EVALUATION OF 

THE ACL TITLE VI 

PROGRAMS

YEAR 2 

INTERIM 

REPORT

January 2019
BACKGROUND

WHAT IS TITLE VI?

In 1965, the Older Americans Act (OAA) was 

authorized to protect the well-being of older 

Americans. The OAA promotes community and 

home-based services to support independent 

living, physical and mental health, suitable housing, 

restorative services for those requiring institutional 

care, and retirement in “health, honor, and dignity” 

(OAA Title I, Sec. 101: 42 U.S.C. 3001).

In 1978, the OAA was amended to include homeand community-based supportive services for 

older American Indian, Alaska Native, and Native 

Hawaiian (AI/AN/NH) populations. This amendment, 

Title VI, recognizes that older AI/AN/NHs are a 

“vital resource entitled to all benefits and services 

available” (OAA Title VI, Sec. 602: 42 U.S.C. 3057a).

Title VI provides nutrition and supportive services 

for elders, including congregate and home-delivered 

meals, information referral services, transportation, 

and other services. The program also provides 

caregiver services for individuals providing care 

for elders or for elders caring for grandchildren. 

Services include information and outreach, respite 

care, and related services. 

The Administration for Community Living (ACL), 

Administration on Aging (AoA), administers the Title 

VI Programs. In fiscal year 2016, ACL awarded 3-year 

grants for the following: 

▶ 270 grants for Nutrition and Supportive Services 

▶ 233 grants for the Caregiver Support Program

ICF has been contracted to conduct the Evaluation 

of ACL’s AI/AN/NH Programs (OAA Title VI) Title VI 

Grant Program under ACL contract #1600197A. This 

report presents a summary and findings from Year 2 

of the evaluation.

TITLE VI PROGRAM SERVICES

▶ Nutrition and supportive services for tribal elders

▶ Caregiver services for individuals providing care 

for elders or for elders caring for grandchildren

WHAT IS THE EVALUATION OF THE ACL TITLE VI PROGRAMS?

Forty years after Title VI was established, the 

Evaluation of the ACL Title VI Programs is an 

opportunity to understand the impact of the Title VI 

Programs on stakeholders, including elder program 

participants, caregivers of elders, and program 

staff. The evaluation consists of two studies: an 

implementation study and an outcomes study. 

The evaluation uses a mix of information that 

grantees already collect (secondary data), as 

well as new sources of information (primary data) 

to describe the implementation and outcomes 

across nutrition services, supportive services, and 

caregiver support services. 

With the help of a stakeholder advisory committee 

(Steering Committee) representing tribal, local, 

national, and state partners to the ACL Title VI 

Programs, the evaluation is grounded by a medicine 

wheel representing the four quadrants of indigenous 

practice: Spiritual, Mental, Emotional, and Physical 

(see Appendix A). Each quadrant of the medicine 

wheel reflects the expected outcomes of the Title VI 

Programs on program participants. 

IMPLEMENTATION STUDY: Looks at the 

context of the Title VI Program, including barriers 

and facilitators to program implementation.

OUTCOMES STUDY: Assesses the impact 

of the program, particularly to understand 

the impact of the program on elders and the 

community.

40

YEARS

Title VI celebrated its 

40th year in 2018.

1
1. How do tribes operate their

Title VI Programs?

2. What is the effect of Title VI

Programs on elders in the

community? Are there differences

nationally or by tribe/tribal groups?

3. Do Title VI Programs that rely only on 

Title VI funds have a different impact 

than programs that have money from 

other programs or agencies?

