94-24050. Public Information Collection Requirement Submitted to the Office of Management and Budget (OMB) for Clearance

[Federal Register Volume 59, Number 188 (Thursday, September 29, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-24050]


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[Federal Register: September 29, 1994]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration on Aging

 

Public Information Collection Requirement Submitted to the Office 
of Management and Budget (OMB) for Clearance

agency: Administration on Aging, HHS.

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    The Administration on Aging (AoA), Department of Health and Human 
Services, has submitted to the Office of Management and Budget (OMB) 
the following proposal for the collection of information in compliance 
with the Paperwork Reduction Act (Pub. L. 96-511):

Title of Information Collection: State Performance Report: Reporting 
Requirements for Titles III and VII of the Older Americans Act;
Type of Request: Extension and Revision;
Use: To revise an existing information collection form to conform to 
the newly-developed National Aging Program Information System (NAPIS) 
resulting from amendments to the Older Americans Act which directed the 
Administration on Aging to improve State reporting requirements;
Frequency: Annually;
Respondents: State Agencies on Aging;
Estimated Number of Responses: 57;
Total Estimated Burden Hours: 293,721.
Additional Information or Comments: Written comments and 
recommendations for the proposed information collections should be sent 
within 10 days of the publication of this notice directly to the 
following address: OMB Reports Management Branch, Attention: Allison 
Eydt, New Executive Office Building, Room 3208, Washington, DC 20503.

    Dated: September 23, 1994.
William F. Benson,
Deputy Assistant Secretary for Aging.

A. Justification

1. Explanation of Necessity
    The Older Americans Act (OAA) requires annual program performance 
reports from the States. The 1992 reauthorization of the (OAA) directed 
the Administration on Aging to develop reporting procedures for use by 
States to correct deficiencies in current reporting practices. In 
response to this mandate, AoA has developed a new reporting system 
known as the National Aging Program Information System (NAPIS) which 
necessitates as revised form 0980-0199. The current Form 0980-0199 will 
be divided into two separate forms. The first form will be known as the 
State Performance Report (SPR) and will require an accounting of 
performance under Title III and the newly established Title VII. The 
SPR component of the NAPIS which we are submitting is intended to be 
phased in over a three year period with levels of detail increasing 
annually (except for states that elect faster implementation), 
beginning with program information collected in FY 1995. The second 
form, which in the past was included in the SPR, will be known as the 
State Annual Ombudsman Report to the Administration on Aging and will 
be the basis for the National Ombudsman Reporting System (NORS).
    AoA will test both the SPR and the State Annual Ombudsman Report in 
FY 1995. The test of the new SPR will focus on the new requirements for 
registration and data on client characteristics. AoA will seek out the 
test states through an open solicitation process. the pilot sites will 
include both states which have the capacity to fully implement all 
reporting requirements in FY 1995 as well as states that are not as far 
along in the development of their reporting system capacities. AoA will 
use the test results to evaluate the feasibility of the proposed 
reporting specifications. Based on the test results AoA will consider 
revision of the timing and the substance of the specifications, as 
appropriate. Approval for such final changes will be requested form OMB 
by June 30, 1995. However, at this time we fully intend to implement 
the reporting system on the proposed schedule.
    The revised State Annual Ombudsman Report is to be implemented in 
FY 1995 at state option, and required for information collected in FY 
1996. Therefore, we ask that OMB extend, also, approval for AoA to use 
Part V, Long Term Care Ombudsman Program, of our current Form 0980-0199 
through FY 1995.
2.Use of Information and Consequence of Not Collecting
    The information will be used to meet existing and new statutory 
requirements under the (OAA) which includes evaluation of program 
operations; preparation of reports for the Congress and the Office of 
Management and Budget; policy analysis; response to other Federal 
agencies; and to other public and private sector agencies and 
organizations.
    If the revised form 0980-0199 is not approved, the Assistant 
Secretary for Aging will not be able to comply with (OAA) statutory 
requirements for state program performance information in FY 1995 due 
to lack of State-by-State data. Introduction of the revised system 
during FY 1995 would be prohibited. The current form 0980-0199 expires 
on 12/31/94.
3. Information technology and Reducing Burden
    State and Area Agencies on Aging (AAAs) are rapidly automating the 
collection, processing, and transmission of data. This has a profound 
effect on estimates of time and cost to produce program service data. A 
few States have limited ADP capacity, but virtually all States will, 
within a very short time, have ADP capacity that was rare 10 years ago. 
In the past, a large State with many AAAs using a ``paper and pencil 
reporting system'' might have used several thousands of hours to 
produce an annual report. Furthermore, the burden would be much the 
same each year a similar report was developed. Currently, States that 
have commonplace and relatively inexpensive ADP capacity perform these 
tasks in a fraction of the time needed with a paper system. Beyond 
this, the burden is greater in the first year of reporting than in any 
subsequent year, because ADP costs load on the front end. AoA has 
consulted extensively with States in the development of these 
requirements and has limited the burden to the extent practical and 
allowable under the OAA.
4. Efforts to Identify Duplication
    The information specified for this report is not available form 
other collection source.
5. Availability of Similar Information
    Similar information is not available from any other source.
6. Small Business or other Small Entities--N/A
7. Consequences of Less Frequent Collection
    State performance reports are required on an annual basis by 
statute.
8. Guidelines in 5 CFR 1320.6
    The existing State Program Report is consistent with 5 CFR 1320 and 
this request for extension would have no adverse effect.
9. Outside Consultation
    Outside consultation with the aging network on the proposed 
reporting specifications has been extensive:

1991

    AoA issued an Information Memorandum 91-17 (January, 1991) to 
States indicating a need to improve the State Program Report (SPR). 
States were provided an opportunity to comment on improvements on the 
current SPR. 41 States wrote comments and nearly all wanted substantial 
changes in the SPR, including improvements to the taxonomy, 
computerization, and changes to facilitate greater accuracy. AoA held a 
meeting (June, 1991) with a group of State and Area Agency on Aging 
personnel to discuss major issues.

Dimensions International Report (September, 1992-March, 1993)

    AoA funded a contractor, Dimensions International (DI), to develop 
comprehensive information, analyze program issues and provide 
recommendations on a reporting system for (OAA) funded programs. DI 
engaged a Policy Committee and a Technical Committee each of which met 
twice in Washington, D.C. to provide aging network input to the 
recommendations. An executive summary of the findings and 
recommendations is attached.

NORS Work Group Activities (1991-1993)

    AoA staff worked with numerous state Long-Term Care (LTC) Ombudsman 
over a period of two years to develop an improved reporting system for 
the Ombudsman Program--the National Ombudsman Reporting System (NORS), 
which is currently proposed. At AoA's invitation, State Directors on 
Aging reviewed the product of this extensive work by program staff. Of 
thirty-two State responses, twenty-five states concurred with the new 
system, one state did not concur, and six states provided an ambivalent 
response.

Technical Review Meeting (August, 1993)

    AoA convened a two day technical work group with State and Area 
Agency on Aging Staff from the NY, WA, NC, NY City and Prince Georges 
County, MD to review a draft of the reporting requirements which AoA 
submitted to OMB in March of 1994.

Information Memoranda

    AoA provided States and AAAs a copy and an opportunity to comment 
on the DI recommendations in an Information Memorandum (June, 1993).
    In March of 1994, an Information Memorandum with a copy of AoA's 
Previous submission to OMB was provided to States and AAAs. Three major 
areas of concern were identified in the public comments: (1) timing of 
the implementation; (2) cost of implementation; and (3) level of 
reporting detail. In light of these concerns, AoA proposed the 
following revisions to the previous OMB submission:
     PSA level reporting was eliminated;
     Performance measures were eliminated;
     Client registration has been delayed to FY 1996;
     Services in the three clusters were rearranged;
     Nutritional risk screening was limited to four services--
case management, home delivered and congregate meals and nutrition 
counseling;
     A number of client descriptors and expenditure related 
data requirements were dropped; and
     SPR reports will be required to be submitted to AoA 
electronically. (AoA will provide software specifications to assist 
States in transmitting the required files.)

State Governors and State Agency on Aging Comments (June, 1994)

    AoA, in consultation with OMB, provided proposed reporting 
specifications to State Governors and Directors of State Agencies on 
Aging and requested comments.
    Nine Governors made comments on the reporting specifications. Most 
governors that responded indicated support for accurate and useful 
information gathering; the need for more administrative funds to pay 
for information gathering; and, that only necessary information be 
gathered. One Governor said that AoA should collect information on the 
impact of the services on elderly clients instead of the information 
which AoA proposes to collect.
    37 State Units on Aging and 11 AAAs provided comments. These 
comments were very diverse and often dealt with technical issues 
related to services reporting. The more general comments from this 
group were similar to the comments received from Governors. A more 
detailed account of the comments is included in the enclosed analysis.
    Based on this set of comments, AoA has revised the implementation 
dates for key components of this reporting system to allow states the 
option of a phased implementation over a 3 year period. Moreover, the 
collection of information on transfers between parts of Titles III-B 
and C and information on modified meals has been dropped. We have again 
included a required estimate of the percentage of Title III funds in 
expenditures for certain services, based on comments received. The 
definition of ``new persons served'' has been simplified and other 
definitions were modified to make reporting easier.
10. Confidentiality
    To assure confidentiality, CFR 45, Part 1321.19 states ``The State 
Agency on Aging must have procedures to protect the confidentiality of 
information about older persons collected in the delivery of 
services.'' Further regulations, under the U.S. Code, governing 
Programs for Older Persons require that information may not be 
disclosed by the service provider or agency in a manner which 
identifies the person without the informed consent of the person.
11. Questions of a Sensitive Nature
    The State program report as applicable to this request for revision 
contains no questions of a sensitive nature.
12. Estimated Cost to Federal Government and Respondent
    The (OAA) provides funds to States for administration (including 
ADP and reporting). Most States use for administrative costs 
approximately five percent of the total funds allocated to them by the 
OAA. Therefore, large states, such as California and New York State are 
provided state administrative funds of $3.7 million and $3 million 
respectively, not including required matching funds or administrative 
funds from other programs which they administer. AAAs are permitted 
under the (OAA) to use approximately 10% of OAA funds they administer 
for administrative purposes. In large states, such as California and 
New York State, AAAs are provided about $6 million annually for 
administrative activities such as providing information on services 
provided. Service providers include the costs of administrative 
activities in budgets which they negotiate with AAAs. AAAs will 
continue to limit the administrative costs of service providers. 
However, the mechanism to allocate additional funds to meet legitimate 
increased costs for reporting at the services provider level are in 
place currently. Most of any increase in reporting burden caused by 
these proposed reporting specifications falls outside state 
administrative budgets.
    AoA has made one-time grants to State Agencies on Aging in FY-94 to 
assist States with the start-up costs of meeting the NAPIS requirements 
which we propose to OMB. The one-time state grants are $45,000 for 
states, with lesser amounts for some of the territories.
    AoA has spent approximately $640,000 on staff, expenses, and 
contracts to develop the reporting system proposed. it is estimated 
that AoA will spend an additional $900,000 in the rest of FY 1994 
combined with FY 1995 on staff, expenses, and contracts to implement 
the revised reporting system. After FY 1995, the reporting system is 
estimated to require $150,000 in AoA staff and expenses each year to 
maintain and operate, if no major changes are made in the reporting 
system.
13. Burden of Collection Information
    AoA has determined through consultation with states that some 
states wish to implement all of the proposed reporting requirements in 
FY 1995. Other states advise us that they must have the option of 
implementing the system in stages. AoA proposes reporting standards 
that will permit, at state option, some of the more complicated 
reporting requirements to be deferred to FY 1996 and a few requirements 
to FY 1997. This optional phased approach to implementation complicates 
the estimation of burden hours per year. We are basing our estimate on 
the burden an average state might encounter if all of the reporting 
requirements are implemented in the first year. However, we assume that 
a state that implements the components of the reporting system over a 
three year period will have a lower first year burden, but annual 
effort may not substantially decline until the fourth year that the 
system is employed.
    The first year (FY-1995) national reporting burden on the 
respondents is estimated to be 294,000 hours. The burden will drop to 
70,000 hours in each subsequent year in which these reporting 
components are used.
14. Reasons for Changes in Burden
    The estimates of burden reflect an increase in reporting required 
by 1992 Amendments to the OAA and adjustments to the estimate of the 
burden required by the existing AoA reporting requirements for these 
programs.
15. Collection of Statistical Information for Publication and 
Collection of Information Employing Statistical Methods--N/A.

State Performance Report for Title III and VII of the Older Americans 
Act (Excluding LTC Ombudsman Report)

For Implementation In Fiscal Year 1995 by the National Network on Aging

Report Sections

Section I: Estimated Unduplicated Counts of Clients Served
Section II. Utilization Profile
Section III: Expenditure Profile
Section IV: Other Services Profile (Optional)
Section V: Developmental Accomplishments
Section VI: Profile of Community Focal Points and Senior Centers
Section VII: Staffing Profile

Revised Requirements as of: September 20, 1994

Title III and VII Performance Reporting Requirements

Introduction

    The Older Americans Act calls for annual performance reporting by 
the National Network on Aging. In the 1992 reauthorization of the Older 
Americans Act, the Administration on Aging (AoA) was directed to 
develop refined reporting procedures for use by state agencies on aging 
which correct deficiencies in current reporting practices. As a 
response to these mandates, AoA is issuing new reporting guidelines for 
Titles III and VII, to be effective in FY95 with the exception of 
client registration which will not be required until FY96. As a result, 
a number of data elements will be delayed until FY96 and in two cases, 
nutritional risk data for congregate meals and new clients data, until 
FY97.
    This document summarizes the new requirements for the State Program 
Performance Report (SPR) for Titles III and VII.
    The sections of the new SPR include:

Section I: Estimated Unduplicated Counts of Clients Served

A. Unduplicated Client Count By Type of Service
B. Unduplicated Client Count By Characteristic

Section II: Utilization Profile

A. Service Use
B. Detailed Client Profile for Registered Services (1-6)
C. Summary Client Profile for Other Registered Services (7-9)

Section III: Service Expenditures Profile

A. Title III Expenditures By Part And Service
B. Title VII Expenditures By Chapter

Section IV. Other Services Profile (Optional)

Section V: Developmental Accomplishments

A. For Home and Community Based Programs
B. For A System of Elderly Rights

Section VI: Profile of Community Focal Points/Senior Centers

Section VII: Staffing Profile

A. State Unit on Aging
B. Area Agency on Aging

    On the following pages, the SPR format is exhibited through a 
series of data tables corresponding with the sections of the SPR listed 
above. The tables are for presentation purposes only. AoA is requiring 
electronic transmittal of the annual SPR data. The SPR data will be 
transmitted in several data files organized around logical groupings of 
performance data--clients, units, expenditures and the like. AoA will 
provide software which can be used by state units on aging to create 
the required transmittal files. Following the forms, SPR instructions 
are provided and the specifications for the data files which will be 
used to electronically transmit the SPR data to AoA.
    While the state long term care ombudsman program is now part of 
Title VII of the Older Americans Act, there are distinct reporting 
requirements which exist for the ombudsman program. As a result, the 
state long term ombudsman report format and related instructions are 
described in a separate package.

Legislative Requirements for Reporting

    The SPR is designed, first and foremost, to respond to legal 
requirements of the Act, while expanding the performance data available 
to support management and advocacy by AoA and the National Network on 
Aging.
    Section 202(a)(19) of the Older Americans Act outlines the 
principal requirement for performance reporting, directing AoA to 
``Collect for each fiscal year, for fiscal years beginning after 
September 30, 1988, directly or by contract, statistical data regarding 
programs and activities carried out with funds provided under this Act, 
including:
    (A) with respect to each type of service provided with such funds:
    (i) The aggregate amount of such funds expended to provide such 
service;
    (ii) the number of individuals who received such service; and
    (iii) the number of units of such service provided;
    (B) the number of senior centers which received such funds; and
    (C) the extent to which each area agency on aging designated under 
Section 305(a) satisfied the requirements related to adequate 
proportions and the giving of preference to those services to older 
individuals with the greatest economic or social needs, with particular 
attention to low income minority individuals.''
    Section 207(a)(4) of the Act requires that AoA prepare and submit a 
report to the President and to the Congress which includes 
``statistical data and an analysis of information regarding the 
effectiveness of the State agency and area agencies on aging in 
targeting services to older individuals with greatest economic need and 
older individuals with greatest social need, with particular attention 
to low income minority individuals, low-income individuals, and frail 
individuals (including individuals with any physical or mental 
functional impairment)* * *''
    Congress, during the 1992 reauthorization process, expressed strong 
reservations and concerns about the quality of reporting related to 
Older Americans Act programs. In response to these concerns, Congress 
placed new mandates on AoA in section 202(b)(29) to design and 
implement, for purposes of compliance with Section 202(a)(19) 
performance reporting requirements listed above, uniform data 
collection procedures for use by State agencies, including:
    (A) uniform definitions and nomenclature:
    (B) standardized data collection procedures;
    (C) a participant identification and description system;
    (D) procedures for collecting information on gaps in services 
needed by older individuals, as identified by service providers in 
assisting clients through the provision of the supportive services; and
    (E) procedures for the assessment of unmet needs for services under 
this Act.
    Likewise, in the Older Americans Act reauthorization, Congress 
inserted language requiring the creation of a National Aging 
Information Center. Among the requirements for the Center is the 
collection of information, biennially, on the functions, staffing 
patterns and funding sources of state agencies and area agencies on 
aging.

