2012 Needs Assessment Survey - CMCOA2012 Needs Assessment Survey . 2 Table of Contents ... Individuals will be connected with a Senior LinkAge Line® Advocate if more assistance is

1

Central Minnesota Council on Aging

www.cmcoa.org

Survey Results

2012 Needs Assessment Survey

2

Table of Contents

EXECUTIVE SUMMARY ..................................................................................... 3

INTRODUCTION .................................................................................................... 4

THE STUDY ............................................................................................................. 4

PART I: CLIENT SURVEY FINDINGS .............................................................. 5

PART II: PROVIDER SURVEY FINDINGS .....................................................20

PART III: COMPARISON DATA (BOTH SURVEYS) ...................................28

APPENDIX A: CLIENT ONLINE SURVEY .....................................................33

APPENDIX B: PROVIDER ONLINE SURVEY ...............................................34

APPENDIX C: INTERACTIONS BETWEEN AGE AND SERVICES ..........35

APPENDIX D: INTERACTIONS BETWEEN INCOME AND SERVICES..37

3

Executive Summary The Central Minnesota Council on Aging has federal mandates to develop a comprehensive coordinated system of services as well as administer Older Americans Act funds within a 14-county region. To understand service needs, CMCOA conducted a regional survey of older adults (n=868) and providers (n=284) in 2011. Twenty-five percent of older adults in the region were sent invitations to participate and 3% responded making it difficult to generalize the data to a broader population. However the data still provide important narratives regarding the intricacies of service utilization in the region. A number of interesting demographic snapshots are available in the report on a number of questions relating to service utilization (i.e., over half reported “frequently” or “sometimes” feeling stress or burden due to caregiving responsibilities, an overwhelming majority could continue in their role as a caregiver with additional supports, etc.). In addition, some statistical trends were apparent in the older adult responses. Couples from the highest income group were more likely to indicate a willingness to pay for services and couples from the lowest income groups were more likely to respond they would NOT consider using a wide range of services. Younger cohorts were less likely to indicate they would NOT consider using a wide range of services and younger cohorts were more likely to be providing care than older cohorts. Providers offered insight regarding the capacity to meet the service needs of older adults. No region-wide services were identified as “surplus” or “unavailable.” Only home-based respite was identified as “inadequate” through the region. However, county-level results more detailed information about the lack of services. A number of services were listed as “inadequate” by respondents including assisted transportation (8 counties), out of home respite (7), adult day care (5), caregiver support groups (5), and transportation (7). While older adults responded that the major reason individuals cannot remain in their home is that they do not know where to receive help (57.9%), providers noted that it was because they were reluctant to pay for services (56.5%) and they waited too long to ask (56.8%). This is counter to the older adults responding that they overwhelmingly would be willing to pay for services (85.7%). The full report is available for download at www.cmcoa.org.

http://www.cmcoa.org/

4

Introduction The Central Minnesota Council on Aging (CMCOA) is a 501c3 non-profit organization designated as the Area Agency on Aging by the Minnesota Board on Aging to serve the fourteen county central region including the counties of Benton, Cass, Chisago, Crow Wing, Isanti, Kanabec, Mille Lacs, Morrison, Pine, Sherburne, Stearns, Todd, Wadena, and Wright. CMCOA serves the region through information and assistance services, grants and contracts administration, and administration and planning. Information & Assistance Area Agencies on Aging provide seniors, their families, and caregivers with information about services, financial assistance, and health care coverage through the Senior LinkAge Line® (1-800-333-2433), in-person visits, and group education sessions. Senior LinkAge Line® is a program that helps families, friends and seniors find answers and support that will help older people stay in the community longer and remain independent. With a single call to the Senior LinkAge Line® a person can locate particular services near them or get help evaluating their situation to determine what kind of service might be helpful. A Senior LinkAge Line® Specialist will research options and automatically transfer the caller to the service provider in their area. Individuals will be connected with a Senior LinkAge Line® Advocate if more assistance is needed in-person. The Advocate will conduct an in-depth assessment with the individual in their home or community site and help them navigate appropriate community services. As the designated State Health Insurance Assistance Program (SHIP), Area Agencies on Aging provide free health insurance counseling to persons receiving Medicare, help prevent and report fraud, waste and abuse in the Medicare system. Area Agencies on Aging provide a critical link to vulnerable or isolated elders through services provided in home such as home delivered meals, chore services and respite care. Grants and Contracts Administration One of the primary roles of Area Agencies on Aging is to administer at the local level, the Federal Older Americans Act funding. Using a planning process to review needs and trends, Area Agencies on Aging fund core services to help people live at home. These include meals, chore services, medication management, transportation, caregiver support, and legal services. Administration & Planning Area Agencies on Aging collaborate with communities, counties, and health and social service providers to increase local capacity to meet the needs of an aging population. This is accomplished through coordinated development of caregiver support, volunteer-based services, and community resources. CMCOA utilizes various tools to collect and analyze data to recognize trends in aging issues and determines appropriate development needs.