TWO STUDIES: 

IMPLEMENTATION 

& OUTCOMES

EVALUATION 

QUESTIONS

REPORTING & 

DISSEMINATION

Primary Data

• Staff, Caregiver, Elder Focus Groups

• Staff, Elder Interviews

• Caregiver Survey

Secondary Data

• Title VI Needs Assessment

• n4a Survey

• Program Performance Reports

• Title VI Applications

SNAPSHOT OF THE EVALUATION OF THE ACL TITLE VI PROGRAMS

2

Evaluation Grantees

Twelve Title VI grantees representing 5 Title 

VI regions and 6 states are participating in the 

Evaluation of the ACL Title VI Programs (see 

Appendix B). Each grantee identified 2-3 people 

from their Title VI Program, including the Title 

VI program director, to serve on the Evaluation 

Working Group (EWG). The EWG guides and informs 

all stages of the evaluation, including data collection 

instruments, recruiting participants to take part 

in focus groups and interviews, and local data 

collection and technical assistance needs. 

Training and Technical Assistance

As part of the evaluation, the ICF evaluation team 

provides training and technical assistance (TTA) 

to the EWG on topics that include Evaluation 101: 

Making Evaluation Work for You; Human Subjects 

Protection: Participant’s Rights and Local Decisions; 

Using Data to Inform Programming; and Everyday 

Evaluations. TTA is provided through annual inperson meetings with the EWG, virtual trainings/

webinars, quarterly calls with a dedicated evaluation 

liaison, and in-person site visits.

EVALUATION TIMELINE

The first year of the evaluation focused on evaluation planning and preparation. Activities included 

development of data collection tools and recruitment of Title VI grantees to participate in the evaluation. 

The second year of the evaluation focused on data collection and TTA with the evaluation grantees.

Final

Report

Caregiver

Focus Groups

IRB Approval

Received

Subawards

 Interim

Report

Program Staff

Focus Groups Data

Analysis Plan

2016 2017 2018 2019 2020

Interim

Report

Briefings

with Title VI

Stakeholders

Project

Kick-Off

IT Security

Plan

Kick-off Call

with EWG

Caregiver

Survey

EWG & TTA Plan

OMB 

Approval 

Received

Interim

Report

n4a Data 

Analysis

Tribal Elder

Focus Groups

& Interviews

Data

Collection 

Tools Dev.

2021

Program Staff

Interviews

Second 

Site Visit

Evaluation

Plan

NRCNAA 

Data Analysis

First Site Visit/

Evaluation Needs

Assessment

EWG In-person Meetings
KEY ACHIEVEMENTS IN YEAR 2 OF THE 

EVALUATION OF ACL TITLE VI PROGRAMS

2018

February 5

The Office of Management and Budget 

(OMB) approved the plan for the 

Evaluation of the ACL Title VI Programs. February 9

The ICF Institutional Review Board (IRB) 

approved the project modification to the February 26 – March 30 Evaluation of the ACL Title VI Programs. 

ICF staff conducted the Title VI Program 

Staff Interviews. February 28

The 1st Evaluation Working Group (EWG) 

webinar, Prepping for Your Site Visit, 

was held. 

3

March

ICF staff conducted quarterly evaluation 

calls with Title VI Evaluation grantees. 

March 6 – 9

ICF staff conducted data analysis 

on-site at National Resource Center on 

Native American Aging – University of 

North Dakota. 

April 30 – June 28

ICF staff conducted Year 1 site visits to all 

evaluation grantees. Site visits included 

focus groups and interviews with elder 

program participants and an evaluation 

and data needs assessment. 

May 10

ICF staff shared a Spring e-letter update 

with the ACL Title VI Evaluation Steering 

Committee. June

ICF staff conducted quarterly evaluation 

calls with Title VI Evaluation grantees. 

August 15

ACL and ICF hosted an ACL Title VI 

Evaluation Steering Committee luncheon 

during the National Title VI Training and 

Technical Assistance Conference. 

August 17

ACL and ICF hosted an in-person, full day 

training with members of the EWG in 

conjunction with the National Title VI Training 

and Technical Assistance Conference. 