Framing a Strategy for Future Reporting

    Three specific goals have guided the development of the SPR. They 
respond to the basic mandates raised by Congress, the information needs 
of AoA and capacities of the Aging Network to meet federal reporting 
requirements. The goals are:
    1. Integrate performance data for Older Americans Act programs into 
a broader information acquisition and analysis framework to be 
developed and supported by AoA. AoA is developing a three-pronged 
information framework which will include: 1) performance data on OAA 
funded programs; 2) data on the broader infrastructure of state 
administered home and community based services for the elderly; and, 3) 
data on the needs and unmet needs of the elderly population.
    2. Improve accuracy and quality of information being reported. This 
is being accomplished by introducing standard definitions/nomenclature 
and the requirement of client registration for selected services. Both 
steps are designed to address basic concerns raised by Congress about 
the quality of past performance data submitted by AoA.
    3. Focus and expanded the collection of data on clients and their 
characteristics in ways which help AoA determine if basic targeting 
provisions of the Act are being met. Additional data on clients are now 
required for nine services requiring client registration. These 
additional data items are designed to give Congress, AoA and the rest 
of the Aging Network a clearer picture of persons being helped by a 
core set of home and community based services. Statistical reporting 
priorities include:
     Low income status of persons served (to be defined in the 
SPR as persons with incomes at or below poverty).
     Minority status of persons served.
     Frailty status of persons served--defined in the Older 
Americans Act as individuals unable to perform at least two activities 
of daily living (ADL) with substantial human assistance or due to a 
cognitive or mental impairment. (Note, the Act allows states the option 
of defining frailty based on impairments in at least three activities 
of daily living).
    Because of the Congressional requirement for information on the 
frailty status of persons served, AoA now requires the determination of 
ADL (activities of daily living) status and IADL (instrumental 
activities of daily living) status for clients of six services.
    While the scope and procedures for reporting has been expanded and 
strengthened, it must be reiterated that clients may freely refuse to 
provide the requested information and still participate in the program 
or receive a needed service without restriction. Specifically, while 
information is requested on the number of persons whose income is at or 
below the poverty threshold, the Older Americans Act bars means 
testing. In no way has the eligibility or participation requirements of 
the Act been changed. The new SPR procedures make allowances for 
clients' refusal to provide selected information.
    An incremental approach to upgrading reporting capacities has been 
adopted. In FY94, states will use the current SPR and follow the 
current data collection guidelines. Beginning in FY95, selected data 
elements of the new SPR will be implemented, such as information on 
developmental accomplishments and a profile of state unit on aging and 
area agency on aging staffing. In FY96 client registration for nine 
services will be required along with specific counts of unduplicated 
clients served for each of the nine services requiring client 
registration. In FY97 nutrition risk screening for congregate meals 
will be required along with information on new clients served.
    Key features of the revised SPR include the following:
    Adoption of Uniform Definitions and Nomenclature--After extensive 
consultation, AoA has identified fourteen services which will be the 
focus of annual reporting. There are standard nomenclature and 
definitions for all fourteen services. They are organized into 3 
clusters, each with distinctive reporting requirements:
    Cluster 1--Requies client registration and collection of an 
expanded set of client characteristics information, notably information 
on the ADL and IADL status. Services in this cluster include:

1. Personal Care
2. Homemaker
3. Chore
4. Home Delivered Meals
5. Adult Day Care/Health
6. Case Management

    Cluster 2--Requires client registration and collection of basically 
the same information at cluster 1 services except for ADL and IADL 
status. Services in this cluster include:

7. Congregate Meals
8. Nutrition Counseling
9. Assisted Transportation

    Cluster 3--Requries collection of information on units of services, 
expenditures and providers, but does not require client registration or 
a profile of client characteristics. The services in this cluster are:

10. Transportation
11. Legal Assistance
12. Nutrition Education
13. Information and Assistance
14. Outreach
    As can be seen, the level and type of information to be collected 
on the services varies by cluster. More client information is required 
on the services in the first cluster, less on the services in the 
second cluster and very limited information on the services in the last 
cluster.
    For all other services supported by the OAA, summary expenditure 
information is required. State units may optionally provide information 
on each of the ``other'' services related to the mission/purposes of 
the service, service expenditures, estimated unduplicated persons 
served and service units. See Section IV. of the SPR.
    Participant Identification and Description System--For nine of the 
fourteen services included in the new SPR performance report format, 
client registration is required. It should be noted that states are 
still required to make estimates of clients served through services 
where client registration is not required.
    In the client registration process, it is expected that clients 
will be assigned a unique client identification number. For registered 
clients, a uniform set of data on client characteristics will be 
collected, either at intake or some time during the course of the year. 
Area agencies must be able to aggregate client data across providers, 
by service, to produce unduplicated client counts and an accurate 
profile of the characteristics of the registered clients.
    The use of a master client registry does not mean state and area 
agencies will need to implement a full scale client tracking system. In 
client tracking systems, clients are uniquely identified and service 
utilization data are routinely linked or assigned to individual 
clients. Under the new SPR data collection procedures, neither service 
providers nor area agencies on aging will be required to track units of 
service by individual client. However, area agencies on aging will need 
to maintain a master client registry which is a list of client names 
accompanied by a unique client identifier, a set of descriptive 
information on their characteristics and a list of what services the 
client is currently receiving. In most cases, a computerized client 
index or registry will be required in order to generate the required 
PSA level data subsequently compiled into the annual SPR by the state 
unit on aging.
    While area agencies are likely to require computer capacities to 
maintain the client registry, it is assumed that providers without 
computers can meet the SPR requirements through manual data collection 
procedures. However, in such case, area agencies on aging will need to 
develop the capacity to enter client data into a client registry and 
assist providers determine if new clients are already registered.
    Standardized Data Collection Procedures--AoA has tried to balance 
the Congressional mandate for standardized data collection procedures 
with the need to provide the National Network on Aging flexibility in 
the reporting systems used to collect data. AoA encourages states to 
refine or modify existing reporting systems to comply with the new 
requirements, where appropriate. To assure standardization across 
states, AoA will require the following:
     The requirement for client registration for selected 
services.
    Standardization of information describing the 
characteristics of clients served for nine services related to:

--Age, sex, race/ethnicity
--Income status/rural status/living alone

     For a subset of the nine services requiring registration, 
the requirement for collection of additional information on:

--ADL/IADL Status
--Nutritional risk status

    State units on aging will have considerable flexibility in setting 
up these procedures and methods for data collection. As feasible, AoA 
will make resources available to assist SUAs and AAAs in meeting the 
reporting specifications.

Testing

    The proposed changes in the SPR requirements will be phased in. For 
FY94, states will submit performance data using the current SPR. For 
FY95, states will implement those elements of the new reporting 
guidelines, which are either the same as the old requirements or a 
relatively small change. For FY96, states will be asked to implement a 
client registration process and, through client registration, collect 
additional information on clients of nine selected services. In FY97, 
two additional date elements will be added.
    The introduction of client registration data and the collection of 
additional data on client characteristics in FY96 represent the largest 
change in requirements. Congress requires a test of the proposed 
reporting requirements and a report to Congress not later than 1 year 
after developing the data collection procedures.
    The test of the new SPR requirements will occur in FY95, focusing 
on the new requirements for registration and data on client 
characteristics. Two basic questions will be addressed in the test: 1) 
the feasibility of collection of the data elements to be included in 
the SPR, focusing on client related data; and 2) the implementation 
tasks and timetable for implementing reporting systems which can 
satisfy the SPR requirements.
    AoA will seek out, through an open solicitation process, a total of 
six states to test the SPR requirements in FY95. The six pilot states 
will represent a cross-section of state characteristics, reflecting 
variations in the size of the program, number of area agencies on aging 
in place (including at least one single PSA state), existing reporting 
system capacities, geographic diversity and the breadth of services and 
clients supported by OAA funding.
    Three of the six test states will be selected based on their 
capacities to implement all elements of the SPR data requirements in 
FY95. Specifically, they must be able to test the introduction of 
client registration and the collection of descriptive information on 
clients served which complies with SPR specifications.
    The other three test states will be selected because they do not 
have reporting systems in place currently responsive to the requirement 
of client registration and reporting data on client characteristics. 
AoA will follow the progress of these states in terms of implementation 
planning, reporting systems development and training of the Aging 
Network to meet the SPR requirements. The experience of these states 
will help AoA determine how states are preparing to meet the FY96 
reporting requirements in the context of their other responsibilities.
    Participating sites will be asked to designate a state unit on 
aging staff member to serve as a liaison between the state and AoA. An 
initial baseline profile will be established for each of the six test 
states, at the beginning of FY95. AoA will review the progress in each 
test state on a bi-monthly basis, by phone and possibly teleconferences 
with all six test sites including information on the reporting system 
design which emerges, implementation tasks and timetables, how the SPR 
requirements were introduced to the Aging Network within the state, and 
what issues/difficulties arose in building the reporting systems 
required to meet the SPR specifications. In all six states, input will 
be sought from state unit on aging staff and selected staff from area 
agencies on aging an provider personnel on SPR implementation issues.
    In April-May, 1995, AoA will compile the experiences of the test 
sites to use a basis for reporting to Congress and finalizing the 
reporting requirements scheduled to go into effect in FY96. Any 
revisions to the reporting requirements will be made by June 30, 1995 
with states notified of the changes at that time. It should be 
indicated that AoA will not introduce any new data elements in FY96 or 
FY97 as a result of the testing process. There will be insufficient 
time for states to incorporate any such additions and still comply with 
the FY96 timetable for SPR reporting.

Use of SPR Data

    Right now, AoA finds it difficult to meaningfully analyze 
performance of OAA programs relative to fundamental mandates of the 
Older Americans Act. The data currently being collected are too limited 
and inaccurate. For example, the Older Americans Act provides clear 
guidance on targeting services to older individuals in greatest social 
need, including such conditions as physical and mental disabilities, 
and cultural, social, or geographic isolation, with particular 
attention to low income minority older individuals. In the absence of 
specific, accurate descriptive information on clients, AoA cannot 
determine if this fundamental Congressional mandate is being met. By 
requiring additional descriptive information on clients served through 
selected services. AoA will be better able to determine when the basic 
targeting provisions are being met. Additional client data will also 
allow AoA to sharpen its program policies, target technical assistance 
efforts and help shape future discretionary grant programs.
    With the added emphasis on greater accountability for the use of 
federal funds, AoA is now required to include performance indicators as 
part of the AoA budget justification for the annual budget 
appropriation for aging programs administered by AoA. Reliable, 
accurate performance data is proving to be increasingly important to 
AoA in acting as an advocate for aging programs and services and the 
critical role of the National Network on Aging.
    In 1993 Congress passed the Government Performance and Results Act 
(GPRA) which calls for the federal government to establish strategic 
planning and performance measurement in the federal government. By 
1997, departments must prepare and transmit to the Office of Management 
and Budget a strategic plan for program activities. Performance plans 
will be required for specific program activities. Where possible, the 
plans will include performance measures to be used in measuring or 
assessing the relevant outputs, service levels, and outcomes of each 
program activity; provide a basis for comparing actual program results 
with established performance goals; and describe the means to be used 
to verify and validate measured values.
    AoA has been designated as one of the agencies to test these new 
requirements. To comply with GPRA, AoA must begin now to transform its 
internal capacities to plan and assess program performance. That means 
a new data base capacity must be developed in AoA to collect and 
analyze a diverse array of data. Considering the GPRA requirements and 
AoA's national leadership role on aging issues, the Administration on 
Aging must be able to collect and analyze data responsive to three 
basic AoA responsibilities:
    1. Assuring Compliance With the Older Americans Act--For example:
     What services/activities were supported and how many 
service units were provided?
     What level of expenditures were incurred?
     What type of clients were served and how many, focusing on 
target populations cited by the Older Americans Act?
     Did the Network comply with the assurances required in the 
State Plan by the Older Americans Act?
    2. Strategic Planning and Performance/Results Oriented Management--
For example:
     How did actual performance comply with planned 
performance?
     Was the Network effective in meeting targeting priorities?
     Were the services of acceptable quality?
     Did the Network serve clients cost effectively?
    3. Ongoing Advocacy and Program Development--For example:
     Do the Network programs, supported in whole or part, make 
a difference in clients' lives?
     How are client needs changing?
     To what extent is the Network keeping up with unmet needs?
     Which needs and services will become future priorities?
    Over time the SPR must be able to supply accurate data which can be 
used to help respond to the basic questions in all three areas of 
responsibility. In the near term, the SPR will become an important 
vehicle for collecting performance data pertinent to basic compliance 
and results oriented management questions. In its current form, the SPR 
does not include information on clearly defined outcomes or results. 
However, the new SPR requirements represent the first step toward 
building improved data to support AoA strategic planning and advocacy. 
Accurate information on clients, units and expenditures for selected 
services is considered by AoA to be the first building block toward a 
results oriented approach to strategic planning and performance 
measurement at the federal and state level of the Aging Network.

Summary

    The new SPR to be implemented in FY95 provides a vehicle for 
improving the accuracy and utility of performance data submitted by 
SUAs. The new requirements are designed to focus reporting on selected 
clients and services and obtain accurate, complete information about 
these clients and services. Through the issuance of the new SPR, AoA is 
embarking on a multi-year effort designed to enhance the capacities of 
the National Network on Aging and AoA to effectively use performance 
data in support of compliance, management and advocacy 
responsibilities. AoA is committed to building its own analytic 
capacities in ways which will assure the submitted SPR data will be put 
to good use. New data bases are being designed by AoA to process the 
data. At the same time, AoA is designing related data bases which will 
be compatible with the SPR data sets and also provide a broader 
information framework for review of OAA supported programs and 
services.

BILLING CODE 4150-04-M

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BILLING CODE 4150-04-C

Instructions for Completion of the Annual State Performance Report

General Instructions

    Development and submission of the Annual State Performance Report 
(SPR) by state units on aging in compliance with the provisions of the 
Older Americans Act (OAA) should be guided by the following provisions:
    Submission Date--The new SPR will be due November 30 of the federal 
fiscal year, beginning November 30, 1995.
    FY95 Phase-in--Delays in gaining approval of the reporting 
requirements means that states are not likely to have the final 
reporting requirements in hand until after FY95 has begun. For that 
reason, AoA is prepared to accept, for FY95, estimated performance data 
based on implementation of new data collection and reporting procedures 
for a portion of FY95, for example, six months, four months, etc.
    As background to implementation planning, it is important to 
remember that many of the new SPR data elements will require 
implementation of data collection and reporting procedures in FY95. The 
following data elements must be reported for FY95:
     Estimate of the total unduplicated clients served through 
Title III and VII.
     Number of providers (and minority providers) for fourteen 
listed service categories.
     Number of AAAs directly providing each of the fourteen 
listed service categories.
     Number of persons estimated to have been served for each 
of nine registered services.
     Number of service units for each of fourteen listed 
services.
     Title III and VII expenditures by service and also by 
part, for Title III, plus program income data.
     Developmental accomplishments--home and community based 
programs plus elder rights.
     Focal point/senior center profile data.
     SUA and AAA staffing profile data.
    For FY95, AoA is deferring submission, except on a voluntary basis, 
of the following data elements:
     Unduplicated client counts broken down for registered 
services versus services which did not require registration (See SPR 
Section I.)
     Client characteristics associated with the unduplicated 
client counts for registered and unregistered services (See SPR Section 
I.)
     Counts of new persons served (See SPR Section II.A.)
     Breakdown of registered clients for services in cluster 1 
by client characteristic (See SPR Section II.B.)
     Breakdown of registered clients for services in cluster 2 
by client characteristic (See SPR Section II.C.)
     Count of persons served at high nutritional risk (See SPR 
Section II.A.)
    Transmittal--SUAs should submit the SPR data, on diskette, using 
the data entry and file creation software provided by AoA. 
Alternatively, SUAs may generate the required transmittal files using 
their own applications software in conjunction with the standardized 
file transmittal specifications developed by the Administration on 
Aging. File transmittal specifications are provided in Appendix II for 
states electing to develop the data files using their own systems 
software.
    Level of Reporting--Performance data will be reported for the state 
as a whole. The only exception is the requirement for a staffing 
profile for each area agency on aging.
    Scope of Reporting--The revised SPR is designed to provide 
information on all clients, service units and expenditures for services 
which are funded in whole or in part by Older Americans Act funding. 
Include performance data (clients, providers, units of service, program 
income etc.) related to the service as a ``whole'', even if the OAA 
funding is one of several funding sources used to support the service. 
This is based on the assumption that all the units of service and 
persons served etc. are attributable to the presence of the OAA 
funding.

Instructions for Completion of Individual Sections of the SPR

Completion of Section I: Estimated Unduplicated Count of Clients 
Served

    Section I of the SPR is designed to provide a summary profile of 
the clients served, through programs funded, in whole or in part, by 
the Older Americans Act. There are two parts to Section I: (A) 
Unduplicated Client Count By Type of Service; and (B) Unduplicated 
Client Count By Characteristic.

Section I.A. Unduplicated Client Count by Type of Service

    In Section I.A., enter summary counts of the unduplicated persons 
served through programs supported by Older Americans Act funding. To 
increase the reliability and validity of these unduplicated counts, 
three separate counts should be furnished: (1) Unduplicated counts of 
persons receiving services where client registration is required (not 
required until FY96); (2) an estimate of unduplicated clients receiving 
non registered services (not required until FY96); and (3) an estimate 
of the total clients receiving services, which takes into account the 
two counts/estimates of clients served which are entered on lines 1 and 
2.
    Line 1--Enter the unduplicated count of persons served for the 
first nine services listed in Section II.A. (cluster 1 and 2 services). 
It is expected the count of unduplicated clients for the nine services 
requiring client registration will be very accurate. The counts entered 
in line 1 should correspond with the unduplicated client count, across 
the nine registered services.
    Line 2--Enter a best estimate of unduplicated persons served 
through transportation, legal assistance, nutrition education, 
information and referral and outreach plus all other services which are 
supported by OAA Title III and VII funds.
    Line 3--Enter a best estimate of the total unduplicated persons 
served in the state through OAA supported programs. There will, in all 
likelihood, be an overlap of clients included in lines 1 and 2. A 
single client may receive a registered service(s) and also be assisted 
through unregistered services. As a result, line 3 is not simply a sum 
of lines 1 and 2.

