pima council on aging€¦ · 89% stated the meals provided a larger variety of fruits, vegetables...

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Pima Council on Aging

Area Agency on Aging – Region II

FY 2016-2017 Year End Services Report Major Funding for Programs and Services Provided By:

Federal Older Americans Act through AZ Department of Economic Security, Division of Aging and Adult Services

Federal Social Service Block Grant through AZ Department of Economic Security, Division of Aging and Adult Services

State of Arizona through AZ Department of Economic Security, Division of Aging & Adult Services

Center for Medicare and Medicaid Services through AZ Department of Economic Security, Division of Aging and Adult Services

City of Tucson Pima County United Way of Tucson and Southern Arizona Pima Association of Governments, Regional Transit Authority Arizona Long Term Care System (ALTCS) through Mercy Care and United Health

Care National Council on Aging University of Arizona Center on Aging (GWEP) Arizona Living Well Cenpatico Oasis Care 1st Individual, business and faith community contributions through memberships,

donations and bequests.

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Foundations/Corporations Including:Allyn Family Foundation Amazon Smile Foundation Arizona Care Advocates Blue Cross Blue Shield of Arizona Care Coordinators, Inc. Connie Hillman Family Foundation Costco Wholesale Corporation Diamond Foundation Don and Antoinette Falasca Charitable Foundation Donald Pitt Family Foundation Eliot Spalding Foundation Fangamer, LLC Fluor Facility and Plant Services, Inc. Freeport-McMoRan Copper and Gold Fry’s Community Rewards Program GE Foundation Greater Green Valley Community Foundation, Inc. Hudson Foundation Intuit, Inc.

JHH Donor Advised Fund held at the Community Foundation for Southern Arizona Joseph O. and Geraldine C. Waymire Fund, a fund of Central Indiana Community Foundation

L.E.S Is More Charitable Fund held at the Community Foundation for Southern Arizona LGBT&S Alliance Fund, a fund of the Community Foundation for Southern Arizona of Southern Arizona Lorraine Maria Hamilton Endowment Fund held at the Community Foundation for Southern Arizona Med-Tech Systems, Inc. Merck Foundation, Inc. National Council on Aging Raytheon Missile Systems Services and Advocacy for LGBT Elders (SAGE)

Shaol and Evelyn Pozez Endowment Fund held at the Jewish Community Foundation Southwest Gas Corporation The HSLopez Family Foundation The Stocker Foundation Thomas and Jeanne Elmezzi Foundation Tucson Airport Authority United Healthcare Plan Vance Foundations White Elephant, Inc.

Special Event Sponsors AARP-Arizona Adult Care Home Placement Services Allied MedCor Services, Inc. BAYADA Home Health Care Blue Cross Blue Shield of Arizona Blue Cross Blue Shield of Arizona Advantage Broadway Proper Care1st Health Plan Arizona, Inc. Carondelet St. Mary's Hospital Casa de la Luz Foundation Casa de La Luz Hospice Catalina In Home Services

CBIZ Benefits and Insurance Services CliftonLarsonAllen LLP CODAC Health, Recovery & Wellness CopperPoint Insurance Companies Cox Media Elmcroft River Centre HBL CPAs, PC Law Offices of Kay Richter Medline Industries, Inc. Mercy Care Plan RBC Wealth Management, Falbaum Investment Group

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Right at Home and IKOR of Tucson Soreo In Home Support Services Southwest Gas Corporation Tucson Electric Power Tucson Medical Center USI Insurance Vantage West Credit Union Watermark Companie

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As the Area Agency on Aging, Pima Council on Aging plans, develops, administers, funds and monitors a non-medical home

and community-based delivery system of nutrition and supportive services. PCOA contracts with community agencies to deliver designated services within this delivery system as noted below

PROVIDER PAID FY 16-17

SERVICE

Catholic Social Services $884,956 Congregate & Home Delivered Meals, Refugee Resettlement

Lutheran Social Services of the Southwest $1,082,004 Home Delivered Meals, Shopper Service, Caregiver Training, Attendant Care, Personal Care, Housekeeping, Respite, Shopper

City of Tucson (Parks and Recreation)

$332,118 Congregate Meals, Transportation

Arcadia $522,071 Attendant Care, Personal Care, Housekeeping, Respite

Soreo

$285,827 Attendant Care, Personal Care, Housekeeping, Respite

My House


United Cerebral Palsy

$330,854 Attendant Care, Housekeeping, Respite

Aires


Southern Arizona Family Services


Community Home Repair Projects of Arizona (CHRPA)

$207,190 Major Home Repair

Tucson Urban League $112,036 Congregate Meals

Rescare


Philips Lifeline Systems, Inc. $130,342 Emergency Alert

Accent Care


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PROVIDER PAID FY 16-17

SERVICE

Aventas $61,445 Attendant Care, Housekeeping, Respite

Southern Arizona Legal Aid $47,955 Legal Assistance

Arizona Children’s Association $43,592 Grandparents Raising Grandchildren Support Groups and Information & Assistance

Pima County Health Department $22,749 Nursing Clinics

La Posada at Park Center $16,092 Transportation, Adult Day Care

Patient Care Advocates $2,168 Attendant Care, Housekeeping, Respite

TOTAL $5,086,048

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PIMA COUNCIL ON AGING SUPPORTED SERVICES July 1, 2016 – June 30, 2017

NUMBER OF UNDUPLICATED SERVICE UNITS DELIVERED INDIVIDUALS BY SERVICE

PCOA Helpline/Intake

9,891 client contacts

6,048

Home Delivered Meals 185,914 meals 1,304 Congregate Meals 81,050 meals 1,794 Nursing Clinics

1,614 client contacts

304

General Transportation 16,034 one-way rides 112 Minor Home Repair 315 repairs 208 Major Home Repair 702 repairs 538 Legal Services 350 hours 124 Family Caregiver: Information & Referral Support Groups Caregiver Training Supplemental Services (incontinent supplies/adaptive equipment) Respite Grandparents Raising Grandchildren: Information & Assistance Support Groups

1,739 client contacts 121 sessions 18 classes 50 jobs 12,918 hours 196 client contacts 115 sessions

1,155

213 76 72

93

194 109

Case Management 12,944 hours 1,653 Housekeeping 19,571 hours 416 Personal Care 150 hours 1 Attendant Care 114,063 hours 698 Adult Day Care 552 hours 2 Visiting Nurse 37 hours 2 Shopper Service 4,502 hours 154 Emergency Alert System 4,868 hours 549

Elder Rights & Benefits 4,205 client contacts 2,316 Medicare/Insurance Counseling 5,304 client contacts 3,748 Personal Budgeting Assistance 526 volunteer hours 65 Long Term Care Ombudsman 603 complaint resolutions NA Ambassador 772 volunteer hours 53 Neighbor’s Care Alliance 108,102 volunteer hours 1,301 HOPE Workshop for Hoarding Disorder 2 series (27 classes) 88 Enhance Fitness 10 classes (3x week on-going) 299 A Matter of Balance 22 classes 201 Diabetes Self Management Program 4 classes 35 Chronic Pain Self-Management Program 4 classes 42 OASIS Healthy Habits for Adults Aging Mastery Program

65 classes 2 series (20 classes)

345 60

INDIVIDUALS COULD BE RECEIVING ONE OR MORE SERVICES 8/2017

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PCOA HELPLINE/INTAKE

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PIMA COUNCIL ON AGING HELPLINE/INTAKE

FY 2016-2017 Service Description The PCOA Helpline is usually the first point of contact when clients contact the agency. Intake staff complete an initial screening, gathering basic information about the caller and the problem or question they are calling about. After determining the primary problem, staff refer the caller to the services PCOA provides directly or to other agencies and programs in the community that can address the particular problem or need. Intake staff also serve as the central intake point for the Community Services System, which provides subsidized in-home assistance to frail elderly. The Helpline Staff assist people with an extremely diverse range of problems and questions. The primary needs addressed include the following:

Advanced Directives

ALTCS (Arizona Long Term Care)

Benefits Assistance

Care Planning

Caregiver Respite

Caregiver Support

Emergency Response System

Elder Rights

Financial

Food Assistance

Health Insurance

Home Repair/ Adaptation/ Maintenance

Housekeeping

Housing (Independent & supportive)

Legal or Quasi-Legal

Personal Care

Shopping

Tax Assistance

Transportation Outputs Intake staff provided 9,891 contacts to 6,048 unduplicated clients.

Client Demographic Summary

Female 69% White 73% Male 31% Black/African American 4% Live Alone 47% Asian 1% Frail/Disabled 57% Other Multi-Racial 1%

Under 65 21% Hispanic 20% 65-74 33% Unknown 1% 75-84 28% 85+ 15% Unknown 3%

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PROGRAM YEAR

Nutrition ServicesHome Delivered &Congregate Meals

HOME DELIVERED MEALS CONGREGATE MEALS

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PIMA COUNCIL ON AGING HOME DELIVERED MEALS

FY 2016-2017 Service Description:

Chilled meals meeting 1/3 of the Dietary Reference Intake for older adults are delivered to eligible individuals who are homebound, unable to prepare a nutritious meal because of health or physical limitations and have no one to assist them. PCOA contracts with two meal providers to prepare and deliver meals utilizing 20 routes throughout metro Tucson and Green Valley, Sahuarita, Marana and Ajo. Meal routes are delivered on either Monday/Wednesday or Tuesday/Thursday depending upon the area of town. An in-home assessment is completed to determine eligibility, need and individuals are linked to other supportive services when necessary. Outcomes/Outcome Measures:

The Home Delivered Meals Program: (1) enhanced participants’ nutritional intake; (2) increased or maintained the participants’ self-sufficiency and independence; and (3) increased the participants’ social contacts by at least two visits a week and sense of security knowing the driver would check on them. These outcomes were evidenced by the responses made in the evaluation questionnaires received from 503 participants inclusive of all routes.