The Study The federally mandated responsibilities of an Area Agency on Aging (AAA) include both the development of a comprehensive coordinated system of services for older people and family caregivers, as well as the administration of Older Americans Act funds. It is because of these

5

roles as a planner, funder, coordinator and developer that there is a need to periodically conduct a regional survey of the system of services available to older adults. CMCOA has not completed a regional survey since the consolidation of the 14 county planning and service area. As a result, CMCOA surveyed older adults 60 years and older in their 14 county planning and service area to learn more about service utilization and need. The survey was released in October 2011. A survey letter requesting provider participation was emailed to provider contacts in the region. Providers only had the option of completing the survey online. All older adults were sent a postcard in the region encouraging them to go online to complete the survey but also provided them the option to request a paper copy. The postcard invitation was distributed to clients of Title III services and a mailing list of individuals 60 years and older living in a home or apartment setting. CMCOA also received assistance from several key providers who included information or did a direct mail to their members/clients including RSVP, Senior Companion, Foster Grandparent, Todd County Social Services, and CMCOA Board and Advisory members. Information was collected utilizing Survey Monkey. The survey closed in December 2011. A consulting researcher analyzed data utilizing measures of central tendency as well as cross-tab analyses to examine county differentiations. Qualitative data obtained through questions was analyzed utilizing standard free coding techniques. The researcher established codes and developed a frequency matrix based on words obtained from respondents. Information gathered from the surveys will be helpful to CMCOA, Board of Directors and Advisory Committee to continue their Mission to keep seniors in their homes and communities. It will also be available to other agencies interested in planning for the needs of older adults and their caregivers across central Minnesota. Rajean P. Moone, Ph.D. of Moone Consulting and John G. Cagle, Ph.D. of the University of California – San Francisco conducted data analyses and drafted the final report.

Part I: Client Survey Findings 981 older adult participants began the survey online, those that did not complete the questions were removed from analysis. 868 participants fully completed the survey for a total response rate of 3.7%. While the data presented represent a low sample response rate, they provide important insight into service provision and utilization amongst older adults in the region. The majority of respondents identified as white, female, and fully retired. For those identified as single, the income was fairly evenly distributed. For those identified as “married,” one-third had monthly income larger than $2,452.

6

The largest identified county of residents was Stearns, though there were respondents from every county in the region. This is consistent with Census data.

Table 1 Age of Respondents

n (%)

59 or younger 51 (5.9%)

60-74 years 546 (62.9%)

75-84 years 225 (25.9%)

85 or older 46 (5.3%)

Total 868

Table 2 Race of Respondents

n (%)

American Indian, Alaskan Native 4 (0.5%)

Asian 2 (0.2%)

Black or African American 1 (0.1%)

Hispanic or Latino 4 (0.5%)

Native Hawaiian or Pacific Islander 0 (0.0%)

White 849 (98.8%)

Other 3 (0.3%)

Total 868

59 or younger 60-74 75-84 85 or older

7

Table 3 Gender of Respondents

n (%)

Female 592 (68.9%)

Male 267 (31.1%

Total 859

Table 4 Employment Status

n (%)

Fully retired 620 (72.7%)

Working full time 90 (10.6%)

Working part time 119 (14.0%)

Unemployed, looking for work 24 (2.8%)

Total 868

Table 5 Single Income

n (%)

Under $908 47 (6.5%)

$908-$1,362 96 (13.4%)

$1,362-$1,816 60 (8.3%)

More than $1,816 126 (17.5%)

Unknown 12 (1.7%)

Total 719

Female Male

Fully retired Full time

Part Time Unemployed

Under $908 $908-$1,362

$1,362-$1,816 More than $1,816

Unknown

8

Table 6 Married Income

n (%)

