

...volunteer activities 

...senior center 

...lunch program 

...friends, neighbors, and relatives 

...social events and recreation activities 

...clubs and meetings 

...religious services 

Note: These questions were only asked to respondents 

who reported using the transportation service to get to 

each particular destination (in TR25). 

47 [4,744] 

1,676 [207,031] 

983 [113,872] 

429 [50,490] 

1,048 [123,017] 

777 [91,204] 

200 [24,094] 

617 [76,167] 

287 [36,431] 

138 [17,813] 

TRRATE Overall (TR24): Next, how would [you/NAME OF 2,515 [303,580] 

satisfaction PARTICIPANT] rate the transportation service that 

[you/s/he] received? 

TRFRE05 – Other 

TRFRE17 measures of 

satisfaction 

For the next few questions, please tell me how frequently
 

these statements apply to [your/NAME OF 

PARTICIPANT’s] overall experience with [PROVIDER 

NAME/AGENCY NAME]? Please select one of these 

five responses: always, usually, sometimes, rarely, or 

never. 

...(TR9): The vehicles are comfortable. 

...(TR10): The vehicles are easy to get into and out of. 

...(TR11): [You arrive/S(He) arrives] at [your/his/her] 

destination on time. 

...(TR12): The drivers pick [you/him/her] up when they
 

are supposed to. 

...(TR13): The service calls [you/NAME OF 

PARTICIPANT] if [your/his/her] ride has been cancelled.
 

...(TR14): [You/NAME OF PARTICIPANT] can get to 

the places [you want/s(he) wants] or [need/needs] to go. 

...(TR15): The trips take too long. 

...(TR16): The drivers are polite. 

...(TR17): The drivers offer to help passengers into and
 

out of the van when they need it.
 

...(TR18): The drivers help passengers into and out of
 

their homes when they need it. 

...(TR19): [You get/NAME OF PARTICIPANT gets] the 

number of rides [you need/s/he needs] from this service. 

...(TR20): [You get/S(He) gets] rides at the times and on
 

the days [you need/s/he needs] them. 

...(TR21): [You have/NAME OF PARTICIPANT has]
 

the information [you need/s/he needs] to schedule and 

take [your/his/her] local trips.
 

2,471 [298,050] 

2,472 [299,317] 

2,470 [298,931] 

2,486 [299,703] 

1,259 [147,958] 

2,446 [295,483] 

2,399 [290,464] 

2,508 [302,731] 

2,401 [291,540] 

1,949 [236,715] 

2,435 [294,199] 

2,453 [296,460] 

2,369 [287,302] 

C.10 
 

 

 

 

 

 

 

 

Variable Variable 

Name Description Question Text Sample Size 

CGACTI01 – 

CGACTI06 

Types of 

activities 

that 

caregiver 

assists with 

(CG2): I’m going to read several activities that some 

people need help with. [Do you/Does NAME OF 

CAREGIVER] help [CARE RECIPIENT] with... 

... activities like dressing, eating, bathing, or getting to 

the bathroom. 

1,074 [589,795] 

...medical needs such as taking medicine or changing 

bandages. 

...keeping track of bills, checks, or other financial 

1,075 [590,714] 

1,073 [589,984] 

matters. 

...preparing meals, doing laundry, or cleaning the house. 

...going shopping or to the doctor’s office. 

...arranging for care or services provided by others. 

1,075 [590,714] 

1,075 [590,714] 

1,068 [588,356] 

Caregiver Support Services42 

CGWORK Employment status 

of caregiver 

What is [your/NAME OF CAREGIVER’s] current 

employment status? 

1,069 [589,338] 

CGQUIT Quit work 

because of 

caregiving 

role 

(CG23): Did [your/his/her] caregiving responsibilities 

cause [you/him/her] to quit work or retire early? 

Note: This question was only asked to those who said they 

were not working or retired (answered retired or not 

working to CG22). 

717 [382,788] 

CGINTRFR Caregiving 

ever 

interfered 

with job 

(CG24): Has providing care for [CARE RECIPIENT] 

interfered with [your/NAME OF CAREGIVER’s] job? 

Note: This question was only asked to those who said they 

were working full- or part-time (answered full-time or 

part-time to CG22). 