1. 84% of clients surveyed reported that their home delivered meal was their main cooked meal of the day.

2. When asked to explain how the meal program was helpful to them, the responses were as follows:

85% stated the meals increased their daily intake of food. 89% stated the meals provided a larger variety of fruits, vegetables and meats

than they would be able to prepare for themselves. 91% stated the meals helped them stretch their financial resources as they didn’t

have to buy so much food. 75% stated the meals helped them gain or maintain weight. 91% stated the meals helped them maintain their health. 88% stated they feel more secure knowing the driver will be checking on them at

least two times per week. 70% stated they know they can ask the driver for additional services if they need

them. 88% stated the meals helped them maintain their independence.

Units of Service: 185,914 meals delivered Client Demographic Summary: 1,304 unduplicated clients served

Female 60% White 71% Male 40% Black/African American 5% Live Alone 71% Asian 1% Frail/Disabled 100% American Indian/Alaskan Native 1%

< 60 3% Other Multi-Racial 6% 60-74 41% Hispanic 15% 75-84 28% Unknown 1% 85+ 28%

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PIMA MEALS ON WHEELS SERVICE AREA PROGRAM YEAR: July 1, 2016 – June 30, 2017

CATHOLIC SOCIAL SERVICE LUTHERAN SOCIAL SERVICES 624-1562 (FAX: 519-1303) 514-7642, Ext. 204 (FAX: 514-7646)

85653 (Marana) 85710 85654 (Rillito) 85711 85321 - Ajo 85712 85614/85622 (Green Valley) 85629 (Sahuarita) 85714 (East of Campbell) 85701 85715 85704 85716 85705 85718 85706 85719 85713 85730* 85714 (West of Campbell) 85747 (Vail/Rita Ranch) 85735 85748 (Wrightstown) 85736 (close to Ajo Hwy) 85737* (south of Lambert Lane) 85749* 85741 85750* 85742* 85641* (Vail, Corona de Tucson) 85743 85745 85746 85756 (north of Hughes) 85757 (Robles Junction, Three Points) DA/PCOA 7-01-2016 *DENOTES LIMITED SERVICE AREA

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PIMA COUNCIL ON AGING CONGREGATE MEALS

2016-2017

Service Description: Congregate meals and social and recreational activities are offered at 13 sites throughout Pima County. At these sites, older adults receive a daily wholesome meal designed to meet specific nutritional requirements for 1/3 of the Dietary Reference Intake for older adults. In addition, these sites serve as neighborhood focal points, providing opportunities for interaction with peers, assessment and referral to other services as needed and health promotion programs. Outcomes/Outcome Measures: The Socialization & Nutrition Program (1) enhanced the participants nutritional status, (2) maintained the participants mental and physical wellness, (3) reduced participants social isolation and (4) increased or maintained the participants self-sufficiency.

These outcomes were evidenced by the responses participants made in the evaluation questionnaire received from a sampling of 686 participants inclusive of all 13 sites. 1. 79% of surveyed respondents reported their center meal was their main hot, prepared meal

of the day. 2. When asked to explain how the meal program was helpful to them, the responses were as

follows: 77% stated the meals increased their daily intake of food. 76% stated the meals provided a larger variety of fruits, vegetables and meats than they

would be able to prepare for themselves. 64% stated the meals helped them stretch their financial resources as they don’t have

enough money to always buy food. 60% stated the meals helped them gain or maintain their weight. 70% stated the meals helped them maintain their health. 83% stated the center provided them with an incentive to eat as it is more enjoyable to

share a meal in the company of others. 89% stated the center helped them make friends and gave them people to talk to each

day. 87% stated they felt happier by attending the center. 69% stated the programs at the center helped them manage health conditions. 74% stated they feel a greater sense of security by knowing people at the center can help

them with problems. 61% stated they can make more healthful choices about their diet because of what they

learned at the center. 80% stated the center helped them feel less lonely. 70% stated the center helped them remain independent.

Units of Service: 81,050 meals served

Client Demographic Summary: 1,794 unduplicated clients served Female 62% <60 2% White 56% Male 38% 60-74 54% Black/African American 5% Live Alone 56% 75-84 30% Asian 1% Frail Disabled 30% 85+ 14% American Indian 1% Other Multi-Racial 2% Hispanic 35%

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1 - Ajo Community Center

290 5th St – Ajo 85321 (520) 387-5040

2 - Archer Center 1665 S. La Cholla Blvd- Tucson 85713 791-4353 a* 3 - Amory Park Senior Center 220 S 5th Ave – Tucson 85701 791-4070 4 - Casa Community Center 780 S Park Centre Ave

Green Valley 85614 393-6814 b. 5 - Eastside El Dorado TMC El Dorado Health Campus 1400 N. Wilmot Tucson 85712 546-2257 a, b 6 - El Pueblo Neighborhood Center 101 W Irvington Rd – Tucson 85714 889-0928 a, b 7 - El Rio Neighborhood Center 1390 W Speedway – Tucson 85705 837-8210 a, b** 8 - Ellie Towne/Flowing Wells Community Center 1660 W Ruthrauff Rd – Tucson 85705 887-9786 a 9 - Freedom Recreation Center 5000 E 29th St – Tucson 85711 791-4969 a, b 10 - Donna Liggins Center 2160 N 6th Ave – Tucson 85705 791-3247 a 11 - Quincie Douglas Senior Center 1575 E 36th St – Tucson 85713 – 791-2509 ** 12 - Robles Junction Community Center 16150 W Ajo Way – Tucson 85735 578-3063

b 13 - William Clements Regional Center 791-5787

8155 E. Poincianna Dr. – Tucson 85730

Other Enhance Fitness Sites:

Morris K Udall Regional Center

7200 E. Tanque Verde Rd. – Tucson 85715 Picture Rocks Community Center

55615 N. Sanders Road – Tucson 85743

Drexel Heights Community Center

5220 S. San Joaquin Ave. – Tucson 85741

N 7 5

N 3 2

4

N 6

1

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SENIOR LUNCH

PROGRAM Please call in advance to reserve a meal and for

days and hours of operation *Dinner Meal

**Open Mon., Wed., Fri

N 10

N 8

1 a = Location of Nursing Clinics b = Location of Enhance Fitness

Funded by:

Federal Older Americans Act through AZ DES/DAAS,

United Way of Tucson and Southern Arizona

City of Tucson

Individual Contributions

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SENIOR CENTER TRANSPORTATION

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PIMA COUNCIL ON AGING

SENIOR CENTER TRANSPORTATION FY 2016-2017

Service Description: All the goals of the congregate nutrition program would be defeated if clients could not get to the centers for service. It is the responsibility of center managers to assist clients in making transportation arrangements. Older Americans Act funds are available to purchase this service for clients who cannot. This subsidized service is for persons age 60 and over, or spouse, who have mobility limitations that prevent them from driving or using Sun Van. Service is provided in Tucson by Sun Van, Ajo Transportation in Ajo, and Casa de Esperanza in Green Valley. Ajo Transportation pays for the rides for the seniors to the Ajo Senior Center. Clients who attend the centers in Tucson must be registered with the ADA Eligibility Office and attend the center closest to their home. PCOA also has a contract with City of Tucson Parks & Recreation to provide transportation to the El Rio and Armory Park senior centers. Outcomes/Outcome Measures: These outcomes were evidenced by the responses participants made in the evaluation questionnaire received from a sampling of 75 participants in the last quarter of the fiscal year.

92% of respondents stated the rides helped improve the quality of their lives. 92% of respondents stated the rides contributed to their overall health. 83% of respondents stated that they would not be able to attend the senior lunch

program without the transportation service. Units of service: 16,034 one-way rides Client Demographic Summary: 112 unduplicated clients served

Female 76% White 38% Male 24% Hispanic 53% Live Alone 79% Black/African American 4% Frail Disabled 52% Asian 1% <60 0% American Indian/ 2% 60-74 54% Alaskan Native 75-84 26% Other Multi-Racial 2% 85+ 20%

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HOME REPAIR/ADAPTATION/RENOVATION

MINOR HOME REPAIR MAJOR HOME REPAIR

*Inceases due to: Started reporting separate jobs - not number of invoices paid**Decrease due to started counting nomber of invoices paid

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HOME REPAIR/ADAPTATION/RENOVATION PROGRAMS (Major & Minor Home Repair) - FY 2016-2017

Service Description:

PCOA supports two home repair, adaptation and modification programs for homeowners aged 60 and over in greatest social and economic need living in non-reservation areas of Pima County. All programs concentrate on correcting health and safety hazards, improving accessibility and performing routine maintenance services that assist clients to remain independent in their own homes.

1) PCOA contracts with Community Home Repair Projects of Arizona (CHRPA) for smaller repairs, adaptations and cooler and heater maintenance typically costing $750 and under for clients screened and referred by PCOA staff 702 different repairs and adaptations were made, with 244 cooler and 92 furnace maintenance visits as the largest single category for 538 separate individuals.

2) PCOA provides an allocation of funds to the Community Services System case managers to be used for Minor Home Repairs for their clients, maximum $750 per person, per year. 315 different repairs were made, with cooler and furnace maintenance and disability modifications leading the repair categories, for 208 different individuals.