October

ICF staff conducted quarterly evaluation 

calls with Title VI Evaluation grantees. October 9

ICF staff shared a Fall e-letter update 

with the ACL Title VI Evaluation Steering 

Committee. November 13

ICF staff hosted a webinar for the EWG, 

Everyday Evaluations. December

ICF staff conducted quarterly evaluation calls 

with Title VI Evaluation grantees.
WHAT WE’VE LEARNED

This year, the evaluation team focused on understanding the Title VI Programs from the 

perspective of program staff and elders. The following sections include a summary of 

emerging themes from the evaluation based on data collection and analysis in 2018. 

The evaluation uses mixed methods, including quantitative (primary and secondary) and 

qualitative (primary) data sources (see Appendix C). At the end of the evaluation in 2020, all 

data sources will be combined to describe the implementation and impact of Title VI.

The evaluation team analyzed multiple data sources to 

present a first look at the Title VI Programs. Emerging 

themes include elders’ met and unmet needs, social 

connectedness, and independence and quality of life.

TITLE VI EVALUATION GRANTEES

The Title VI Evaluation grantees represent 4% of all 

Title VI programs and 10% of those that participate 

in the Elder Needs Assessment. While Title VI 

programs are diverse in terms of program structure, 

location, and cultural traditions, Title VI Evaluation 

grantees are similar to other Title VI grantees in 

important ways including elder characteristics and 

number of elders participating in nutrition programs 

(see related figures that follow in this report section). 

Thus, Title VI Evaluation grantees may be considered 

representative of Title VI grantees as a whole.

2018 EVALUATION DATA SOURCES

▶ National Resource Center on Native American 

Aging/University of North Dakota’s Identifying 

Our Needs: A Survey of Elders (Elder Needs 

Assessment)

▶ Program Staff Interviews

▶ Tribal Elder Interviews and Focus Groups

▶ Evaluation and Data Needs Assessment

▶ Title VI Grant Application

▶ n4a Title VI Survey

▶ Title VI Program Performance Report

ELDERS’ CHARACTERISTICS ACROSS TITLE VI AND EVALUATION GRANTEES

TITLE VI GRANTEES EVALUATION GRANTEES

Elders Engaged in 

Cultural Activities

Elders Socializing 

Monthly

Elders Using 

Title VI Services

Unemployed Elders

AN or NH Elders

Elders Living on 

Tribal Lands

75%

74% 80%

50% 61%

76% 81%

20%

29% 36%

67%

9%

Data Source: Elder Needs Assessment

4
ELDERS’ HEALTH AND NUTRITION STATUS ACROSS TITLE VI AND EVALUATION GRANTEES

Meal Inadequacies

Mostly Happy

Current Smoker

Challenges 

with Any IADL

Challenges with 

Any ADL

Generally Unhealthy

42% 47%

71% 71%

22% 20%

67% 63%

59% 54%

54% 51%

TITLE VI GRANTEES EVALUATION GRANTEES

Data Source: Elder Needs Assessment

5

AVERAGE NUMBER OF TITLE VI CLIENTS 

AND MEALS PROVIDED ACROSS TITLE VI AND 

EVALUATION GRANTEES

PROGRAM DELIVERY ALL TITLE VI 

GRANTEES

EVALUATION 

GRANTEES

Congregate Meal Clients 217 156

Congregate Meals Served 9,436 8,952

Home-Delivered Meal Clients 74 54

Home-Delivered Meals Served 9,365 9,027

Data Source: Title VI Program Performance Report

Elder Health and Nutrition

Overall, as described, Title VI Evaluation elders are 

similar to those of other Title VI grantees. While 

elders in both groups experience challenges related 

to their health and overall well-being, they also 

largely report feeling happy:

▶ Feel generally unhealthy

▶ Have challenges with at least one Activity of 

Daily Living (ADL) and Instrumental Activity of 

Daily Living (IADL)

▶ Feel mostly happy

PROGRAM CONTEXT AND DELIVERY

Data sources, including the n4a Title VI Survey, Program Staff Interviews, and the Evaluation and Data Needs 

Assessment, were used to describe program context and service delivery for Title VI Evaluation grantees. This 

section presents an overview of Title VI service provision, including service locations, administration, staffing 

structures and roles, and sources of additional program support.

