Home-Delivered Meals AAA/ADSD Rachel Coates x1727 & Helen King x1734 Program Purpose Enhance nutrition and socialization for home-bound adults age 60 and older and their caregivers, and persons with disabilities, so vulnerable adults may remain independent in the community and link with other supportive home and community-based services. Program Information Home-Delivered Meals (HDM) are mandated by the Federal Older Americans Act (OAA) and administered locally by the Arlington Area Agency on Aging, part of Department of Human Service s Aging and Disability Services Division. The program promotes self-sufficiency and opportunities for participants to remain independent in the community by targeting delivery to frail, homebound or isolated individuals age 60 or over, persons with disabilities, and their caregivers. Jeffrey s Catering Company, a newly contracted vendor (effective October 2017) prepares and delivers meals to a central location in Arlington five days per week, Monday Friday. Intakes are received, and meals are delivered daily by approximately 250 volunteers of Meals on Wheels of Arlington, a nonprofit organization. Participants receive (2) meals per day, five (5) days per week. The meals provide 66 and 2/3 of dietary requirements for program participants. Meals are delivered at no cost to adults age 60 and older and their caregivers as per guidelines from the OAA. Individuals are invited to contribute based on a sliding fee scale tied to federal poverty; however, no one is denied service due to inability to pay. Federal and state funds are used to provide meals. Persons with disabilities under age 60 may also receive the service utilizing alternative funding sources. Home-Delivered Meals is often the first in-home service that an older adult receives and is the primary access point for other home and community-based services. The average age of participants is 75 years. More than half of all participants (59%) are female and 67% of all participants are in poverty. More than three-quarters (74%) of participants live alone, and a total of live in an apartment building. Participants with limited English proficiency comprise of 17% of the total individuals served. On average participants require assistance with 2 activities of daily living. Nearly half of participants continue to receive meals for 1-3 years, with 23% participating for three years or longer. PM1: How much did we do? Staff Total 1.5 FTEs: 0.35 FTE Supervisor (35% of one FTE) 0.3 FTE Program Coordinator (30% of one FTE) 0.25 FTE Administrative Support (25% of one FTE) 0.5 Human Services Specialist 0.1 Registered Dietician Home Delivered Meals FY 2018 Page 1
Customers and Service FY 2016 FY 2017 FY 2018 Participants 151 155 144 Participants Age 85+ 53 47 50 Meals Delivered 40,928 44,469 39,307 PM2: How well did we do it? 2.1 Customer Satisfaction with food quality, nutrition and choice 2.2 Compliance with Eligibility Determinants PM3: Is anyone better off? 3.1 Participants continue to live independently and are more likely to be referred to other services 3.2 Stabilize and reduce Nutritional Risk Home Delivered Meals FY 2018 Page 2
Home Delivered Meals Measure 2.1 Customer Satisfaction with food quality, nutrition and choice 100% 90% 70% 60% 50% 40% 30% 20% 10% 0% 74% 92% 84% Target 85% Customer Satisfaction 60% 86% 82% 91% 91% 92% 92% 85% FY 2016 FY 2017 FY 2018 FY 2019 proj. Q1: Satisfaction with the meals (Excellent or Good) Q4: Like the taste (Yes or Sometimes) Q7: Eat healthier FY 2018 (Spring) FY 2019 (Proj.) FY 2016 FY 2017 Q1: Satisfaction 63/85 42/71 36/44 73/85 Q4: Like the taste 78/85 61/71 40/44 78/85 Q7: Eat healthier 71/85 57/71 40/44 78/85 Summary Annually, during September - October, a satisfaction survey of participants is conducted by phone by AAA staff and interns who then utilize Survey Monkey to track and record results. In FY 2017, 71 participants responded to the survey. The response rate of 47% was consistent with the previous survey. The results were as follows: o Q1: Only 60% of participants (42/71) reported the meal was Excellent or Good. o Q4: When asked whether participants like the taste of the meals 86% o (38/71) reported Yes or Sometimes. Q7: of participants (57/71) reported that they eat healthier because of the meals. A new meal vendor was introduced in October 2017 after the annual survey was conducted. A follow up survey of a smaller sample size (n=44) was administered in Spring 2018, with more favorable results: o Q1: 82% of the participants (36/44) report the meal was Excellent or Good. o Q4: When asked whether participants like the taste of the meals 91% o reported Yes or Sometimes. Q7: 91% of participants (40/44) reported that they eat healthier because of the meals. Home Delivered Meals FY 2018 Page 3