3) PCOA received a donation of 17 water heaters from Southwest Gas Corporation to assist individuals. Outcomes/Outcome Measures: A satisfaction survey was sent to all participants as contractor invoices were paid and/or clients verified receipt of service. This survey allowed recipients to comment on and evaluate their satisfaction, or lack of it, with staff, workmen or volunteers and quality of the work performed. 92% of respondents to the individual client service evaluation questionnaire reported they feel more independent in their homes because of the service. 92% of respondents reported they feel more comfortable in their homes because of the service. 91% of respondents reported the service met their immediate repair or adaptation need. Many individuals indicate in their comments that without this service they would not be able to remain in their own homes and a large number indicate they cannot afford repairs they need to be safe and comfortable. Units of Service: 1,017 repairs Client Demographic Summary: 746 unduplicated clients served

Female 77% <60 3% White 47% Male 23% 60-74 60% Black/African American 6% Live Alone 64% 75-84 27% Asian 1% Frail Disabled 58% 85+ 10% American Indian 1%

Other Multi-Racial 1% Hispanic 44%

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PIMA COUNCIL ON AGING HOME REPAIR/ADAPTATION/RENOVATION PROGRAMS

(Major & Minor Home Repair) FY 2016-2017 – Page 2

HOME REPAIR CATEGORIES

285 Cooler Maintenance - routine (pump, pads, belt, draining, cleaning, start up, shut down, etc.)

61 Cooler Repair - (New motor, cage, pulley, water line, Midwest box, stand, etc.)

19 Cooler Replacement – (New cooler and installation with water & electric lines if needed) 13 Air Conditioning Repair/Replacement 117 Furnace Maintenance – routine (Annual filter, Co2 test, cleaning, start up, shut down, etc.)

22 Furnace Repair - (New blower, thermostat, ignition, lines, wiring, etc.)

5 Furnace Replacement – (New furnace and installation with gas and/or electric lines if needed)

4 Hot Water Heater Repair – (thermocouple, water or gas leaks, etc.) 17 Hot Water Heater Replacement – (New hot water heater and installation) 35 Electrical – Light (shorts, outlets, fuses, light fixtures, wiring) 283 Plumbing: General Leaks; replacement of fixtures (including drains, faucets, sinks, shower, main water

lines, tubs, toilets, sewers repairs, garbage disposals)

3 Gas line repair/replacement 253 Disability modifications or equipment: (including grab bars, hand held showers, shower chair,

transfer bench, toilet seat, safety frame, wheelchair ramp, steps/railings, quad cane)

82 Structural repairs: (including, doors/locks, ceiling, wall and window repairs/ replacement, steps,

floors/tile, cabinets)

54 Roof repair/replacement 4 Pest Control: (bed bugs, bee removal, mice)

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LEGAL SERVICES

*Decrease in reported in-kind units

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PIMA COUNCIL ON AGING LEGAL SERVICES

FY 2016-2017 Service Description: Southern Arizona Legal Aid provides low income residents of Pima County with representation for civil legal problems. Service is provided for individuals referred by the Pima Council on Aging Elder Rights and Benefits Program and through its community outreach workers. Representation in certain types of cases such as fee generating and criminal cases is prohibited or restricted by regulation and statute. NAELA Clinic Attorneys from the Tucson Chapter of the National Academy of Elder Law Attorneys (NAELA) volunteered their time for NAELA clinics that are usually held twice a month. The clinic was established to allow persons 60 and over to see an Elder Law Attorney for thirty minutes at no charge. The attorney gives advice and information only and may be consulted about any Elder Law issue, such as making a will or Living Trust, guardianship and conservatorship, powers of attorney, and probate. In FY 2016-2017, assistance was provided to 103 individuals through 21 National Academy of Elder Law Attorneys Legal Clinics. Outcomes/Outcome Measures:

60% of individuals who responded to the client survey stated that Southern Arizona Legal

Aid was able to help them resolve their problem satisfactorily.

Units of Service: 350 (includes 39 in-kind units) Client Demographic Summary: 124 unduplicated individuals served

Female 56% White 50% Male 44% Hispanic 40% Live Alone 64% Black/African American 6% Frail Disabled 58% Asian 1% <60 0% American Indian/Alaskan Native 2% 60-74 80% Other Multi Racial 1% 75-84 19%

85+ 1%

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EMERGENCY ALERT (LIFELINE)

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PIMA COUNCIL ON AGING EMERGENCY ALERT SYSTEM

2016-2017

Service Description: Lifeline is a 24-hour a day electronic emergency response and home safe wireless system that can be installed in a senior’s home. PCOA contracted with Phillips Lifeline for the provision of this service. Outcomes/Outcome Measures:

100% of clients surveyed reported that the services made it easier for them to remain in their home. 88% of clients surveyed stated that the service made them feel more safe and secure. 45% of clients surveyed stated that the service helped them remain independent. Units of Service: 4,868 hours Client Demographic Summary: 549 unduplicated clients served

Female 78% White 62% Male 22% Black/African American 6% Live Alone 90% Asian 1% Frail Disabled 100% Other Multi-Racial 7% <60 3% Hispanic 23% 60-74 39% Unknown 1% 75-84 33% 85+ 25%

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CAREGIVER PROGRAM (INFORMATON & ASSISTANCE)

OLDER ADULTS GRANDPARENTS

*In FY 2013-2014, the definition of and process for identyfying client contacts was changed for grandparents

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(incontinent supplies/adaptive equipment

TRAINING CLASSES (Older Adults) SUPPLEMENTAL JOBS (Older Adults)

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PIMA COUNCIL ON AGING FAMILY CAREGIVER SUPPORT PROGRAM

FY 2016-2017


The Family Caregiver Support Program supports, supplements and enhances the role of unpaid family caregivers as they provide care for their older family members in Pima County. In addition to the PCOA direct services, two components of the program are contracted out: 1) Family Caregiver Training that builds confidence and skills for family caregivers and 2) Support to grandparents (age 55 or older) who are raising grandchildren (18 years of age and younger). The major components include: Direct Services:

Caregiver Information and Referral

Support groups for family caregivers

Caregiver Supplemental Services

Community Outreach and Education Contracted Services:

Family Caregiver Training (Provided by Lutheran Social Services of the Southwest)

Grandparents Raising Grandchildren – Information and Assistance and Caregiver Support Groups (Provided by the K.A.R.E. Family Center).

Respite Services (Provided by Home Care Agencies)

Partners in Planning: PCOA continued to provide Partners in Planning, a decision-support process where individuals, family members and/or significant others can find assistance in planning for their long-term needs. The process is a holistic approach addressing physical health, emotional well-being, housing and in-home care, financial concerns, legal considerations, and end-of-life issues. Participants receive an individual consultation and follow-up, comprehensive resource materials, and a personalized plan to guide decisions about the future. The fee for this service is $75.00 per person or $125.00 per couple. Outputs PCOA Caregiver staff provided 1,739 contacts to 1,155 unduplicated clients PCOA staff facilitated 121 sessions of Support Groups for 213 unduplicated unpaid family

caregivers 50 Supplemental jobs were provided for 72 unduplicated individuals. 12,918 Respite hours were provided for 93 unduplicated individuals. 18 Family Caregiver Training classes were held with 76 unduplicated participants 196 client contacts for information and assistance were provided through the KARE Family

Center for Grandparents Raising Grandchildren to 194 unduplicated clients. 115 sessions of caregiver support groups were provided through the KARE Family Center

for Grandparents Raising Grandchildren to 109 unduplicated clients.

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PIMA COUNCIL ON AGING FAMILY CAREGIVER SUPPORT PROGRAM

FY 2016-2017– Page 2 Client Demographic Summary Female 72% <60 41% White 82% Male 28% 60-74 46% Black/African American 2% 75-84 11% Asian 1% Frail Disabled 1% 85+ 2% American Indian/Alaskan Native 1% Other Multi-Racial 1% Hispanic 13% Outcomes 93% of the clients surveyed reported that the information and assistance they received

helped them to be better caregivers. 84% of PCOA clients reported the information and assistance enabled them to provide care

for a longer period of time than would have been possible without the assistance. Of the caregivers attending PCOA support groups, 99% reported that they benefitted by

attending a support group. PCOA surveyed clients receiving Respite Services. 100% of respite clients reported the

service made it easier for them to remain in their home; 74% reported the service relieved their stress while 46% reported the service helped them feel more safe and secure.

K.A.R.E. Family Center surveyed clients and found that 93% of grandparents reported the assistance helped them give better care to their grandchildren.

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CASE MANAGEMENT

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PIMA COUNCIL ON AGING CASE MANAGEMENT

FY 2016-2017


Case Management is provided for individuals age 60 and older and for individuals with disabilities who are enrolled in the Community Services System which is the local comprehensive delivery system of in-home support services. After initial screening and determination of program eligibility by the Helpline staff, the Care Coordinators make in-home visits to complete a thorough assessment of needs, develop a service plan and authorize the services to be delivered. Care Coordinators provide information, service referrals, conduct home safety audits and monitor the service plan, amending services as needed. Outcomes/Outcome Measures:

The following outcomes were evidenced by the responses made in the evaluation questionnaires received from 366 clients.

86% stated they would not be able to remain living in their home if the services they received were not available.

60% stated the services improved their living situation

65% stated the services reduced their stress level 42% stated the program introduced them to other services and programs.