Under $1,226 27 (3.4%)

$1,226-$1,839 81 (10.3%)

$1,839-$2,452 133 (16.8%)

More than $2,452 263 (17.5%)

Unknown 45 (5.7%)

Total 719

Table 7 Marital Status

n (%)

Married 531 (61.7%)

Single 329 (38.3%)

Table 8 County of Respondents

n (%)

Benton 50 (5.8%)

Cass 39 (4.5%)

Chisago 42 (4.8%)

Crow Wing 67 (7.7%)

Isanti 29 (3.3%)

Kanabec 22 (2.5%)

Mille Lacs 48 (5.5%)

Morrison 40 (4.6%)

Pine 39 (4.5%)

Under $1,226 $1,226-$1,839

$1,839-$2,452 More than $2,452

Unknown

9

Table 8 County of Respondents

n (%)

Sherburne 79 (9.1%)

Stearns 181 (20.9%)

Todd 117 (13.5%)

Wadena 36 (4.1%)

Wright 79 (9.1%)

Total 868

Client respondents were asked to select two reasons older people are unable to remain in their homes. Over half of the respondents reported that the main reason people are unable to remain in the home is that they are unaware of where to get help. Respondents nearly equally selected “unable to identify help needed,” “reluctant to pay,” “wait too long to ask,” and “lack of family support.” A minority of respondents selected “services not available.” A greater proportion of people 60-74 selected “people don’t know what help is available for someone living in their home” more so than people 59 and younger. Younger respondents were more likely to select “people wait too long before asking for help” than older respondents in the 85 and older group. There was no association between respondents who answered they are “reluctant to pay for help” and whether they would pay for general services or caregiver services. A substantial number of respondents added “other” as a category. These included fear of liens, information unavailable, perception of needing to be low income, all are applicable, family changes, fear of loss of control/patriarchal providers, home upkeep needs, isolation or location, unexpected health changes or failing health, pride of asking for help, and income too high or not enough income. Several provided responses unrelated to the question.

Table 9 Main Reasons People are Unable to Remain in Home

n (%)

Unable to identify help needed 294 (35.3%)

10


n (%)

Services not available 71 (8.5%)

Don’t know where to get help 482 (57.9%)

Reluctant to pay 289 (34.7%)

Wait too long to ask 247 (29.7%)

Lack of family support 239 (28.7%)

Other 91

Client respondents were asked which services they would use to remain in the community. Respondents were able to select if they were currently using, would consider using, would not consider using, or do not know enough about the service to make a selection. The majority respondents reported that they would consider every service. The most commonly used services included treatment (care by a licensed professional), health assessment, and senior center. The least commonly used services included facility based respite, home base respite, and out of home non-facility based respite. The service categories with the largest number of individuals that did not know enough about the service to make a selection include special access, legal education, and organizational advocacy. In general, younger individuals were less likely to NOT consider using the services described in Question 10. However, the interpretation of these findings may be confounded by several factors. First, older persons are more likely to be active users of the services listed in Question 10. Second, given the lengthy list of services, respondents may have been subject to acquiescent response bias (i.e., when given a long list of similar items, people will tend to give similar responses without regard to the specific item in question). There was no significant association between age and consideration for use of caregiver services (described in Question 12). The detailed relationships between age and services is available in Appendix C.