Services Provided

All Title VI Evaluation grantees provide:

More than two-thirds of programs provide:

Meals

(congregate or delivered)

Outreach

Telephone Reassurance Special Events/

Activities

Elder abuse prevention and intervention 

services, including case management 

for victims of abuse or neglect and 

community education. 

OUTREACH

Program directors provide outreach for elders and 

caregivers in various ways.

Home Visits: 100%

Verbal Announcements: 92%

Informal Conversations: 92%

Posters and flyers: 77%

Data Source: n4a Title VI Survey and Title VI Program Staff Interviews
Administration and Guidance

58% of program directors reported that their 

Title VI program is administered 

as an independent division of 

the tribe, tribal consortium, or 

inter-tribal council.

54% of program directors reported that 

their Title VI program has an 

advisory board or committee.

Title VI Program Staffing Structure

While not supported solely through Title VI funding, 

Title VI program staff and volunteers include, on 

average: 

5 full-time employees 

4 part-time employees

5 unpaid volunteers 

Many programs use volunteers to support program 

activities.

“Like the wintertime, right now, there’s a lot 

of our elders that need help, stacking wood. 

And if we didn’t have our volunteers to go out 

and do that right now, I don’t know what. 

We’d be lost.”

— Title VI Program Director

Service Locations 

On average, Title VI Programs report 

having 2.4 service delivery sites and/

or office locations.

The greatest distance that Title VI 

program staff travel to provide 

services is about 24 miles (one-way).

The average round trip for homedelivered meal service requires 

about 3 hours (including driver stops 

for meal delivery or related activity).

84%

6

Most Title VI programs receive support 

from non-Title VI program staff who help 

to implement program activities and 

services. 

PROGRAM STAFF ROLES

▶ Information and assistance

▶ Intake assessment

▶ Meal preparation 

and service

▶ Transportation coordination

▶ Caregiver coordination

OTHER (NON-TITLE VI) STAFF 

SUPPORTING TITLE VI PROGRAMS

▶ Nurses 

▶ Behavioral health professionals 

▶ Nutritionist/dietitian

▶ Coordinators or benefit counselors 

▶ Evidence-based program coordinator

▶ Wellness coach 

TITLE VI PROGRAM PARTNERS

Title VI programs partner with other agencies to provide 

services to elders.

▶ Veterans Administration 

▶ Nursing homes and assisted-living facilities 

▶ Non-tribal health department 

▶ State Health Insurance Assistance Program

▶ Transportation agencies 

▶ Tribal health department 

▶ Adult protective services
Program Resources

In addition to their Title VI funding, the majority of 

Title VI programs rely on supplemental funding to 

support service delivery. Often, the tribe is a major 

source of additional funding. Nearly 70% of program 

directors receive funding from the local Title III 

organization or Area Agency on Aging. Several 

program directors also describe holding community 

fundraising activities, applying for other state or 

regional grants, and receiving donations, including 

produce from a community garden, gift certificates, 

and supplies. Most Title VI Programs (75%) do not 

bill Medicaid for any home- and community-based 

services. 

Title VI program directors address limited funding in 

the following ways: 

69% Exploring new funding 

opportunities 

62% Requesting additional funds and support from the tribe

62% Reducing or eliminating business travel 

54% Exploring new partnerships 

54% Reorganizing the program 

7

SUPPLEMENTAL FUNDING SOURCES

▶ Tribe (general funding)

▶ United States Department of Agriculture 

reimbursement for meals

▶ Older Americans Act nutrition services 

incentive program

▶ Medicare Improvements for Patients and 

Providers Act (MIPPA)

▶ AmeriCorps–services for elders

▶ Local associations

Program Monitoring and Evaluation 

All Title VI Evaluation grantees collect some program 

data. Examples include:

▶ Number of congregate and home-delivered meal 

clients and units served

▶ Transportation mileage 

▶ Elder intake information (demographics and 

nutrition needs assessment)

In addition to the required annual Program 

Performance Report, some grantees provide monthly 

program reports for their tribal council, department 

head, or other funders (e.g., state).

