Check out: https://olderindians.acl

1. Check out: https://olderindians.acl.gov New Title VI Director Orientation National Title VI Conference 2019 9:00am-12:00pm Minneapolis, MN August 13, 2019

2. OVERVIEW OF THE OLDER AMERICANS ACT

3. The Older Americans Act • The Older Americans Act was first a law in 1965 • Nutrition Programs were first added in 1971 and Title VI programs followed in 1978 • The “Act” is divided in to separate chapters called “Titles” • Like in a book, each Title (chapter) deals with a different subject • Under each Title, there are separate sections called “Parts” • Under each Part, there are separate sections called “Sections”

4. The Older Americans Act assures that preference will be given to providing services to older individuals with greatest economic needand greatest social need with particular attention to low-income older individuals, including low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas.

5. To assure older Americans: An adequate income in retirement Best possible physical and mental health Suitable housing Comprehensive long term care services Employment opportunities Retirement in health, honor & dignity Civic, cultural, educational and recreational opportunities Continuum of care for vulnerable elderly Benefits from proven research Freedom & independence to manage their own lives Older Americans ActDeclaration Of Objectives

6. Older Americans Act: Key Provisions Title I — Objectives Title II — Administration on Aging Title III — Grants for State & Community Programs A. Administration B. Supportive Services & Senior Centers C-1. Congregate Nutrition Services C-2. Home Delivered Nutrition Services D. Evidence-Based Disease Prevention & Health Promotion Services E. National Family Caregiver Support Program

7. Title IV – Activities for Health, Independence and Longevity Title V - Community Service Senior Opportunities Act Title VI - Grants for Native Americans Part A – Indian Program Part B – Native Hawaiian Program Part C – Native American Caregiver Support Program Title VII – Allotments for Vulnerable Elder Rights Protection Section 10 – Holocaust Survivors Older Americans Act: Key Provisions 7

8. How it Stacks Up! OAA Title III Title VI Part B I&A Part C-1 Cong Part C-2 HD Part A AI/AN Part B NH Part C Caregiver Sections Sections Sections

9. Title VI Rules • If you read the OAA, you won’t find much under Title VI • Programs are designed to follow the OAA Title III Programs and tribes will find most of the rules in that section of the OAA • If you can, ask you local Title III for copies of their standards and policy manuals, the rules are the same for both programs. • Look at the manual on line at https://olderindians.acl.gov/ • Or look to your State’s standards for assistance

10. Other OAA Title VI Requirements • Evaluate the need for supportive and nutrition services (needs assessment). • Administer the program properly and efficiently, including providing satisfactory fiscal control and fund accounting procedures to ensure proper disbursement of and accounting for federal funds. • Submit timely and accurate reports. • Periodically evaluate program activities and projects. • Establish and follow objectives to carry out the program to meet the needs of the elders and identify obstacles to achieving these objectives and a plan to overcome the obstacles. • Provide convenient access to information and assistance. • Provide a preference for older American Indians, Alaskan Natives, or Native Hawaiians for employment, when feasible. • Provide nutrition services substantially in compliance with Part C of Title III. • Provide legal or ombudsman services substantially in compliance with Title III. • Coordinate with Title III regarding services in the same geographical area.

11. TITLE III/VI COORDINATION

12. The Older Americans Act requires that the state plans must: provide an assurance that the State agency will coordinate programs under title III and programs under title VI, if applicable; and provide an assurance that the State agency will pursue activities to increase access by older Native Americans to all aging programs and benefits provided by the agency, including programs and benefits provided under title III, if applicable, and specify the ways in which the State agency intends to implement the activities. Coordination of Title III and Title VI Services 12

13. Reasons to Coordinate The reasons for coordination are numerous and will differ from program to program. • As you coordinate with Title III you will increase your knowledge about the programs they have available which could benefit the Elders. • Many Elders have multiple needs. Through program coordination they can access additional services besides just what Title VI funds can provide.

14. Reasons to Coordinate (cont.) • Greater efficiency. Coordination can reduce duplication of services (the same services being provided by VI and III). • This could free funds for additional services. • Improved staff effectiveness. • In working with other programs it makes available many new resources such as new staff skills, facilities, and equipment. • Increased community support. Each program has its own base of community support. When programs work together, it will service to expand the base of community support and can assist in bringing the different communities together.