Section I.B. Summary Estimate by Selected Client Characteristics

    In Part B. show the characteristics of the persons served. The 
breakdown of data of client characteristics, by registered services and 
other services, will not be required until FY96.

[Note: see Appendix I for definitions of the client descriptors used in 
this section of the SPR.]

Completion of Section II: Utilization Profile

    Servie utilization will be examined in several ways. The focus is 
on units of service and clients served. Three different sections are 
included in the utilization profile. See Sections II.A., B. and C.

Section II.A. Service Utilization

    Section II.A. should be completed using the following guidelines.
    (1) Provide utilization data for any or all of the 14 listed 
services, for which OAA Title III and Title VII funds were used to 
support services provision.
    Many states may need to develop a cross-walk between the service 
names used for in-state reporting and those used in the SPR. For 
example, if a service called Home Aide II is funded in the state which, 
in practice, matches the definition of Personal Care [See Appendix I 
Service Definitions], then report the performance data for Home Aide II 
as Personal Care. Feel free to send AoA any explanations which clarify 
how services funded in the state relate to the SPR listed services.

[Note: some states support what is called respite care. Where possible, 
include respite care data in the service category which best defines 
what type of respite is typically provided; for example, personal care, 
adult day care, homemaker/chore services, etc.]

    (2) Include performance data related for the service ``as a 
whole'', even if the OAA Title III and VII funding is one of several 
funding sources used to support the service. For example, document all 
service units provided and clients served by a service provider, even 
if the OAA funds only 25% of the total cost of the service. Treat OAA 
Title V and Title VI funding as other sources of funding in the SPR.
    The fourteen services listed in Section II.A. are organized into 
three clusters. [Note: see Appendix I for service definitions for these 
fourteen services.] Each cluster has distinctive reporting 
requirements.

Cluster 1: Registered Services Requiring Detailed Client Profile

    All six services included in cluster 1 require registration of 
clients. For each service, provide the following information:
    Total Number of Providers--Enter a count of the number of providers 
who provide each listed service in the state using OAA Title III or 
Title VII funding, in whole or part. If an area agency on aging (AAA) 
provides the service directly, include the AAA in the count of 
providers.
    Also provide the unduplicated number of providers supported with 
OAA funding across all fourteen services, taking into account that 
provider organizations are likely to provide multiple services.
    Number of Minority Providers--Of the total providers listed in the 
first column, identify how many are minority organizations. [See 
Appendix I, for a definition of a minority provider.]
    # of AAAs Direct Services Provision--Enter the number of AAAs 
providing each listed service directly, using AAA paid and/or volunteer 
personnel.
    Total Unduplicated Persons Served--Provide an unduplicated count of 
persons served in the state. The total count should include all persons 
served during the course of the year, regardless of how many services 
units individual clients receive.
    Provide an unduplicated count of persons served, across the nine 
registered services. See the box below the Cluster 2 services on 
Section II.A.. Beginning no later than FY96, the count of unduplicated 
persons served should be based upon the use of a master client registry 
of persons served through the nine registered services in each PSA or 
the state as a whole. The registry will, in most states, be maintained 
by area agencies on aging (or SUAs in single PSA states).
    New Persons Served This Year--By service, identify how many persons 
were newly registered for the service during the course of the year. 
Also, provide an unduplicated count of persons served, across the nine 
registered services. See the box below the Cluster 2 services on 
Section II.A.

[Note: a ``new client'' is any client who has never been previously 
registered as a client for the service, either in the current fiscal 
year or a prior fiscal year by any provider funded with Older Americans 
Act funds.]

    This data item is designed to help AoA learn more about the extent 
of client turnover. Submission of data on new clients will not be 
required to be reported until FY97. Voluntary reporting prior to that 
point is encouraged.
    The count of new persons served should be based upon the use of a 
master client registry of persons served through the nine registered 
services.
    # of Persons Served-At High Nutritional Risk--For four listed 
services [home delivered meals, case management, congregate meals and 
nutrition counseling], identify the unduplicated number of persons 
served who were determined to be at high nutritional risk. To assure 
uniformity of the responses, please use the Nutrition Screening 
Checklist. High nutritional risk is defined as a score of 6 or higher 
using the Checklist. See Appendix III for the checklist and related 
instructions.
    Provision of information on clients who are at high nutritional 
risk will be required for home delivered meals, nutrition counseling 
and case management services beginning in FY96 and in FY97 for 
congregate meals.
    Total Service Units--Enter a total count of service units provided 
during the year. If there are multiple service providers for the same 
service, the total is a sum of the service units provided by all 
providers to all clients. Report all service units, even if the OAA 
funding and related match funds are not the exclusive source of funding 
for the provider.

[Note: in the case of meals, enter the number of USDA eligible meals.]

Cluster 2. Registered Services Requiring Summary Client Profile

    For services 7-9 on Section II.A., please follow the same 
directions provided for Cluster 1 services.

Cluster 3. Non-Registered Services

    For cluster 3 services, AoA is requesting a more limited set of 
data: 1) an unduplicated count of providers; 2) a count of minority 
providers; 3) the number of AAAs directly providing the service; and 4) 
a count of service units. For these services, it is difficult or 
inappropriate to require client registration. As a result, the 
provision of client specific information is not required for cluster 3 
services.

Section II.B. Detailed Client Profile for Registered Services (1-6)

    For the six services in cluster 1, the SPR requires a ``detailed'' 
profile of client characteristics. The profile is a breakdown of the 
unduplicated count of persons served (by service) by client 
characteristics. The six services requiring a detailed client profile 
are:

1. Personal Care
2. Homemaker
3. Chore
4. Home Delivered Meals
5. Social Adult Day Care/Adult Day Health
6. Case Management

    Required data elements include:
     Minority status, by individual minority group.
     Age group.
     ADL/IADL status.
     Sex.
     Rural.
     Live alone.
     Poverty status.
    To complete Section II.B., the following guidelines apply:
    1. Section II.B. Should be completed for each of the six services 
requiring a detailed client profile.
    2. For each cluster 1 service, identify how many persons in each of 
five racial/ethnic groups were served:
     African American.
     Hispanic.
     American Indian/Native Alaskan.
     Asian/Pacific Islander.
     Non-Minority.
    A separate profile will be developed for each racial/ethnic group, 
whose members were served. The transmittal guidelines provide for a -9 
code for records where the racial/ethnic status of the client is 
missing.
    3. Provide for each minority group a count of total clients and 
total clients in poverty.

[Note: the profile of Non-Poverty Clients will be computed using the 
counts for Total Clients and Total Clients In Poverty.]

    4. Within the Total Clients category and Total Clients in Poverty 
category for each racial/ethnic group, provide a breakdown by age and 
ADL status; then document how many persons in each age/ADL sub-group 
have no IADLS, 1IADL, 2IADLs etc., how many persons were female or 
male, how many live in rural areas and how many live alone.
    Remember, a separate record is prepared for each minority group 
served for each of the six services.
    5. Document missing data. Indicate for each client data element how 
many client records, by minority group, which do not contain a valid 
response for the data element, either because of data collection 
problems or the client refused to provide the required information. See 
Section II.B. Missing Information By Data Element for the client data 
elements for which a count of missing data is sought. Note that the 
counts for missing data are specific to Total Clients and Total Clients 
In Poverty.
    In the transmittal guidelines, the data files make provision for 
reporting the counts of client records with missing data elements. See 
Appendix II.

Section II.C. Summary Client Profile for Other Registered Services

    A summary client profile is required for three services--congregate 
meals, nutrition counseling and assisted transportation. The client 
characteristics to be documented for these services include:
     Minority status.
     Age group.
     Sex.
     Rural.
     Live alone.
     Poverty status.
    The following guidelines should be used for completion of this 
Section:
    1. For each Cluster 2 service supported with OAA Title III and/or 
VII funds, identify, by individual racial/ethnic group, the total 
number of persons served by each of four age groups. Then, for each age 
group total, indicate how many of the total clients are female or male, 
live in rural areas and how many live alone.
    2. Provide a comparable profile as developed for Total Clients for 
Clients In Poverty.
    3. Document missing data. Follow the same procedures as described 
for Section II.B. above.

Completion of Section III. Service Expenditures Profile

    Section III calls for OAA expenditure data by service and Title III 
Part and Title VII Chapter. Fourteen services are highlighted for data 
collection and analysis. In addition, this section calls for summary 
expenditure data on the other services supported with OAA funding.
    The information to be reported is organized into two segments: A) 
Title III Expenditures by Part and Service and B) Title VII 
Expenditures By Chapter. Guidelines for completion of each segment are 
provided below:

Section III.A. Title Expenditures by Part and Service

    Section III.A. is organized by service and Title III part. All 
Title III parts included in the Act are listed. The columns for Title 
III Parts currently without an appropriation are shaded. No data should 
be entered in the shaded columns. To complete this portion of Section 
III, please follow these guidelines:
    (1) Complete this Section for the fourteen listed services and the 
total of ``other'' services supported by OAA funds.
    (2) Enter the appropriate data on the following information items 
for the fourteen listed services.
    Total Title III Expenditure--Enter the total amount of Title III 
expenditures for the service in the state. Do not include match in this 
total, only the federal portion.

[Note, Total Title III expenditures are defined as ``outlays/payments 
made by the AAA or SUA using OAA Title III funds in the form of an 
advance or a reimbursement for a payment request submitted by a 
provider for the service.]

    Percent of Total Service Expenditure--Indicate the percent of total 
service expenditures represented by or attributable to OAA Title III 
federal funding.

    Note: Total Service Expenditures are defined as expenditures for 
the service ``contractually linked'' to Title III funds through an 
award of funds (contract or grant) which includes federal OAA Title 
III funds. When other funding sources and amounts are included in 
the award, including Title VII funding, then the total expenditures 
attributable to the multiple sources of funding should be reported. 
Other sources of funding which may be linked to the OAA funding are 
match resources, overmatch, program income or other federal and 
state program funds.

    Total Program Income--Enter the estimate of total program income 
derived as a result of service provision.
    OAA Title III Expenditures By Part--Allocate the OAA Title III 
expenditures by Title III Part. This should be based on fund accounting 
data or an allocation algorithm in states where OAA funds are bundled 
and awarded across Title III parts or bundled with other funding 
sources.
    (3) Provide, on line 15, summary data on the aggregate of 
expenditures for other services supported with OAA Title III funds.

Section III.B. Title VII Expenditure Summary

    In Part B. please report total Title VII expenditures, exclusive of 
match, by individual chapter. Also, indicate how much of the total 
service expenditures for the Title VII services were covered by Title 
VII funding. See the definition of total service expenditures cited 
above. Include any Title III expenditures used for the Title VII 
supported services (federal and match) as part of the total service 
expenditure.

[Note, for Chapter 4, there is no OAA appropriation at this time, so 
this box is shaded out. Do not enter any expenditure data in this box.]

Completion of Section IV. Other Services Profile (Optional)

    In Section IV. state units on aging, at their option, may provide 
descriptive information on other services supported by the OAA.
    For each ``other'' service, SUAs are asked to provide a service 
name (up to 30 characters), service unit name (up to 15 characters), 
identify the purpose/mission of the service, total Title III 
expenditures for the year, the percent of total service expenditures 
represented by OAA Title III and Title VII funding, as well as an 
estimate of persons served (unduplicated) and service units.
    If other services are individually reported in this Section, please 
complete all data elements. Note: do not include ombudsman as an other 
service. A separate set of reporting requirements have been developed 
for the long term care ombudsman program.
    To identify the mission or purpose of the service, use one code (A-
F) from the list below which best fits the purpose of the service.

A. Services Which Address Functional Limitations
B. Services Which Maintain Health
C. Services Which Protect Elder Rights
D. Services Which Promote Socialization/Participation
E. Services Which Assure Access and Coordination
F. Services Which Support Other Goals and Purposes

    When assigning the services to the mission/purpose categories, 
consider the following ``other'' services as potentially falling in 
each mission/purpose category:

A. Services Which Address Functional Limitations

     Home Modification.
     Home Repair.
     Alternative Living Arrangements/Supportive services.

B. Services Which Maintain Health

     Medical Alert.
     Health Screening.
     Exercise/Physical Fitness.
     Wellness.

C. Services Which Protect Elder Rights

     Adult Protective Services, Guardianship.
     Consumer Protection Services.
     Crime Prevention Services.
     Protective Payee Services.

D. Services Which Promote Socialization/Participation

     Recreation.
     Friendly Visiting.
     Telephone Reassurance.
     Letter Writing.
     Interpreting/Translation.
     Volunteer Development/Opportunities.

E. Services Which Assure Access and Coordination

     Counseling.
     Screening.
     Geriatric assessment.
     Home or Roommate Matching.
     Placement services.

F. Services Which Support Other Goals/Outcomes

     Employment Assistance.
     Utility Assistance.
     Financial Assistance/Material Aid (including discounts).

Completion of Section V. Developmental Accomplishments

    This section of the SPR is designed to provide a narrative summary 
of developmental accomplishments in the state by the SUA and/or AAAs in 
two areas: 1) development of home and community based programs (Section 
V.A.) and 2) development of system of elder rights (Section V.B.).
    Guidelines for completion of these two sub-sections are as follows:

Section V.A. Developmental Accomplishments for Home and Community Based 
Programs

    State units on aging are requested to identify and describe three 
key accomplishments during the year which enhanced the array of home 
and community based services which meet the health and long term care 
needs of non-institutionalized older persons.
    1. In each of the three accomplishment narratives, describe the 
result, the potential impact on older persons, the process/steps 
followed and what organization(s) were primarily responsible for the 
accomplishment.
    2. For each accomplishment, identify the type of development 
activities which were undertaken. Use one or more of the following 
development type codes and place the codes at the conclusion of each 
accomplishment narrative:

a. Public education/awareness
b. Resource development
c. Training/education
d. Research and development
e. Policy development
f. Legislative development
g. Other

Section V.B. Developmental Accomplishments for a System of Elder Rights

    Follow the same guidelines as outlined in Section V.A.

Completion of Section VI. Profile of Community Focal Points and Senior 
Centers

    This section is used to document the status of focal point 
designations and the use of senior centers by the National Network on 
Aging. The data elements are self-explanatory.

Completion of Section VII. Staffing Profile

    In Section VII, two staffing profiles are required, one for the 
state unit on aging and one for each area agency on aging. Guidelines 
for completion of each profile are provided below:

Section VII.A. State Unit on Aging

    To complete this section, follow these steps:
    1. Categorize all paid SUA staff by the categories listed on lines 
1-3. The definitions for each personnel category are provided in 
Appendix I.
    2. Develop the staffing profile based on a snapshot taken on any 
given day during the fiscal year. The SUA should select what day(s) 
during the year is appropriate.
    3. Determine the total number of full time equivalents (FTEs) for 
each position category. The number of FTEs should reflect filled or 
staffed positions at the time of the survey. Do not include authorized 
but unfilled positions. Add the FTE totals for lines 1, 2 and 3 to 
create an agency total in line 4.

[Note, full time equivalents (FTEs) should be based on a state 
definition of what constitutes a full time employee.]

    4. For each personnel category, identify how many FTEs are filled 
by minority staff. Enter this number in the column titled (Number of 
Minority FTEs).
    5. Identify, by personnel category, how many FTEs are paid for, in 
full or in part, using OAA funds.

Section VII.B. Area Agency on Aging

    Follow the same guidelines as outlined for Section VII.A. Make sure 
Section VII.B. is completed for each area agency on aging in the state.

[Note: this section includes a count of the volunteers who assist the 
area agency in carrying out its responsibilities either in direct 
service provision or any of its planning, development, administration, 
access/care coordination roles. Include volunteers in the count of 
Total AAA staff on line 5.]

Summary

    Remember the SPR data will be transmitted electronically, The 
specifications for the data files to be sent by SUAs to AoA are 
included in Appendix II to this document. These transmittal guidelines 
take precedence over the SPR forms as a basis for actually submitting 
the performance data to AoA.
    Remember, the ombudsman annual report is submitted separately, 
using a special report format and set of instructions.

Appendix I. Definitions

    The following definitions should be used when completing the SPR.

