Consumer Characteristic: Older Adult Services (Title - B, C, and D) Total At or Below Poverty ADL 3+ IADL 3+ Age Age: <60 X X X X Age: 60 -64 X X X X Age: 65-74 X X X X Age: 75 - 84 X X X X Age: 85+ X X X X Age Missing X X X X Gender Female X X X X Male X X X X Other X X X X Gender Missing X X X X Geographic Distribution Rural X X X X X X X X Geographic Distribution Missing X X X X Poverty Status At or Below Poverty X X X Above Poverty X X X Poverty Status Missing X X X Household Status Alone X X X X Lives with Others X X X X Lives in Long Term Care (LTC) Facility X X X x Household Status Missing X X X X Ethnicity Hispanic or Latino X X X X Not Hispanic or Latino X X X X Ethnicity Missing X X X X Race American Indian or Alaska Native X X X X Asian X X X X Black or African American X X X X Native Hawaiian or Pacific Islander X X X X White X X X X Race Missing X X X X Minority Status Minority X X X X Not Minority X X X X Minority Status Missing X X X X ADL Limitations 0-1 X X 2 X X
NC2 Other Federal Funds Indication of other federal funds used for OAA services. (multiple selection) Yes Multiple Boolean (multiple select) 01=Medicaid 02=Medicaid Waiver 03=SSBG 04=CSBG 05=USDA 06=DOT 99=None • If 99=None is selected; other codes are not available. NC3 Federal Funds Comments Comments on Other Federal Funds, if appropriate. No Single String N/A (not a coded element) • Maximum length of 700 characters with spaces. Network Staff and Volunteers Subcomponent The Network subcomponent includes data regarding staffing and volunteers and the and Area Agency on Aging level of the network. All data elements are single quantifier. All data elements are numeric (integer) and not a coded element. Element Number Data Element Element Description Required Business Rules/Notes SV1 SUA Staff Number of paid full-time (average 35+ hours a week) at SUA as of September 30 of reporting year. Ombudsman staff are not included in count. Yes SV2 SUA Staff Number of paid part-time (average less than 35 hours a week) at SUA as of September 30 of reporting year. Ombudsman staff are not included in count. Yes
RV2 Title III Expenditure - Caregivers Older Adult Were outlays/payments made by the SUA and/or AAA’s using OAA federal funds to provide respite services for Caregivers of Older Adults through vouchers? Check box (Yes/No) RV3 Other - State Expenditure - Caregivers Older Adult Were outlays/payments made by the SUA and/or AAA’s using state funds (e.g., general revenue, Medicaid) to provide respite services for Caregivers of Older Adults through vouchers? Check box (Yes/No) RV4 Other - Non-State Expenditure - Caregivers Older Adult Were outlays/payments made by the SUA and/or AAA’s not using OAA or state funds to provide respite services for Caregivers of Older Adults through vouchers? Check box (Yes/No) RV5 Program Income Expended - Caregivers Older Adult Was any gross income received and expended by the grantee and all sub grantees such as voluntary contributions or income earned only as a result of the grant project during the grant period? Check box (Yes/No) RV6 Persons Served - Older Relative Caregivers Total Unduplicated Count of Older Relative Caregivers who use vouchers to obtain respite services funded in whole or in part by Title III-E of the OAA. Numeric (integer) • Value must be equal to or less than element # OR1 (persons served respite). RV7 Title III Expenditure - Older Relative Caregivers Were outlays/payments made by the SUA and/or AAA’s using OAA federal funds to provide respite services for Older Relative Caregivers through vouchers? Check box (Yes/No) RV8 Other - State Expenditure - Older Relative Caregivers Were outlays/payments made by the SUA and/or AAA’s using state funds to provide respite services for Older Relative Caregivers through vouchers? box (Yes/No)
CD5 Poverty Status - Total • At or Below Poverty • Above Poverty • Poverty Status Missing Total Count of Consumers by poverty status that received service. Yes • All registered services – unduplicated • Registered services w/ ADLs and IADLs - unduplicated • Each registered service separately • Restricted service: Legal Assistance CD6 Household Status - Total • Lives Alone • Lives with Others Lives in Long Term Care (LTC) Facility • Household Status Missing Total Count of Consumers by household status that received service. Yes • All registered services – unduplicated • Registered services w/ ADLs and IADLs - unduplicated • Each registered service separately Restricted service: Legal Assistance CD7 Ethnicity - Total • Hispanic or Latino • Not Hispanic or Latino • Ethnicity Missing Total Count of Consumers by ethnicity that received service. Yes • All registered services – unduplicated • Registered services w/ ADLs and - unduplicated • Each registered service separately • Restricted service: Assistance CD8 Race - Total • American Indian or Alaska Native • Asian or Asian American • Black or African American • Native Hawaiian or Pacific Islander • White • Race Missing Count of Consumers by race that received