Title VI Director’s Manual - 2007

1. Title VI Director’s Manual - 2007 Chapter ? – Data Uses ADMINISTRATION ON AGING KAUFFMAN AND ASSOCIATES, INC. NATIONAL RESOURCE CENTER ON NATIVE AMERICAN AGING

2. Course objectives By completing this chapter, you will: • Be able to use data obtained from a local, state, or national needs assessment. • Understand local community data. • Understand the reasons for using community level data and national comparisions. • Be able to use data collected after conducting a local needs assessment.

3. CHAPTER ?CONDUCTING NEEDS ASSESSMENTS DEVELOPED BY THE NATIONAL RESOURCE CENTER ON NATIVE AMERICAN AGING – 2007 – GRANT NUMBER AoA 90-AM-2751-03

4. TOPIC 1 - What is community data? • Information specific to a group of people residing in the same area, in this case native elders. • Residents that may share a common background or interest in the community (some tribes have sub communities such as clans). • Culture, spirituality, economics, and or politics may be factors that define a community or its members. Relevant graphic

5. TOPIC 2 – What are the uses for community data?

6. TOPIC 3 – How do I obtain community level data? • Community level data is usually obtained in the community, by a researcher, consultant, or academic partner. • A needs assessment is required by the Administration on Aging (AoA) for renewal of the Title VI Native Elder Nutrition Programs. • According to the Agency for Healthcare Research and Quality, four issues should be considered by researchers when conducting community research: • Interaction with the community as partners not just subjects. • Use of community knowledge to understand issues and develop interventions. • Community involvement in the design and outcomes • Immediate benefits from results to participating communities.

7. TOPIC 4 – Where can I find help to obtain community level data? • The National Resource Center on Native American Aging (NRCNAA) has been working closely with Native elder organizations since 1994. • NRCNAA has a project specific to collecting community level data Identifying Our Needs: A Survey of Elders. • The Center is currently conducting its third such survey of social and health needs. • The goal for this ongoing national project is to serve as a resource to tribes to assist them with building their long term care infrastructure and increase the quality of life for elders residing on reservations, in villages, and other communities. • A collaborative agreement between the NRCNAA and AoA allows the project to provide resources for conducting a needs assessment by providing: • Survey instruments • Technical assistance • Regional and national training

8. TOPIC 5 – General Template for Using NRCNAA Needs Assessment Data Using NRCNAA Needs Assessment Data The NRCNAA template is designed to help people with using data from the National Resource Center on Native American Aging survey; however, the template can be used with other sources if a different survey was used. You can follow the examples that follow to expand the number of tables or items you include in your presentation of the your needs assessment. Please look at the comparison sheets to see what else might be important for your community and add those to the report using the sameformat. The example is not intended to include everything, but it is meant as a starting point for using the data for grant and reporting purposes. Find relevant data and use it!

9. TOPIC 5 – General Template for Using NRCNAA Needs Assessment Data Background Information According to the ___________enrollment office, there are presently 853 men and women over the age 55 enrolled and living on or around the ________ reservation. Of the 853, there are 492 over the age of 65. According to the National Resource Center on Native American Aging (NRCNAA), the national Native elder population ages 55 and over are expected to grow by 110% between 2000 and 2020. Clearly the impact of the large cohorts born during post World War II, now known as the Baby Boom generation, will become a major source of change for our tribe.

10. TOPIC 5 – General Template for Using NRCNAA Needs Assessment Data Chronic Disease The top chronic diseases found among our elders were high blood pressure, arthritis, diabetes, depression and osteoporosis. Each of these lead to limitations on peoples’ ability to take care of themselves and each are diseases where treatments are available to manage the disease. Nutritional care is particularly important for high blood pressure, diabetes and osteoporosis.

11. TOPIC 5 – General Template for Using NRCNAA Needs Assessment Data Data Comparison Comparisons between our tribe and the nation provide documentation of disparities on specific diseases where American Indian people appeared to be at greater risk than others in the nation. This information assists in identifying diseases where health promotion efforts will assist in making significant improvements in health status for our elders. The table on the next slide presents these diseases.

12. TOPIC 5 – General Template for Using NRCNAA Needs Assessment Data

13. TOPIC 5 – General Template for Using NRCNAA Needs Assessment Data Functional Limitations Functional limitations serve as the basis for establishing informal or formal need for care. Functional limitations or Activities of Daily Living (ADLs) include bathing, dressing, getting in or out of bed, walking and using the toilet. One’s ability to manage each of these is essential for self care. The following table shows that our people, although reporting higher rates of chronic diseases, are significantly less likely to report such needs for assistance. .