A. Client Descriptors

    1. Minority Status--Minority older persons are confined to the 
following designations:
     African American, Not of Hispanic Origin--A person having 
origins in any of the black racial groups of Africa.
     Hispanic Origin--A person of Mexican, Puerto Rican, Cuban, 
Central or South American or other Spanish culture or origin, 
regardless of race.
     American Indian or Alaskan Native--A person having origins 
in any of the original peoples of North America, and who maintain 
cultural identification through tribal affiliation or community 
recognition.
     Asian American/Pacific Islander--A person having origins 
in any of the original peoples of the Far East, Southeast Asia, the 
Indian Subcontinent, or the Pacific Islands. This area includes, for 
example, China, Japan, Korea, the Philippine Islands, Samoa and the 
Hawaiian Islands.
     Non-Minority--Any person who is not considered a minority.
    2. Activities of Daily Living--States may use their own definition 
of activities of daily living (ADL) when reporting the number of ADL 
impairments. AoA will continue to explore options for a standard 
definition of ADLs working with the Aging Network and other federal 
agencies. If long term care reform occurs, any definitions of 
disability used for eligibility determination will be considered in 
framing a standardized definition of ADLs.
    3. Instrumental Activities of Daily Living--States may use their 
own definition of instrumental activities of daily living (IADL) when 
reporting the number of IADL impairments. AoA will continue to explore 
options for a standard definition of IADLs working with the Aging 
Network and other federal agencies.
    4. Poverty--Persons considered to be in poverty are those whose 
income is at or below the official poverty guideline (as defined each 
year by the Office of Management and Budget, and adjusted by the 
Secretary (DHHS) in accordance with subsection 673(2) of the Community 
Services Block Grant Act (42 U.S.C. 9902(2)).
    5. Living alone--A one person household (using the Census 
definition of household) where the householder lives by his or herself 
in an owned or rented place of residence in an non-institutional 
setting, including board and care facilities, assisted living units and 
group homes.

B. Service Definitions

    Standardized names, definitions, and service units are provided for 
the fourteen services which are singled out in the SPR for reporting.
    1. Personal Care (1 Hour)--Providing personal assistance, stand-by 
assistance, supervision or cues for persons having difficulties with 
one or more of the following activities of daily living: eating, 
dressing, bathing, toileting, and transferring in and out of bed.
    2. Homemaker (1 Hour)--Providing assistance to persons having 
difficulty with one or more of the following instrumental activities of 
daily living: preparing meals, shopping for personal items, managing 
money, using the telephone or doing light housework.
    3. Chore (1 Hour)--Providing assistance to persons having 
difficulty with one or more of the following instrumental activities of 
daily living: heavy housework, yard work or sidewalk maintenance.
    4. Home Delivered Meals (1 Meal)--Provision, to an eligible client 
or other eligible participant at the client's place of residence, a 
meal which:
    (a) complies with the Dietary Guidelines for Americans (published 
by the Secretaries of the Department of Health and Human Services and 
the United States Department of Agriculture;
    (b) provides, if one meal is served, a minimum of 33 and \1/3\ 
percent of the current daily Recommended Dietary Allowances (RDA) as 
established by the Food and Nutrition Board of the National Research 
Council of the National Academy of Sciences;
    (c) provide, if two meals are served, together, a minimum of 66 and 
\2/3\ percent of the current daily RDA; although there is no 
requirement regarding the percentage of the current daily RDA which an 
individual meal must provide, a second meal shall be balanced and 
proportional in calories and nutrients; and,
    (d) provides, if three meals are served, together, 100 percent of 
the current daily RDA; although there is no requirement regarding the 
percentage of the current daily RDA which an individual meal must 
provide, a second and third meals shall be balanced and proportional in 
calories and nutrients.
    5. Adult Day Care/Adult Day Health (1 hour)--Provision of personal 
care for dependent adults in a supervised, protective, congregate 
setting during some portion of a twenty-four hour day. Services offered 
in conjunction of adult day care/adult health typically include social 
and recreational activities, training, counseling, meals for adult day 
care and services such as rehabilitation, medications assistance and 
home health aid services for adult day health.
    6. Case Management (1 Case)--Assistance either in the form of 
access or care coordination in circumstances where the older person 
and/or their caregivers are experiencing diminished functioning 
capacities, personal conditions or other characteristics which require 
the provision of services by formal service providers. Activities of 
case management include assessing needs, developing care plans, 
authorizing services, arranging services, coordinating the provision of 
services among providers, follow-up and reassessment, as required.
    7. Congregate Meals (1 Meal)--Provision, to an eligible client or 
other eligible participant at a nutrition site, senior center or some 
other congregate setting, a meal which:
    (a) complies with the Dietary Guidelines for Americans (published 
by the Secretaries of the Department of Health and Human Services and 
the United States Department of Agriculture;
    (b) provides, if one meal is served, a minimum of 33 and \1/3\ 
percent of the current daily Recommended Dietary Allowances (RDA) as 
established by the Food and Nutrition Board of the National Research 
Council of the National Academy of Sciences;
    (c) provides, if two meals are served, together, a minimum of 66 
and \2/3\ percent of the current daily RDA; although there is no 
requirement regarding the percentage of the current daily RDA which an 
individual meal must provide, a second meal shall be balanced and 
proportional in calories and nutrients; and,
    (d) provides, if three meals are served, together, 100 percent of 
the current daily RDA; although there is no requirement regarding the 
percentage of the current daily RDA which an individual meal must 
provide, a second and third meals shall be balanced and proportional in 
calories and nutrients.
    8. Nutrition Counseling (1 Hour)--Provision of individualized 
advice and guidance to individuals, who are at nutritional risk, 
because of their health or nutritional history, dietary intake, 
medications use or chronic illnesses, about options and methods for 
improving their nutritional status, performed by a health professional 
in accordance with state law and policy.
    9. Assisted Transportation (1 One Way Trip)--Provision of 
assistance, including escort, to a person who has difficulties 
(physical or cognitive) using regular vehicular transportation.
    10. Transportation (1 One Way Trip)--Provision of a means of 
transportation for a person who requires help in going from one 
location to another, using a vehicle. Does not include any other 
activity.
    11. Legal Assistance (1 Hour)--Provision of legal advice, 
counseling and representation by an attorney or other person acting 
under the supervision of an attorney.
    12. Nutrition Education (1 Session)--A program to promote better 
health by providing accurate and culturally sensitive nutrition, 
physical fitness, or health (as it relates to nutrition) information 
and instruction to participants or participants and caregivers in a 
group or individual setting overseen by a dietitian or individual of 
comparable expertise.
    13. Information and assistance (1 Contact)--A service for older 
individuals that (A) provides the individuals with current information 
on opportunities and services available to the individuals within their 
communities, including information relating to assistive technology; 
(B) assesses the problems and capacities of the individuals; (C) links 
the individuals to the opportunities and services that are available; 
(D) to the maximum extent practicable, ensures that the individuals 
receive the services needed by the individuals, and are aware of the 
opportunities available to the individuals, by establishing adequate 
follow-up procedures.
    14. Outreach (1 Contact)--Interventions initiated by an agency or 
organization for the purpose of identifying potential clients and 
encouraging their use of existing services and benefits.

[Note: respite care services which offer temporary, substitute supports 
or living arrangements for older persons in order to provide a brief 
period of relief or rest for family members or other caregivers, should 
be assigned to the service which best matches the form of respite being 
offered--such as home health aide or personal care. If the respite care 
service is designed to offer a temporary, alternative living 
arrangement, do not assign the respite care service to any of the 
fourteen services. In SPR IV., list this activity as institutional 
respite care and also include the expenditure/resource data for this 
service as part of the total for ``other service'' in Section III.]

C. Other Definitions

    A variety of other terms are used in the SPR. Definitions for these 
terms are as follows:
    Agency Executive/Management Staff--Personnel such as SUA director, 
deputy directors, directors of key divisions and other positions which 
provide overall leadership and direction for the state agency.
    Other Paid Professional Staff--Personnel who are considered 
professional staff who are not responsible for overall agency 
management or direction setting but carry out key responsibilities or 
tasks associated with the SUA in the following areas:
     Planning--Includes such responsibilities as needs 
assessment, plan development, budgeting/resource analysis, inventory, 
standards developmental and policy analysis.
     Development--Includes such responsibilities as public 
education, resource development, training and education, research and 
development and legislative activities.
     Administration--Includes such responsibilities as bidding, 
contract negotiation, reporting, reimbursement, accounting, auditing, 
monitoring, and quality assurance.
     Access/Care Coordination--Includes such responsibilities 
as outreach, screening, assessment, case management, information and 
referral.
     Service Delivery--Includes those activities associated 
with the direct provision of a service which meets the needs of an 
individual older person and/or caregiver.
    Clerical/Support Staff--All paid personnel who provide support to 
the management and professional staff.
    Minority Provider--A business concern that (a) is at least 51 
percent owned by one or more individuals who are either an African 
American, Hispanic origin, American Indian/Native Alaskan/Native 
Hawaiian, Asian American/Pacific Islander minority or a publicly owned 
business having at least 51 percent of its stock owned by one or more 
minority individuals and (b) has its management and daily business 
controlled by one or more minority individuals.
    New Persons Served--Any client who has never been previously 
registered as a client for the service, either in the current fiscal 
year or a prior fiscal year by any provider funded with Older Americans 
Act funds.
    Total OAA Expenditures--Outlays/payments made by the AAA or SUA 
using OAA federal funds in the form of an advance or a reimbursement 
for a payment request submitted by a provider for the service.
    Percent of Total Service Expenditures--The portion of total service 
expenditures for the year which were covered by the federal portion of 
the Older Americans Act funding.
    Rural--States may use their own definition of rural until such time 
as AoA adopts, by rule, a uniform definition of rural.

Appendix II. Title III/VII SPR Transmittal Requirements

    To ensure compatibility of State Program Report (SPR) data across 
states, AoA has developed a standard set of guidelines for transmittal 
of the Title III and VII SPR data, exclusive of the LTC Ombudsman 
Program by state units on aging.
    AoA will provide software to states which will allow entry of the 
SPR data and creation of the required data files. Those states with 
their own data systems may wish to create the data files directly, 
eliminating the need to reenter summary data into the AoA software 
package. In such cases, this section of the SPR guidelines provides 
file transmittal specifications. [Note: only those states choosing to 
use their own systems software to generate the transmittal files will 
need to use the specifications outlined in this Appendix.]
    The transmittal specifications are organized around a set of data 
files to be forwarded by states using diskettes or a modem. Each 
submitted file must be in the format specified below. It must 
incorporate the codes for selected data files specified by AoA as well.

General Guidelines

    When preparing the files, please observe the following:
    1. AoA is requesting that state agencies provide SPR data in a 
machine readable format, conveyed either by diskette or by modem. The 
data files can be transmitted as ASCII files, or .DBF files. AoA 
prefers .DBF for data oriented files but will accept ASCII files which 
comply with the specifications addressed in this document. In the case 
of selected narrative information requested in Title III and VII 
reporting requirements, please provide text files.
    2. Use the file names included in the file descriptions provided 
below.
    3. Please embed the state ID in the name of data file submitted by 
the state. The naming convention should place the state ID as the first 
two characters of the file name, as a substitute for the XX which is 
included in each generic file name. For example, Alabama when 
submitting expenditure data by Part will submit a file named 
ALEXPTYP.DBF.
    4. Submit the files no later than 60 days following the end of the 
federal fiscal year, beginning November 30, 1995;
    5. Please use the following codes to denote individual services in 
the services ID field:

01--Personal Care
02--Homemaker
03--Chore
04--Home Delivered Meals
05--Adult Day Care/Health
06--Case Management
07--Congregate Meals
08--Nutrition Counseling
09--Assisted Transportation
10--Transportation
11--Legal Assistance
12--Nutrition Education
13--Information and Assistance
14--Outreach
99--Other Services

    6. Please use the following codes to denote racial/ethnic groups:

1--African-American
2--Hispanic Origin
3--American Indian/Native Alaskan
4--Asian/Pacific Islander
5--Non-Minority (White, not of Hispanic origin)
9--Missing

    7. Round all expenditure data to the nearest dollar;
    For Title III and Title VII SPR, excluding ombudsman, 10 data files 
are required along with one optional file. The record layout is 
provided for each file including the field number, field name, field 
type and field width. The field types are coded as follows:

C = Character
D = Date
L = Logical
N = Numeric

    The transmittal files should fit on a single diskette.

1. Unduplicated Client Count File--XXUNDUPL.DBF

    This file will contain the summary data on unduplicated clients 
served through services and programs supported by the Older Americans 
Act. See SPR Section I, for the table which includes the data requested 
in this file. The record layout for the file is:

------------------------------------------------------------------------
 Field No.                     Field name                        Type   
------------------------------------------------------------------------
1.........  State ID........................................  C2        
2.........  Fiscal Year.....................................  N4        
3.........  Registered Services--Total undup................  N7        
4.........  Other Services--Total unduplicated..............  N7        
5.........  Total Unduplicated (All services)...............  N8        
6.........  Registered Svcs--African American...............  N7        
7.........  Registered Svcs--Hispanic-origin................  N7        
8.........  Registered Svcs--American Indian................  N7        
9.........  Registered Svcs--Asian Amer./PI.................  N7        
10........  Registered Svcs--Non-Minority...................  N7        
11........  Registered Svcs--Rural..........................  N7        
12........  Registered Svcs--Clients in poverty.............  N7        
13........  Registered Svcs--In poverty/minority............  N7        
14........  Other Svcs--African American....................  N7        
15........  Other Svcs--Hispanic-origin.....................  N7        
16........  Other Svcs--American Indian.....................  N7        
17........  Other Svcs--Asian Amer./PI......................  N7        
18........  Other Svcs--Non-Minority........................  N7        
19........  Other Svcs--Rural...............................  N7        
20........  Other Svcs--Clients in poverty..................  N7        
21........  Other Svcs--In poverty/minority.................  N7        
22........  Total--African American.........................  N7        
23........  Total--Hispanic-origin..........................  N7        
24........  Total--American Indian..........................  N7        
25........  Total--Asian American/PI........................  N7        
26........  Total--Non-Minority.............................  N7        
27........  Total--Rural....................................  N7        
28........  Total--Clients in poverty.......................  N7        
29........  Total--In poverty/minority......................  N7        
------------------------------------------------------------------------

2. Abbreviated Client Profile Date File--XXCLBREV.DBF

    This file will contain records which contain descriptive 
information on each client served by five different services which 
require client registration and an abbreviated set of client 
characteristics (congregate meals, nutrition counseling, 
transportation, assisted transportation and legal assistance). See SPR 
II.C. for the data elements.

------------------------------------------------------------------------
 Field No.                     Field name                        Type   
------------------------------------------------------------------------
1.........  State ID........................................  C2        
2.........  Fiscal Year.....................................  N4        
3.........  Service ID......................................  N2        
                                                                        
Please use the following codes to denote individual services:           
    07--Congregrate Meals                                               
    08--Nutrition Counseling                                            
    09--Assisted Transportation                                         
                                                                        
4.........  Race/ethnicity ID...............................  N1        
                                                                        
(Data fields 5-44 are numeric and 7 positions in width)                 
                                                                        
5.........  Total Clients, Age 60-64........................  N7        
6.........  Total Clients, Age 60-64, Female                            
7.........  Total Clients, Age 60-64, Male                              
8.........  Total Clients, Age 60-64, Rural                             
9.........  Total Clients, Age 60-64, Alone                             
10-14.....  Repeat for Poverty Clients, Age 60-64                       
15-19.....  Repeat for Total Clients, Age 65-74                         
20-24.....  Repeat for Poverty Clients, Age 65-74                       
25-29.....  Repeat for Total Clients, Age 75-84                         
30-34.....  Repeat for Poverty Clients, Age 75-84                       
35-39.....  Repeat for Total Clients, Age 85+                           
40-44.....  Repeat for Poverty Clients, Age 85+                         
45........  Total Clients Served (For the Service)..........  N8        
                                                                        
In fields 46--56 of this file, please provide the count of client       
 records with missing data elements, by type. The format for these      
 fields is numeric and 6 positions wide                                 
                                                                        
46........  Total Clients--Income data missing..............  N6        
47........  Total Clients--Age data missing                             
48........  Total Clients--Sex data missing                             
49........  Total Clients--Rural status data missing                    
50........  Total Clients--Live alone status data missing               
51........  Poverty Clients--Age data missing                           
52........  Poverty Clients--Sex data missing                           
53........  Poverty Clients--Rural status data missing                  
54........  Poverty Clients--Live alone data missing                    
55........  New Clients (Optional FY95/96; required FY97)...  N8        
56........  # High Nutr. Risk (Required FY97 for Cong Meals   N8        
             and FY96 for Nutr. Counseling).                            
------------------------------------------------------------------------

3. Detailed Client Profile Data File--XXCLDET.DBF

    States will use this file format to transmit data which satisfy the 
requirements for data contained in SPR Section II.B. The record 
description for this file includes the following:

------------------------------------------------------------------------
 Field No.                     Field name                        Type   
------------------------------------------------------------------------
1.........  State ID........................................  C2        
2.........  Fiscal Year.....................................  N4        
3.........  Service ID......................................  N2        
                                                                        
Please use the following codes to denote individual services:           
    01--Personal Care                                                   
    02--Homemaker                                                       
    03--Chore                                                           
    04--Home Delivered Meals                                            
    05--Adult Day Care/Health                                           
    06--Case management                                                 
                                                                        
4.........  Race/ethnicity ID...............................  N1        
                                                                        
(Data fields 5-301 are all numeric and 7 positions wide.)               
                                                                        