11

Table 10

Using Consider Not Consider Don’t Know

Assisted Transportation 34 4.2%

681 83.9%

73 9.0%

24 3.0%

Caregiver Coach 25 3.1%

624 78.3%

83 10.4%

65 8.2%

Caregiver Education 17 2.2%

607 77.9%

98 12.6%

57 7.3%

Caregiver Supplemental 11 1.4%

623 79.0%

88 11.2%

67 8.5%

Caregiver Support 15 2.0%

564 75.6%

106 14.2%

61 8.2%

Chore 34

4.1% 652

78.7% 104

12.6% 38

4.6% Congregate Meals 108

13.5% 524

65.6% 129

16.1% 38

4.8% Counseling 20

2.8% 480

66.1% 150

20.7% 76

10.5% Education 47

5.9% 539

67.7% 145

18.2% 65

8.2% Guardian 35

4.3% 422

52.4% 244

30.3% 105

13.0% Health Assessment 103

12.5% 617

75.0% 66

8.0% 37

4.5% Health Promotion 64

7.9% 578

71.2% 134

16.5% 36

4.4% Home Delivered Meals 26

3.3% 631

79.4% 110

13.8% 28

3.5% Home Injury Control Services 14

1.9% 525

70.9% 111

15.0% 91

12.3% Homemaker 34

4.1% 652

78.7% 104

12.6% 38

4.6% Home Modification/Repair 20

2.5% 648

79.7% 94

11.6% 51

6.3% Information & Assistance 33

4.1% 709

87.4% 38

4.7% 31

3.8% Legal Education 20

2.5% 541

67.5% 146

18.2% 95

11.8% Medication Management 49

6.1% 532

66.3% 150

18.7% 72

9.0% Mental Health 28

3.5% 494

61.4% 191

23.8% 91

11.3% Nutrition Counseling 54 531 166 56

12

Table 10

Using Consider Not Consider Don’t Know

6.7% 65.8% 20.6% 6.9% Organizational Advocacy 25

3.1% 549

68.5% 134

16.7% 94

11.7% PCA 20

2.4% 664

80.7% 85

10.3% 54

6.6% Placement 14

1.8% 491

62.3% 189

24.0% 94

11.9% Recreation 49

6.5% 556

73.7% 100

13.3% 49

6.5% Respite – Facility based 2

0.3% 542

69.7% 151

19.4% 83

10.7% Respite – Home Based 9

1.1% 654

82.7% 78

9.9% 50

6.3% Respite – Out of Home 8

1.0% 579

73.9% 127

16.2% 69

8.8% Self-directed Nutrition 81

12.2% 452

68.0% 79

11.9% 53

8.0% Senior Center 101

13.3% 524

68.8% 83

10.9% 54

7.1% Special Access 17

2.1% 391

49.2% 260

32.7% 126

15.9% Telephone Reassurance 49

6.2% 490

61.6% 177

22.3% 79

9.9% Transportation 37

4.8% 579

75.9% 76

10.0% 71

9.3% Treatment 122

15.0% 629

77.2% 44

5.4% 20

2.5% Visiting 34

5.0% 487

71.3% 105

15.4% 57

8.3%

Client respondents were asked if they were willing to pay for service. An overwhelming majority reported they were willing to pay compared to not willing. For couples, income was significantly associated with a willingness to pay for services. Specifically, coupled individuals from the highest income group were more likely to indicate a willingness to pay for the services described in Question 10 than respondents from lower income groups (i.e., <$1,226/mo, $1,226-$1,839, and $1,839-$2,442).

13

Table 11 Willing to Pay for Services

n (%)

Yes 722 (85.7%)

No 120 (14.3%)

Related, client respondents were asked if they were willing to pay for caregiver services. Again, an overwhelming majority reported they were willing to pay compared to not willing. There is no association between those providing caregiver services and their willingness to pay for the services. Income for singled persons was not significantly associated with an unwillingness to consider any of the services listed in Questions 10 and 12. Income for coupled persons, however, was associated with an unwillingness to consider using a service. In general, lower income coupled individuals were less willing to consider utilizing the services described in Questions 10 and 12. Taken together with the findings reported above in section 3, charging a means-based fee for the services to coupled persons in the highest income group(s) may be justified. See Appendix C for the complex relationship between the variables.

Table 12 Willing to Pay for Caregiver Services

n (%)

Yes 636 (80.8%)

No 151 (19.2%)

Total 787

Client respondents were asked is they were currently providing help to someone. A large majority reported they were not. There is no association with individuals providing caregiver services and the types of services they would use (Question 12). Younger cohorts (59 and younger, 60-74) were more likely to be providing care than older cohorts (75-84, 85+).

14

Table 13 Providing Help to Someone

n (%)

Yes 265 (30.4%)

No 585 (69.6%)

Total 841

Client respondents were asked for who do they provide care. Nearly one-third provided care for either a parent or a spouse. Table 14 Care Recipient

n (%)

Spouse 73 (28.4%)

Parent 74 (28.8%)

Parent-in-law 25 (9.7%)

Sibling 10 (3.9%)

Child 11 (4.3%)

Another relative 19 (7.4%)

Friend 66 (25.7%)

Neighbor 37 (14.4%)

Grandchild 11 (4.3%)

Total 257

When asked the number of hours that they provided care, the majority of client respondents provided zero to ten hours per week. Nearly one-third provided more than 20 hours per week.