347 [202,258] 

CGINTJB Caregiving 

ever 

interfered 

with job 

(CG25): How frequently has providing care for [CARE 

RECIPIENT] interfered with [your/NAME OF 

CAREGIVER’s] job? 

Note: This question was only asked to those who were 

working full- or part-time and reported that caregiving has 

interfered with job (answered full- or part-time to CG22 

and yes to CG24). 

196 [124,489] 

42 Questions in the caregiver survey were asked of all respondents unless otherwise noted. Other variations in 

sample size are due to people responding that the question did not apply, they did not know the answer, or refused to 

answer the question. 

C.11 
 

 

 

 

 

 

 

 

 

Variable Variable 

Name Description Question Text Sample Size 

CGYOU03 – Other 

CGYOU11	 effects of 

caregiving 

on 

employment 

(CG26): Because of providing care for [CARE 

RECIPIENT], [have you/has NAME OF
 

CAREGIVER]...: 

...taken a less demanding job?
 

...changed from full-time to part-time work?
 

...reduced [your/his/her] official working hours?
 

...lost some of [your/his/her] employment fringe benefits? 

...had time conflicts between working and caregiving?
 

...used [your/his/her] vacation or personal time or sick
 

leave to provide care?
 

...taken a leave of absence to provide care?
 

...lost a promotion?
 

...worked less than [your/NAME OF CAREGIVER’s]
 

normal hours last month because of providing care for 

[CARE RECIPIENT]?
 

Note: These questions were only asked to those who said
 

that caregiving interfered with their job (answered always, 

usually, or sometimes to CG25). 

170 [108,792] 

169 [108,524] 

169 [108,099] 

170 [108,792] 

170 [108,792] 

167 [108,205] 

169 [108,555] 

168 [108,151] 

168 [107,260] 

RGENDER Descriptive (CG64): (DON’T ASK IF OBVIOUS) What is [CARE 1,075 [590,714] 

statistics of RECIPIENT’s] gender 

care 

recipients: 

gender 

CGPAGE Descriptive (CG63): We have [CARE RECIPIENT’s] date of birth as 1,064 [580,805] 

statistics of [MM,DD,YYYY]. Is that correct? If not, (CG63B): 

care What is [CARE RECIPIENT’s] date of birth? 

recipients: 

age 

CGCRHL Descriptive (CG54): In general, would [you/NAME OF 1,062 [583,849] 

statistics of CAREGIVER] say [CARE RECIPIENT’s] health is: 

care excellent, very good, good, fair, or poor? 

recipients: 

health status 

PFDISACG – Health 

PFDISOCG conditions 

of care 

recipients 

(CG55): Has a medical doctor told [you/NAME OF 

CAREGIVER] that [CARE RECIPIENT] has any of the 

following?
 

...Alzheimer’s/dementia?
 

...arthritis?
 

...breathing/lung problems?
 

...depression or anxiety?
 

...diabetes?
 

...eye or vision conditions?
 

...hearing problems?
 

...heart disease?
 

...high cholesterol?
 

...hypertension?
 

...osteoporosis?
 

...stroke?
 

1,057 [580,135] 

1,063 [584,892] 

1,070 [588,128] 

1,052 [576,499] 

1,069 [587,353] 

1,064 [585,289] 

1,069 [587,710] 

1,058 [579,511] 

1,042 [568,612] 

1,067 [587,210] 

1,051 [572,750] 

1,061 [581,328] 

C.12 
 

 

 

 

 

Variable Variable 

Name Description Question Text Sample Size 

PFBATHC, Care Does [s(he)] have difficulty... 

PFDRESC, recipient ...(CG58): when taking a bath or shower? 1,068 [588,072] 

PFBEDC, difficulties ...(CG59): when dressing? 1,074 [590,075] 

PFWCC, with ...(CG57): getting in or out of bed or a chair? 1,067 [582,373] 

PFWALKC, activities of ...(CG62): using the toilet or getting to the toilet? 1,068 [586,142] 

PFEATC daily living ...(CG60): walking? 1,071 [589,128] 

...(CG61): eating? 1,071 [587,740] 

CGHLTH Caregiving (CG36): [Have your/Has NAME OF CAREGIVER’s] 442 [245,371] 

led to caregiving activities created or worsened any of these 

worsened conditions or problems or disabilities? 

health 

problems Note: This question was only asked to those who said they 

had a health problem, physical condition, or disability 

(answered yes to CG35). 