5.........  Total Clients, Age 60-64, Total                             
6.........  Total Clients, Age 60-64, with 0 ADL, Total                 
7.........  Total Clients, Age 60-64, with 0 ADL, No IADLs              
8.........  Total Clients, Age 60-64, with 0 ADL, 1 IADL                
9.........  Total Clients, Age 60-64, with 0 ADL, 2 IADLs               
10........  Total Clients, Age 60-64, with 0 ADL, 3+IADLs               
11........  Total Clients, Age 60-64, with 0 ADL, Female                
12........  Total Clients, Age 60-64, with 0 ADL, Male                  
13........  Total Clients, Age 60-64, with 0 ADL, Rural                 
14........  Total Clients, Age 60-64, with 0 ADL, Live Alone            
15........  Total Clients, Age 60-64, with 1 ADLs, Total                
16........  Total Clients, Age 60-64, with 1 ADLs, No IADLs             
17........  Total Clients, Age 60-64, with 1 ADLs, 1 IADL               
18........  Total Clients, Age 60-64, with 1 ADLs, 2 IADLs              
19........  Total Clients, Age 60-64, with 1 ADLs, 3+IADLs              
20........  Total Clients, Age 60-64, with 1 ADLs, Female               
21........  Total Clients, Age 60-64, with 1 ADLs, Male                 
22........  Total Clients, Age 60-64, with 1 ADLs, Rural                
23........  Total Clients, Age 60-64, with 1 ADLs, Live                 
             Alone                                                      
24........  Total Clients, Age 60-64, with 2 ADLs, Total                
25........  Total Clients, Age 60-64, with 2 ADLs, No IADLs             
26........  Total Clients, Age 60-64, with 2 ADLs, 1 IADL               
27........  Total Clients, Age 60-64, with 2 ADLs, 2 IADLs              
28........  Total Clients, Age 60-64, with 2 ADLs, 3+IADLs              
29........  Total Clients, Age 60-64, with 2 ADLs, Female               
30........  Total Clients, Age 60-64, with 2 ADLs, Male                 
31........  Total Clients, Age 60-64, with 2 ADLs, Rural                
32........  Total Clients, Age 60-64, with 2 ADLs, Live                 
             Alone                                                      
33........  Total Clients, Age 60-64, with 3+ADLs, Total                
34........  Total Clients, Age 60-64, with 3+ADLs, No IADLs             
35........  Total Clients, Age 60-64, with 3+ADLs, 1 IADL               
36........  Total Clients, Age 60-64, with 3+ADLs, 2 IADLs              
37........  Total Clients, Age 60-64, with 3+ADLs, 3+IADLs              
38........  Total Clients, Age 60-64, with 3+ADLs, Female               
39........  Total Clients, Age 60-64, with 3+ADLs, Male                 
40........  Total Clients, Age 60-64, with 3+ADLs, Rural                
41........  Total Clients, Age 60-64, with 3+ADLs, Live                 
             Alone                                                      
42-78.....  Repeat for Poverty Clients, Age 60-64                       
79-115....  Repeat for Total Clients, Age 65-74                         
116-152...  Repeat for Poverty Clients, Age 65-74                       
153-189...  Repeat for Total Clients, Age 75-84                         
190-226...  Repeat for Poverty Clients, Age 75-84                       
227-263...  Repeat for Total Clients, Age 85+                           
264-300...  Repeat for Poverty Clients, Age 85+                         
301.......  Total Clients Served                                        
                                                                        
(In the following data fields of this file, please provide the count of 
 missing data elements, by type. The format for the fields is numeric   
 and 6 positions wide)                                                  
                                                                        
302.......  Total Clients--Income Missing...................  N6        
303.......  Total Clients--Age Missing                                  
304.......  Total Clients--ADL Status Missing                           
305.......  Total Clients--IADL Status Missing                          
306.......  Total Clients--Sex Missing                                  
307.......  Total Clients--Rural Status Missing                         
308.......  Total Clients--Live Alone Status Missing                    
309.......  Total Poverty Clients--Age Missing                          
310.......  Total Poverty Clients--ADL Status Missing                   
311.......  Total Poverty Clients--IADL Status Missing                  
312.......  Total Poverty Clients--Sex Missing                          
313.......  Total Poverty Clients--Rural Status Missing                 
314.......  Total Poverty Clients--Live Alone Missing                   
315.......  New Clients (Optional FY95/96; req. FY97).......  N8        
316.......  # At High Nutr. (Req. FY96 Case Mgt, HDM).......  N8        
                                                                        
Because of the number of variables, this file may be segmented into two 
 subfiles, labeled XXCLDET1.DBF and XXCLDET2.DBF. Please indicate in a  
 ReadMe file which variables are in each sub-file. Remember that the    
 first four data elements uniquely identify each record in each subfile 
------------------------------------------------------------------------

4. Expenditure Data by Type of Resource File--XXEXPTYP.DBF

    This file will be used to transmit expenditure data for 14 listed 
services and aggregate expenditure data for all other services 
supported by OAA funds. See SPR Section III form for the data elements. 
Remember, expenditure data should be rounded to the nearest dollar. Use 
code 99 to denote the information on ``other'' services. The record 
layout for each service is defined below:

------------------------------------------------------------------------
Field No.                      Field name                        Type   
------------------------------------------------------------------------
1.........  State ID........................................  C2        
2.........  Fiscal Year.....................................  N4        
3.........  Service ID......................................  N2        
4.........  Total OAA Expenditure...........................  N8        
5.........  % of Total Serv Exp.............................  N2        
6.........  Total Progam Income $...........................  N7        
7.........  Part B $........................................  N8        
8.........  Part C1 $.......................................  N8        
9.........  Part C2 $.......................................  N8        
10........  Part D $........................................  N7        
11........  Part F $........................................  N7        
------------------------------------------------------------------------

5. Other Expenditures File--XXOTHEXP.DBF

    This file is used to report expenditures on other services or 
activities not associated with the listed 14 services in the SPR 
requirements. The record layout for this file is as follows:

------------------------------------------------------------------------
Field No.                      Field name                        Type   
------------------------------------------------------------------------
1.........  State ID........................................  C2        
2.........  Fiscal Year.....................................  N4        
3.........  Title VII Ombudsman $...........................  N8        
4.........  Title VII Elder Abuse $.........................  N8        
5.........  Title VII Benefit Assist $......................  N8        
6.........  Ombudsman % of Total Serv Exp...................  N2        
7.........  Elder Abuse % of Total Serv Exp.................  N2        
8.........  Benefits Asst % of Tot Serv Exp.................  N2        
------------------------------------------------------------------------

6. Service Units Data File--XXUNITS.DBF

    This file will contain records containing information on service 
units organized around one or more of fourteen listed services. The 
record layout is:

------------------------------------------------------------------------
Field No.                      Field name                        Type   
------------------------------------------------------------------------
1.........  State ID........................................  C2        
2.........  Fiscal Year.....................................  N4        
3.........  Personal Care Units.............................  N6        
4.........  Homemaker Units.................................  N6        
5.........  Chore Units.....................................  N6        
6.........  Home Delivered Meals Units......................  N6        
7.........  Adult Day Care/Health Units.....................  N6        
8.........  Case Management Units...........................  N6        
9.........  Congregate Meals Units..........................  N6        
10........  Nutrition Counseling Units......................  N6        
11........  Assisted Transport Units........................  N6        
12........  Transportation Units............................  N6        
13........  Legal Assistance Units..........................  N6        
14........  Nutrition Education Units.......................  N6        
15........  Info and Assistance Units.......................  N6        
16........  Outreach Units..................................  N6        
------------------------------------------------------------------------

7. Provider Profile File--XXPROVDR.DBF

------------------------------------------------------------------------
Field No.                      Field name                        Type   
------------------------------------------------------------------------
1.........  State ID........................................  C2        
2.........  Fiscal Year.....................................  N4        
3.........  Personal Care--Total Providers..................  N4        
4.........  Personal Care--# Minority Provdrs...............  N4        
5.........  Personal Care--# of AAA Providers...............  N4        
6.........  Homemaker--Total................................  N4        
7.........  Homemaker--# Minority...........................  N4        
8.........  Homemaker--# of AAA Providers...................  N4        
9.........  Chore--Total....................................  N4        
10........  Chore--# Minority...............................  N4        
11........  Chore--# of AAA Providers.......................  N4        
12........  Home Del. Meals--Total..........................  N4        
13........  Home Del. Meals--# Minority.....................  N4        
14........  Home Del. Meals--# of AAA Providers.............  N4        
15........  Adult Day Care/Hlth--Total......................  N4        
16........  Adult Day Care/Hlth--# Minority.................  N4        
17........  Adult Day Care/Hlth--# of AAA Prov..............  N4        
18........  Case Management--Total..........................  N4        
19........  Case Management--# Minority.....................  N4        
20........  Case Management--# of AAA Providers.............  N4        
21........  Congregate Meals--Total.........................  N4        
22........  Congregate Meals--# Minority....................  N4        
23........  Congregate Meals--# of AAA Providers............  N4        
24........  Nutrition Counseling--Total.....................  N4        
25........  Nutrition Counseling--# Minority................  N4        
26........  Nutrition Counseling--# of AAA Providers........  N4        
27........  Transportation--Total...........................  N4        
28........  Transportation--# Minority......................  N4        
29........  Transportation--# of AAA Providers..............  N4        
30........  Assist. Transportation--Total...................  N4        
31........  Assist. Transportation--# Minority..............  N4        
32........  Assist. Transportation--# of AAA Providers......  N4        
33........  Legal Assistance--Total.........................  N4        
34........  Legal Assistance--# Minority....................  N4        
35........  Legal Assistance--# of AAA Providers............  N4        
36........  Nutrition Education--Total......................  N4        
37........  Nutrition Education--# Minority.................  N4        
38........  Nutrition Education--# of AAA Providers.........  N4        
39........  Info and Assistance--Total......................  N4        
40........  Info and Assistance--# Minority.................  N4        
41........  Info and Assistance--# of AAA Providers.........  N4        
42........  Outreach--Total.................................  N4        
43........  Outreach--# Minority............................  N4        
44........  Outreach--# of AAA Providers....................  N4        
45........  Total Providers (14 svcs).......................  N4        
46........  Total Minority Providers (14 svcs)..............  N4        
------------------------------------------------------------------------

8. Development Accomplishments Data File--XXDEVLOP.TXT (DOS Text file)

    This file will contain brief narratives describing the 
developmental accomplishments in the state related to the development 
of home and community based programs and a system of elder rights. 
Please furnish the data in a DOS text file, making sure to include at 
the end of text describing each narrative the codes identifying the 
type of developmental activities involved:

1. Public education/awareness
2. Resource development
3. Training/education
4. Research and development
5. Policy development
6. Legislative development
7. Other

9. Focal Point Data File--XXFOCAL.DBF

    This file is used to transmit data on focal points required to be 
reported by states under provisions of the Older Americans Act.

------------------------------------------------------------------------
Field No.                      Field name                        Type   
------------------------------------------------------------------------
1.........  State ID........................................  C2        
2.........  Fiscal Year.....................................  N4        
3.........  Total # of Focal Points Designated Under Section  N4        
             306(a)(3) of the Act in Operation in the Past              
             Year.                                                      
4.........  Of the Total # of Focal Points Designated Under   N4        
             Section 306(a)(3) of the Act in Operation in               
             the Past Year, the Number That Were Senior                 
             Centers.                                                   
5.........  Total Number of Senior Centers in the PSA in the  N4        
             Past Fiscal Year.                                          
6.........  Total Number of Senior Centers in the PSA in the  N4        
             Past Fiscal Year That Received Funds During the            
             Past Fiscal Year.                                          
------------------------------------------------------------------------

10. Staffing Profile Data File--XXSTAFF.DBF

    Use one file to transmit both the state unit staffing profile and 
area agency staffing profiles. Identify the state unit on aging record 
by placing a -99 in the PSA ID field. To further identify the PSAs/
AAAs, please include a ReadMe file with the PSA names and IDs.

------------------------------------------------------------------------
Field No.                      Field name                        Type   
------------------------------------------------------------------------
1.........  State ID........................................  C2        
2.........  PSA ID..........................................  C6        
3.........  Fiscal Year.....................................  N4        
4.........  # of Agency Executive/Mgt Staff FTEs............  N4        
5.........  # of Agency Executive/Mgt Staff Minority FTEs...  N4        
6.........  # of Agency Executive/Mgt Staff FTEs -Pd w/OAA    N4        
             funds.                                                     
7.........  # of Paid Prof. Staff With Planning Resp. FTEs..  N4        
8.........  # of Paid Prof. Staff With Planning Resp.         N4        
             Minority FTEs.                                             
9.........  # of Paid Prof. Staff FTEs W/Plan. Resp.-Pd w/    N4        
             OAA funds.                                                 
10........  # of Paid Professional Staff with Development     N4        
             Resp. FTSs.                                                
11........  # of Paid Professional Staff With Development     N4        
             Resp. Minority FTEs.                                       
12........  # of Pd Profess. Staff FTEs W/Development Resp.-  N4        
             Pd w/OAA funds.                                            
13........  # of Paid Professional Staff With Admin. Resp.    N4        
             FTEs.                                                      
14........  # of Paid Professional Staff With Admin. Resp.    N4        
             Minority FTEs.                                             
15........  # of Pd Profess. Staff FTEs With Admin. Resp.--   N4        
             Paid with OAA funds.                                       
16........  # of Paid Professional Staff With Serv. Del.      N4        
             Resp. FTEs.                                                
17........  # of Paid Professional Staff With Serv. Del       N4        
             Resp. Minority FTEs.                                       
18........  # of Paid Profess. Staff FTEs With Serv. Del.     N4        
             Resp.--Paid with OAA funds.                                
19........  # of Paid Professional Staff With Access Resp.    N4        
             FTEs.                                                      
20........  # of Paid Professional Staff With Access Resp.    N4        
             Minority FTEs.                                             
21........  # of Paid Profess. Staff FTEs With Access Resp.-- N4        
             Paid with OAA funds.                                       
22........  # of Paid Professional Staff With Other Resp.     N4        
             FTEs.                                                      
23........  # of Paid Professional Staff With Other Resp.     N4        
             Minority FTEs.                                             
24........  # of Paid Profess. Staff FTEs With Other Resp.--  N4        
             Paid with OAA funds.                                       
25........  # of Clerical Staff FTEs........................  N4        
26........  # of Clerical Staff Minority FTEs...............  N4        
27........  # of Clerical Staff FTEs paid with OAA funds....  N4        
28........  # of Volunteer FTEs (AAAs only).................  N4        
29........  # of Volunteer Minority FTEs (AAAs only)........  N4        
30........  Total Staff FTEs (All)..........................  N4        
31........  Total Minority Staff FTEs--All..................  N4        
32........  Total Staff FTEs--Pd with OAA funds.............  N4        
------------------------------------------------------------------------

11. Other Services Profie (Optional)--XXOTHSER.DBF

    States units on aging may, at their option, submit a file 
containing information on other services supported by OAA funds. The 
format for this file will be as follows:

------------------------------------------------------------------------
Field No.                      Field name                        Type   
------------------------------------------------------------------------
1.........  State ID........................................  C2        
2.........  Fiscal Year.....................................  N4        
3.........  # of Other Services Being Reported..............  N2        
                                                                        
(Field #3 is used as check to make sure all ``other'' services are      
 included in the file.)                                                 
                                                                        
4.........  Service Name....................................  C30       
5.........  Service Unit Name...............................  C15       
6.........  Service Purpose.................................  C1        
                                                                        
Please use the following codes to identify the purpose:                 
    A--Services which address functional limitations                    
    B--Services which maintain health                                   
    C--Services which protect elder rights                              
    D--Services which promote socialization/participation               
    E--Services which assure access and coordination                    
    F--Services which support other goals/outcomes                      
                                                                        
7.........  OAA Expenditures................................  N8        
8.........  % of Total Serv. Exp............................  N2        
9.........  Persons Served..................................  N8        
10........  Service Units...................................  N8        
                                                                        
Repeat the above format for additional services                         
------------------------------------------------------------------------

Appendix III. Nutritional Risk Status Screen

    The Nutrition Screening Checklist was developed as part of the 
Nutrition Screening Initiative jointly sponsored by The American 
Academy of Family Physicians, The American Dietetic Association and the 
National Council on the Aging, Inc. The Checklist appears on the next 
page. It will be used as a tool to determine which clients are at high 
nutritional risk.
BILLING CODE 4150-04-M

TN29SE94.011


BILLING CODE 4150-04-C

Instructions for Completing the State Long Term Care Ombudsman Program 
Reporting Form for The National Ombudsman Reporting System (NORS)

Part I--Cases, Complainants and Complaints

A. Cases Opened.

    Provide the total number of cases opened during the reporting 
period. Use definition of case provided on form.

B. Complainants/Case Closed.

    For all cases closed during the reporting period, provide the 
number of complainants, by type of facility/setting. Refer to 
discussion of type of facility or other setting under D.1, below.
    Use definition of case closed provided on the form. A case is 
closed when all complaints which are part of the case have been 
resolved and/or no further ombudsman action can be taken for reasons 
listed in Part I. E.2.
    (A word about the definition of closed cases: Ombudsman sometimes 
must refer complaints to another agency for resolution. The ombudsman 
should follow up on these complaints and record the outcome under the 
appropriate category in Part I, E.2, Complaint Disposition. Disposition 
categories d. (1) and (2) in Part I, E.2 are for use only in those 
instances when the agency to which the case was referred fails to act 
on a complaint or provide a response to the ombudsman's attempts to 
follow up, or follow-up is otherwise not possible. Since this outcome, 
although undesirable, occasionally occurs with complaints, it is 
included in the definition of closed case.)
    A complainant is an individual or a party (i.e., husband and wife; 
siblings) who files one or more complaints with the ombudsman program. 
A referring agency is not a complainant, but staff of another agency 
may be aware of a situation and file a complaint about it, thus 
qualifying as a complainant. The number of complainants will equal the 
number of cases filed.
    If more than one person or party independently file separate 
complaints about the same situation in the same facility, or the same 
problem outside of any facility, count as separate cases. If more than 
one person jointly file complaint(s) about the same situation in the 
same facility or outside the facility, count as one complainant and one 
case.
    Clarification of selected categories (self-evident categories not 
repeated):
    2. Relative/friend or resident includes relatives who are also 
guardians or legal representatives but not friends who are also 
guardians/legal representatives. For friends, use category 3.
    6. Physician, other medical staff includes physicians and staff of 
hospitals, hospices, clinics, visiting nurse programs and similar 
programs, which are primarily oriented toward medical/health care.
    7. Representative of other social services agency or program 
includes individuals other than ombudsmen or ombudsman volunteers who 
file complaints (not merely refer other complainants) and are 
affiliated with such agencies as area agencies on aging, facility 
licensure and certification, homemaker agencies and similar agencies 
which are primarily oriented toward social services.
    9. Other includes any complainant whose identity is known but who 
does not fit easily into a listed category. Examples: banker, law 
enforcement officer. If you report complainants in this category, 
indicate in the space on the form the types included.

