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Rebalancing Long Term Care: The Role of the Older Americans Act Nutrition Program

Rebalancing Long Term Care: The Role of the Older Americans Act Nutrition Program. Jean Lloyd Dian Weddle 4 th State Units on Aging Nutritionists & Administrators Conference August 29, 2006. Objectives of Presentation. Introduce the Challenge Brief Describe the Rebalancing Environment

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Rebalancing Long Term Care: The Role of the Older Americans Act Nutrition Program

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  1. 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

  2. Objectives of Presentation • Introduce the Challenge Brief • Describe the Rebalancing Environment • Present Choices for Independence & Role for OAA Nutrition Program

  3. OAA Nutrition Program • Cost effective service for older adults that: • Assists them to engage in society & community life • Maintains their health & independence • Allows them to remain at home in their communities • Supports the OAA vision and • Meets performance outcomes & indicators established AoA.

  4. 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

  5. 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

  6. Heart Disease Hypertension Stroke Emphysema Asthma Chronic Bronchitis Cancer Diabetes Arthritis Top Nine Chronic Health Conditions All have dietary & nutritional implications affecting independence!

  7. 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

  8. Benefits of Rebalancing • Empower older adults & families to select services & providers • Increased consumer satisfaction • Money saved through ↓ use of high cost ER & institutional care

  9. 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

  10. 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

  11. Challenges & Opportunities Lie Ahead • Need philosophical & operational shift… FROM: provider/service driven model TO: empowered consumers making their own decisions

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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!

  18. 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.

  19. Nutrition Care Process • Screen • Assess • Problem ID • Intervention • Follow up

  20. 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!

  21. 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)

  22. 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 system 2.) medical problem-oriented treatment • Nutrition Program uses holistic system addressing nutrition related social and medical issues

  23. 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

  24. 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

  25. 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)

  26. 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

  27. The Question is… HOW DO WE DO THIS?

  28. 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

  29. 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

  30. 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

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