CGDIF Biggest (CG33): What is the biggest difficulty [you have/NAME 1,002 [544,488] 

hardship OF CAREGIVER has] faced in caring for [CARE 

RECIPIENT]? 

CGBEST Biggest (CG28): In [your/NAME OF CAREGIVER’s] experience 1,018/559,774] 

reward as a caregiver, what would [you/s(he)] say is the most 

positive aspect of caregiving? 

CGPSTRN, Other 

CGEMSTRS, burdens of 

CGFINHD, caregiving 

CGHDSHP 

(CG29): Think of a scale from 1 to 5, where 1 is “not a 

strain at all” and 5 is “very much of a strain.” How much
 

of a ______ would [you/NAME OF CAREGIVER] say 

that caring for [CARE RECIPIENT] is for [you/him/her]?
 

...physical strain?
 

...emotionally stressful?
 

...financial burden?
 

...hardship?
 

1,073 [589,085] 

1,071 [589,301] 

1,063 [584,899] 

1,057 [/576,404] 

CGMINUT How far 

away the 

caregiver 

lives from 

the care 

recipient 

(CG38): How far away [do you/does NAME OF 

CAREGIVER] live from [CARE RECIPIENT]? 

1,075 [590,714] 

CGALONE Whether 

care 

recipient 

lives alone 

(CG39): Does [CARE RECIPIENT] live alone? 

Note: This question was only asked to those who were not 

living in the same house as the care recipient (answered 

something other than “in the same house” to CG38. 

301 [167,991] 

CGLFTLN Whether 

care 

recipient 

could be left 

alone for a 

whole day 

(CG40): Can [CARE RECIPIENT] be left alone for an 

entire day? 

Note: This question was only asked to those whose care 

recipient did not live alone (answered yes to CG39). 

884 [488,057] 

C.13 
 

 

 

 

 

 

 

Variable Variable 

Name Description Question Text Sample Size 

CGHRS Amount of (CG41): In [your/NAME OF CAREGIVER’s] judgment, 1,037 [572,252] 

care the how many hours per day of help, care, or supervision does 

care [CARE RECIPIENT] need? 

recipient 

needs per 

day 

CGHRSWK	 Amount of (CG42): In a typical 24-hour week day, how many hours 1,047 [575,148] 

care the [do you/does NAME OF CAREGIVER] provide help, 

caregiver care, or supervision for [CARE RECIPIENT] in person? 

provides on 

weekdays 

CGHRSWD	 Amount of (CG43): In a typical 24-hour weekend day, how many 1,044 [574,752] 

care the hours [do you/does NAME OF CAREGIVER] provide 

caregiver help, care, or supervision for [CARE RECIPIENT] in 

provides on person? 

weekends 

CGRSPT Service use (CG5): [Have you/Has NAME OF CAREGIVER] 1,067 [587,969] 

among received Respite Care, which allows [you, the 

caregivers caregiver/NAME OF CAREGIVER], a brief period of rest 

or relief while temporary care is provided to [CARE 

RECIPIENT] either in [your/his/her] home or someplace 

else? 

CGSUP01 – Service use 

CGSUP05 among 

caregivers 

(CG14): Has the National Family Caregiver Support 

Program provided any other Supplemental Services to 

complement the care [you provide/s/he provides], such
 

as...: 

... home modifications?
 

...nutritional supplements, such as Ensure or Boost?
 

...assistive devices, such as walkers, canes or crutches?
 

...emergency response systems?
 

...specialized equipment, such as CPAP, Apnea 

machines, hospital bed, wander guard, or other
 

equipment?
 

1,072 [586,473] 

1,069 [588,437] 

1,061 [584,473] 

1,064 [586,507] 

1,070 [589,194] 

CGEDU Service use 

among 

caregivers 

(CG11): [Have you/Has NAME OF CAREGIVER] 

received caregiver training or education, including 

counseling or support groups, to help [you/him/her] make 

decisions and solve problems in [your/his/her] role as a 

caregiver? 