C. Total Complaints

    For all cases closed during the reporting period, provide the total 
number of complaints received. This will be the same number as the 
combined total from Part I, D, Types of Complaints, including 
complaints from nursing facilities, board and care and similar types of 
facilities and other settings. (Do not report complaints in cases which 
are still open at the end of the reporting period. Save those for the 
next reporting period, after the case is closed.)

D. Type of Complaints

1. General Instructions for Complaint Categories
    For all cases closed during the reporting period, provide the total 
number of complaints received by the statewide ombudsman program in 
each of the complaint categories listed. Use the definition of 
complaint provided in Part I, C, page 1 on the form.
    Type of Facility. For each type of complaint, place in the first 
column the number received involving a skilled nursing facility as 
defined in section 1819 of the Social Security Act or a nursing 
facility as defined in section 1919(a) of the Social Security Act.
    Place in the second column totals of complaints received from 
facilities termed board and care homes, adult congregate living 
facilities, assisted living facilities, foster care facilities and 
other similar group facility which: provides room, board and personal 
care services to older individuals and which the ombudsman program is 
authorized to serve under Section 102(34) (C) and (D) of the Older 
Americans Act and includes within its purview.
    Place in the last section, Q, numbers of ombudsman complaints 
involving settings other than nursing or board and care or similar 
facilities, such as home care, hospitals, hospices, shelters, or 
congregate housing where personal care to residents is not provided. 
(The categories in Section Q are provided for documenting numbers of 
complaints only; the form does not include types of complaints for 
these settings, as such settings are not included within the purview of 
the Ombudsman Program in the Older Americans Act.)
    The first four major headings (Residents Rights, Resident Care, 
Quality of Life and Administration) are for complaints involving acts 
of commission or omission by staff or management of the facility, or 
problems which staff or management has the responsibility to resolve. 
The fifth major heading is for complaints against individuals or 
agencies outside the facility, or problems which can be resolved only 
by outside agencies or individuals.
    As stated in the definitions of case and complaint, each case may 
have more than one complaint. However, each problem, or complaint, will 
have only one code. Use only one category for each type of problem 
(i.e., do not check both A.3 and D.26 for the same staff behavior--
determine which category is most appropriate to the particular problem) 
and report only the primary complaint or complaints, not problems which 
are incidental to, or even causal to, the primary complaint.
    For example: A resident complains of lack of fresh water by her 
bedside and odors in the bathroom. Both problems may be due to any one 
of the problems listed under M. Staffing, but only the codes for the 
primary problems reported--lack of water (category J.70) and odors 
(category K.83)--should be entered on the intake form. (The narrative 
section on the ombudsman intake form will, of course, reflect the 
ombudsman's assessment of why the problems occurred and what is 
required to solve them; but if all of these concerns were coded as 
complaints, the purpose and value of the complaint categories would be 
eroded.)
    For each other category, list in the space provided on the form 
other types of complaints included in the number listed.
2. Clarification and Definitions of Selected Complaint Categories
    Complaint categories provide only the identification of the problem 
area, not a statement of the problem. The assumption is that the 
complaint is about a problem of commission or omission. Otherwise, 
there would be no problem and thus no complaint.
    Each category has been assigned its own number in order to avoid 
confusion and aid in aggregating the data by computer. (If States wish 
to add other categories for their own use, they can place these at the 
end of the NORS list. However, these must be included in the annual 
report under one of the 133 categories; i.e., at the end of the year, 
they must be ``folded'' into one of the NORS categories, which may 
include the ``other'' category listed for each group of types of 
complaints.)
    Many of the categories are self-explanatory. The following 
definitions/explanations are for those major complaint headings and 
specific categories where further interpretation is required.

Residents Rights

A. Abuse, Gross Neglect, Exploitation

    Use categories in this section for serious complaints of willful 
mistreatment of residents by facility staff, management, other 
residents (use category 6) or unknown or outside individuals who have 
gained access to the resident through negligence or lax security on the 
part of the facility. (Use P.117 and P.121 for complaints of abuse, 
exploitation by family members, friends and others whose actions the 
facility could not reasonably be expected to oversee or regulate.)
    For all categories in this part, use the broad definitions of 
abuse, neglect and exploitation in the Older Americans Act and 
Paragraph 483.13(b) of the Health Care Financing Administration's 
Survey Forms and Interpretive Guidelines for the Long Term Care Survey 
Process, April 1992:
    The term abuse means the willful (A) infliction of injury, 
unreasonable confinement, intimidation, or cruel punishment with 
resulting physical harm, pain or mental anguish; or (B) deprivation by 
a person, including a caregiver, of goods or services that are 
necessary to avoid physical harm, mental anguish, or mental illness. 
(Older Americans Act, Section 102 [13])
    The term (financial) exploitation means the illegal or improper act 
or process of an individual, including a caregiver, using the resources 
of an older individual for monetary or personal benefit, profit or 
gain. (Older Americans Act, Section 102[26])
    In addition to the above broad definitions, use the following 
specific definitions from the HCFA Interpretive Guidelines:
    Physical abuse (A.1) includes hitting slapping, pinching, kicking, 
etc. It also includes controlling behavior through corporal punishment.
    Examples of effects of abuse include, but are not limited to, 
substantial or multiple skin bruising, burns, bone fractures, 
poisoning, subdural hematoma, soft tissue swelling, suffocation. (from 
Colorado adult protection statute)
    Sexual abuse (A.2) includes, but is not limited to, sexual 
harassment, sexual coercion, or sexual assault.
    Verbal abuse (A.3) refers to any use of oral, written or gestured 
language that includes disparaging and derogatory terms to residents or 
their families, or within their hearing distance, to describe 
residents, regardless of their age, ability to comprehend, or 
disability. (Use D.3 for less severe forms of staff rudeness or 
insensitivity; use M.5 if staff is unavailable, unresponsive to 
residents' needs.)
    Mental abuse (A.3) includes, but is not limited to, humiliation, 
harassment, threats of punishment or deprivation.
    Involuntary seclusion (A.3) means separation of a resident from 
other residents or from his or her room against the resident's will or 
the will of the resident's legal representative. Emergency or short 
term monitored separation will not be considered involuntary seclusion 
* * * if used for a limited period of time as a therapeutic 
intervention to reduce agitation. * * *
    For financial exploitation (A.4) and gross neglect (A.5), use the 
definitions of exploitation and deprivation (Part B of abuse 
definition) in the Older Americans Act, provided above. Use A.5 only 
for the most extreme forms of willful neglect. Use the appropriate 
categories under Resident Care, Quality of Life or, in some cases, 
Administration for less severe forms or manifestations of resident 
neglect. Use resident-to-resident physical or sexual abuse (A.6) only 
for complaints of abuse by a resident against one or more other 
residents which meet the definitions of abuse provided above. For less 
severe forms of resident-to-resident conflict, use I.66 if conflict is 
with a roommate or other appropriate category (such as F.51) if it is 
with a resident other than a roommate.

B. Access to Information

    Use the appropriate category for complaints involving access to 
information or assistance made by or on behalf of the resident or the 
resident's representative. Use B.9 if ombudsman is denied access in 
response to a complaint. If there is a general problem with ombudsman 
access to one or more particular facilities or types of facilities, but 
no complaint has been filed, do not use complaint categories. Describe 
the access problem under Part III, B--Statewide Coverage.

C. Admission, Transfer, Discharge, Eviction

    Use the appropriate category for complaints involving placement, 
whether into, within or outside of the facility. If resident requests 
assistance in transferring to another facility and there is no stated 
problem (complaint), record as ``information and assistance to 
individuals,'' Part III, F.5 on page 13.

D. Autonomy, Choice, Exercise of Rights, Privacy

    Use the appropriate category for any complaint involving the 
resident's right, as stated in the category. If it is a related 
problem, but not one specific to this heading, use a category under 
another heading. For example, if the resident is permitted to choose 
her personal physician but that physician is unavailable, use P.125. 
Use D.29 if the resident has a communication or language barrier. Use 
M.96 if staff have the communication or language barrier. Use D.27 for 
right to smoke. Use K.77 for smoke-polluted air.

E. Financial, Property (Except for Financial Exploitation)

    Use the appropriate category for complaints involving non-criminal 
mismanagement or carelessness with residents' funds and property and 
billing problems. Use A.4 for complaints involving willful financial 
exploitation, including, but not limited to, possible criminal 
activity.

F. Care

    Use the appropriate category for complaints involving negligence, 
lack of attention and poor quality in the care of residents. If the 
care situation is so poor that the resident is in a condition of 
overall neglect which is threatening to health and/or life, use A.5, 
gross neglect.

G. Rehabilitation or Maintenance of Function

    Use the appropriate category for complaints involving failure to 
provide needed rehabilitation or services necessary to resident to 
maintain the expected level of function.

H. Restraints

    Use the appropriate category for any complaint involving the use of 
physical or chemical restraint.

I. Activities and Social Services

    Use categories under this heading for complaints involving social 
services for and/or social interaction of residents. Note that 
transportation is included in category I.65 because community 
interaction is sometimes (not always) dependent upon transportation. 
Use I.65 for any complaint involving the resident's need for 
transportation, for whatever reason.

J. Dietary

    Use the appropriate category for complaints involving food and 
fluid intake. Use J.74 for failure to follow special/therapeutic diet. 
Use J.75 for inadequate nutrition. Use the appropriate category under A 
(either 1 or 5) for severe cases of food deprivation.

K. Environment

    Use the appropriate category for complaints involving the physical 
environment of the facility and resident's space. Use K.77 for smoke-
polluted air. For lack of supplies, including nursing supplies, use 
K.85.

L. Policies, Procedures, Attitudes, Resources

    Categories under this heading are for acts of commission or 
omission by facility managers, operators or owners in areas other than 
staffing or the specific problems included in previous sections, such 
as policies on advance directives; fair and due process on admissions, 
transfers and discharges; billing; management of residents' funds. Use 
L.90 for complaints involving falsification of records.

M. Staffing

    Use appropriate categories under this heading for complaints 
involving staff unavailability, training, turnover, and supervision. 
Use M.96 for staff language or other communication barrier. (Use D.29 
if problem involves resident inability to communicate.) Use M.100 if 
staff is unresponsive or unavailable. (Use D.26 if staff is available 
but rude or otherwise disrespectful to resident; use A.3 or other 
category under A if rudeness or disrespect is so severe that it 
qualifies as abuse.)

N. Certification/Licensing Agency

    Use categories under this heading for all complaints involving 
decisions, policies, actions or inactions by the agency in the State 
which licenses nursing facilities and certifies them for participation 
in Medicaid and Medicare. Use any category which also may apply to 
decisions, policies, actions or inactions by the agency which licenses 
board and care or similar facilities, using the board and care/similar 
column. (If the problem is failure to license and regulate such 
facilities, or inadequate regulation, use P.119.) Use N.106 if 
appropriate intermediate sanctions are required and have not been 
applied, if intermediate sanctions which are applied are not 
appropriate, or if intermediate sanctions negatively impact on 
residents.

O. State Medicaid Agency

    Categories in this section are for complaints about Medicaid 
coverage, benefits and services.

P. System/Others

    Use appropriate categories in this section to document the range of 
complaints against or involving individuals who are not managers/staff 
of facilities or of the State's licensing and certification or Medicaid 
agency. Use P.124 for problems involving implementation of the 
Preadmission Screening and Annual Resident Review (PASSAR) requirements 
of the Nursing Home Reform Amendments of the Omnibus Budget 
Reconciliation Act (OBRA) of 1987. Use P.126 for complaints involving 
the agency in the State charged with investigating reports of adult 
abuse and exploitation and providing protective services for victims of 
abuse and exploitation.

Q. Complaints in Other Than Nursing Facility or Board and Care/Similar 
Settings

    Use categories in this section to document any complaints accepted 
and acted upon by the ombudsman involving individuals living in (1) 
private residences, (2) hospitals or in hospice care, (3) congregate 
and/or shared housing not providing personal care, or (4) shelters.
    Add totals in both columns, sections A through P, to total for 
Section Q. Place grand total at Total Complaints on page 7 and in box 
at C on page 1.

Part I, E. Action on Complaints

    1. Verification: Provide, for cases closed during the reporting 
period, the total number of complaints which were verified, by type of 
facility. Use the definition of verified on the form. Complaints not 
included are considered unverified.

(Note: Some States investigate complaints which cannot be verified; 
other States do not. For this reason, the definition of ``case 
closed'' on page 1 of the form includes ``complaint cannot be 
verified'' as a reason for closing a case. However, the disposition 
categories in Part I, E. 2 do not include ``complaint unverified.'' 
States which do not investigate unverified complaints should use 2.e 
or another category which best describes the disposition of a 
particular unverified complaint.)

    2. Disposition: Provide, for cases closed during the reporting 
period, the total number of complaints, by type of facility or setting, 
for each disposition category. Where there are two possible choices, 
the ombudsman must choose the one category which best describes the 
outcome of the complaint. See note above for documentation of 
unverified complaints. Total must be same as total number of complaints 
received, as provided on page 7 and in box at C on page 1.

Part I, F. Optional Discussion of Legal Assistance/Remedies: 
Instruction Provided on Form

Part I, G. Optional Complaint Description: Instruction Provided on Form

Part II--Major Issues: Instruction Provided on Form

Part III--Program Information and Activities

A. Facilities and Beds

    Provide, for both nursing facilities and licensed board and care 
and similar adult care facilities, as instructed on form, the number of 
facilities which were licensed in the State during the reporting period 
and the number of beds in those facilities.

B. Program Coverage

    Instruction provided on form.

C. Local Programs

    Provide, according to type of host organization, the number of 
regional or local entities which were geographically located outside of 
the State Office of the Ombudsman and where one or more paid staff and/
or volunteers were designated by the State Ombudsman to investigate 
complaints and represent the State Ombudsman Program. As indicated on 
form, include regional offices of the State Ombudsman Office.

D. Staff and Volunteers

    Instruction provided on form; include all volunteers who worked for 
the program during the reporting period except those who served only as 
members of advisory or policy committees.

E. Program Funding

    Provide funds expended during the reporting period on the Ombudsman 
Program as it is defined under Section 712 of the Older Americans Act. 
Do not include amounts which were budgeted or obligated but not 
expended. Do not include amounts which were expended on ombudsman 
activities not authorized under Section 712 (i.e., ombudsman activity 
in settings other than long-term care facilities, as defined in the 
Act). Provide on the third line Title III expenditures for State or 
local ombudsman activity made by the State from Title III funding under 
Section 304(d)(1)(B) of the Act. Provide on the fourth line Title III 
expenditures for local ombudsman activity made by area agencies on 
aging from Title III funding provided under Section 304(d)(1)(D) of the 
Act. Provide other funding, by source, as specified on form.