What is the story behind the data? A new meal vendor, Jeffrey s Catering Company was introduced in October 2017. Initial feedback from participants, MOW and the survey indicates that higher satisfaction with the new vendor. Since January 2017, a registered dietician with the AAA evaluates the menu by conducting menu planning and nutrient analysis, reviewing menus to ensure meals meet dietary guidelines, and offering recommendations to improve taste. Participants may be concerned about an impact to this service if they share honest feedback about the service. Forecast Recommendations Continue to conduct satisfaction surveys annually and recommend enhancements to the menu and program based on feedback. Continue to offer seasonal menus and incorporate feedback from satisfaction surveys in menu planning. Staff will include satisfaction as part of site visits and quarterly contract evaluations to proactively implement changes. Involve registered dietician when crafting menus and to enhance quality of meals. Continue to emphasize program benefits to older adults and their caregivers through tailored outreach and education materials that illustrate healthy nutrition. Staff will continue to request honest feedback and include a disclaimer before survey is administered that feedback enhances the program and is incorporated in menu planning. AAA will continue to use objective parties, such as interns and volunteers, to assist with collecting feedback. AAA staff will continue conducting survey in the Spring to more closely align with the County FY. AAA staff will maintain a frequent onsite presence during meal delivery and distribution, conduct route assessments, promote relevant outreach materials, and meet quarterly with vendor. FY 2019: Continue to contract with current vendor. AAA staff and interns will conduct the full annual survey with target rates of 85% or greater with respect to satisfaction, meal taste and reports of eating healthier because of the meals. Home Delivered Meals FY 2018 Page 4
Home Delivered Meals Measure 2.2 Compliance with Eligibility Determinants 100% 95% 90% 85% 99% 98% 99% 99% HDM Eligibility Guidelines Target 95% 95% 93% 98% 96% 96% 97% 95% 95% 75% 70% 65% 60% 55% 50% Age Race Income FY 2016 FY 2017 FY 2018 FY 2019 - Proj. Summary Program eligibility is established by the Federal Older Americans Act to ensure priority to the most vulnerable populations. Participants must be age 60 or older, and priority is given to low-income minorities. According to governing guidelines, required information about age, race, and income must be collected during initial assessment, which is conducted by AAA staff. AAA staff enter information in online database, PeerPlace, to determine eligibility and update during annual reassessment or when any significant change in status occurs. Program guidelines require the number with missing information must be less than 10% to ensure compliance with state service standards. AAA staff monitor program eligibility on a quarterly basis and data reflects compliance with state guidelines. What is the story behind the data? Staff record basic demographic information, the first four pages of the Virginia Uniform Assessment Instrument in PeerPlace database. Eligibility documentation is consistent with established state service standards. Any percentage less than 90% would place AAA out of compliance with eligibility guidelines. Age is the most seamlessly requested eligibility requirement, whereas race and income may be perceived as more sensitive to reveal. Staff turnover and training may have influenced consistency of data gathering. Recommendations Conduct quarterly monitoring of program guidelines and closely monitor missing eligibility information. Include assessment in annual monitoring visits with key staff. Staff will utilize person-centered training techniques to increase comfort and learn best practices around collecting sensitive information. AAA Staff will offer ongoing support Home Delivered Meals FY 2018 Page 5
In FY 2017, staff were trained in personcentered techniques to increase comfort and learn best practices around collecting sensitive information. Forecast to staff who record information so that reporting reflects the diversity of the population served. FY 2019 Projections: Exceed state guidelines of recording information for no less than 90% and aim for a target of 99% (age), 95% (race), and 95% (income) compliance with reporting required eligibility information. Home Delivered Meals FY 2018 Page 6
Home Delivered Meals Measure 3.1 100% 90% 70% 60% 50% 40% 30% 20% 10% 0% Participants continue to live independently and are more likely to be referred to other services 98% Increased Independence because of HDM 67% 89% Target 91% age in place 59% 98% 77% 95% 2016 2017 2018 2019 - Proj. Age In Place because of meals Receiving meals more than one-year Summary A survey of participants is conducted annually by AAA staff to evaluate their ability to live independently because of the service. In FY 2017, 71 participants responded to the survey. A follow up survey was conducted with a smaller sample size in Spring 2018 to reflect the changes with the new vendor. Self-reported information is corroborated by a quarterly report submitted by vendor and the information regarding living arrangements as recorded in PeerPlace. Nationally 91% of participants indicate that the Home-Delivered nutrition program helps them stay in their own home (National Survey of Older Americans Act Participants). Most participants who choose to remain with the service do so for one year or longer. In 2018, data for all years was derived from a PeerPlace on all clients served, replacing survey data from previous years. What is the story behind the data? Participants remain in the program because it promotes independence and healthy living. Living independently with home and community-based services results in cost savings compared to a nursing facility, estimated at $10,539 per month for a semi-private room in the D.C. metro area. Recommendations Increase outreach to promote the program and benefits to nutrition and opportunities for socialization. Continue to promote socialization through daily contact between program participant and volunteer drivers. Ensure volunteers and staff recognize risk factors, know how to refer for services, and understand benefits of interventions. Home Delivered Meals FY 2018 Page 7