14. TOPIC 5 – General Template for Using NRCNAA Needs Assessment Data

15. TOPIC 5 – General Template for Using NRCNAA Needs Assessment Data Instrumental Activities of Daily Living Instrumental Activities of Daily Living (IADLs) serve as indicators for assistance for living safely in ones home. This includes meal preparation, shopping, money management, telephone use, heavy and light housework and getting outside of the home. With the exception of meal preparation, our tribe’s elders reported fewer IADL limitations than the nation. This may be due to the relatively young age of our elders compared to the nation.

16. TOPIC 5 – General Template for Using NRCNAA Needs Assessment Data

17. Topic 5 – General Template for Using NRCNAA Needs Assessment Data.Levels of Functional Limitation The measure of need for long term care contains four levels of limitation; little or none, moderate, moderately severe and severe. Each of these reflected differing levels of need and eligibility for care. Although our elders are relatively independent, they are also relatively young. The table on the next slide contains the percentages for each level of need for both our tribe and the nation. .

18. TOPIC 5 – General Template for Using NRCNAA Needs Assessment Data

19. Topic 6 – General Template for Using NRCNAA Needs Assessment Data.Why Local Survey Data? The NRCNAA survey asked a series of questions on whether services were available, whether people were using them now and whether they would use them. The following table shows the services now available and the additional services that would most likely be in future demand. The survey suggested that people would use a larger array of services if they were available. In some instances, the expression of interest is very high when the services are rarely available. For example, respite care is almost non-existent, but over 40% indicated they would use it when the time was appropriate. These results provide the basis for maintaining and prioritizing services, and for determining what services the elders need to continue living in their homes. .

20. TOPIC 6 – General Template for Using NRCNAA Needs Assessment Data

21. Topic 7 - General Template for Using NRCNAA Needs Assessment Data Weight and Nutrition Specifically related to nutrition are the findings about weight, diet and exercise. Using the people’s weight and height, a Body Mass Index was calculated to determine how many people are overweight (BMI 25 to 29) or obese (BMI 30 and over). Weight issues have become a focus of concern due to the relationship between weight and chronic disease (diabetes, arthritis, hypertension, and cancer) and functional limitations (ability to get around). Our results for the Body Mass Index are found on the next slide. Another method used to determine weight issues is waist circumference.

22. TOPIC 7 – General Template for Using NRCNAA Needs Assessment

23. TOPIC 7 – General Template for Using NRCNAA Needs Assessment Dietary concerns are reflected in an item that asked about eating habits and conditions that are important to consider when designing nutrition programs for our elders. A large proportion of the elders reported too few fruits and vegetables in their diet and many have an insufficient number of meals per day to receive adequate nourishment.

24. TOPIC 7 – General Template for Using NRCNAA Needs Assessment

25. TOPIC 8 – General Template for Using NRCNAA Needs Assessment Social and Housing Characteristics One third of the elders in our community live alone. These results indicate that 1/3 of our elders are at risk for requiring help from outside the household – formal services or informal care from relatives who do not live with them. This proportion is large and suggests a strong need for building home and community based services that can support both the elder and his or her informal care provider. Additionally, our elders reported 56% had received care from family members. Again, this supports the need for family caregiver support services as well as formal services for the elders. Almost a third (30.4%) of the elders reported providing care to grandchildren. This responsibility is high and must be considered when designing programs for the elders. They have responsibilities and tasks that in many other contexts would not be present. This responsibility for child care limits their options for using some services.

26. Topic 9 – Specific Areas to use Your NCRNAA Needs Assessment Data • Page 5: Application Guidelines: e) other nutrition services. • The first three nutrition items on Question 35 on your • comparison sheet will help to establish a baseline of need. • Persons reporting illnesses or conditions that require them • to change their diet are in need of education and • counseling. • The next two items, fewer than 2 meals per day and eating • few fruits and vegetables, are also both important for • nutritional education and counseling. • The thirteen (home delivered meals) and fourteenth • (congregate meals) items now using and would use on • Question 46 of your comparison sheet reflect current level of • use and receptivity to nutritional services and will also assist in • answering this question.

27. Topic 9 – Specific Areas to use Your NCRNAA Needs Assessment Data • Page 6: Question 6: “Describe the results and benefits expected…” • The thirteen (home delivered meals) and fourteenth • (congregate meals) items on Question 46 now using • document access; whereas, the would use column • indicates an increase in demand for the next funding • cycle. • Use Question 35 to document levels of dietary • adequacy and state that you expect the percentages • with fewer than 2 meals a day and those with few fruits • and vegetables to decrease over the next 3 years. • You can monitor progress by comparing the • percentages from this year to three years from now.