F. Other Ombudsman Activities

    Provide the information requested in the appropriate column. Use 
the State column for activities performed by the State Office of the 
Ombudsman. Use the local column for activities performed by local or 
regional designated ombudsman programs or regional offices of the State 
Ombudsman Program. Provide exact numbers wherever possible; where not 
possible, provide your best estimate of the numbers requested. Please 
be sure to record each activity only once, under the most appropriate 
heading. Do not, for example, count a media interview under both items 
10 and 11. Clarification of items listed on chart:
1. Training for Ombudsman Staff and Volunteers
    In the State Office column, give the number of training sessions 
(meetings) and total hours provided or otherwise arranged by staff of 
the State Office of the Ombudsman for State or local program staff and 
volunteers, whether the meetings were held in the State capital or 
elsewhere in the State. In the local program column give the total 
number of sessions and total hours provided or otherwise arranged by 
staff of local ombudsman entities or regional offices for staff and 
volunteers of the local program. For each, provide the total number of 
people trained (not an unduplicated count of individuals) during the 
reporting year. For this item, a session is a meeting, whether it lasts 
for three hours, all day or all week.
2. Technical Assistance to Local Ombudsman and/or Volunteers
    Provide in the State column an estimate of the percentage of total 
staff time which paid staff of the State Office of the Ombudsman (i.e., 
State Ombudsman, plus other staff) devote to developing and assisting 
local programs, whether in person or by telephone. Provide in the local 
column an estimate of the percentage of total staff time which local 
program paid staff devote to developing volunteers programs and 
supporting other staff and volunteers. Include staff time spent in 
developing and delivering training as well as in providing informal 
assistance.
3. Training for Facility Staff
    Give the number of sessions provided at both State and local levels 
and the three most frequent topics of training at each level. (Hours 
are not requested. It is assumed that most sessions for facility staff 
are would last for 45 minutes to an hour. If sessions are two hours, 
count as two sessions; three hours, three sessions, etc.)
4. Consultation to Facilities
    Ombudsman often provide information and assistance to facility 
managers and staff. To capture the extent of this important activity, 
report the number of such consultations provided during the year. If 
there are repeated consultations to the same facility, count each 
consultation separately. Do not count training sessions, documented in 
F.3. Provide the three most frequent subject areas of consultation.
5. Information and Consultation to Individuals
    Provide the number of individuals assisted by telephone or in 
person on a one-to-one basis on needs ranging from how to select a 
nursing home to residents' rights to understanding Medicaid. Count each 
separate request for information or assistance (but not each call 
related to the same request), whether made by someone who requested 
assistance earlier in the year or by a new caller. Do not include here 
participants in community education sessions documented in F.10. 
Document the three most frequent topics/areas of requests or needs.
6. Resident Visitation
    Document the number of facilities (unduplicated count) covered on a 
regular basis (weekly, bi-weekly, monthly or quarterly) in any 
ombudsman visitation program established in the State. If there is no 
visitation program, write N.A.
7. Participation in Facility Survey
    Provide the number of facility surveys in which the Ombudsman or 
designated ombudsman representatives participated, including 
participation in exit interviews. Do not count survey team contacts to 
the ombudsman regarding complaints against the facility. (HCFA survey 
procedure requires surveyors to contact the ombudsman to inquire 
whether complaints have been received about the facility and obtain 
information about any complaints. If surveyors fail to make this 
contact, document as an ombudsman-filed complaint under complaint 
category N.108.)
8./9. Work With Resident and Family Councils
    Provide the total count of all resident and family council meetings 
attended by designated ombudsman representatives during the reporting 
period, for both State and local levels.
10. Community Education
    Provide the total number of presentations made to and or other 
meetings with community groups, students, churches, etc.
11. Work With Media
    Provide the information requested at both State and local levels.
12. Monitoring/Work on Laws, Regulations, Government Policies and 
Actions
    Provide, for both state and local levels, a best estimate of the 
percentage of total paid staff time spent working with other agencies 
and individuals, both inside and outside of government, on laws, 
regulations, policies and actions to improve the health, welfare, 
safety and rights of long-term care residents.
State:-----------------------------------------------------------------
Fiscal Year: 199______

State Annual Ombudsman Report to the Administration on Aging

    Agency or organization which sponsors the State Ombudsman Program:

----------------------------------------------------------------------

Part I--Cases, Complainants and Complaints

    A. Provide the total number of cases opened during reporting 
period.
    Case: Each inquiry brought to, or initiated by, the ombudsman on 
behalf of a resident or group of residents involving one or more 
complaints or problems which requires opening of a case file and 
includes ombudsman investigation, fact gathering, setting of objectives 
and/or strategy to resolve, and follow-up.
    B. Provide the number of cases closed, by type of facility/setting, 
which were received from the types of complainants listed below.
    Closed: Ombudsman activity on a case has stopped for any of the 
following reasons: (1) resolution or partial resolution, (2) by request 
of complainant, (3) complaint(s) unresolvable, (4) complaint(s) not 
verified, (5) resident died and no further investigation was required 
or (6) complaint(s) referred to other agency for resolution and final 
disposition was not obtained and/or reported to ombudsman.

------------------------------------------------------------------------
                                                 Board and              
          Complainants               Nursing      care (or      Other   
                                    facility     similar)     settings  
------------------------------------------------------------------------
1. Resident......................                                       
2. Relative/friend of resident...                                       
3. Non-relative guardian, legal                                         
 representative..................                                       
4. Ombudsman/ombudsman volunteer.                                       
5. Facility administrator/staff..                                       
6. Other medical: physician/staff                                       
7. Representative of other social                                       
 service agency or program.......                                       
8. Unknown/anonymous.............                                       
9. Other; specify types..........                                       
                                  --------------------------------------
      Total number of cases                                             
       closed during the                                                
       reporting period:                                                
------------------------------------------------------------------------

    C. For cases which were closed during the reporting period (those 
counted in B above), provide the total number of complaints received:
    Complaint: A concern brought to, or initiated by, the ombudsman for 
investigation and action by or on behalf of one or more residents of a 
long-term care facility relating to health, safety, welfare or rights 
of a resident. One or more complaints constitute a case.
    D. Types of Complaints, by Type of Facility.
    Below and on the following pages provide the total number of 
complaints for each specific complaint category, for nursing facilities 
and board and care or similar type of adult care facility. The first 
four major headings are for complaints involving action or inaction by 
staff or management of the facility. The last major heading is for 
complaints against others outside the facility. See Instructions for 
additional clarification and definitions of types of facilities and 
selected complaint categories.

                     Ombudsman Complaint Categories                     
------------------------------------------------------------------------
                                                              Board and 
               Residents' rights                  Nursing      care (or 
                                                  facility     similar) 
------------------------------------------------------------------------
A. Abuse, Gross Neglect, Exploitation:                                  
    1. Abuse, physical (including corporal                              
     punishment)..............................                          
    2. Abuse, sexual..........................                          
    3. Abuse, verbal/mental (including                                  
     involuntary seclusion)...................                          
    4. Financial exploitation (use E for less                           
     severe forms of financial complaints)....                          
    5. Gross neglect (use categories under                              
     Resident Care for less severe forms of                             
     neglect).................................                          
    6. Resident-to-resident physical or sexual                          
     abuse....................................                          
    7. Other--specify.........................                          
B. Access to Information:                                               
    8. Access to own records..................                          
    9. Access to ombudsman/visitors...........                          
    10. Access to facility survey.............                          
    11. Information regarding advance                                   
     directive................................                          
    12. Information regarding medical                                   
     condition, treatment and any changes.....                          
    13. Information regarding rights,                                   
     benefits, services.......................                          
    14. Information communicated in                                     
     understandable language..................                          
    Other--specify............................                          
C. Admission, Transfer, Discharge, Eviction:                            
    16. Admission contract and/or procedure...                          
    17. Appeal process--absent, not followed..                          
    18. Bed hold--written notice, refusal to                            
     readmit..................................                          
    19. Discharge/eviction--planning, notice,                           
     procedure................................                          
    20. Discrimination in admission due to                              
     condition, disability....................                          
    21. Discrimination in admission due to                              
     Medicaid status..........................                          
    22. Room assignment/room change/                                    
     intrafacility transfer...................                          
    Other--specify............................                          
D. Autonomy, Choice, Exercise of Rights,                                
 Privacy:                                                               
    24. Choose personal physician, pharmacy...                          
    25. Confinement in facility against will                            
     (illegally)..............................                          
    26. Dignity, respect--staff attitudes.....                          
    27. Exercise choice and/or civil rights                             
     (includes right to smoke)................                          
    28. Exercise right to refuse care/                                  
     treatment................................                          
    29. Language barrier in daily routine.....                          
    30. Participate in care planning by                                 
     resident and/or designated surrogate.....                          
    31. Privacy--telephone, visitors, couples,                          
     mail.....................................                          
    32. Privacy in treatment, confidentiality.                          
    33. Response to complaints................                          
    34. Reprisal, retaliation.................                          
    35. Other--specify........................                          
E. Financial, Property (Except for Financial                            
 Exploitation):                                                         
    36. Billing/charges--notice, approval,                              
     questionable, accounting wrong or denied                           
     (includes overcharge of private pay                                
     residents)...............................                          
    37. Personal funds--mismanaged, access                              
     denied, deposits and other money not                               
     returned (report criminal-level misuse of                          
     personal funds under A.4)................                          
    38. Personal property lost, stolen, used                            
     by others, destroyed.....................                          
    39. Other--specify........................                          
Resident Care:                                                          
F. Care:                                                                
    40. Accidents, improper handling..........                          
    41. Call lights, requests for assistance..                          
    42. Care plan/resident assessment--                                 
     inadequate, failure to follow plan or                              
     physician orders (put lack of resident/                            
     surrogate involvement under D.30)........                          
    43. Contracture...........................                          
    44. Medications--administration,                                    
     organization.............................                          
    45. Personal hygiene (includes oral                                 
     hygiene).................................                          
    46. Physician services....................                          
    47. Pressure sores........................                          
    48. Symptoms unattended, no notice to                               
     others of change in condition............                          
    49. Toileting.............................                          
    50. Tubes--neglect of catheter, NG tube                             
     (use D.28 for inappropriate/forced use)..                          
    51. Wandering, failure to accommodate/                              
     monitor..................................                          
    52. Other--specify........................                          
G. Rehabilitation or Maintenance of Function:                           
    53. Assistive devices or equipment........                          
    54. Bowel and bladder training............                          
    55. Dental services.......................                          
    56. Mental health, psychosocial services..                          
    57. Range of motion/ambulation............                          
    58. Therapies--physical, occupational,                              
     speech...................................                          
    59. Vision and hearing....................                          
    60. Other--specify........................                          
H. Restraints--Chemical and Physical:                                   
    61. Physical restraint--assessment, use,                            
     monitoring...............................                          
    62. Psychoactive drugs--assessment, use,                            
     evaluation...............................                          
    63. Other--specify........................                          
Quality of Life:                                                        
I. Activities and Social Services:                                      
    64. Activities--choice and appropriateness                          
    65. Community interaction, transportation.                          
    66. Roommate conflict.....................                          
    67. Social services--availability/                                  
     appropriateness/ (use G.56 for mental                              
     health, psychosocial counseling/service).                          
    68. Other--specify........................                          
J. Dietary:                                                             
    69. Assistance in eating or assistive                               
     devices..................................                          
    70. Fluid availability/hydration..........                          
    71. Menu--quantity, quality, variation,                             
     choice...................................                          
    72. Snacks, time span between meals.......                          
    73. Temperature...........................                          
    74. Therapeutic diet......................                          
    75. Weight loss due to inadequate                                   
     nutrition................................                          
    76. Other--specify........................                          
K. Environment:                                                         
    77. Air temperature and quality (heating,                           
     cooling, ventilation, smoking)...........                          
    78. Cleanliness, pests....................                          
    79. Equipment/building--disrepair, hazard,                          
     poor lighting, fire safety...............                          
    80. Furnishings, storage for residents....                          
    81. Infection control.....................                          
    82. Laundry--lost, condition..............                          
    83. Odors.................................                          
    84. Space for activities, dining..........                          
    85. Supplies and linens...................                          
    86. Other--specify........................                          
Administration:                                                         
L. Policies, Procedures, Attitudes, Resources                           
 (See other complaint headings, of above, for                           
 policies on advance directive, due process,                            
 billing, management residents' funds):                                 
    87. Abuse investigation/reporting.........                          
    88. Administrator(s) unresponsive,                                  
     unavailable..............................                          
    89. Grievance procedure (use C for                                  
     transfer, discharge appeals).............                          
    90. Inadequate record-keeping.............                          
    91. Insufficient funds to operate.........                          
    92. Operator inadequately trained.........                          
    93. Offering inappropriate level of care                            
     (for B&C's/similar)......................                          
    94. Resident or family council/committee                            
     interfered with, not supported...........                          
    95. Other--specify........................                          
M. Staffing:                                                            
    96. Communication, language barrier (use                            
     D.29 if problem involves resident                                  
     inability to communicate)................                          
    97. Shortage of staff.....................                          
    98. Staff training, lack of screening.....                          
    99. Staff turn-over, over-use of nursing                            
     pools....................................                          
    100. Staff unresponsive, unavailable......                          
    101. Supervision..........................                          
    102. Other--specify.......................                          
N. Certification/Licensing Agency:                                      
    103. Access to information (including                               
     survey)..................................                          
    104. Complaint, response to...............                          
    105. Decertification/closure..............                          
    106. Intermediate sanctions...............                          
    107. Survey process.......................                          
    108. Survey process--ombudsman                                      
     participation............................                          
    109. Transfer or eviction hearing.........                          
    110. Other--specify.......................                          
O. State Medicaid Agency:                                               
    111. Access to information, application...                          
    112. Denial of eligibility................                          
    113. Non-covered services.................                          
    114. Personal Needs Allowance.............                          
    115. Servcies.............................                          
    116. Other--specify.......................                          
P. System/Others:                                                       
    117. Abuse/abandonment by family member/                            
     friend/guardian or, while on visit out of                          
     facility, any other person...............                          
    118. Bed shortage--placement..............                          
    119. Board and care/similar facility                                
     licensing, regulation....................                          
    120. Family conflict......................                          
    121. Financial exploitation by family or                            
     other not affiliated with facility.......                          
    122. Legal--guardianship, conservatorship,                          
     power of attorney, wills.................                          
    123. Medicare.............................                          
    124. PASARR...............................                          
    125. Resident's physician not available...                          
    126. Protective Service Agency............                          
    127. SSA, SSI, VA, Other Benefits.........                          
    128. Other--specify.......................                          
      Total, categories A through P...........                          
                                               -------------------------
Q. Complaints in Other Than Nursing or Board                            
 and Care/Similar Settings:                                             
    129. Home care............................                          
    130. Hospital or hospice..................                          
    131. Public or other congregate housing                             
     not providing personal care..............                          
    132. Shelters.............................                          
    133. Other--specify.......................                          
      Total, Heading Q........................                          
                                               -------------------------
      Total Complaints\1\.....................                          
                                               =========================
                                                                        
------------------------------------------------------------------------
\1\(Add total of nursing facility complaints, board and care/similar    
  complaints and complaints in Q, above. Place this number in Part I,   
  C).                                                                   

    E. Action on Complaints: Provide for cases closed during the 
reporting period the total number of complaints, by type of facility or 
other setting, for each item listed below.

------------------------------------------------------------------------
                                                 Board and              
                                     Nursing      care (or      Other   
                                     facility     similar)     settings 
------------------------------------------------------------------------
1. Complaints which were                                                
 verified:                                                              
                                                                        
Verified: It is determined after work [interviews, record inspection,   
 observation, etc.] that the circumstances described in the complaint   
 are substantiated or generally accurate.                               
                                                                        
2. Disposition: Provide for all                                         
 complaints reported in C and D,                                        
 whether verified or not, the                                           
 number:                                                                
    a. For which government                                             
     policy or regulatory change                                        
     or legislative action was                                          
     required to resolve (this                                          
     may be addressed in the                                            
     issues section).............                                       
    b. Which were not resolved\1\                                       
     to satisfaction of resident                                        
     or complainant..............                                       
    c. Which were withdrawn by                                          
     the resident or complainant.                                       
    d. Which were referred to                                           
     other agency for resolution                                        
     and:........................                                       
        (1) report of final                                             
         disposition was not                                            
         obtained................                                       
        (2) other agency failed                                         
         to act on complaint.....                                       
    e. For which no action was                                          
     needed or appropriate.......                                       
    f. Which were partially                                             
     resolved\1\ but some problem                                       
     remained....................                                       
    g. Which were resolved\1\ to                                        
     the satisfaction of resident                                       
     or complainant..............                                       
                                  --------------------------------------
      Total......................                                       
                                  ======================================
      Grant Total (Same number as                                       
       that for total complaints                                        
       on pages 1 and 7).........                                       
------------------------------------------------------------------------
\1\Resolved: The complaint/problem was addressed to the satisfaction of 
  the resident or complainant.                                          

    F. Legal Assistance/Remedies (Optional) Discuss on an attached 
sheet the types and percentages of total complaints for which (a) legal 
consultation was needed and/or used; (b) regulatory enforcement action 
was needed and/or used; (c) an administrative appeal or adjudication 
was needed and/or used; and (d) civil legal action was needed and/or 
used.
    G. Complaint Description (Optional): Provide on an attached sheet a 
concise description of the most interesting and/or significant 
individual complaint your program handled during the reporting period. 
State the problem, how the problem was resolved and the outcome.

Part II--Major Long-Term Care Issues

    Describe on attached sheets the priority long-term care issues 
which your program identified and/or worked on during the reporting 
period. For each issue, briefly state: (a) The problem, (b) barriers to 
resolution, and (c) recommendations for system-wide changes needed to 
resolve the issue, or how the issue was resolved in your State.

Part III--Program Information and Activities

A. Facilities and Beds

    1. How many nursing facilities are licensed and operating in your 
State?
    2. How many beds are there in these facilities?
    3. Provide the type-name(s) and definition(s) of the types of board 
and care facilities and any other adult care home similar to a nursing 
or board and care facility for which your ombudsman program provides 
services, as authorized under Section 102(19) and (34), 711(6) and 
712(a)(3)(A)(i) of the Older Americans Act:

(Continue on back of sheet if insufficient space.)
    (a) How many of the board and care and similar adult care 
facilities described above are licensed in your State?
    (b) How many beds are there in these facilities?

B. Program Coverage

    In the space below describe how your program provides statewide 
ombudsman coverage for nursing facilities and board and care or similar 
adult care facilities, described in Part III, A.3 above. If you are not 
able to provide statewide coverage, what are the barriers and what do 
you plan to do to overcome the barriers? Use additional sheet if 
needed.
    Statewide coverage: Residents of both nursing homes and a board and 
care homes (and similar adult care facilities) and their friends and 
families throughout the State have access to knowledge of the ombudsman 
program and how to contact it, and complaints received from any part of 
the State are investigated and documented and steps are taken to 
resolve problems in a timely manner, in accordance with Federal and 
State requirements.

Nursing Facilities

Board and Care/Similar Adult Care Facility

C. Local Programs

    Provide for each type of host organization the number of local or 
regional ombudsman entities (programs) designated by the State 
Ombudsman to participate in the statewide ombudsman program:

Local entities hosted by:                                               
  Area agency on aging.....................................             
  Other local government entity............................             
  Legal services provider..................................             
  Social services non-profit agency........................             
  Free-standing ombudsman program..........................             
  Regional office of State ombudsman program...............             
  Other; specify...........................................             
                                                            ------------
      Total Designated Local Ombudsman Entities............  ...........
                                                                        

D. Staff and Volunteers

    Provide numbers of staff and volunteers, as requested, at State and 
local levels.