92%

Most grantees reported that they 

assess the quality of services through 

informal conversations with elders or 

caregivers during delivery of Title VIfunded services.
WHAT IS WORKING

Nearly 70%

of program directors 

shared they are 

able to meet at least 

some of their elders’ 

needs (e.g., nutrition, 

transportation, 

referrals).

66% 

of elders’ met needs 

are congregate and 

home-delivered 

meals.

“I would say it helps me 

growing old. To grow old 

and to be neglected would 

be really, I’m searching for 

the right word. It would be 

disastrous.”

— Elder Client

Data Source: n4a Title VI Survey

8

NUTRITION SERVICES

The majority of elders and program staff report the Nutrition Services fulfill a critical need for elders. Many elders 

shared that the meal programs provide their only hot and nutritious meal of the day. They also genuinely like the 

food served and praised the skill of the cooks. For many elders, due to illness or disability, cooking is difficult. The 

Title VI Programs help to remove the stress of having to worry about meals. The home-delivered and congregate 

meals also give elders something to look forward to and peace of mind knowing they are being taken care of.

Meals

Elders shared that the congregate and homedelivered meals are balanced and nutritious, 

helping them to improve their health, combat 

illness, and maintain their overall well-being. Many 

elders appreciated that the programs often serve 

traditional, native food.

“And I know we’re getting our vitamins because I 

look at the food...and I know it’s the vitamins that 

we need.”*

“We come here and share. Everybody is eating 

it. It makes you feel good....It’s the way the cook 

prepares it. The native culture, you have it here 

and we all share that, because we can’t go home 

to do that, have the native food.”*

“You know, homebound...elderly might not have a 

balanced meal in the home. Maybe that’s the only 

meal they get in the day.”*

Social Connection

For many elders who participate in congregate 

meals, the communal dining experience provides 

far more than a meal. It is an event that enhances 

their mood and provides for friendship and a 

sense of belonging to the community. Similarly, for 

homebound elders, a visit from a meal delivery driver 

provides an opportunity for much-needed social 

contact and support from a caring staff member.

“When you’re home alone, you might fix something 

but you’re not happy, because you know you’re 

all alone, sitting there trying to eat that meal. And 

when you’re here, you have people around you 

talking, laughing, and seem to enjoy the meal.”*

“[I like best] that somebody comes into my house 

when I’m really down and they take the time to 

come in and say hello and give you a hug.”*

* Elder Client
Additional Benefits

Title VI Nutrition Services also provide support for 

elders in many other ways. The meal service provides 

elders with “something to look forward to” and relieves 

stress and burden as elders do not have to worry about 

preparing meals. In addition, the meal delivery service 

for homebound elders provides an opportunity for the 

driver to check in on elders and assess their health and 

overall well-being, providing elders a sense of being 

looked after and cared for. Moreover, the meal service 

reduces the burden on family caregivers, which often 

relieves stress for elders.

“[The program is] something to look forward 

to. Sometimes you don’t have anything to look 

forward to in the daytime. I know I get that way 

sometimes.”* 

“I’m disabled and I can’t prepare good meals for 

myself, you know, that’s why I count on the delivery 

system there to provide me with beneficial meals 

like that.”*

“And we just think the world of our drivers....They’re 

checking on us....And that’s safety, and they’re 

eyeballing us and making sure, things like that. I 

think that’s a plus for us.”*

PROGRAM STAFF 

PERSPECTIVE

Program staff described home-delivered 

and congregate meals as the most used

Title VI service and the service having 

the most significant impact on elders. 

Confirming what elders’ shared, while 

the meal program is meant to provide 

supplementary nutrition for elders, for 

many elders it is their only meal of the day. 