15

Table 15 Number of Hours Per Week Providing Care

n (%)

0-10 Hours 153 (61.2%)

11-20 Hours 28 (11.2%)

More than 20 Hours 69 (27.6%)

Total 250

Respondents providing care were then asked their frequency of feelings of burden or stress in the last two months. One in ten responded that they frequently felt burden or. Nearly half reported a frequency of “sometimes” and nearly half reported “never”. There is no significant association between employment status and caregiver burden or stress. However, due to the sparseness of data this finding should be interpreted with caution because low cell counts violated assumptions of the chi-squared test. Table 16 Frequency of Feelings of Burden or Stress in Last 2 Months

n (%)

Frequently 25 (10%)

Sometimes 116 (46.6%)

Never 108 (43.4%)

Total 249

Client respondents were asked if they could continue providing care for their care receivers for as long as is necessary. The majority of respondents replied they could with the same help. 23 respondents noted “unsure” and specified their answer. The unsure answers were categorized as: yes, no, unsure, continued care dependent upon changing needs of the care receiver, explaining care provided, and unrelated answers to the question.

16

Table 17 Continue Providing Care as Long as Necessary

n (%)

Yes, with same help 169 (72.8%)

Yes, with additional help 57 (24.6%)

Not able 6 (2.6%)

Total 232

Client respondents were asked an open ended question of “in an ideal world, what would be most helpful to you as a caregiver?”162 individuals responded to the question. Data were categorized into themes. The largest category was “general caregiver support.” This included caregiver coaching and education as well as family interventions and family meetings. A surprising number were classified as “mental health” and included basic reassurance, someone to listen to them, and consoling. The qualitative analysis portrayed caregivers as requesting additional support in their role as caregivers including navigating complex familial relationships between siblings. Many respondents noted that they could continue providing services with support from other family or a trusted individual to provide respite.

Table 18 Most Helpful Services – Open Ended Question

n

General caregiver support 30

Mental health 21

Financial assistance 18

General help 16

Information / education 13

Respite care 12

Chore help 11

Transportation 11

Friendly visiting 7

17

Table 18 Most Helpful Services – Open Ended Question

n

In home help 7

Support groups 7

PCA 5

Recreation 4

Housing 4

Medication management 4

Time 3

Health insurance counseling 3

Grandparents raising grandchildren 3

Nutrition 1

Employment 1

Case management 1

Nursing home 1

First aid training 1

Neutral third party 1

Client respondents were asked an open ended question of “When you feel it is becoming difficult to continue your caregiving, what kind of help could you use in your caregiving role?”175 individuals responded to the question. Data were categorized into themes. The largest category of responses was “time off” or “respite care” with 38 respondents mentioning this. In addition, mental health in the form of reassurance or support was indicated as an important service. A number of respondents noted the importance of including additional family in providing care. PCA and general support were noted as important services by 11 respondents each.

18

Table 19 Services When Caregiving Is Difficult

n

Time off, respite 38

Mental health, reassurance 19

Family support 17

Financial support 12

PCA 11

General support 11

Transportation 10

Chore 9

Caregiver coaching 8

Family counseling 3

Nutrition 2

Friendly visiting 1

Legal 1

Meals 1

Nursing home 1

Time 1

Finally, client respondents were asked an open ended question of “is there anything else you would like us to know about you or about services or programs for older adults in your commnity?”262 individuals responded to the question. Data were categorized into themes. The majority of respondents provided a resource that was lacking in the community. These were collapsed into a broad category and reported separately (see Table 21). In addition a number of respondents noted a lack of information about services for older adults and caregivers. Several described a lack of financial resources to pay for services. Approximately 5% of respondents offered appreciation for local community resources that provided services for family members. A small number noted the importance of supporting unpaid caregivers and criticized the survey methods (lack of options for lesbian and gay participants, lack of geographic distinctions, lack of options to note when “unavailable” due to financial considerations). Finally, three respondents noted a fear of cuts to services.

19

Table 20 Other Information

n

Lack of services 38

More information about services 30

Financial help 18

Appreciation for specific providers 10

Caregiver support 6

Survey methods 3

Fear of cuts 3

Many respondents specifically listed services that were lacking in their community. They included transportation, chore services, services that are local, senior housing, and one for each of the following: community center, dental services, caregiver support, employment, and services for people with disabilities that are not over 60.