1,067 [586,823] 

CGINFO Service use 

among 

caregivers 

(CG9): Has someone, such as [your/NAME OF 

CAREGIVER’s] caseworker, case manager or other AAA 

staff person, helped [you/him/her] or given [you/him/her] 

information to connect [you/him/her] to available services 

and resources? 

1,056 [583,665] 

CGRATE Overall 

ranking of 

caregiver 

support 

services 

(CG20): Overall, how would [you/NAME OF 

CAREGIVER] rate the caregiver support services that 

have been provided? 

1,070 [588,670] 

C.14 
 

 

 

 

 

 

 

Variable 

Name 

Variable 

Description Question Text Sample Size 

CGDIFF Overall ease 

of getting 

services 

(CG21): How difficult has it been for [you/NAME OF 

CAREGIVER] to get services from agencies for [CARE 

RECIPIENT]? 

1,028 [564,835] 

CGRSPTHP Effectiveness of 

services 

(CG8): To what extent have the respite care services [you 

have/NAME OF CAREGIVER has] received helped 

[you/him/her] as a caregiver? 

588 [305,263] 

Note: This question was only asked to those who have 

received respite care (answered yes to CG5). 

CGEDUHLP Effectivenes 

s of services 

(CG13): To what extent have the caregiver training, 

education, counseling, or support group services [you 

have/NAME OF CAREGIVER has] received helped 

[you/him/her] as a caregiver? 

313 [201,501] 

Note: This question was only asked to those who received 

caregiver training or education (answered yes to CG10). 

CGINFOHP Effectivenes 

s of services 

(CG10): To what extent has the help or information [you 

have/NAME OF CAREGIVER has] received helped 

[you/him/her] connect to available services and resources? 

797 [444,074] 

Note: This question was only asked to those who were 

able to connect to available services and resources 

(answered yes to CG9). 

CGSUPHLP Effectivenes 

s of services 

(CG15): To what extent have the [INSERT ALL 

SERVICES IN CG6E THAT ARE YES] [you 

have/NAME OF CAREGIVER has] received helped 

[you/him/her] as a caregiver? 

550 [294,021] 

Note: This question was only asked to those who received 

a supplemental service (answered yes to any part of 

CG14). 

CGAFECA –	 Effect of 

CGAFECF caregiving 

on daily life 

of caregiver 

(CG17): As a result of the caregiver services [you
 

have/NAME OF CAREGICER has] received, [do 

you/does s/he]...
 

...have more time for personal activities?
 

...feel less stress?
 

...find it easier to care for [CARE RECIPIENT] ?
 

...have a clearer understanding of how to get the services 

[you/NAME OF CAREGIVER] and [CARE
 

RECIPIENT] need?
 

...know more about [CARE RECIPIENT’s] condition or 

illness?
 

...think that [CARE RECIPIENT] benefits from the 

caregiver services [you receive/NAME OF CAREGIVER 

receives]?
 

1,060 [582,583] 

1,060 [580,932] 

1,056 [574,856] 

1,052 [581,485] 

1,058 [582,457] 

1,062 [581,090] 

C.15 
 

 

Variable 

Name 

Variable 

Description Question Text Sample Size 

CGHELP Whether 

services led 

to being a 

better 

caregiver 

(CG18): Overall, to what extent have these caregiver 

services helped [you/her/him] to be a better caregiver? 

1,061 [580,855] 

CGCARLG Whether 

services 

enabled 

caregiving 

for a longer 

time 

(CG19): Have these caregiver services enabled 

[you/NAME OF CAREGIVER] to provide care for 

[CARE RECIPIENT] for a longer time than would have 

been possible without these services? 

1,044 [575,704] 

CGDFPLC Whether 

service 

enabled 

care 

recipient to 

continue to 

live at home 

(CG47): In [your/NAME OF CAREGIVER’s] judgment, 

if the services that [you/NAME OF CAREGIVER] and 

[CARE RECIPIENT] have received had not been 

available, would [CARE RECIPIENT] be able to continue 

to live in the same residence? 

1,024 [561,413] 

C.16