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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
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