service. Race is duplicated person count -- NOT unduplicated. Multi-racial Consumers are counted for each racial identity. Yes • All registered services – unduplicated • Registered services w/ ADLs and IADLs - unduplicated • Each registered service separately Restricted service: Legal Assistance CD9 Minority Status - Total • Minority • Not Minority • Minority Status Missing Count of Consumers by minority status that received service. Racial and ethnic minority populations are defined as: Asian American, Black or African American, Hispanic or Latino, Native Hawaiian and Pacific Islander, American Indian and Alaska Native. (CDC) Yes • All registered services – unduplicated • Registered services w/ ADLs and IADLs - unduplicated • Each registered service separately • Restricted service: Legal Assistance
CD10 ADL Score - Total • 0-1 • 2 • 3+ • ADL Missing Total Count of Consumers by ADL score that received service. Yes • Registered services with ADL/IADL - unduplicated • Each registered service separately for this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt) CD11 IADL Score - Total • 0-1 • 2 • 3+ • IADL Missing Total Count of Consumers by IADL score that received service. Yes • Registered services with ADL/IADL - unduplicated • Each registered service separately for which this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt) CD12 Nutrition Risk - Total • 0-5 • 6+ • Score Missing Total Count of Consumers by Nutrition Risk Score that received service. Yes • Registered services with Nutrition Risk Score - unduplicated Each registered service separately that requires Risk (Home-delivered nutrition, congregate nutrition, nutrition counseling) CD13 Age - At or Poverty • <60 • 60-64 • 65-74 • 75-84 • 85+ • Age Missing Count of Consumers at or below poverty by age group that received service. Yes • All registered services - unduplicated • Registered services with ADL/IADL - unduplicated • Each registered service separately Restricted service: Legal Assistance CD14 Gender Identity - At or Below Poverty • Female • Male • • Gender Missing Total Count of Consumers by gender identity that received service. Yes • All registered services - unduplicated • Registered services with ADL/IADL - unduplicated • Each registered service separately Restricted service: Legal Assistance
CD19 Minority Status - At or Below Poverty • Minority • Not Minority • Minority Status Missing Count of Consumers at or below poverty by minority status that received service. CDC Source: Racial and ethnic minority populations are defined as: Asian American, Black or African American, Hispanic or Latino, Native Hawaiian and Pacific Islander, American Indian and Alaska Native. Yes • All registered services - unduplicated • Registered services with ADL/IADL - unduplicated • Each registered service separately • Restricted service: Legal Assistance CD20 ADL Score - At or Below Poverty • 0-1 • 2 • 3+ • ADL Missing Count of Consumers at or below poverty by ADL score that received service. Yes • Registered services with ADL/IADL - unduplicated • Each registered service separately for which this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt) CD21 IADL - At or Below Poverty • 0-1 • 2 • 3+ • IADL Missing Count of minority Consumers by poverty status that received service. Yes • Registered services with ADL/IADL - unduplicated Each registered service separately for which this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt) CD22 Nutrition Risk - At or Below Poverty • 0-5 • 6+ • Missing Count of Consumers at or below poverty by Nutrition Risk Score that received service. Yes • All registered services - unduplicated • Registered services with ADL/IADL - unduplicated • Each registered service separately that requires Risk Score (Home-delivered nutrition, congregate nutrition, nutrition counseling)
CD32 Age - IADL 3+ • <60 • 60-64 • 65-74 • 75-84 • 85+ • Age Missing of Consumers IADL score of 3 and above by age group that received service. Yes • Registered services with ADL/IADL – unduplicated • Each registered service separately for which this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt) Excluding Legal Assistance CD33 Gender Identity - IADL 3+ • Female • Male • Other • Gender Missing Total Count of Consumers with IADL score 3 and above by gender identity that received service. Yes • Registered services with ADL/IADL – unduplicated • Each registered service separately for which this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt) Excluding Legal Assistance CD34 Geographic Distribution - IADL 3+ • Rural • Non-rural • Geographic Distribution Missing Count of Consumers IADL score of 3 and above by geographic distribution that received service. Yes • Registered services with ADL/IADL – unduplicated • Each registered service separately for this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt) Excluding Legal Assistance CD35 Poverty Status - IADL 3+ • At or Below Poverty • Above Poverty • Poverty Status Missing Count of Consumers IADL score of 3 and above by poverty status that received service. Yes • Registered services with ADL/IADL – unduplicated • Each registered service separately for which this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt Excluding Legal Assistance)