Units of Service: 12,944 hours delivered

Client Demographic Summary: 1,653 unduplicated individuals served

Female 74% White 63% Male 26% Black/African American 5% Live Alone 64% Asian 1% Frail Disabled 100% American Indian/Alaskan Native 1% <60 8% Hispanic 22% 60-74 39% Other Multi-Racial 5% 75-84 30% Unknown 3% 85+ 23%

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HOME CARE SERVICE (Housekeeping, Personal Care, Attendant Care, Visiting Nurse, Shopper Service)

*In FY 09-10 PCOA started funding Attendant Care (which is a combination of Personal Care & Housekeeping)in addition to the separate Housekeeping & Personal Care Services

31

PIMA COUNCIL ON AGING HOME CARE SERVICES

FY 2016-2017


Home care services include Housekeeping, Personal Care, Attendant Care, Visiting Nurse and Shopper Services. Housekeeping provides assistance in the performance of activities related to routine household maintenance, at an individual’s residence. Examples of tasks completed include: dusting, cleaning floors, bathroom, windows (if necessary to attain safe or sanitary living conditions); cleaning oven and refrigerator (if necessary to prepare food safely); cleaning kitchen, washing dishes, changing linens; making beds and routine maintenance of household appliances; washing, drying and folding laundry. Personal Care provides assistance with personal grooming and hygiene activities such as: bathing, shampooing hair, dressing, nail and skin care. Attendant Care provides a combination of personal care and housekeeping tasks. Shopper service provides assistance with shopping for groceries. PCOA contracts with local businesses and agencies that have trained staff to provide hands-on Personal Care, Attendant Care, Housekeeping, Shopper and Visiting Nurse Services.

Outcomes/Outcome Measures:

The following outcomes were evidenced by the responses made in the evaluation questionnaires received from 1,271 clients.

Self-sufficiency was increased or maintained for 1,271 individuals. 70% of survey respondents stated the service helped them remain independent.

Safe and sanitary living conditions were maintained for 416 individuals through the provision of housecleaning tasks: washing and drying laundry, changing linens, making beds, washing dishes, etc.

99% of individuals who completed the satisfaction survey stated the receipt of homecare services made it easier for them to remain in their own home.

46% of survey respondents stated the service relieved their stress. 53% of survey respondents stated the service made them feel safer and more secure.

Units of Service: 138,323 hours Client Demographic Summary: 1,271 unduplicated individuals served

Female 84% White 64% Male 16% Black/African American 5% Live Alone 75% Asian 1% Frail Disabled 100% American Indian/Alaskan Native 1% <60 5% Other Multi-Racial 6% 60-74 44% Hispanic 23% 75-84 32%

85+ 19%

32

2,886

2,514

1,279

779

566 552

0

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1,500

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2,500

3,000

3,500

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PROGRAM YEAR

ADULT DAY CARE

33


ADULT DAY CARE FY 2016-2017


Adult Day Care provides supervised social and health-related services to older adults in a group setting for a portion of a day. This service is generally for individuals sixty years of age or older who need supervised care. The service provides respite for family caregivers, a brief period of relief or rest from caregiving responsibilities. This service is authorized by a Care Coordinator as a component of the non-medical Community Services System.


100% of clients surveyed stated the service made it easier to remain in their home. 100% of clients surveyed stated the service relieved their stress.

Units of Service: 552 hours

Client Demographic Summary: 2 unduplicated individuals served

Female 100% White 100% Male 0% Black/African American 0% Live Alone 0% Asian 0% Frail Disabled 100% American Indian/Alaskan Native 0% <60 0% Other Multi-Racial 0% 60-74 0% Hispanic 0% 75-84 50% 85+ 50%

34

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PROGRAM YEAR*Provider Change

NURSING CLINICS

35

PIMA COUNCIL ON AGING PIMA COUNTY HEALTH DEPARTMENT

HEALTH PROMOTION CLINICS 2016-2017

(At Congregate Meal Sites)

Service Description: Pima Council on Aging, in conjunction with the Pima County Health Department, operated nursing clinics for older adults (60 and above) at seven congregate meal sites. At these locations, an advanced practice registered nurse provided health assessments, referrals, and education. The nurse also serves as an advocate, often contacting social service agencies or other health care providers on behalf of the client. Outcomes/Outcome Measures: Client satisfaction surveys were made available in Spanish and English in the clinical sites. Surveys were completed at the end of the program year on a voluntary basis. According to 99 survey responses:

Clients saw the clinic nurses between one to two times per month. 89% received a blood pressure assessment. 22% indicated they received education on

medicines; 19% diet; 30% exercise; 32% on health conditions and illness. 20% of respondents indicated that they had been instructed to call their primary care

providers or referred for other care. Of the 99 clients who completed the satisfaction survey, 92% reported that the nurse was

“Very Helpful” or “Helpful” in meeting their needs.

Units of Service: 1,614 client contacts

Client Demographic Summary: 304 unduplicated individuals served

Female 55% White 40% Male 45% Black/African American 6% Live Alone NA Asian 1% Frail Disabled 100% American Indian/ 1% <60 7% Alaskan Native 60-74 49% Hispanic 52% 75-84 30% 85+ 14%

36

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PROGRAM YEAR

ELDER RIGHTS & BENEFITS

37

PIMA COUNCIL ON AGING ELDER RIGHTS AND BENEFITS PROGRAM (ERAB)

FY 2016-2017 Service Description: The Elder Rights and Benefits Program works to empower clients to help themselves whenever possible. Staff assist older adults with determining eligibility for a variety of benefits and help educate about and resolve issues around:

Taxes and property tax credit ALTCS AHCCCS Housing and Landlord/Tenant Issues Consumer Fraud Debts Guardianships and Conservatorships Reporting financial, physical and emotional abuse

To meet the diverse needs of low-income older adults, collaborations with legal service providers continue to be utilized and include:

Southern Arizona Legal Aid provides legal services for low-income older adults. National Academy of Elder Law Attorneys (NAELA) volunteers hold legal clinics at PCOA

twice a month. In order to make programs and services more accessible to the citizens of Pima County, PCOA maintained a staff presence in the following locations:

Main office – 8467 E. Broadway Blvd.

Green Valley – Friends in Deed, 301 W. Camino Casa Verde

Armory Park Center - 220 S. 5th Street

Ellie Towne/Flowing Wells Community Center - 1660 West Ruthrauff Road

El Rio Community Center – 1390 W. Speedway Boulevard

El Pueblo Community Center - 101 West Irvington Road

House of Neighborly Service - 243 West 33rd Street

Quincie Douglas Center – 1576 E. 36th Street

Outputs ERAB staff provided 4,205 contacts to 2,316 clients

Assisted 902 clients in accessing legal services

Provided information to 585 clients to allow them to remain independent and in control of their finances.

Assisted 601 clients in either maintaining stability in their housing or improving the quality of that housing.

Assisted 260 clients in resolution of utility problems. ERAB staff provided twelve (12) ALTCS workshops for 246 participants

38


ELDER RIGHTS AND BENEFITS PROGRAM (2) FY 2016-2017 – Page 2

Client Demographic Summary

Female 72% White 66% Male 28% Black/African American 3% Live Alone 51% Asian 1% Frail/Disabled 44% Other Multi-Racial 1%

< 65 17% Hispanic 24% 65-74 39% Unknown 5%

75-84 29% 85+ 13% Unknown 2% Outcomes Services: 81% reported that the information and assistance received helped to resolve their problems.

78% reported that the information received increased their access to needed services.

ALTCS Workshops: 93% reported that their knowledge about ALTCS increased.

39

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MEDICARE/INSURANCE COUNSELING

Historically, this number reflects the topics discussed with clients. For FY 12-13, we began including particpants and topics discussed at our Understanding Medicare classes.

*In 2015-2016 units changed to number of Cllient Contacts.

40


MEDICARE/HEALTH INSURANCE ASSISTANCE PROGRAM FY 2016-2017

Service Description: Pima Council on Aging’s Medicare Program is the designated SHIP (State Health Insurance Assistance Program) for Pima County. SHIP is an independent program funded by federal agencies and is not affiliated with the insurance industry; PCOA neither sells nor endorses any Medicare plan. Trained staff and volunteers provide unbiased information in the following areas:

Medicare eligibility, how and when to enroll, and how to avoid late enrollment penalties

The options with original Medicare, Medicare Advantage Plans and Medicare

Supplemental Plans

Medicare Prescription Drug Plan choices

Programs that help pay Medicare Part B premiums and/or prescription drug costs

How Medicare works with other insurance

New to Medicare Classes: PCOA’s Medicare Program offers a two-hour class at least once a month in various locations in the community to assist beneficiaries in making informed decisions about their insurance coverage choices. 685 individuals attended a total of 21 classes in FY 16-17 with 97% of respondents reporting an increase in knowledge. Medicare Update Conferences: Five (5) Medicare Update conferences were held in October and November 2016 in locations around Pima County with 511 individuals attending. 98% of respondents reported that their overall knowledge of Medicare had increased and 98% reported that the information presented will assist them in making a decision regarding their Medicare/Health Insurance needs. Senior Medicare Patrol (SMP) SMPs empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, errors, and abuse through outreach, counseling, and education. SMPs give presentations to groups, exhibit at events, and work one-on-one with Medicare beneficiaries. When fraud or abuse is suspected, they make referrals to the appropriate state and federal agencies for further investigation. Outcomes/Outcome Measures:

96% of those completing the Client Service Assessment Survey reported that they were very satisfied/satisfied with the information and assistance they received and 93% reported that the information will help them make a better decision about their Medicare/insurance needs.