Table 21 Lack of Services

n

Transportation 9

Chore services 5

Geographically local 5

Senior housing 3

Community center 1

Dental services 1

Caregiver support 1

Employment 1

Services for people with disabilities 1

20

Part II: Provider Survey Findings Parallel to the older adult survey, CMCOA conducted a similar study with providers of senior services in the 14 county region. 441 individuals began the survey and 284 (64.4%) completed it. The largest types of provider that responded was County Public Health or Social Services and agencies that identified themselves as “Other Community Based Service Provider”. Other responses were categorized as housing, older adult/retired, community or senior center, uncategorized other, nutrition, volunteer or volunteer program, health care, hospital or hospice, caregiver, multiple services, township, and senior companion/foster grandparent. Medical equipment, adult day program and parish nurse each were reported twice. Area agency on aging, foundation, respite care, veterans services and advocacy organization each were reported once.

Table 22 Organization Type

n (%)

County Public Health or Social Services 71 (20.3%)

Faith Community 20 (5.7%)

Faith in Action/Living at Home Block Nurse 13 (3.7%)

Health Care Provider 30 (8.9%)

Health Plan 8 (2.3%)

Home Care Agency 31 (9.1%)

Nursing Home 42 (12.0%)

Senior Housing 64 (18.3%)

Other Community Based Service Provider 69 (19.7%)

Other 105 (12.1%)

Total 350

Nearly one-third to one-quarter of respondents provided services surrounding Saint Cloud including Stearns County, Sherburne County, Benton County, and Wright County.

21

Table 23 County Where Provide Services

n (%)

Benton 96 (23.3%)

Cass 48 (11.7%)

Chisago 58 (14.1%)

Crow Wing 66 (16.0%)

Isanti 62 (15.0%)

Kanabec 52 (12.6%)

Mille Lacs 65 (15.8%)

Morrison 62 (15.0%)

Pine 47 (11.4%)

Sherburne 114 (27.7%)

Stearns 132 (32.0%)

Todd 68 (16.5%)

Wadena 44 (10.7%)

Wright 91 (22.1%)

Participants were asked to describe their existing service area’s supply of home and community based services that are fundable under the Older Americans Act. Using a Likert scale they reported based on “surplus,” “adequate,” “inadequate,” “unavailable,” and “don’t know.” Only one service with a majority of responses selecting the “inadequate” option compared to the other scale options was in-home (home-based) respite care. No services were listed as “surplus” or “unavailable.” Services with a majority of responses selecting the “don’t know” option compared to the other scale options included guardianship, legal education, special access, home injury control services, and self-directed nutrition. Table 24 Respondent Perceived Supply of Services