“I have my daughter who I live with and [the meal 

delivery] helps quite a bit because she prepares 

my breakfast and my dinners and this...just gives 

her a chance to go and do things on her own that 

she wants to do....And it makes me feel better that 

she can do other things.”* 

SUPPORTIVE SERVICES

Title VI programs provide supportive services to elders. These services include information and assistance, 

outreach, case management and transportation, and homemaker and chore support, among others. Elders 

identified transportation, educational opportunities, physical activity, and linkages and referrals as most helpful to 

them.

Transportation 

Many elders spoke to the importance of 

transportation services that help them access 

medical appointments, shopping and errands, and 

congregate meals.

“If there were no transportation, I’d be in trouble. I 

don’t have no more horses. I don’t have a burro, I 

don’t have no mules to carry me around. So I have 

to depend on these two right here.”*

“Transportation plays a big role over here, having 

them pick us up or take us home, or even taking 

you to your appointments or wherever you want to 

go to make an appointment at the tribal office or 

whatever.”*

“It’s very hard to get around and all that. And if 

that transportation was not there either, we won’t 

be able to come over here.”*

PROGRAM STAFF 

PERSPECTIVE

Many program staff shared that 

transportation is an important need 

for elders, particularly for rural 

communities without centralized 

services. Title VI transportation helps 

elders access medical, pharmacy, and 

shopping services. While recognized as 

important, not all programs are able to 

provide this service.

* Elder Client

9
Educational Opportunities

Elders also described the educational opportunities they have through Title VI, including “lunch and learns” on 

nutrition, Medicaid services, and substance abuse, among others.

“But since we had the talk, I’m more aware of the food I’m putting in my mouth. I’m kind of paying attention to 

what’s going on and the sugar part of it, cutting that out, cutting down on it.”*

“I guess it’s about being well informed about what we’re supposed to do at our age and when we have people 

come to speak to us and tell us about our high blood pressure, about our diabetes. So that’s good, that keeps us 

well informed, and I like that.”*

Physical Activity and Exercise

Many programs offer physical activity and opportunities for exercise, including Senior Olympics. Elders enjoy 

these and shared they help to keep them physically and mentally active.

“We did a line dance here and it’s an exercise. You know, when you exercise your legs and stuff that’s really 

helpful. So I’m glad somebody brought that exercise because we need that as we age.”*

“They always tell me, my doctors, to not just sit around. I just need to move around, exercise....And we really need 

that, no matter what age we are, we need that regular exercise.”*

Linkages/Referrals 

Many elders described that they appreciated assistance in being linked through their Title VI program to other 

needed resources and supports. 

“...what I think is so neat is if I needed handrails in my house, I know she’d know where the resources are at. She’s 

a good resource person for us seniors. All we have to do is pick up the phone and she’ll direct us or check on it 

herself.”*

“But I appreciate everything that happens here, the staff, they’re very attentive. And they’re very observant in 

terms of, at least, help. They’ll ask you, they’ll address your issue: How are you doing, what’s happening, do you 

need help?”*

* Elder Client

10
MAINTAINING CULTURE, 

BUILDING COMMUNITY

A CULTURAL CONNECTION

In addition to the meals, many elders shared that the Title VI program helps to feed their hunger for cultural knowledge 

and connection. Many elders, especially younger elders, appreciate the opportunity to learn from the “old elders”—the 

ones seen as culture bearers. Many elders see this as a valuable way to keep their culture alive.

“Since I’ve been in the program, I’ve been getting 

into learning about the culture. I am just starting to 

hula, which I never did in my whole life.”**

“Because when you think about it, if we don’t grab 

onto it now, it’s just going to fade away. We have to 

do it now because a lot of it is already gone, so we 

have to start doing it now within ourselves.”*

Several elders shared that their local Title VI programs 

practices and promotes the cultural values of their 

tradition. 