41

PIMA COUNCIL ON AGING MEDICARE/HEALTH INSURANCE ASSISTANCE PROGRAM

FY 2016-2017 – Page 2 Units of Service: 3,748 unduplicated clients Units of Service: 5,304 client contacts Community Presentations Total Number of Presentations in Community – 115 Total Number of Attendees – 1,899 Total Number of Health/Senior Fairs or Special Events – 18 Total Number of Media Events (Radio/TV/Print Activity –35 “New to Medicare” Classes Total Number of Classes (2 hours each) – 21 Total Number of Attendees - 685 Medicare/Senior Medicare Patrol Volunteers Number of Active SHIP Volunteers – 22 Number of Active SMP Volunteers – 6 Number of SHIP Volunteer Hours – 1838.50 Number of SMP Volunteer Hours - 85 Client Demographic Summary:

Female 63% White 85% Male 36% Black/African American 1% Unknown 1% Asian 1% Live Alone 13% Other Multi-Racial 3%

Frail/Disabled 19% Hispanic 8% <65 40% Unknown 2%

65-74 42% 75-84 12%

85+ 6%

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PERSONAL BUDGETING ASSISTANCE

43

PIMA COUNCIL ON AGING PERSONAL BUDGETING ASSISTANCE

FY 2016-2017

Service Description Personal Budgeting Assistance matches trained volunteers with older adults who are identified by PCOA and other agencies as needing assistance in organizing their finances, budgeting, balancing their check books, and completing forms, etc. PCOA does not advertise directly to older adults who may need assistance, but does receive calls requesting assistance through the Helpline. Almost all of our current clients came through PCOA Intake and the Care Coordinators. PCOA now has a larger base of volunteers to work in the program and has this year been accepting new clients. Units of Service: 32 volunteers provided assistance 526.15 total direct service hours. There were an additional 353.2 hours of time given including meetings, phone calls and travel. Client Demographic summary: 65 unduplicated individuals were served. 43 clients received assistance on a monthly or semi-monthly basis. An additional 22 clients were able to maintain their finances on their own after 1-3 visits to help them organize their finances, assist with mail and creditors, and other issues

Client Demographic Summary: Female 78% White 91% Male 22% Hispanic 7% Live Alone 75% Black 2% Frail Disabled 67% <60 0% 60-74 46% 75-84 39% 85+ 15%

Outcomes: No surveys were completed in the FY 16-17 program year

44

467

554

883

1,403

889795

722

493

877

537603

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1400

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PROGRAM YEAR

LONG TERM CARE ADVOCATES

45

PIMA COUNCIL ON AGING LONG-TERM CARE ADVOCATES

FY 2016 – 2017 Long-term care ombudsmen are trained and certified staff and volunteers who advocate for residents of nursing homes, board and care homes and assisted living facilities. Ombudsmen visit all of these facilities in Pima County and:

Resolve complaints made by or for residents of long-term care facilities

Educate consumers and long-term care providers about residents' rights and good

care practices

Provide information to the public on nursing homes and other long-term care facilities

and services, residents' rights and legislative and policy issues

Advocate for residents' rights and quality care in nursing homes, personal care,

residential care and other long-term care facilities

Promote the development of family councils and resident councils

Outcomes/Outcome Measures 603 complaints resolved Units of Service: 1,752 visits were made to 450 Skilled Nursing and Attendant Care Facilities 11,471 resident contacts to Skilled Nursing and Attendant Care Facilities 11 volunteers provided services in the program with 345 volunteer hours 190 resident council meetings attended 15 family council meetings attended 440 information and consultations to individuals (usually by phone) 282 consultations to facilities Client Demographic Summary: Federal guidelines, as presented to PCOA, do not track demographics

46

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PROGRAM YEAR

PCOA AMBASSADOR PROGRAM

# of Active Ambassadors # of Sites Served

47

PIMA COUNCIL ON AGING AMBASSADOR PROGRAM

FY 2016-2017

Service Description: The Pima Council on Aging Ambassador Program is a national award winning service for older adults and their caregivers who may need assistance but don’t know whom to ask. (2005 National Association of Area Agencies on Aging Achievement in Aging Award.) The program is a grassroots effort that provides advocacy, information and referral to services, and delivers educational material through the Ambassadors to older adults in a variety of settings. Ambassador resources are distributed via email, printed material, and 1-2 presentations at monthly meetings. Ambassadors connect older adults in inner city impoverished areas; rural isolated areas; average or affluent neighborhoods, and in workplaces throughout Tucson and Pima County to a network of community resources. They are often the first contact with PCOA for many older adults and their caregivers and serve in senior residential communities, faith-based organizations, libraries, neighborhood associations, and organizations such as the Neighbors Care Alliance programs. Ambassadors may volunteer for health fairs and special events and are instrumental in distributing 1,600 copies a month of the PCOA newsletter, Never Too Late. Outcomes/Outcome Measures: 100% of Ambassadors who responded to the annual survey stated that the information they received

increased their knowledge of senior resources. 100% of Ambassadors who responded to the annual survey stated their participation makes them feel

useful and/or productive. This fiscal year, the partnership with Pima County Library was rejuvenated. Ambassadors now serve

in eight libraries. Updated Ambassador Resource Manuals were distributed to all 28 libraries with monthly manual updates being emailed to the librarians.

Ambassadors captured the following concerns and/or questions from individuals they encounter in the community (in order of significance): Living independently in their home, Medicare and Insurance coverage and costs, Transportation options, Meal and Food sources, and Fraud.

Units of Service: 772 hours; 1,985 older adults and/or their caregivers were served. Ambassador Volunteers Demographic Summary: 53 total Ambassadors (volunteer and non-volunteer); 58 sites served Client Demographic Summary:

- 29 volunteer ambassadors - 4 ELDER Connectors - 13 employees from other organizations - 3 independent community residents - 4 volunteers from other organizations.

Female 80% Female 75% White 80% Male 20% Male 25% African American 14% Asian American 6%

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PROGRAM YEAR

PCOA NEIGHBORS CARE ALLIANCE

Volunteer caregiver programs developed through Neighbors Care Alliance

Number of neighborhood associations and faith communities represented within these programs

49

PIMA COUNCIL ON AGING NEIGHBORS CARE ALLIANCE

FY 2016-2017

Service Description

The Neighbors Care Alliance (NCA) membership includes 16 active programs of Neighbors Helping Neighbors. Each program is unique and dedicated to helping older neighbors remain independent, safe and less isolated in their homes for as long as possible. They provide natural, neighborly services through trained volunteers at no charge to the recipients. Services might include transportation, friendly visits and phone calls, family caregiver relief, yard work, meal delivery and other errands, as well as other creative options. NCA members and PCOA staff work with organizing neighborhoods, faith communities and community organizations to create additional service programs where they don’t already exist. Outreach is ongoing in under-served areas. Sustainability within programs is encouraged, as is creating social and educational events, informal coffee gatherings, field trips, monthly luncheons, support groups for grief or dementia, end of life workshops, exercise/wellness activities, music concerts, pet care information, fresh food distribution via Produce on Wheels Without Waste (POW-WOW) and more.

Service Area Individual programs are located in various Tucson city neighborhoods, as well as in areas within Pima County. These include Catalina, Vail, Corona de Tucson, Green Valley, Robles Junction and Tucson Estates. Altogether these groups include more than 300 reported neighborhoods, faith communities and organizations. Two new programs joined the NCA this year; one is in Vail and one is served by and for the LGBTQI community of Tucson. Outcomes

Services

Just over 1300 Neighbors Care volunteers provided over 100,000 individual services to at least

2,073 recipients.

Volunteers reported 108,102 service hours, a contribution valued over $2.5 million for the Tucson

area.

Transportation and errands are the most requested and provided services of Neighbors Care

programs. 1,124 volunteer drivers reported driving over 454,870 miles for more than 1200

recipients this year.

PCOA’s Neighbors Care outreach coordinator provided over 900 hours of training for program

start-up, neighborhood collaboration, coordinator skills and information, new volunteers, board

development, resource sharing and data collection, entry and reporting.

Impact on Older Adults

The NCA programs surveyed recipients and volunteers during the spring. 81% of the responding

recipients report that Neighbors Care services help them to live independently in their homes.

96% of responding Volunteers report feeling useful and productive for their community.

50

PIMA COUNCIL ON AGIN NEIGHBORS CARE ALLIANCE

FY 2016-2017 – PAGE 2

100% of the program coordinators reported that PCOA support helps them provide needed

services to older adults; and 93% felt membership improves their ability to recruit volunteers and

increase services.

Survey sample comments:

o Recipient: “I am so thankful for the rides – I cannot drive.” o Volunteer: “I really enjoy working with all the friendly people and helping people in need. I’m

73 and want to give back.” One Story: A Neighbors Care Program has recipients who are brother and sister. She cannot drive and is his caregiver, as he has Alzheimer’s disease. Dedicated volunteers drive him twice a week to a day-program offering activities to assist him with the progression of his condition, while allowing some respite for his sister. The volunteers also drive them to doctor appointments, the local senior center for bingo and other social events. They would remain isolated without these services, placing their health and independence at grave risk.

Outreach, Expansion, Collaboration and Community Connections

At least 200 presentations were given to community groups and individuals by Neighbors Care

members and the PCOA Outreach Coordinator.