28. Topic 9 – Specific Areas to use Your NCRNAA Needs Assessment Data Page 6: Section B: Information and Assistance. Use items from Question 46 to establish a baseline for the percentage that are now using or would use in the future if needed. Each of these baseline percentages can be compared with the next survey in 3 years to see if they changed. Each should improve and exhibit higher percentages after 3 or more years. Section on Native American Caregiver Support Program – Will be completed by summer!

29. Topic 9 – Specific Areas to use Your NCRNAA Needs Assessment Data • Page 10: Question 4. • Question 44 on the comparison sheet will assist in • reporting the number of elders who are receiving care • from a family member. • Question 45 will assist in reporting the number of • elders providing care to their grandchildren. • The percentages from these two questions will provide • a baseline for service use and acceptability of people • involved in caregiving relationships. These should • improve over time and will be measured again after 3 • years.

30. Topic 9 – Specific Areas to use Your NCRNAA Needs Assessment Data • Page 11: Question 4. • The question asks for the expected results of providing • assistance. Here you should first list the assistance to be • provided, and then take those services from question 46 for • use as baseline data. Once again you predict improvement • and will re-measure this in 3 years. • Example: If you provide respite care during this funding period, you would report the percentage now using for acceptability and report the would use column to estimate the increase for the next 3 years. Do this for each service you intend to provide. • The NRCNAA needs assessment data is designed to have many uses. We urge you to also use this data in other applications to provide documentation of your current level of need and to set baselines. These efforts will help your organization to determine if your goals are being met!

31. Topic 10 – Best Practices Wisdom Steps-Health Promotion Wisdom Steps was organized as a partnership between Minnesota American Indian communities and the Minnesota Board on Aging. Wisdom Steps is governed by a Board of Directors that is made up of a representative from each of Minnesota’s eleven reservations and from the cities of Duluth, Minneapolis, and St. Paul. Wisdom Steps developed a logo to provide for recognition, consistency, and ownership. The logo consists of a pair of worn, tipped, moccasins surrounded by symbols from the Dakota and Ojibwe tribes. The moccasins identify with the American Indian community and the worn and tipped represent the wisdom of the elderly. One of the first things Wisdom Steps did was to conduct a needs assessment. Wisdom Steps formed a partnership with the National Resource Center on Native American Aging (NRCNAA) to find out what elders could tell us about their health. The survey, Identifying Our Needs: A Survey of Elders was conducted in each interested community and the results were used for planning Wisdom Steps activities.

32. Topic 10 – Best Practices • Elders are encouraged to participate in three preventive health activities: • Health Screenings - Elders are encouraged to practice • good preventive health by visiting their physicians and • setting personal health goals. Elders are encouraged • to have annual screenings for blood pressure, blood • glucose, cholesterol, and weight. • Health Education – Elders are encouraged to attend • education programs that support their health goal, and • to watch and learn how and why preventive health is • important. • Healthy Living Activities – Elders are encouraged to • practice good health by walking or joining in • preventive health promotions that encourage routine • exercise.

33. Topic 10 – Best Practices These preventive health activities correspond to the little or none category of the functional limitations chart developed by NRCNAA. Based on the needs assessment results, the majority of Minnesota’s American Indian elderly fell into this category. Additionally, a model project was developed for each of the preventive health activities. Health screenings contain “Medicine Talk” where communication is encouraged between elders and pharmacists.

34. Topic 10 – Best Practices For more information on the Wisdom Steps program, please contact: Joni Minnesota Board on Aging Indian Elder Desk 444 Lafayette Road St. Paul, MN 55155-3843 Telephone: (651) 297-5458 Or visit their website at http://www.wisdomsteps.com

35. Topic 10 – Best Practices Eagle Shield Senior Citizens Center-Home and Community Based Services The Eagle Shield Senior Citizens Center is a program developed by the Blackfeet Tribe to provide assistance to the elderly of the Blackfeet Reservation. The Blackfeet Reservation is located in the northwestern part of Montana and encompasses approximately 1.5 million acres. Over the years, the Eagle Shield Senior Citizens Center has developed from a bare bones operation to a program that offers a wide range of senior services, from nutrition education and meal delivery to home personal assistance and social activities.

36. Topic 10 – Best Practices • The nutrition program includes meal services that are • provided as congregate meals at the Eagle Shield site, • home-delivered meals, and medical waiver provided • meals to disabled individuals. • Social activities at the Center provide the elders with • a place to visit, read newspapers, or just hang out. • Other social activities at the Center include television • viewing with videos of Blackfeet history, card and • board games, space for quilting, a pool table, an arbor • and picnic tables for outdoor meals and socializing. • In addition, the Center serves as a base for community • health activities such as flu shot clinics, eye • examinations for glaucoma and cataracts, educational • and social gatherings for cancer and dialysis patients and their families.