----------------------------------------------------------------------------------------------------------------
                                                                                           State        Local   
                     Type of staff                                  Measure                office      programs 
----------------------------------------------------------------------------------------------------------------
Paid program staff....................................  FTE's.........................                          
                                                        Number people working full-                             
                                                         time on ombudsman program.                             
Paid clerical staff...................................  FTE's.........................                          
Volunteer ombudsmen certified to address complaints...  Number volunteers.............                          
                                                                                                                
Certified Volunteer: An individual who has completed a training course prescribed by the State Ombudsman and is 
 approved by the State Ombudsman to participate in the statewide Ombudsman Program.                             
                                                                                                                
Other volunteers......................................  Number volunteers.............                          
----------------------------------------------------------------------------------------------------------------

E. Program Funding

    Provide the amount of funds expended from each source for your 
statewide program:

Federal--Older Americans Act (OAA) Title VII, Chapter 2........        $
Federal--Older Americans Act (OAA) Title VII, Chapter 3........        $
Federal--OAA Title III provided at State level.................        $
Federal--OAA Title III provided at AAA level...................        $
Other Federal; specify:........................................        $
State funds....................................................        $
Local; specify.................................................       $ 
                                                                --------
      Total Program Funding....................................       $ 
                                                                        

F. Other Ombudsman Activities

    Provide below and on the next page information on ombudsman program 
activities other than work on complaints. 

------------------------------------------------------------------------
      Activity                Measure            State         Local    
------------------------------------------------------------------------
1. Training for        Number sessions......                            
 ombudsman staff, and                                                   
 volunteers.                                                            
                       Number hours.........                            
                       Total number of                                  
                        trainees.                                       
2. Technical           Estimated percentage                             
 assistance to local    of total staff time.                            
 ombudsmen and/or                                                       
 volunteers.                                                            
3. Training for        Number sessions......                            
 facility staff.                                                        
                       3 most frequent                                  
                        topics for training.                            
4. Consultation to     3 most frequent areas                            
 facilities             of consultation.                                
 (Consultation:                                                         
 providing                                                              
 information and                                                        
 technical                                                              
 assistance, often by                                                   
 telephone).                                                            
                       Number of                                        
                        consultations.                                  
5. Information and     3 most frequent        State                     
 consultation to        requests/needs.                                 
 individuals (usually                                                   
 by telephone).                                                         
                                              Local                     
                       Number of                                        
                        consultations.                                  
6. Resident            Number Nursing                                   
 visitation (other      Facilities visited                              
 than in response to    (unduplicated).                                 
 complaint).                                                            
                       Number Board and Care                            
                        (or similar)                                    
                        facilities visited                              
                        (unduplicated).                                 
7. Participation in    Number of surveys....                            
 Facility Surveys.                                                      
8. Work with resident  Number of meetings                               
 councils.              attended.                                       
9. Work with family    Number of meetings                               
 councils.              attended.                                       
10. Community          Number of sessions...                            
 Education.                                                             
11. Work with media..  Number of interviews/                            
                        discussions.                                    
                       Number of press                                  
                        releases.                                       
12. Monitoring/work    Estimated percentage                             
 on laws,               of total paid staff                             
 regulations,           time.                                           
 government policies                                                    
 and actions.                                                           
------------------------------------------------------------------------

 State Annual Ombudsman Report; File Transmittal Requirements

    To ensure compatibility of data submitted as part of the State 
Annual Ombudsman Report across states, AoA has developed a standard set 
of guidelines for transmittal of the State Annual Ombudsman Report data 
by state units on aging.
    These specifications are organized around a set of seven data files 
to be forwarded by states using diskettes or a modem. Each submitted 
file must be in the format specified below.

General Guidelines

    When preparing the files, please observe the following:
    1. AoA is requesting that state agencies provide annual report data 
in a machine readable format, conveyed either by diskette or by modem. 
The data files can be transmitted as ASCII files, or .DBF files. AoA 
prefers .DBF for data oriented files but will accept ASCII files which 
comply with the specifications addressed in this document. In the case 
of narrative information, please provide text files.
    2. Use the file names included in the file descriptions provided 
below.
    3. Please embed the state ID in the name of data file submitted by 
the state. The naming convention should place the state ID as the first 
two characters of the file name, replacing the XX in each file name. 
For example, Alabama when submitting ombudsman program summary data 
will submit a file named ALOMBSUM.DBF.
    4. Submit the files no later than 60 days following the end of the 
federal fiscal year, beginning November 30, 1995.
    5. Round all expenditure data to the nearest dollar.
    Like the Title III data sets, AoA has developed transmittal 
guidelines designed to encourage the use of electronic media. As a 
reminder, the ombudsman report is only for the state aggregate, not by 
PSA or other local program component. The files should be transmitted 
in .DBF format, where possible. The layout for each transmittal file is 
as follows:

1. Summary Performance Data--XXOMBSUM.DBF

    This file summarizes data contained in Part I.A. B. and C. of the 
Ombudsman Report format. Please refer to the Ombudsman Report format 
and instructions for further definitions and explanations of the data 
elements to be reported in this file. The file format for this single 
record file is as follows: 

1. State ID...............................................  C2          
2. Fiscal Year............................................  N4          
3. Name of Agency/Organization Sponsor....................  C30         
4. Total Cases Opened During Year.........................  N6          
                                                                        
The remaining fields all are numeric and 5 positions wide.              
                                                                        
5. Number Cases Closed--NF, Resident......................              
6. Number Cases Closed--NF, Relative/friend of Resident...              
7. Number Cases Closed--NF, Non-relative Guardian, Legal                
 Representative.                                                        
8. Number Cases Closed--NF, Ombudsman/Ombudsman Volunteer.              
9. Number Cases Closed--NF, Facility Administrator/Staff..              
10. Number Cases Closed--NF, Other Medical: Physician/                  
 staff.                                                                 
11. Number Cases Closed--NF, Representative of Other                    
 Agency.                                                                
12. Number Cases Closed--NF, Unknown/Anonymous............              
13. Number Cases Closed--NF, Other (In a separate text                  
 file describe Other).                                                  
14. Number Cases Closed--B&C, Resident....................              
15. Number Cases Closed--B&C, Relative/friend of Resident.              
16. Number Cases Closed--B&C, Non-relative Guardian, Legal              
 Representative.                                                        
17. Number Cases Closed--B&C, Ombudsman/Ombudsman                       
 Volunteer.                                                             
18. Number Cases Closed--B&C, Facility Administrator/Staff              
19. Number Cases Closed--B&C, Other Medical: Physician/                 
 staff.                                                                 
20. Number Cases Closed--B&C, Representative of Other                   
 Agency.                                                                
21. Number Cases Closed--B&C, Unknown/Anonymous...........              
22. Number Cases Closed--B&C, Other (In a separate text                 
 file, describe Other).                                                 
23. Number Cases Closed--Other Settings, Resident.........              
24. Number Cases Closed--Other Settings, Relative/friend                
 of Resident.                                                           
25. Number Cases Closed--Other Settings, Non-relative                   
 Guardian, Legal Representative.                                        
26. Number Cases Closed--Other Settings ,Ombudsman/                     
 Ombudsman Volunteer.                                                   
27. Number Cases Closed--Other Settings, Facility                       
 Administrator/Staff.                                                   
28. Number Cases Closed--Other Settings, Other Medical:                 
 Physician/staff.                                                       
29. Number Cases Closed--Other Settings, Representative of              
 Other Agency.                                                          
30. Number Cases Closed--Other Settings, Unknown/Anonymous              
31. Number Cases Closed--Other Settings, Other (In a                    
 separate text file, describe Other).                                   
                                                                        

2. Nursing Home and Other Settings Complaint File--XXNFCPL.DBF

    This single record file is used to transmit the information on the 
types of complaints. See Part I.D. of the Ombudsman Report format. In 
this file the nursing facility complaints are reported along with the 
information on complaints related to ``other settings'' ; see page 7 of 
the Ombudsman Report format. Note, the complaint data for board and 
care/similar facilities are included in a separate file.
    The data elements and format for this file are organized around the 
individual complaint categories.

1. State ID...............................................  C2          
2. Complaint Category A.1.................................  N6          
3. Complaint Category A.2.................................  N6          
    Through                                                             
128. Complaint Category P.128. Other......................  N6          
                                                                        
The balance of the data elements in this file pertain to complaints in  
 other settings of care.                                                
                                                                        
129. Complaints in Home Care settings.....................  N6          
130. Complaints in Hospital or Hospice....................  N6          
131. Public/Other Congregate Hsg, Not Providing Personal    N6          
 Care.                                                                  
132. Shelters.............................................  N6          
133. Other................................................  N6          
                                                                        

3. Board and Care Facility Complaint File--XXBCCMPL.DBF

    The data elements and format for this single record file are 
organized around the individual complaint categories.

1. State iD...............................................  C2          
2. Complaint Category A.1.................................  N6          
3. Complaint Category A.2.................................  N6          
    Through                                                             
128. Complaint Category P.128. Other......................  N6          
                                                                        

4. Action on Complaints File--XXCMPLAC.DBF

    This single record file is used to transmit data describe in Part 
I. E of the Ombudsman Report. The data elements and format are as 
follows:

1. State ID...............................................  C2          
2. NF, Verified Complaints................................  N7          
3. NF, Disposition--a.....................................  N6          
4. NF, Disposition--b.....................................  N6          
5. NF, Disposition--c.....................................  N6          
6. NF, Disposition--d.1...................................  N6          
7. NF, Disposition--d.2...................................  N6          
8. NF, Disposition--e.....................................  N6          
9. NF, Disposition--f.....................................  N6          
10. NF Dispoisition--g....................................  N6          
1. B&C, Verified Complaints...............................  N7          
12. B&C, Disposition--a...................................  N6          
13 B&C, Disposition--b....................................  N6          
14. B&C-Disposition--c....................................  N6          
15. B&C, Disposition--d.1.................................  N6          
16. B&C, Disposition--d.2.................................  N6          
17. B&C, Disposition--e...................................  N6          
18. B&C, Disposition--f...................................  N6          
19. B&C, Disposition--g...................................  N6          
20. Other Settings, Verified Complaints...................  N7          
21. Other Settings, Disposition--a........................  N6          
22. Other Settings, Disposition--b........................  N6          
23. Other Settings, Disposition--c........................  N6          
24. Other Settings Disposition--d.1.......................  N6          
25. Other Settings, Disposition--d.2......................  N6          
26. Other Settings, Disposition--e........................  N6          
37. Other Settings, Disposition--f........................  N6          
28. Other Settings, Disposition--g........................  N6          
                                                                        

5. Profile Data File--XXPROFLE.DBF

    This single record file is used to transmit a variety of 
descriptive data which helps describe the circumstances and 
characteristics of the LTC Ombudsman Program in each state. The data 
elements are as follows:

1. State ID...............................................  C2          
2. Fiscal Year............................................  N4          
3. # of NFs Licensed/Operating in State...................  N6          
4. # of Beds in Lic. NFs..................................  N7          
5. # of B&C/Similar Licensed Facilities...................  N6          
6. # of Beds in Lic. B&C/Similar Facilities...............  N7          
7. # of Local/Reg. Ombuds Prog. Hosted By Area Agencies on  N4          
 Aging.                                                                 
8. # of Local/Reg. Ombuds Prog. Hosted By Other Local       N4          
 Govt. Entity.                                                          
9. #of Local/Reg. Ombuds Prog. Hosted By Legal Services     N4          
 Provider.                                                              
10. # of Local/Reg. Ombuds Prog. Hosted By Social Services  N4          
 Non-Profit Agency.                                                     
11. # of Local/Reg. Ombuds Prog. Hosted By Free-standing    N4          
 Ombudsman Prog..                                                       
12. # of Local/Reg. Ombuds Prog. Hosted By Reg. Office of   N4          
 State Ombuds Program.                                                  
13. # of Local/Reg. Ombuds Prog. Hosted By Other Type(s)    N4\1\       
 of Local Entities.                                                     
14. # of State office Pd Program Staff FTEs...............  N4          
15. # of State Office Pd Program Staff Working Full Time    N4          
 on Ombudsman Prog..                                                    
16. # of State Office Pd Clerical Staff FTEs..............  N4          
17. # of State Office Volunteers Certified To Address       N4          
 Complaints.                                                            
18. # of State Office Other Volunteers....................  N4          
19. # of Local Program Pd Program Staff FTEs..............  N5          
20. # of Local Program Pd Program Staff Working Full Time   N5          
 on Ombuds Program.                                                     
21. # of Local Program Paid Clerical Staff FTEs...........  N6          
22. # of Local Program Volunteers Certified to Address      N5          
 Compliants.                                                            
23. # of Local Programs, Other Volunteers.................  N5          
24. Federal--OAA Title VII, Chapter 2 Funding For           N8          
 Statewide Program.                                                     
25. Federal--OAA Title VII, Chapter 3 Funding For           N8          
 Statewide Program.                                                     
26. Federal--OAA Title III Funding (At State Level) For     N8          
 Statewide Program.                                                     
27. Federal--OAA Title III Funding (At AAA Level) For       N8          
 Statewide Program.                                                     
28. Other Federal Funding For Statewide Prog..............  N8          
29. State Funding For Statewide Program...................  N8          
30. Local Funding.........................................  N8\2\       
31. Total Statewide Program Funding.......................  N8          
                                                                        
\1\In separate text file, describe other.                               
\2\In separate text file, describe local.                               

6. Ombudsman Activity File--XXOMBACT.DBF

    This single record file will be used to transmit required 
information on Ombudsman activities at the state and local level. See 
Part III.F. of the Ombudsman Report. The data elements and file layout 
are as follows:

1. # of Trning Sess for State Ombuds Staff/Volunteers.....  N5          
2. # of Trning Sess for Local Ombuds Staff/Volunteers.....  N5          
3. # of Trning Hrs for State Ombuds Staff/Volunteers......  N5          
4. # of Trning Hrs for Local Ombuds Staff/Volunteers......  N5          
5. # of Trainees--State Ombuds Staff/Volunteers...........  N5          
6. # of Trainees--Local Ombuds Staff/Volunteers...........  N5          
7. % of State Staff Time on TA to Local Ombudsmen/          N2          
 Volunteers.                                                            
8. % of Local Staff Time on TA to Local Ombudsmen/          N2          
 Volunteers.                                                            
9. # of Trning Sess by State Prog. For Facility Staff.....  N5          
10. # of Trning Sess by Local Prog. For Facility Staff....  N5          
11. # of State Prog Consults To Facilities................  N5          
12. # of Local Prog Consults To Facilities................  N5          
13. # of State Prog Consults To individuals...............  N5          
14. # of Local Prog Consults To Individuals...............  N5          
15. # of NFs Visited by State Program.....................  N5          
16. # of NFs Visited by Local Programs....................  N5          
17. # of B&C Facilities Visited by State Programs.........  N5          
18. # of B&C Facilities Visited by Local Programs.........  N5          
19. # of Fac. Surveys Participated In by State Programs...  N5          
20. # of Fac. Surveys Participated In by Local Programs...  N5          
21. # of Mtg. W/Res. Councils Attended By State Prog......  N5          
22. # of Mtg. W/Res. Councils Attended By Local Prog......  N5          
23. # of Mtg. W/Fam. Councils Attended By State Prog......  N5          
24. # of Mtg. W/Fam. Councils Attended By Local Prog......  N5          
25. # of Comm. Ed. Sessions Sponsored By State Prog.......  N5          
26. # of Comm. Ed. Sessions Sponsored By Local Prog.......  N5          
27. # of Interviews/Disc. With Media by State Prog........  N5          
28. # of Interviews/Disc. With Media by Local Prog........  N5          
29. # of Press Releases By State Programs.................  N5          
30. # of Press Releases By Local Programs.................  N5          
31. % of Total Pd State Staff Time Spent on Monitoring/     N5          
 Work On Laws, Regulations, Government Policies and                     
 Actions.                                                               
32. % of Total Pd Local Staff Time Spent on Monitoring/     N5          
 Work On Laws, Regulations, Government Policies and                     
 Actions.                                                               
                                                                        

4. Narrative Summaries--XXOMBNAR.WP

    In addition to the data files, SUAs should prepare an exportable 
text file. It should contain narrative responses to the open-ended 
questions in the Ombudsman Report. Specifically provide a narrative for 
each of the following:
     Part I. F. Legal Assistance/Remedies (Optional submission)
     Part I. G. Complaint Description (Optional submission)
     Part II. Major Long Term Care Issues
     Part III. A. Facilities and Beds, Item 3--Type, name and 
definitions of the types of board and care facilities and any other 
adult care home similar to a nursing or board and care facility for 
which your ombudsman program provides services.
     Part III. C. Program Coverage--Nursing Facilities and 
board and care/similar adult care facilities
     Part III. F. Other Ombudsman Activities:

--Three most frequent topics for training of facility staff
--Three most frequent areas of consultation to facilities
--Three most frequent requests/needs encountered in the provision of 
consultation to individuals--by state programs and separately by local 
programs.

     Explanation or responses to data elements in the Ombudsman 
Report where ``Other'' data are reported or states have been adked to 
specify/further describe a response, specifically:

--Number of cases closed--NF, Other
--Number of cases closed--B&C, Other
--Number of cases closed--Other, Other
--Other types of local entities hosting ombudsman programs
--Other federal funding sources
--Local funding sources

[FR Doc. 94-24050 Filed 9-28-94; 8:45 am]
BILLING CODE 4150-04-M