Outreach and collaboration is ongoing throughout the year with neighborhood and homeowner

associations, faith communities, the ELDER Alliance, Pima Association of Governments, University

of Arizona, Pima County, United Way, Adult Protective Services, Project Visibility/Sr. Pride, Elder &

Caregiver Assistance & Support At-Home (ENCASA), Pima Alliance for Animal Welfare and more.

Programs often offer educational events for their recipients & volunteers on end of life preparation,

dementia, medications, home safety, community resources, etc.

The Neighbors Care Programs are featured in each edition of PCOA’s Never Too Late, often with

a volunteer writer’s assistance.

51

2 3 8 9 10 8 10 10 10 10

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89

218

289 293

226

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305297 299

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2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 2016-2017

PROGRAM YEAR

ENHANCE FITNESS

# of classes (3 times a week on-going) people attending

52


ENHANCE FITNESS FY 2016-2017


Enhance Fitness is an evidence-based community exercise program for older adults. The program is taught in hourly sessions three (3) times per week, focusing on strength, endurance, balance and flexibility exercises. PCOA maintains a Project Enhance license with Senior Services of Seattle/King County. PCOA also has an in-house Master Trainer, who provides New Instructor Training workshops as requested and is the Site Coordinator for Pima County EFit classes.

The Site Coordinator/Master Trainer communicates with site contacts and holds

networking meetings and trainings to maintain integrity, enthusiasm and communication between PCOA, instructors and site staff. The promotion of classes, scheduling of fitness assessments, evaluation of instructors, changing of routines and safety procedures are addressed in networking meetings. Music and new choreography ideas are provided to instructors by the Site Coordinator.

PCOA receives quarterly communication updates from Seattle regarding work being

done to improve overall quality of the program. The ACE continuing education track has been implemented and the Medicare and Silver & Fit relationships are being cultivated.

PCOA partners with Tucson Parks & Recreation, Pima County Parks & Recreation and Tucson Medical Center to host the 10 classes at 9 locations throughout Tucson. EFit instructors develop and maintain both internal and external customer relationships by offering guest passes, monthly birthday pot-lucks, and other social support. The collaboration with El Rio Health has been slow to get off the ground, but we continue to communicate with them and the voucher system that allows their clients to take the classes at no charge to the client, but is paid by El Rio.


The EnhanceFitness program includes evaluation of four parameters of physical fitness at start of the exercise program, at four-month intervals, then annually. The assessment protocol uses four of the assessments from the Senior Fitness Test Battery developed by Rikli and Jones at California State Fullerton.

299 participants attended classes in FY 16-17. This number has been consistent for the past 3 years. 128 were new to the program this fiscal year. All participants complete baseline Fitness Assessments when they start the program, with 4 and 12 month follow-up Fitness Assessments to measure change.

53

PIMA COUNCIL ON AGING ENHANCE FITNESS

FY 2016-2017 – Page 2

Chair Stands: This assessment measures the number of times the participant can stand from a sitting position in 30 seconds. It is a measurement of lower body strength and lower body range of motion around the hip and knee joints.

73% of those who completed a pre and post assessment Improved or Maintained at Average or above.

This increase in lower body strength relates directly to older adult independence, balance and fall prevention, as well as tasks of daily living from walking to climbing steps to navigating over and around objects.

Arm Curls (Bicep Curl): This assessment measures the number of times the participant can move handheld weights from an extended position at the side of the body to the shoulders in 30 seconds. Women lift 5 pound weights and men lift 8 pound weights. It is a measurement of upper body strength and range of motion around the elbow as well as shoulder stability.

68% Improved or Maintained at Average or above The increase in upper body strength and efficiency relates directly to older adult ability to lift, carry, use assistive devices and perform a variety of tasks related to independent daily living. Up and Go: This assessment measures amount of time to stand from a seated position to walk around a cone place 8 feet in front of the chair then return to the seated position. It is a measurement of dynamic balance, power and speed.

60% Improved or Maintained at Average or above Dynamic balance and speed are directly related to locomotion, gait, and ability to recover to an upright position from a loss of balance, and overall independence and well-being. 2 Minute step in place had been discontinued for the past year because of the time involved and the difficulty in accomplishing the test. Because the results are very informative, the test will be reinstated September 1, 2017. Cardiovascular endurance is directly related to independence and ability to walk, travel, and perform tasks of everyday living as well as recreational activities. Discussion: The increases documented from the EnhanceFitness Fitness Assessments provide strong evidence for the benefits of a regular exercise program that focuses on cardiovascular endurance, muscular strength and endurance, flexibility training, static and dynamic balance skills. The improvements have led directly to improved confidence, increased activity, and significant functional improvements that lead to a lifestyle of independence and good health for older adults in Pima County. Staff continue to work to increase class enrollment to a level where contributions would cover the cost of the contracted instructor. Promotion of the program and working to retain current participants continues to be a goal of the site coordinator. Instructors have been working to develop a social component of the class which is crucial to maintaining attendance. The coordinator has also been focused on establishing collaborations to bring EnhanceFitness to additional people. The relationship at the Tucson Parks and Recreation Centers has been changing over the years as city staff has changed. The Pima County sites have assumed increased ownership of the program.

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PIMA COUNCIL ON AGING ENHANCE FITNESS

FY 2016-2017 – Page 3

Units of Service: Average daily attendance: Clements 14, Ellie Towne 11, El Pueblo I 8, El Pueblo II 9, El Rio 11, Donna Liggins 3, Picture Rocks 8, Udall 17, El Dorado 11, Drexel Heights 3

Client Demographic Summary: 299 unduplicated individuals

Female 85% Male 15% Caucasian 57% Non Caucasian 43% <65 16% 65-74 34% 75-84 19% 85+ 10% Unknown 21% Identified chronic diseases:

arthritis 44% diabetes 19% hypertension 33% depression 13% lung disease 12% cancer 11%

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PROGRAM YEAR

MATTER OF BALANCE

# of classes held people attending

56

PIMA COUNCIL ON AGING A MATTER OF BALANCE

FY 2016-2017

Service Description

Falls are the leading cause of injury deaths among people 65 and older. Up to half of community dwelling older adults experience fear of falling, and many respond to this fear by curtailing activity. This leads to loss of muscle strength and compromised social interaction. A Matter of Balance classes acknowledge the risk of falling but emphasize practical coping strategies. Trained facilitators conduct eight two-hour sessions designed for a group of 8 to 15 participants. Participants learn to make behavioral and environmental changes to reduce fall risks and to exercise to increase strength and balance. Pima Council on Aging provides these classes in a variety of community settings. Outcomes/Outcome Measures

Participants were asked to fill out a survey form that contained demographic and medical information as well as questions about their levels of concern over falling and how those concerns affected their lives. During the last class session those same people were given an identical survey without the demographic and medical sections. All participants were also given a class evaluation form asking about the quality of the coaches, the materials and the class in general. The data was entered locally at PCOA into data software for local licensees. Reports provide a statistical breakdown of the collected data; including a nation-wide breakdown.

• Twenty two classes were provided, with a 96% completion rate of the enrolled participants completing five or more of the eight classes.

Units of Service: 22 classes were held, 201 individuals enrolled with 193 completing. This 96% completion rate is a 1% improvement over last year’s completion rate and 18% greater than the national average. The program realized a 24% increase in participants. Classes were held throughout the Tucson metro area, in Avra Valley and in Green Valley.

Other: Classes were held in six new locations: three (3) in Avra Valley, one (1) in the Northwest area, one (1) on the Southside, and one (1) on the Eastside. PCOA's partnership with the Veteran's Administration has continued successfully with the VA committing to hold four classes a year. Our relationship with El Rio Community Health Centers has developed with them offering up to six classes a year.

57

PIMA COUNCIL ON AGING A MATTER OF BALANCE

FY 2016-2017 – Page 2

Client Demographic Summary: 201 un-duplicated individuals

Women 72.1%

Men 27.9%

Live Alone 40.8%

Age Avg. 77 (<65: 11, 65-74: 67, 75-84: 74, 85+: 41, unknown: 8) Race White: 88.4%, Hispanic: 7.7%, Asian: 0%, Nat. Am: 1.6%, (unknown = 3.0%)

Fiscal year: 7/1/2016-6/30/2017 Participants improved on ALL parameters measured by the first and last session

survey. The results and survey questions follow: Baseline and 8-Week

PCOA N=143

1-Get Up

2-Reduce Falls

3-Protect Self

4-Increase Strength

5-Become Steady

6-Falls Concern

7-Current Exercise

Baseline This

Organization 2.81 2.96 2.33 3.13 2.91 3.65 4.63

8-week 3.42 3.54 3.05 3.53 3.36 4.04 5.14 Change 0.62 0.58 0.72 0.4 0.45 0.39 .51

% + Change +22% +20% +31% +13% +15% +11% +11% Change over

last year +1% -3% -6% -3% -3% +1% -2%

Survey Questions: Average improvement

1. I can find a way to get up if I fall +22%

2. I can find a way to reduce falls +20%

3. I can protect myself if I fall +31%

4. I can increase my physical strength +13%

5. I can become more steady on my feet +15%

6. Concerns about falling interfered with normal social activities with family, friends, neighbors or groups in the last four weeks +11%

7. Amount of walking or exercising now +11%

Discussion:

The greatest improvements documented from the participants completing all of the 8 A Matter of Balance class sessions, were in the participant’s ability to find a way to get up after falls (+22%) and in learning to protect themselves if they fall (+31%).

Also, of significance is the improved confidence demonstrated in learning to prevent a fall (+20%), have become steadier on their feet (15%), and that participants reported an increase in the amount of exercise by 11%.