CD40 Nutrition Risk Score - IADL 3+ • 0-5 • 6+ • Score Missing Count of Consumers IADL score of 3 and above by Nutrition Risk Score that received service. Yes • Home Delivered Meals Caregiver of Older Adults for Select Services (Title III-E) Subcomponent The Service subcomponent includes data regarding specific demographics and characteristics of caregivers of older adults. All data elements are single quantifier. Note some variables are not required for the first 3-years of data collection All data elements are numeric (integer) and not a coded element. Element Number Data Element Element Description Required Services CG1 Total Caregiver of Older Adults - Total Total Count of Caregivers of Older Adults that received service. Yes • Each registered service separately (including supplemental services and respite - see • Unduplicated for Total Respite • Unduplicated count by respite service type: (in-home, out of day, out of home overnight, and Other Respite). • Assistance – Information & Assistance service; estimated unduplicated) • Information Services (non-registered service; estimated audience size) (Note: Registered services – unduplicated is not included as SC4 captures this data)
CG2 Age - Total • 18-49 • 50-59 • 60-64 • 65-74 • 75-84 • 85+ • Age Missing Count of Caregivers of Older Adults by age that received service. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services) CG3 Gender Identity - Total • Female • Male • Other • Gender Missing Total Count of Caregivers of Older Adults by gender identity that received service. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services) CG4 Geographic Distribution - Total • Rural • Non-rural • Geographic Distribution Missing Total Count of Caregivers of Older Adults by geographic distribution that received service. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services) CG5 Poverty Status - Total • At or Below Poverty • Above Poverty • Poverty Status Missing Total Caregivers of Older Adults by poverty status that received service. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services) CG6 Ethnicity - Total • Hispanic or Latino • Not Hispanic or Latino • Ethnicity Missing Total Caregivers of Older Adults by ethnicity that received service. Yes • Registered services – unduplicated (i.e. counseling, training, respite, access assistance – case management, supplemental services)
CG7 Race - • American Indian or Alaska Native • Asian or Asian American • Black or African American • Native Hawaiian or Pacific Islander • White • Race Missing Total Caregivers of Older Adults by race that received service. Race is duplicated caregiver count -- NOT unduplicated. caregivers are counted in each race indicated. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services) CG8 Minority Status - Total • Minority • Not Minority • Minority Status Missing Total Caregivers of Older Adults by minority status that received service. CDC Source: Racial and ethnic minority populations are defined as: Asian American, Black or African American, Hispanic or Latino, Native Hawaiian and Pacific Islander, American Indian and Alaska Native. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
CG9 Relationship • Husband • Wife • Domestic partner, including civil union • Son/Son-in-Law • Daughter/Daughter-in-Law • Sister • Brother • Other Relative • Non-Relative • Relationship Missing Total Caregivers of Older Adults by relationship that received service. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services) CG10 Age - At or Below Poverty • 18-49 • 50-59 • 60-64 • 65-74 • 75-84 • 85+ • Age Missing Count of Caregivers of Older Adults at or below poverty by age group that received service. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services) CG11 Gender Identity - At or Below Poverty • Female • Male • Other • Gender Missing Count of Caregivers of Older Adults at or below poverty by gender identity that received service. Yes • Registered services – unduplicated (i.e. counseling, training, respite, access assistance – case management, supplemental services) CG12 Geographic Distribution - At or Below Poverty • Rural • Non-rural • Geographic Distribution Missing Count of Caregivers of Older Adults at or below poverty by geographic distribution that received service. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