37. Topic 10 – Best Practices • Cardio-glide exerciser and aerobics are available for the elders should • they desire to exercise. The Center operates separately from the local • Community Health Representatives and Indian Health Service, but • works in conjunction with them to provide health services to the • elderly. • Eagle Shield Senior Citizens Center also provides access to services • from other programs such as the Personal Care Attendant Program, • Green Thumb Volunteers Worksite, and the Visually Impaired • Program Volunteers. • The Personal Care Attendant (PCA) Program offers in-home care • tasks that are medically necessary for recipients whose health • conditions cause them to be functionally limited in performing • activities of daily living. This program is an option with the purpose of • delivering services to the elderly and/or disabled for their comfort and • safety. Services can include assistance with activities of daily living • and/or personal hygiene, assistance with meal preparation, and • household tasks. • .

38. Topic 10 – Best Practices • Start up funds for the PCA program was provided • by the Tribal Business Council and continues with • the aid of Medicaid reimbursements. An added • benefit to the PCA program is that in a rural • community that has over 70 percent • unemployment, it employs and provides training • for local individuals of the Blackfeet Indian • Reservation. • In 2001, the PCA program employed over 100 • personal care attendants and maintained a pool • of about 300 trained individuals.

39. Topic 10 – Best Practices For more information about Eagle Shield please contact Connie Bremner, Director at (406) 338-3483 or visit their Web site at http://www.blackfeetnation.com

40. Topic 11 – Regional and National Data Use The wide range of tribal participation in the Identifying Our Needs: A Survey of Elders throughout the United States has resulted in the largest Native elder database in the country. The project is crucial to documenting Native elder disparities at the regional and national level to bring awareness to the health and social disparities experienced by these populations. The National Resource Center on Native American Aging (NRCNAA) has provided testimony and documentation to educate tribal, state and congressional representatives as to the high level of need experienced by Native elders. NRCNAA staff could not have done this without our tribal partners and the data they allow our office to use in these efforts.

41. Topic 11 – Regional and National Data Use • The applications for the data at these levels are numerous and focus on: • Training for increasing skills for Native elder service • providers • Advocating for resources at the state, regional, and • national level • Developing policy for informing national Native elder • organizations • Filling the research gap for Native elder related • publication • Training Native researchers in the aging field

42. Topic 11 – Regional and National Data Use The following examples highlight an array of analyses at the regional and national levels that show how assessment data may allow an examination of disease prevalence and health disparities.  The material is valuable to establishing the extent of need and the extent of unmet need in Indian communities.  Prevalence of Chronic Disease Among American Indian and Alaska Native Elders, October, 2005. Patricia Moulton, Ph.D. Leander McDonald, Ph.D. Kyle Muus, Ph.D. Alana Knudson, Ph.D. Mary Wakefield, Ph.D., R.N. Richard Ludtke, Ph.D.

43. Topic 11 – Regional and National Data Use Regional aggregation of data is useful in examining both health and social conditions and services.  In this type of use, the regional data may be used as evidence that is derived from a larger and more detailed examination of conditions.  In some cases, one might prefer to use regional estimates of need when the tribe is very small and local data is limited by small population size. American Indian Elders in the Aberdeen IHS Area: Prevalence of Chronic Disease and Functional Limitations, presented by Kyle Muus and Leander R. McDonald at the Dakota Conference on Rural and Public Health, held March 8-10, 2005 in Bismarck, ND.

44. Topic 11 – Regional and National Data Use Needs assessment data establish the direction for patterns of change in Indian country and serve as a basis for targeting health promotion and wellness.  The following type of use represents another dimension for creative use of needs assessment data. Reducing Long Term Care Needs Through Health Promotion and Disease Prevention, presented by Alan Allery, PhD to Wisdom Steps & WELCOA.

45. Topic 11 – Regional and National Data Use Our use of the data for locating policy recommendations could be replicated for regional, state and local efforts, all of which would lead to eventual improvements in care for elders. Policy recommendations for Native Elders, paper prepared for the National Congress of American Indians 2005 Mid-Year Conference, June 14, 2005, Green Bay, WI.

46. Final Overview http://www.med.und.nodak.edu/depts/rural/nrcnaa/pubs/index/html

47. Data Use Summary Data documents community disparities. Data provides extensive information for strategic planning. Data identifies community issues. Data offers specific information for policy development. Data presents the essentials for advocacy efforts at the tribal, state, and national level.

48. Congratulations You have successfully completed Chapter .. How to use your data.