15. Reasons to Coordinate (cont.) • More money. • As you develop ties to Title III the possibility of receiving funding increases greatly. • If your Tribe or Organization is in agreement to receiving funds from Title III it can significantly increase the type and quality of services you provide to Elders. • Knowing what is going on. • In many cases Title III has access to resources and information that Title VI programs are still struggling to achieve. • This information can be invaluable to Title VI for keeping them updated to what is available in Elder services, additional sources of program funding, staff training opportunities, etc.

16. Reasons to Coordinate (cont.) • Coordination with Title III and all other agencies that can provide services to older persons is the best way to meet the needs of Elders with the limited budgets most Title VI programs face.

17. PROGRAMMATIC GRANT REQUIREMENTS

18. Part A/B GrantsNutrition Services • Nutrition Services: √ congregate meals are required √ home delivered meals are required √ nutrition education and nutrition counseling to be provided, as appropriate

19. Part A/B GrantsRequired Supportive Services • Information is a required service √ simple provision of information to people; can be in a group session or one-on-one √ grantees should have a list of all services that are available to older Indians in the service area √ grantees should maintain a list of services needed or requested by the older Tribal members

20. Part A/B GrantsRequired Supportive Services • Assistance is a required service √ involves providing assistance to older Tribal members to help them access available services; may help fill out forms, etc. √ usually involves siting down with the older adult/family to discuss options for services √ should be able to track the number of unduplicated clients who receive this service

21. Part A/B Grants - Other Permitted Nutrition/Heath-Related Services • diet counseling • sponsorship of Farmers Market programs • distribution centers for food banks • Blood Sugar checks • Diabetes education • Foot Care • Blood Pressure Checks • Evidence-based health programs • Falls avoidance education • Medication management • Traditional foods activities • Other traditional activities • Support groups • Socialization activities • Exercise Classes

22. Part C Grants Caregiver Support Services • Added to Older Americans Act in 2000 • assists families, friends, or neighbors to care for an elder with a chronic illness or disability • helps tribes provide locally determined systems of support services for family caregivers of elders and for grandparents caring for grandchildren

23. Part C Grants Caregiver Support Services • Must also have a Part A/B grant • Services are for two types of unpaid caregivers: √ unpaid informal provider of care to a frail older individual or to an individual with Alzheimer’s disease or a related disorder √ older relative caregivers

24. Part C Grants Caregiver Support Services “Frail’’ means that the older individual is functionally impaired because the individual— • is unable to perform at least two activities of daily living without substantial human assistance, including verbal reminding, physical cueing, or supervision; or • due to a cognitive or other mental impairment, requires substantial supervision because the individual behaves in a manner that poses a serious health or safety hazard to the individual or to another individual.

25. Part C Grants Caregiver Support Services Older Relative Caregiver means a caregiver who— (A)(i) is age 55 or older; and (ii) lives with, is the informal provider of in-home and community care to, and is the primary caregiver for, a child or an individual with a disability; (B) in the case of a caregiver for a child— (i)is the grandparent, stepgrandparent, or other relative (other than the parent) by blood, marriage, or adoption, of the child; and

26. Part C Grants Caregiver Support Services (ii) is the primary caregiver of the child because the biological or adoptive parents are unable or unwilling to serve as the primary caregivers of the child; and (iii) has a legal relationship to the child, such as legal custody, adoption, or guardianship, or is raising the child informally; and (C )in the case of a caregiver for an individual with a disability, is the parent, grandparent, or other relative by blood, marriage, or adoption, of the individual with a disability.