CG13 Ethnicity - At or Below Poverty • Hispanic or Latino • Not Hispanic or Latino • Ethnicity Missing Count of Caregivers of Older Adults at or below poverty by ethnicity that received service. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services) CG14 Race - At or Below Poverty • American Indian or Alaska Native • Asian or Asian American • Black or African American • Native Hawaiian or Pacific Islander • White • Race Missing Count of Caregivers of Older Adults at or below poverty by race that received service. Race is duplicated caregiver count -- NOT unduplicated. caregivers are counted in each race indicated. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services) CG15 Minority Status - At or Below Poverty • Minority • Not Minority • Minority Status Missing Count of Caregivers of Older Adults at or below poverty by minority status that received service. CDC Source: Racial and ethnic minority populations are defined as: Asian American, Black or African American, Hispanic or Latino, Native Hawaiian and Pacific Islander, American Indian and Alaska Native. Yes • Registered services – unduplicated (i.e. counseling, training, respite, access assistance – case management, supplemental services)
CG16 Relationship - At or Below Poverty • Husband • Wife • Domestic partner, including civil union • Son/Son-in-Law • Daughter/ Daughter-in-Law • Sister • Brother • Other Relative • Non-Relative • Relationship Missing Count of Caregivers of Older Adults at or below poverty by relationship that received service. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services) Relative Caregivers of Children and Adults with Disabilities for Select Services (Title III-E) Subcomponent The Service subcomponent includes data regarding specific demographics and characteristics of older relative caregivers (caring for children or adults under age 60 with disabilities). All data elements are single quantifier. Note some variables are not required for the 3-years of data collection All data elements are numeric (integer) and not a coded element. Element Number Data Element Element Description Required Services
OR1 Total Older Relative Caregivers - Total Count of Older Relative Caregivers that received service. Yes • Registered services - unduplicated • Each registered service separately (including supplemental services and respite - see below) • Unduplicated for Total Respite • Unduplicated by respite service type: (in-home, out of home day, out of home overnight, and other respite). • Assistance – Information & Assistance service; estimated unduplicated) • Information Services (non-registered service; estimated audience size) OR2 Age - Total • 55-59 • 60-64 • 65-74 • 75-84 • 85+ • Age Missing Total Count of Older Relative Caregivers by age that received service. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services) OR3 Gender Identity -Total • Female • Male • Other • Gender Missing Count of Older Relative Caregivers at or below poverty by gender identity that received service. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services) OR4 Geographic Distribution Status - Total • Rural • Non-rural • Geographic Distribution Missing Total Count of Older Relative Caregivers by geographic distribution that received service. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services) OR5 Poverty Status - Total • At or Below Poverty • Above Poverty • Poverty Status Missing Total Older Relative Caregivers by poverty status that received service. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
OR6 Ethnicity - Total • Hispanic or Latino • Not Hispanic or Latino • Ethnicity Missing Total Older Relative Caregivers by ethnicity that received service. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services) OR7 Race - • American Indian or Alaska Native • Asian or Asian American • Black or African American • Native Hawaiian or Pacific Islander • White • Race Missing Total Older Relative Caregivers by race that received service. Race is duplicated caregiver count -- NOT unduplicated. Multi-racial caregivers are counted in each race indicated. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services) OR8 Minority Status - Total • Minority • Not Minority • Minority Status Missing Total Older Relative Caregivers by minority status that received service. CDC Source: Racial and ethnic minority populations are defined as: Asian American, Black or African American, Hispanic or Latino, Native Hawaiian and Pacific Islander, American Indian and Alaska Native. Yes • Registered services – unduplicated (i.e. counseling, training, respite, access assistance – case management, supplemental services) OR9 Relationship - • Grandparents • Parents • Other Older Relative • Older Non-Relative • Relationship Missing Total Older Relative Caregivers by relationship that received service. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