Because the purpose of A Matter of Balance is to reduce fear of falling and thereby enhance activity levels of older adults, this data supports the goal and demonstrates effectiveness in improving the function and confidence level of older adults in Pima County.

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05

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PROGRAM YEAR

DIABETES SELF MANAGEMENT PROGRAM


4 3 4

61 58

42

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PROGRAM YEAR

CHRONIC PAIN SELF MANAGEMENT PROGRAM (CPSMP)


*First year of program

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PIMA COUNCIL ON AGING CHRONIC DISEASE SELF-MANAGEMENT PROGRAM (CDSMP), THE DIABETES SELF-MANAGEMENT PROGRAM (DSMP) AND THE CHRONIC PAIN SELF-MANAGEMENT PROGRAM (CPSMP)

FY 2016-2017 Service Description: The Chronic Disease Self-Management Program (CDSMP), Diabetes Self-Management Program (DSMP) and the Chronic Pain Self-Management Program (CPSMP), known respectively in Arizona as Healthy Living, Healthy Living with Diabetes and Healthy Living with Chronic Pain are all evidenced-based programs developed and licensed by Stanford University. All workshops are two and a half hours and are delivered once a week for six weeks. They are facilitated by two trained leaders. CDSMP provides information and practical skills to assist individuals with the confidence and motivation they need to manage the daily challenges of living with a chronic health condition and/or being a caregiver for an individual with a chronic health condition. Participants learn skills needed to control their symptoms through relaxation techniques, proper nutrition, managing pain and fatigue and the importance of physical activity/exercise. Also, they learn ways to deal with their difficult emotions, use medications effectively and communicate with their health care professionals. DSMP provides information and practical techniques to assist individuals and their caregivers who live with the daily challenges of type 2 diabetes. They learn to manage symptoms through relaxation techniques and healthy eating and the importance of physical activity/exercise. They learn to communicate with their health care professionals, the importance of monitoring their blood sugar levels and preventing complications and using medications effectively. CPSMP was developed for people who have a primary or secondary diagnosis of chronic pain and their caregiver. Pain is defined as being chronic or long term when it lasts for longer than 3 to 6 months, or beyond the normal healing time of an injury. The participants learn techniques to deal with problems such as frustration, fatigue, isolation, and poor sleep; appropriate exercise for maintaining and improving strength, flexibility, and endurance; appropriate use of medications; communicating effectively with family, friends, and health professionals; nutrition; pacing activity and rest, and, how to evaluate new treatments.

In CDSMP, DSMP and CPSMP, goal setting and problem-solving are used to assist participants in increasing their confidence, feeling better and taking charge of their health. Pima Council on Aging (PCOA) administers these three programs and facilitates the workshops through the combined efforts of the PCOA Master Trainer and 8 trained volunteer lay leaders.

PCOA’s continued sustainability efforts included the continuation of three partnerships

and the development of a new partnership. They will provide revenue for the Chronic Disease Self-Management Education, (CDSME) programs and to further establish PCOA as a health promotion leader in the health care network. These included:

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PIMA COUNCIL ON AGING CDSMP, DSMP AND CPSMP

FY 2016-2017 – Page 2

PCOA’s Master Trainer in CDSMP, DSMP and is serving as a Mentor for both Southern Arizona (Pima and Santa Cruz counties) and Southeastern Arizona (Cochise, Graham and Greenlee counties) on behalf of the Arizona Living Well Institute

A new partnership with Blue Cross® Blue Shield® Arizona Advantage, a Medicare Advantage plan provider. This partnership will provide referrals to the Diabetes Self-Management Program (DSMP) and A Matter of Balance. PCOA will invoice and receive an established amount for each BCBS AZ Advantage program participant.

A collaborative partnership with the Pima County Health Department (Tobacco and Chronic Disease Prevention Program), to provide leader training for both CDSMP and DSMP. Each organization has two Master Trainers to facilitate the training, primarily available to agencies and service providers throughout Arizona, with an emphasis on those in Cochise, Graham, Greenlee, Pima and Santa Cruz counties. Individuals from other Arizona counties and other states have participated,

A collaborative partnership with the AZ Living Well Institute to provide leader training for CPSMP. Each organization has two Master Trainers to facilitate the training, primarily available to agencies and service providers throughout Arizona, with an emphasis on those in Cochise, Graham, Greenlee, Pima and Santa Cruz counties. Individuals from other Arizona counties and other states have participated.

Chronic Disease Self-Management Program (CDSMP) Units of Service: 0 units There were no CDSMP workshops held during this fiscal year. There was lower demand for this program and higher demand for DSMP and CPSMP. Diabetes Self-Management Program (DSMP) Units of Service: 35 unduplicated individuals Four (4) workshops were held with thirty-five (35) participants attending. Thirty (30) participants (86%) attended at least four of the six classes. Workshops were held at Ellie Towne/Flowing Wells Community Center, Recreation Center at La Vista at La Posada (Green Valley), St. Odilia Catholic Church and Rincon Congregational UCC. PCOA collaborated with the Pima County Health Department to offer a one and a half day (1.5) DSMP Leader Update Training, nine (9) leaders were successfully trained. Participants represented PCOA, Southern Arizona Veterans Healthcare System (SAVHCS) and Apache County Public Health Services District.

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FY 2016-2017 – Page 3 Client Demographic Summary: Female 69% Male 31% American Indian 2% Asian or Asian American 4% Black or African American 8% Hawaiian Native/Pacific Islander 2% White/Caucasian 74%

Live Alone 38% Frail Disabled NA <60 0% 60-74 56% 75-84 29% 85+ 15%

Hispanic 10% Number of Chronic Diseases/Conditions: None 3% One 12%

Two 11% Three or more 52%

Prevalence of Chronic Disease or Condition: Alzheimer’s/Related Dementia 0% Arthritis 40% Breathing/Lung Disease 17% Cancer 20% Chronic Pain 17% Depression/Anxiety 26% Diabetes 63%

Heart Disease 9% High Cholesterol 46% Hypertension 54% Multiple Sclerosis 0% Osteoporosis 6% Stroke 6% Other Chronic Conditions 0%

Outcomes/Outcome Measures: Before the beginning of a Healthy Living with Diabetes (DSMP) workshop, participants are asked to complete and return a PRE Participant survey. Following the completion of the workshop, each participant is asked to complete and return a POST Participant Survey. In both the PRE and POST Participant survey, each workshop participant is asked rate their confidence level from One (1) being Not at All Confident to Ten (10) being Totally Confident, to a series of questions. These questions are: How confident are you that you can . . . Communicate with your doctor? Deal with difficult emotions? Eat healthier?

Be or stay more active? Manage your stress? Make treatment decisions?

Remember to take medications? Manage your fatigue? Manage your condition? Manage pain?

Make an action plan to help manage your condition? Use the problem-solving process to identify the problem, brainstorm solutions and try a solution?

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CDSMP, DSMP AND CPSMP FY 2016-2017 – Page 4

As compared with the responses on the PRE Participant Survey, participant responses on the POST Participant Survey indicated that the participants achieved a higher level of confidence in all twelve (12) areas of workshop content (100%) as measured by the positive increase in their confidence level to all of the twelve (12) questions. Those areas that showed a higher level of confidence were: Eat healthier, Manage your condition and Use the problem-solving process to identify the problem, brainstorm solutions, and try a new solution. Chronic Pain Self-Management (CPSMP) Units of Service: 42 unduplicated individuals Four (4) workshops were held with forty-two (42) participants attending. Thirty-eight (38) of the participants (90%) attended at least four of the six classes. Workshops were held at CareMore, Christ Presbyterian Church, Desert Harmony Hospice and La Vista at La Posada (Green Valley). Client Demographic Summary: Female 67% Male 33% American Indian 2% Asian/Asian American 0% Black or African American 0% Hawaiian Native/Pacific Islander 0% White/Caucasian 98%

Hispanic 26% (Ethnicity) Live Alone 14% Frail Disabled NA <60 0% 60-74 50% 75-84 43% 85+ 7%

Number of Chronic Diseases/Conditions: None 4% One 12%

Two 15% Three or more 69%

Prevalence of Chronic Disease or Condition: Alzheimer’s/Related Dementia 0% Arthritis 36% Breathing/Lung Disease 31% Cancer 19% Chronic Pain 57% Depression/Anxiety 24% Diabetes 19%

Heart Disease 21% High Cholesterol 43% Hypertension 43% Multiple Sclerosis 0% Osteoporosis 14% Stroke 10% Other Chronic Conditions 35%

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FY 2016-2017 – Page 5 Outcomes/Outcome Measures: Before the beginning of a Chronic Pain Self-Management Program (CPSMP) workshop, participants are asked to complete and return a PRE Participant survey. Following the completion of the workshop, each participant is asked to complete and return a POST Participant Survey. In both the PRE and POST Participant survey, each workshop participant is asked to rate their confidence level from One (1) being Not at All Confident to Ten (10) being Totally Confident, to a series of questions. These questions are: How confident are you that you can . . . Communicate with your doctor? Deal with difficult emotions? Eat healthier? Be or stay more active? Manage your stress? Make treatment decisions? Remember to take medications?

Manage pain? Manage your fatigue? Manage your condition? Make an action plan to help manage your condition? Use the problem-solving process to identify the problem, brainstorm solutions and try a solution?

As compared with the responses on the PRE Participant Survey, participant responses on the POST Participant Survey indicated that the participants achieved a higher level of confidence in eleven (11) areas of workshop content (92%) as measured by the positive increase in their confidence level to eleven of the twelve (12) questions. The one area that didn’t show a positive increase was- Managing Your Fatigue.