Surplus Adequate Inadequate Unavailable

Don’t know

Adult Day 5 125 84 20 63

22

Table 24 Respondent Perceived Supply of Services


Don’t know

1.7% 42.1% 28.3% 6.7% 21.2% Assistive Transportation 9

3.0% 128

42.8% 121

40.5% 8

2.7% 33

11.0% Caregiver Coach 2

0.7% 117

39.9% 81

27.6% 9

3.1% 84

28.7% Caregiver Counseling 4

1.4% 130

44.2% 77

26.2% 7

2.4% 76

2.4% Caregiver Education 4

1.3% 119

40.1% 86

29.0% 10

3.4% 78

26.3% Caregiver Support Groups 4

1.3% 129

42.9% 84

27.9% 12

4.0% 72

23.9% Chore 7

2.4% 117

40.1% 70

24.0% 21

7.2% 77

26.4% Congregate Meals 11

3.7% 197

65.7% 35

11.7% 9

3.0% 48

16.0% Counseling 4

1.3% 139

46.6% 53

17.8% 9

3.0% 93

31.2% Education 8

2.7% 158

53.0% 57

19.1% 4

1.3% 71

23.8% Guardian 1

0.3% 108

36.4% 55

18.5% 12

4.0% 121

40.7% Health Assessments 8

2.6% 194

64.2% 34

11.3% 3

1.0% 63


4.1% 158

53.6% 61

20.7% 4

1.4% 60


5.0% 204

67.8% 43

14.3% 8

2.7% 31


1.0% 88

30.2% 62

21.3% 14

4.8% 124

42.6% Homemaker 11

3.6% 184

60.7% 42

13.9% 5

1.7% 61

20.1% Home Modification 1

0.3% 96

32.3% 95

32.0% 17

5.7% 88


5.6% 196

65.1% 44

14.6% 4

1.3% 40

13.3% Legal Assistance 2

0.7% 117

39.1% 75

25.1% 14

4.7% 91


0.7% 92

30.7% 79

26.3% 17

5.7% 110

36.7% Medication Management & Screening 7

2.4% 155

53.1% 56

19.2% 8

2.7% 31

10.3% Mental Health Screening/Referral 1

0.3% 102

34.6% 86

29.2% 12

4.1% 91

31.9% Nutrition Education 6

2.0% 122

41.4% 68

23.1% 6

2.0% 93

31.5% Nutrition Counseling 7

2.4% 138

46.8% 58

19.7% 8

2.7% 84

28.5% Organizational Advocacy 9 129 45 5 103

23

Table 24 Respondent Perceived Supply of Services


Don’t know

3.1% 44.3% 15.5% 1.7% 35.4% PCA 20

6.6% 201

65.9% 33

10.8% 5

1.6% 46

15.1% Placement 3

1.0% 139

46.5% 46

15.4% 3

1.0% 108

36.1% Recreation 10

3.3% 158

52.7% 65

21.7% 7

2.3% 60

20.0% Respite Care – Facility Based 4

1.4% 113

38.3% 71

24.1% 20

6.8% 87

29.5% Respite Care – Home Based 1

0.3% 97

32.9% 103

34.9% 18

6.1% 76

25.8% Respite Care – Out of Home (Non Facility) 5

1.7% 107

35.7% 94

31.3% 17

5.7% 77

25.7% Self-Directed Nutrition 1

0.3% 35.1

104% 62

20.9% 10

3.4% 119

40.2% Senior Center 19

6.3% 191

63.7% 47

15.7% 9

3.0% 34

11.3% Special Access 2

0.7% 99

34.0% 43

14.8% 5

1.7% 142

48.8% Telephone Reassurance 4

1.3% 119

39.8% 64

21.4% 13

4.3% 99

33.1% Transportation 6

2.0% 147

49.0% 115

38.3% 6

2.0% 26

8.7% Treatment 11

3.7% 172

57.3% 32

10.7% 6

2.0% 79

26.3% Visiting 7

2.3% 132

44.3% 84

28.2% 5

1.7% 70

23.5%

When analyzing the data across the region, it would appear that with the exception of home-based respite care, services are at least adequate. However, when conducting specific cross-tabs by county, different results present themselves. Larger populated counties with higher numbers of respondents tend to have less reporting of inadequate levels of services.

Table 25 Inadequate Services by County

Service Categories

Benton Caregiver Support Groups (evenly split between adequate & inadequate)

Caregiver Education/Training (evenly split between adequate & inadequate) Transportation

Cass Adult Day Care Assisted Transportation Chore Home Modification/Repair

24


Service Categories

Respite – Home Based Respite – Out of Home (Non Facility) Transportation

Chisago Assisted Transportation (evenly split between adequate & inadequate) Respite – Out of Home (Non Facility)

Crow Wing Home Modification/Repair Isanti Assisted Transportation

Chore (evenly split between adequate & inadequate) Respite – Home Based

Kanabec Adult Day Care Assisted Transportation Caregiver Education/Training Caregiver Support Groups Education (evenly split between adequate & inadequate) Home Modification/Repair Mental Health Screening/Referral Respite – Home Based Respite – Out of Home (Non Facility) Transportation

Mille Lacs Adult Day Care Assisted Transportation Caregiver Education/Training Caregiver Support Groups Chore Respite – Home Based Respite – Out of Home (Non Facility) Transportation

Morrison Assisted Transportation Caregiver Support Groups (evenly split between adequate & inadequate) Respite – Home Based Self-Directed Nutrition Transportation

Pine Adult Day Care Assisted Transportation Caregiver Support Groups Respite – Home Based Respite – Out of Home (Non Facility)

Sherburne Transportation (evenly split between adequate & inadequate) Stearns Adult Day Care

Respite – Out of Home (Non Facility)

Todd Respite – Home Based Respite – Out of Home (Non Facility)

Wadena Assisted Transportation Home Modification/Repair

25


Service Categories

Caregiver Support Groups Caregiver Education/Training Respite – Home Based

Wright Respite – Home Based

Table 26 Frequency of Inadequate Services in Counties

n (counties)

