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

Objectives of Presentation. Introduce the Challenge BriefDescribe the Rebalancing EnvironmentPresent Choices for Independence

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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 Lloyd Dian Weddle 4th State Units on Aging Nutritionists & Administrators Conference August 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. Top Nine Chronic Health Conditions Heart Disease Hypertension Stroke Emphysema Asthma Chronic Bronchitis Cancer Diabetes Arthritis

    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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