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OASIS CATCH Healthy Habits

NUMBER OF CLASSES NUMBER OF PEOPLE SERVED

*First year of this service

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PIMA COUNCIL ON AGING OASIS Healthy Habits for Adults

January 2017-June 2017

Service Description: Pima Council on Aging (PCOA) entered into an agreement with OASIS Healthy Habits for Adults (HHA) on November 2, 2016. Full program implementation, including volunteer recruitment, training and scheduling classes began in January 2017. Based on the documented impact from the OASIS CATCH Healthy Habits program volunteers, Healthy Habits for Adults was created by the OASIS Institute, using the evidence-based content and a similar lesson format to increase impact among older adults. Healthy Habits for Adults classes focus on better health through improved nutrition behaviors and increased physical activity in older adults. These classes are led by trained volunteers and are offered as a stand-alone class or as a series of classes. Each class includes a healthy snack, nutrition lesson, and safe, effective physical activity. Since Healthy Habits was launched in select sites nationwide in September 2014, over 7,000 older adults in seven (7) states have participated in these classes. Participant evaluations revealed that 89% of adult participants are sure or very sure they can be more physically active after attending the class, 90% are sure they will eat healthier after attending the class, and 92% are sure or very sure they will read nutrition labels more often after attending the class. 96% of participants responded that they learned something new after attending. Participants and Sites: As of June 30, 2017, PCOA’s Healthy Habits for Adults program has had 723 participants (345 unduplicated) across 15 sites and 65 classes. This is 160% of 450 participants PCOA was obliged to offer by August 31, 2017. The sites (and the total number of participants per site) were Agape Hospice and Palliative Care (28), Blanche Johnson Courtyards (43), B’Nai B’rith Covenant House (68), B’Nai B’rith Strauss Manor (76), Community Food Bank of Southern Arizona (19), El Dorado TMC Senior Center (218), Estes Gardens (67), Freedom Rec Center (41), Iora Clinic-Grant Road (10), Iora Clinic-Broadway (4), Pima Council on Aging (17), SAAVI Services for the Blind (25), Southern Arizona VA Health Care System (12), The Place at Broadway East (46), and William Clements Senior Center (49). Beginning July 2017, there are 12 new classes scheduled at the Highlands at Dove Mountain as well as the completion of the series of classes at SAAVI, El Dorado TMC Senior Center, Blanche Johnson and Estes Gardens.

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January 2017 – June 2017 – Page 2 Outcome Measures: The program participants are asked to complete post surveys to measure demographics, behavior outcomes in nutrition, physical activity and knowledge outcomes. The OASIS HHA program coordinator registers all participants, and mails the completed rosters and surveys to the OASIS Institute’s HHA National Coordinator. This collective information is used for reporting to Anthem, locally recognized as the CareMore Foundation, the program’s primary funder. Volunteers:

Nineteen volunteers were recruited and trained in January and February of 2017. We have one male volunteer, and the remainder of the volunteers are female. Four of these 19 volunteers have not yet facilitated a class. Additionally, 4 of the 19 are no longer actively volunteering, two due to a change in employment status, and 2 due to travels and other commitments.

The volunteers have logged 258 hours and helped facilitate 65 classes. Outcomes: These outcomes are derived from surveys completed between January 1 and April 30, 2017. Total number of surveys received: 198 surveys received (70% completion rate) Gender: 77% Female; 23% Male Average Age: 70 years Ethnicity: 79% are not of Hispanic, Latino, or Spanish origin; 21% are of Hispanic, Latino, or Spanish origin Race: 85% White, 6% Black or African American, 5% Other, 2% Asian or Indian, and 1% American Indian or Alaskan Native and Korean Education Completed: 68% More than High School, 21% High School and 11% Less than High School Number of People in Household (including participant): 69% live with one or more people and 31% live alone

78% of participants were sure or very sure that they can be more physically active after

attending the class. (The average was sure, n=191)

82% of participants were sure or very sure that they will eat healthier after attending the

class. (The average was sure and n=186)

96% of participants felt that the class was good or excellent overall. (Average was

excellent and n=186)

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January 2017 – June 2017 – Page 3

97% of participants felt that the instructor (s) overall was good or excellent. (Average was

excellent and n=184)

98% of participants felt that the instructor’s knowledge of the material was good or

excellent. (Average was excellent and n=179)

97% of participants felt that the material was presented clearly and was organized (good

or excellent) (Average was excellent and n=186)

97% of participants felt that the quality of the material presented was good or excellent.

(Average was excellent and n=182)

99% of participants felt that the facility was good or excellent. (Average was excellent and

n=184)

88% of participants were sure or very sure that they will incorporate information and

activities discussed in the program into their lives. (Average was sure and n=188)

91% of participants said that they had learned something at class. (166 out of n=182)

89% of participants said that they plan on taking another class to improve their health.

(152 out of n=170)

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AGING MASTERY PROGRAM


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PIMA COUNCIL ON AGING AGING MASTERY PROGRAM® (AMP)

FY 2016-2017

Service Description: In June 2015, Pima Council on Aging (PCOA) was invited to submit a proposal to partner with the National Council on Aging (NCOA) to bring the Aging Mastery Program® (AMP) to Arizona. As one of eight sites, PCOA received a one year grant of $7,500 to offer two 10-week sessions of the AMP program from June 2015-May 2016. The Aging Mastery Program® (AMP) is a comprehensive, fun and person-centered education program that empowers older adults 55 and over to make and maintain small but impactful lifestyle changes to living that celebrates the gift of longevity. The core curriculum combines evidence-informed knowledge sharing with goal-setting and feedback routines, daily practices, peer support, and small rewards. Classes are led by expert speakers who help participants gain the skills and tools they need to manage their health, remain economically secure, and contribute actively in society. Weekly topics include Navigating Longer Lives: The Basics of Aging Mastery, Exercise and You, Healthy Eating and Hydration, Medication Management, Sleep, Financial Fitness, Advance Planning, Healthy Relationships, Fall Prevention and Community Engagement.

The goal of the 10 core classes is to provide participants with an overview of the challenges encountered while navigating life as an older adult and offer support to master new skills. Interactive activities related to the topic enable everyone to continue the learning process. Units of Service 2 series (10 classes each) In partnership with the National Council on Aging (NCOA), Pima Council on Aging (PCOA) offered two 10-week sessions of the Aging Mastery Program (AMP). The fall 2016 session, held at St. Mark’s United Methodist Church had 38 registered participants. Christ Presbyterian Church hosted the spring 2017 session with 22 individuals registered. Of the sixty (60) participants, fifty-seven (57) paid a full registration fee of $99 and three (3) received scholarships. All participants were asked to complete a Participant Information Survey and a Participant Satisfaction Questionnaire. This information collected provides useful and informative data for local and national aging program planning. Overall, 81% of the total number of AMP Participants graduated (participated in 7 of the 10 class offerings). The national average is 80%.

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PIMA COUNCIL ON AGING AGING MASTERY PROGRAM® (AMP)

FY 2016-2017 – page 2 Client Demographic Summary:

Female 78% White/Caucasian 94% Male 22% Black/African American 3% Average Age of Participant 74 Asian/Asian American 3%

Other Multi Racial 0% Ethnicity

Hispanic, Latino or Spanish 5% Prevalence of Chronic Disease or Condition Arthritis/Rheumatic Disease 6.5% Hypertension (High Blood Pressure) 5% High Cholesterol 5% Other 43% None 5% When asked how they rated the quality of the AMP, 71% of participants rated it as excellent, 27% rated it as good and 2% rated it as fair. Generally, the same percentages were seen in participant responses to the questions related to the helpfulness and enjoyment of the program. Many AMP participants had heard of PCOA, but they were amazed and pleasantly surprised at the breadth and depth of our programs and services. We had two staff members as “community presenters” and their presentations resulted in more individuals executing advanced directives documents and increased participation in our Enhance Fitness Program. We gained new volunteers for our community relations outreach and networking. Collectively, the 60 AMP participants expressed their gratitude to PCOA for bringing a visionary, practical and resourceful program to our community. They voiced that they “appreciate people and programs that meet them where they are!” The Aging Mastery Program® Coordinator for the National Council on Aging (NCOA) provided a statewide training for the Arizona Area Agencies on Aging (n4A) Four staff members from PCOA attended the training.

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HOPE WORKSHOP FOR HOARDING DISORDER

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PIMA COUNCIL ON AGING HOPE WORKSHOP

FY 2016-2017 SERVICE DESCRIPTION: The HOPE workshop is a series of educational sessions about Hoarding disorder to learn how to Organize, Purge and End the cycle. It is a facilitated, self-help, workshop for people who are struggling with hoarding behaviors to help them manage their hoarding behavior, learn skills to reduce their clutter, and most importantly, learn they are not alone. It is based on an evidence-based program called Buried in Treasures but restructured to accommodate more participants. The HOPE workshop is an eleven week program that meets for ninety minutes every week. Weekly attendance is strongly encouraged because the program topics and homework progress with each week. However, participants may attend as many meetings as possible and newcomers may register at any point during the program. The workshop is a collaboration of the Southern Arizona Hoarding Task Force, Pima Council on Aging and the University of Arizona Center on Aging and Department of Psychiatry. Units of Service In FY 2016-17, 2 series of workshops were provided for a total of 27 classes with 88 participants.

pima council on aging€¦ · 89% stated the meals provided a larger variety of fruits, vegetables...

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