“...but truly the Native American community is a 

family. We are a family and those values are here 

and the senior center promotes that. And it’s the 

glue moving that culturally forward so that’s the big 

importance there, too.”*

A SOCIAL EXPERIENCE

The Title VI programs provide an important sense of social connection for many elders. Elders shared the communal 

experience of gathering together for meals and activities sets Title VI apart as exceptional in meeting their needs. For 

many homebound elders, meal delivery sends a powerful message that they are not alone or forgotten.

“It’s a lot of camaraderie here. People getting along, 

making new friends, etc. So, friendship—that’s one of 

the main things. You get to see people, meet people, 

talk with people. A building is just a building, but the 

people make the place a place. And there’s some 

pretty good people around. That’s the main reason 

why I come.”* 

“I’d be very, very down if somebody didn’t stop to 

see me every day. Some days are long, long, long 

when you’re not feeling good. And them coming in 

personally and check on you...and I rely on them 

coming to see I’m alright and if I tell them something, 

they’ll go do it for me.”*

PROGRAM STAFF 

PERSPECTIVE

A majority of program staff also described 

how the congregate meal program 

provides much more than nutrition for the 

elders. Staff shared that the meals provide 

a much-needed chance for elders to 

tell stories about their lives, to ask 

questions, and share their concerns or 

needs with Title VI program staff.

Traditional, Native Foods Speaking Native Language

Exposure to Cultural 

Practices

Peer Sharing and 

Learning

Intergenerational Experiences

TITLE VI PROGRAMS PROVIDE

11

* Elder Client
OPPORTUNITIES FOR GROWTH

According to Title VI program directors, the top 5 unmet needs for elders

HOMEMAKER 

HELP

PERSONAL 

CARE

TRANSPORTATION HOME 

MODIFICATION 

DISASTER/

EMERGENCY 

PREPAREDNESS

NUTRITION SERVICES

While elders largely shared positive feedback about the nutrition services provided, some offered suggestions 

for improvement or changes in the meal programs.

Expand Meal Services

In the case of programs that do not provide homedelivered meals, many elders shared that this is a 

need in their community. Several elders shared that it 

is difficult for them to attend congregate meals due to 

their health or home-life commitments and that having 

a home-delivered meal would improve their nutritional 

health. In the case of the one program that does not 

currently provide congregate meals, elders expressed 

a need for a place to come together to talk and share 

with other elders.

Many elders also voiced a need for additional days 

per week of meals provided, whether congregate or 

home-delivered. This was especially true for elders in 

programs that operate fewer than 5 days per week.

PROGRAM STAFF 

PERSPECTIVE

Program staff noted that if they had 

additional funding, they would increase 

the number of meals provided and 

improve the quality and variety of meals.

More Variety

While elders in some programs expressed complete 

satisfaction with the variety and quality of meals 

provided, elders in other programs offered suggestions 

on ways to improve the meals. Elders’ suggestions 

included more menu rotation; serving more traditional 

foods; and providing separate menus to meet special 

dietary needs (e.g., allergies, diabetic meals). 

ELDERS’ PERSPECTIVE: 

ELDERS’ TOP NEEDS

▶ More meals per week

▶ More traditional foods

▶ Homemaker and personal care services

▶ Transportation services

▶ Exercise programming

12
SUPPORTIVE SERVICES

Across programs, elders offered a variety of suggestions on how supportive services could better meet their needs. 

These suggestions varied by program based on what services their program already provides.

Personal Care Assistant/In-home Help 

Several elders, particularly homebound elders, 

expressed a need for help in the home to help them 

with ADLs and IADLs (e.g., bathing, dressing, light 

housework, chores). 

“I have no caregiver support, which I would like 

somebody to come here and help me when my 

kids are not available. To help me put my shoes 

on or pants on. You know, it’s hard. I don’t even 

take a shower...if my kids aren’t home. I won’t 

take a shower or bath, and I won’t open the door 

for anybody. I’m just not able to take care of 

myself 100%.”*

Transportation Support

Many elders expressed frustration over the lack or 

limited nature of transportation services. Elders shared 

that transportation should be added or expanded to 

support elders in attending congregate meals, as well 

as doing shopping or paying bills.

