Rebalancing Long Term Care:

The Role of the Older Americans Act Nutrition Program

Jean LloydDian Weddle

4th State Units on Aging Nutritionists & Administrators ConferenceAugust 29, 2006

Objectives of Presentation

Introduce the Challenge Brief

Describe the Rebalancing Environment

Present Choices for Independence & Role for OAA Nutrition Program

OAA Nutrition Program

Cost effective service for older adults that:

1) Assists them to engage in society & community life

2) Maintains their health & independence

3) Allows them to remain at home in their communities

4) Supports the OAA vision and

5) Meets performance outcomes & indicators established AoA.

Good Food & Nutrition

Key factors in successful aging

Help reduce disease-related disability

Promote health, support increased mental & physical functioning

Are more important than genetic factors in avoiding decline

Nutrition in Keeping Older Adults Healthy & Independent

Prevention of malnutrition (obesity, undernutrition)

↓ risk of chronic disease & disease-related disability

Critical in management & treatment of chronic disease

Nutrition therapy is cost effective

Top Nine Chronic Health Conditions

Heart Disease

Hypertension

Stroke

Emphysema

Asthma

Chronic Bronchitis

Cancer

Diabetes

Arthritis

All have dietary & nutritional All have dietary & nutritional implications affecting implications affecting

independence!independence!

The Changing Long Term Care System

Different Needs:Current population vs. baby boomers

Current System:Costly facility-based LTC 69% of Medicaid spending on LTC

Rebalanced System:More cost effective home & community-based model

Benefits of Rebalancing

Empower older adults & families to select services & providers

Increased consumer satisfaction

Money saved through ↓ use of high cost ER & institutional care

AoA’s Choices for Independence Initiative Empower consumers to make

informed decisions about Choices for LTC

Target high risk, nursing home appropriate, non-Medicaid individuals & delay institutionalization without current OAA service categories or title restrictions

Build prevention into community living through evidence based health promotion & disease prevention programs designed for older adults

Importance of the OAA

Cornerstone for cost effective, comprehensive, coordinated, high quality, long term home & community based services

OAA has the experience, network & programs to serve as model for a rebalanced LTC system

Visible, creditable & trusted

Challenges & Opportunities Lie Ahead

Need philosophical & operational shift…

FROM: provider/service driven model

TO: empowered consumers making their own decisions

Implications for Nutrition Services

Balance needs of today’s older adults with a more independent, mobile & younger group

Increasing diversity in: Severity of impairments Information & referral needs Mix of therapeutic nutrition Health & social services Array of health promotion & disease

prevention community programs

Serving Nursing Home Eligible Consumers Currently targeting & serving increasingly

frailer, impaired & more underserved population

Possible implications for risk of malnutrition

30% of those getting home-delivered meals eligible for nursing home placement

Regulations in nursing homes require monitoring, evaluation & care plan development to prevent deterioration

EXA: National guidelines for screening, staging, prevention and treatment of pressure ulcers

OAA Aging Network

Nutr Program & RD/ICE dietitians at state AND local levels

First line of defense in monitoring &/or improving nutritional & weight status

Development of state & local area plans should include nutrition expertise & provide for nutritional needs of consumers

OAA Nutrition Program

Promotes Health & Independence in Home & Community-Based LTC

Well integrated into home & community settings through community partners & social service and medical care components

Can serve as model program for implementing AoA’s Choices Initiative

OAA Nutrition Program

Consumer-driven nutrition services/interventions for older adults including: Meals: tasty & nutritionally dense to enhance

food/nutrient intake Congregate Meal Sites: provide interaction &

improves active social engagement Nutrition Education: empowers behavioral

change & provides latest nutritional information

Nutrition Counseling: enhances chronic disease management by consumer & caregiver

Referrals & Coordination: connects consumer & caregiver to community partners

OAA Nutrition Program & Continuous Quality Improvement

Maintains adherence to the latest scientific evidence & highest performance standards

Mechanisms in place for customer & dietary intake assessment as well as adherence to consistency of standards

Provides training & guidance on nutritional aspects to case managers

These assure that process provides safe, comprehensive & scientifically accurate services!

Nutrition & Choices

The OAA Nutrition Program provides nutritional choices including: Congregate sites & restaurant vouchers Menu & food selection (EXA: culturally

appropriate meals) Home Delivered Meals, hot or frozen, including

specialized therapeutic meals (EXA: renal diets)

In-depth individualized nutrition counseling for disease management for consumer & caregiver (EXA: diabetes, cancer)

Educational sessions including caregiver needs, guidance for healthy eating, & tips for physical activity.

Nutrition Care Process

Screen

Assess

Problem ID

Intervention

Follow up

Choices & the OAA Nutrition Program

Older adults are willing to make nutrition-related lifestyle changes when:

Information relevant to their needs is available

They understand how to make changes!

Choices & the OAA Nutrition Program

Choices can:

Provide a seamless, coordinated, comprehensive home & community based system

Close gaps in service (EXA: variations in what federal, state & local agencies offer in regards to consumer eligibility requirements& funding)

Choices & the OAA Nutrition Program

Choices extends OAA Nutrition Program’s health & independent living services to new groups of older adults, families & caregivers

Choices can close current gap in nutrition services. Nutrition often viewed as two separate systems:

1.) social & supportive services system2.) medical problem-oriented treatment

Nutrition Program uses holistic system addressing nutrition related social and medical issues

Choices & the OAA Nutrition Program

Choices allows for flexibility to provide specific information & referral services, long term living options, & health promotion & disease prevention programs

SUAs, AAAs & OAA Nutrition Program providers can build consumer driven nutrition outreach, messages & services into state & area plans

Choices & the OAA Nutrition Program

Choice models should have quality improvement & assurance processes

RDs provide training to case managers & other assessors to help them understand:

Nutrition related needs When services might be needed for

consumers & their families Safe & acceptable nutrition practices

Choices & an Integrated OAA Nutrition Program

Empower consumers to make informed Choices for long term living One-Stop-Shopping to ↓ nutrition risk &

promote healthy eating through consumer-tested brochures & offer information on congregate dining sites

Prioritize service referrals to ↓ malnutrition risk by including key ?s re: inadequate nutrition & health on I&R form

↓ nutrition risk & food insecurity through information & referrals to agencies/programs that ↑ access to food (EXA: Food Stamp Program, Food Banks, Senior Farmers Market Nutrition Program)

Choices & an Integrated OAA Nutrition Program

Target high risk, nursing home appropriate, non-Medicaid individuals

Delay institutionalization through Choices for home & community care to meet their individualized needs & preferences without the current OAA service categories or title restrictions

The Question is…

HOW DO WE DO THIS?

Choices & an Integrated OAA Nutrition Program

Train case managers, homemakers & personal assistants to provide safe & acceptable nutrition practices to meet quality measures.

Choices in home delivered meals including specialized therapeutic meals, meals modified for consistency, choice of hot or frozen meals & service daily or weekly

Coordinate discharge planning & nutrition services including meals & individualized nutrition counseling for disease management

Choices & an Integrated OAA Nutrition Program

Build prevention into community living through evidence based health promotion & disease prevention programs designed for older adults

Provide information & referrals for consumers & families about evidence based HPDP programs in area

Build evidence based HPDP components into senior centers & congregate dining sites

Offer Choices among HPDP programs offered to homebound consumers

The Choices Challenge

Improving the health & independence of consumers & caregivers Quick response Consumer driven model Consumer perceived value Matching need with service array Integrating into Choices for Independence