27. Part C Grants - Required Caregiver Support Services • Information to caregivers about available services • Assistance to caregivers in gaining access to the services • Individual counseling, organization of support groups, and caregiver training to assist the caregivers in the areas of health, nutrition, and financial literacy, and in making decisions and solving problems relating to their care giving roles • Respite care to enable caregivers of frail elders to be temporarily and intermittently relieved from their care giving responsibilities • Supplemental services, on a limited basis, to caregivers of frail elders to complement the care provided by caregivers

28. Part C Grants - Caregiver Support Services • Examples of Supplemental Services: √ emergency response systems √ incontinence supplies √ transportation √ lending closets √ home modification

29. Part C Grants - Caregiver Support Services • If some other program is providing the service, the grantee does not have to provide it directly but must coordinate with the other program to ensure the caregivers can use the program • Program services are for the caregiver; not for the elder who needs care • While there may be a need to find a caregiver for a person who lives alone and does not have a family caregiver, a grantee cannot hire a caregiver for them with Title VI Part C funds

30. PLANNING AND BUDGETING

31. PLANNING • Important element of management • Provide programs and services that older adults want • Provide what older adults need in order to participate

32. PLANNING • Step 1: Establish program goals example: Older adults will remain active in the community • Step 2: Conduct needs assessments: what services are older adults receiving/where are there gaps in services? • Step 3: Identify actions to address the unmet needs

33. PLANNING • Step 4: Determine what results are expected • Step 5: Develop a work plan setting forth tasks to achieve the results – follow the plan – complete tasks in the right order • Step 6: Plan to evaluate outcomes

34. PLANNING Example: Goal is for older adults to remain physically active. • needs assessment: 35% participate in some type of physical activity at least 4 days/week • desired outcome: 50% do some type of physical activity at least 4 days/week

35. PLANNING Action Steps: • Provide yoga classes three days/week at the senior center • Arrange for three water aerobics classes/week at community pool consider: cost, opportunity for participation regardless of ability or skill, location, transportation to activity, how to publicize the activities

36. PLANNING Don’t forget to Evaluate! • Number of class participants • Satisfaction surveys

37. PLANNING • Use of Volunteers: long term: deliver meals episodic: special occasion Older adults may want to volunteer • Coordinate with Tribal HR Department: background checks, insurance written agreement setting forth expectations

38. PLANNING - TIPS • Publicize services and activities • Provide opportunity for participation regardless of ability or skill • Community interest and support are important • Times and locations should be convenient • Allow free time for informal activities

39. PLANNING – TIPS cont... • Prioritize and set deadlines • Delegate to others • Do unpleasant things first; don’t procrastinate

40. BUDGETING

41. BUDGETING • Budget not required by Title VI, but money does not grow on trees

42. BUDGETING Simple budget example: • Staff salary and benefits • Food costs for last year plus an additional 3% • Supplies and other expenses (rent, utilities, administrative support) Divide these amounts by 12 and compare your expenses each month in each category to this amount

43. BUDGETING • Keep good records • Keep copies of all invoices • Coordinate with your finance office • If under budget, find out why and adjust the budget • Spend resources in a timely manner and avoid the need to carry over funds to the next grant period

44. BUDGETING Indirect Costs: • Find out what indirect cost your tribe charges to the program • Understand what is included in the indirect cost so you will not pay the same expense twice example: if rent is included in the indirect cost, do not also charge the program for rent

45. NUTRITION PROGRAM REQUIREMENTS

46. Title VI • In order to get a grant for Title VI services (also known as “Part A” services for nutrition) tribes have to have at least 50 elders aged 60 and up • May determine the age of participation to count meals— 45+ • May determine which services are to be provided but required services are Congregate meals, Home delivered meals, and Information and Assistance

47. Basic Information Congregate Meals Congregate meals are for individuals 60+, and: • Their spouse, regardless of age • Their dependent children with disabilities who live with the elder or accompany them to the meal site • Volunteers of any age • Individuals who reside in a building where meals are served. • Caregivers if Title VI C funds are available and in your policies

48. Basic Information Home Delivered Meals • Home delivered meals are available to people age 60 and over or the age that the tribe has determined • Isolation, Homebound, and Frail • 2 ADL’s • Spouses regardless of age • Dependent Children who live with the elder • Caregivers if Title VI C funds are available

49. Activities of Daily Living • Bathing • Transferring • Eating • Toileting • Walking • Grooming • Dressing • Continence • If an Elder cannot do two of these without “substantial human assistance”, they are eligible for Home Delivered meals. • May also need supervision for safety and be eligible • Just because a meal is “delivered” doesn’t make it a home-delivered meal!

50. Program Effectiveness • Reaching priority clients is important: • Lower Income • Isolated/Living alone • Poorer health • Less likely to perform ADL’s • Recently hospitalized • At risk of going to a nursing home