“It’s such a good program but certain islands are 

lacking the program. And the most important is 

transportation because a lot of Kupunas are older 

and a lot of them don’t drive, and the transportation 

that they have is such a small van, you can’t fit 

everybody. And to get to everybody’s house to pick 

them up, it takes about an hour already.”*

Exercise Programming 

Many elders shared a desire for more physical activity 

or exercise programs to support their well-being.

“I wish that we would do more types of movement 

exercising and stuff. I don’t want to exercise. I tell 

you the truth, I hate to exercise and I love to eat but I 

know for myself that I have to do it.”*

Field Trips and Outings 

The majority of elders in programs that provide 

outings and field trip activities shared how they look 

forward to these events as opportunities to come 

together and suggested increasing the frequency 

of them.

Program Opportunities for Growth

92% of program directors report 

having significant unmet program 

needs.

TOP TECHNOLOGY, EQUIPMENT, OR 

INFRASTRUCTURE UNMET NEEDS 

RELATING TO PROGRAM DELIVERY

▶ Staff computer 

literacy 

▶ Lack of vehicles to 

provide services

▶ Software

▶ Poor roadways

▶ Cell phone reception

Lack of Available or Interested Assistants 

A few elders shared that while they would benefit 

from a personal care assistant, finding such a 

person has been difficult, in part because potential 

individuals are either not interested or cannot pass 

the required background check.

“And her children can’t find anybody to come in. And 

the children want to pay somebody but they can’t 

find anybody around the village that will come in 

and take care of her.”*

Program Funding 

Among major program challenges, over the past 

two years, program directors reported experiencing 

financial constraints. For example, many program 

directors describe that home-delivered meals 

and home-based services are among the most 

difficult to provide to the extent needed due to 

insufficient funding. Some program directors also 

described that their elder populations are growing 

and becoming frailer, with increasing dementia and 

other health problems. As a result, they require 

more intensive services, including in-home care, 

nursing homes, or other 24-hour care that are 

lacking in many of the communities. 

“For our elders...nutrition is always big. That, we’re 

able to do, but sometimes home delivery is a 

greater need than we can necessarily provide for. 

So I know there are some gaps in our service area 

because we just can’t get to some people.”

— Title VI Program Director

* Elder Client

13
WHAT’S NEXT?

During the third year of the evaluation, ICF will continue to provide evaluation TTA to the 

Evaluation grantees, as well as collect program data, including feedback from caregiver 

participants. Year 3 evaluation activities will include:

Two EWG Virtual 

Trainings/Webinars 

Webinars will include helping 

grantees prepare for the second 

site visit, as well as continue to 

provide evaluation capacity and 

skills building.

Site Visits 

Evaluation liaisons will work 

with grantees to schedule 

2-day site visits in the spring of 

2019. The site visits will be an 

opportunity for: 

1. One-on-one support for 

grantees.

2. Conducting focus groups or 

small group interviews with 

Title VI caregiver clients.

Third Annual EWG 

In-person Meeting 

The third annual EWG 

in-person meeting will occur 

in late summer of 2019, in 

conjunction with the National 

Title VI Training and Technical 

Assistance Conference. The 

in-person meeting will include 

evaluation TTA, as well as 

focus groups with Title VI 

program staff.

FOR MORE INFORMATION, CONTACT:

Kristen (Krissy) Hudgins, PhD

Social Science Analyst, Office of Performance and Evaluation

Administration for Community Living

Telephone: 202-795-7732

E-mail: Kristen.Hudgins@acl.hhs.gov

Gretchen Clarke, MPH

Manager, Title VI Evaluation

ICF

Telephone: 907-747-7124

E-mail: Gretchen.Clarke@icf.com

14