OR10 Age - At or Below Poverty • 55-59 • 60-64 • 65-74 • 75-84 • 85+ • Age Missing Count of Older Relative Caregivers at or below poverty by age group that received service. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services) OR11 Gender Identity -At or Below Poverty • Female • Male • Other • Gender Missing Count of Older Relative Caregivers at or below poverty by gender identity that received service. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services) OR12 Geographic Distribution - At or Below Poverty • Rural • Non-rural • Geographic Distribution Missing Count of Older Relative Caregivers at or below poverty by geographic distribution that received service. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services) OR13 Ethnicity - At or Below Poverty • Hispanic or Latino • Not Hispanic or Latino • Ethnicity Missing Count of Older Relative Caregivers at or below poverty by ethnicity that received service. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services) OR14 Race - At or Below Poverty • American Indian or Alaska Native • Asian or Asian American • Black or African American • Native Hawaiian or Pacific Islander • White • Race Missing of Older Relative Caregivers at or below poverty by race that received service. Race is duplicated caregiver count -- NOT unduplicated. Multi-racial caregivers are counted in each race indicated. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
OR15 Minority Status - At or Poverty • Minority • Not Minority • Minority Status Missing Count of Older Relative Caregivers at or below poverty by minority status that received service. CDC Source: Racial and ethnic minority populations are defined as: Asian American, Black or African American, Hispanic or Latino, Native Hawaiian and Pacific Islander, American Indian and Alaska Native. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services) OR16 Relationship - At or Below Poverty • Grandparents • Parents • Other Older Relative • Older Non-Relative • Relationship Missing Count of at Older Relative Caregivers at or below poverty by relationship that received service. Yes • Registered services – unduplicated (i.e. counseling, training, respite, access assistance – case management, supplemental services) OR17 Total Children Receiving Care Count of children under the age of 18 receiving care. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services) OR18 Total Adults with Disabilities Receiving Care Count of adults age 18-59 with disabilities receiving care. Yes • Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
EX7 Program Income Expended Gross income received and expended by the grantee and all sub grantees such as voluntary contributions or income earned only as a result of the grant project during the grant period. • Title III B/C/D/E service separately Note that Title III-E Respite Services are report in total and by 3 types of respite plus "other". The types are in-home respite, out-of-home respite (day), out-of-home (overnight). • Note that the caregiver services are repeated - once for caregivers of older adults and once for older relative caregivers. Title VII Expenditures (Chapters 3 & 4) Subcomponent The Service subcomponent includes data regarding expenditures (federal and non-federal) on Title VII Chapter 3 – Elder Abuse Prevention and Chapter 4 – Legal Assistance Development. All data elements are single quantifier. All data elements are numeric dollar amount (2 decimal) and not a coded element. Element Number Data Element Element Description Required Business Rules/Notes VII1 VII-3 Expenditure Total outlays/payments made by the SUA and/or AAA’s using OAA federal funds for Elder Abuse Prevention (Title VII Chapter 3). Yes VII2 Title VII Ch 3 Funds expended by SUA Total funds retain and expended by the SUA for Elder Abuse Prevention (Title VII Chapter 3) Yes VII3 Title VII Ch 3 funds expended by AAA Total funds distributed to and expended by AAAs for Elder Abuse Prevention (Title VII Chapter 3) Yes (conditional) • Does not apply to Single PSA states VII4 Title VII Ch 3 funds expended by APS Total funds distributed to and expended by APS for Elder Abuse Prevention (Title VII Chapter 3) Yes VII5 VII Ch 3 funds expended by other Entities Total funds distributed to and expended by Other Entities for Elder Abuse Prevention (Title VII Chapter 3) Yes
Element Number Data Element Element Description Type and Values SCG1 Service Name Name of a service provided OAA funds, in whole or in part, that do not fall into the defined service categories for Title III-E Alphanumeric String (30 characters) SCG2 Service Unit Name Service Unit type. e.g. Activity, hours, session Alphanumeric String (15 characters) SCG3 Service Domain Category of service provided. Numeric Code 01=Assistive Technology/ Durable Equipment/ Emergency Response 02=Consumable supplies 03=Home Modifications/ Repairs and/or Financial Consultation 05=Homemaker/chore/personal care 06=Transportation 07 = Nutrition services SCG4 Estimated Persons Served Total Estimated Unduplicated Person served Numeric (integer) SCG5 Estimated Service Unit estimated service units provided. Numeric (integer) SCG6 Title III Expenditure Total outlays/payments made by the SUA and/or AAA’s using OAA federal funds, in whole or in part, to provide the service. Numeric dollar amount (2 decimal) SCG7 Other - State Expenditure Outlays/payments made by the SUA and/or AAA’s state funds to provide the service. Numeric dollar amount (2 decimal) SCG8 Other - Expenditure Outlays/payments made by the SUA and/or AAA’s not using OAA or state funds to provide the service. Numeric dollar amount (2 decimal)