The home-delivered meals program provides participants with a nutritious meal, plus a safety check and face-toface contact to improve quality of life and provide opportunities for socialization, extending the length of time an older adult may live independently in the environment of their choice. Frequent safety checks and reassessments result in earlier interventions based on risk factors and facilitation of direct connections to additional services. Program participants benefit from various interactions with staff and volunteers, which may result in additional services such as Information and Referrals, Transportation services, In-home services and Caregiver respite. Several new referrals to the program came from case managers at the hospital and resulted in participants with more acute needs. Forecast Strive to enhance service to the point that the dominant reason individuals discontinue the service is because of the need for a higher level of care. Track hospitalizations from quarterly report received by Meals on Wheels and compare to PeerPlace record and report. Formalize the process for referrals to additional services for current participants. Ensure consistency in tracking and recording linkages to supportive services, such as Peer Place Referrals tab. Continue to track the total number of individuals who are closed to service and record the reason. For those who close out for reasons other than deceased, or a higher level of care, ensure follow up and provide linkages to other supportive services. Ensure follow up with all participants who disengage with services and offer referrals to other home and community-based supports. Extend this measure to track frequency and types of services to which individuals connect. Continue to strengthen partnerships with hospital staff to ensure care coordination and a smooth transition for individuals discharged from the hospital. FY 2019: AAA anticipates these numbers will continue to remain at or above 91% as aging in the community is the reported preference among older adults. AAA staff will continue to offer additional supportive services as part of annual reassessment. AAA staff will begin to conduct survey in the Spring to more closely align with the County FY and will access reports from PeerPlace to corroborate information. Home Delivered Meals FY 2018 Page 8
Home Delivered Meals Measure 3.2 Stabilize and reduce Nutritional Risk 100% 90% 70% 60% 50% 40% 30% 20% 10% 0% Percentage of participants with reduced or stable nutritional risk 20% Target 18% 27% 19% 41% 39% FY 2016 83 participants 33% 49% FY 2017 72 participants 38% 35% FY 2018 48 participants Reduced Risk Stable Risk Increased Risk 39% 43% FY 2019 (proj) Nutritional Risk 100 90 80 70 60 50 40 30 20 10 0 89 91 82 74 73 68 77 50 53 47 36 Moderate Risk High Risk Age 85+ 2016 2017 2018 2019 - Proj. 45 Summary Of the 144 participants served in FY 2018, 48 received services in both FY 2018 and FY 2017. This is a decrease from FY 2017. Of these 48 participants, 35% reduced their nutritional risk in FY 2018, and 38% remained stable. 27% were assessed at a higher nutritional risk in FY 2018 than in FY 2017. is collected using the Nutritional Screening Index (NSI) tool and included in the intake assessment, completed by ADSD staff. Assessments are updated annually or with a significant change in status. Early and frequent interventions help stabilize or reduce risk. Home Delivered Meals FY 2018 Page 9
A score of 3-5 equates to moderate nutritional risk and reviewed to explore actions that may be taken to improve eating habits and lifestyle. A score of 6 or above indicates high nutritional risk and elevates participant for a follow up and monitoring from AAA Registered Dietician (RD) and referrals to relevant service providers. The largest age cohort served is participants ages 85 and older (30%). Research indicates that adults age 85 and older are at particular risk for malnutrition. What is the story behind the data? The program serves the frailest and vulnerable older adults. The total number of high-risk participants has decreased due to more targeted contacts, referrals to services, increased frequency of contacts, and longer lengths of remaining connected to services. The increase in the proportion of clients who experienced increased nutritional risk was due to improved retention of existing clients, whose challenges may increase as they age. Forecast Recommendations Continue to analyze nutritional screening scores and offer education and referrals for participants who score moderate to high nutritional risk. Continue to closely track the individual nutrition scores of high-risk participants and participants age 85 and older who enroll in nutritional counseling with registered dietician. Registered dietician will track the severity of risk and need for services using a customizable state assessment tool. Continue to refer individuals who score are at higher risk to services like SNAP benefits, dental services, and nutritional counseling with a registered dietician. AAA staff will continue to track outcomes of nutrition counseling such as number of hospitalizations, referrals to services, frequency of contacts, and nutritional screening post-score. Ensure that all clients receive a nutritional screening at least once per year. FY 2019: Anticipate a stable or improved nutrition scores of or higher. Home Delivered Meals FY 2018 Page 10