Adult Day Care 5 Assisted Transportation 8 Caregiver Support Groups 1 Caregiver Education/Training 4 Caregiver Support Groups 5 Chore 3 Education 1 Home Modification/Repair 4 Mental Health Screening/Referral 1 Respite – Out of Home (Non Facility) 7 Respite – Home Based 9 Self-Directed Nutrition 1 Transportation 5

Similar to the client survey, providers were asked to identify the two main reasons an older adult is unable to remain in the home. The majority of respondents selected “wait too long to ask” or “reluctant to pay.” Other responses were categorized as cost, high level of need, lack of transportation, lack of caregiver, pride, and complex/paperwork. Forced to move, lack of prevention, preference to move, none of the above, and not relevant response each received one response. Table 27 Main Reasons People are Unable to Remain in Home

n (%)

Unable to identify help needed 70 (22.7%)

26


n (%)

Services not available 48 (15.6%)

Don’t know where to get help 92 (29.9%)

Reluctant to pay 174 (56.5%)

Wait too long to ask 175 (56.8%)

Lack of family support 52 (16.9%)

Other 31

When asked if they charge a fee for their services, a slight majority responded “yes” compared to “no.” Table 28 Agency Charge a Fee

n (%)

Yes 180 (58.8%)

No 126 (41.2%)

Providers that responded that they charged a fee, were asked what type of fee. The majority utilized a fee for service structure. Over one quarter requested donations only and one fifth utilized a sliding fee. Other responses included EW/AC/MA (n=16), Medicare/Insurance, rental subsidy, and Veterans benefits.

27

Table 29 Fee Structure

n (%)

Fee for service 168 (63.6%)

Sliding fee 54 (20.5%)

Donation requests only 74 (28.0%)

Other 72

Total 264

Providers were asked their opinion on identified important ways to improve conditions and services for older adults in Minnesota. They were asked to mark the top three priorities that are in most urgent need of attention. Responses were fairly unified across the selection options with the variation only 11.6% from the highest rated condition to lowest rated condition. Other responses included more information, accessibility/transportation, funding, and local support/development teams. Changing attitudes of pride, flexibility in services, vision/hearing loss, and saturation of senior housing each received one response. Table 30 Ways to Improve Conditions for Older Adults

n (%)

Strengthen regional capacity to identify at risk older adults 87 (31.4%)

Strengthen regional chronic care management capacity 71 (25.6%)

Improve access to information 112 (40.4%)

Build communities that work for all ages 76 (27.4%)

Dementia issues 119 (43.0%)

Provide technical assistance to organizations 100 (36.1%)

Flexible service options 103 (37.2%)

Transitions of care 116 (41.9%)

Other 25

28

Part III: Comparison Data (Both Surveys) Both clients and providers were asked to select two main reasons that people are unable to remain in their own homes as they age and start to need help. They had the choice of selecting: people are unable to identify the help they need; the right in-home services are not available; people don’t know where to get help; people are reluctant to pay for help; people wait too long before seeking help; lack of family support. A majority of client respondents indicated that they were unaware of where to get help. Provider respondents indicated their perception that clients are reluctant to pay for home and community based services and often wait too long before asking for services. The majority of provider respondents selected “wait too long to ask” or “reluctant to pay.”


Client Responses Provider Responses

n

%

n

%

Unable to identify help

needed

294 35.3% 70 22.7%

Services not available 71 8.5% 48 15.6%

Don’t know where to get help 482 57.9% 92 29.9%

Reluctant to pay 289 34.7% 174 56.5%

Wait too long to ask 247 29.7% 175 56.8%

Lack of family support 239 28.7% 52 16.9%

Clients were asked if they were willing to pay for services and providers were asked if they charge a fee. A majority of clients responded that they would be willing to pay for services and a majority of providers charge a fee for services. Charging a fee from a provider could include any number of options including billing as a fee for service or applying sliding fee scale.

29

Table 32 Willing to Pay (Client) or Currently Charge a Fee (Provider)

Client Responses

Provider Responses

n

%

n

%

Yes 722 85.7% 180 58.8%

No 120 14.3% 126 41.2%

Both clients and providers were asked about the utilization (clients) and perceived supply (providers) of the same services. Regional trends between the two samples were not identified.

30

Table 33 Utilization (Clients) and Perceived Supply (Providers) of Services


Using

Consider Using

Not Consider

Don’t Know


Don’t know

Assisted Transportation 34 4.2%

681 83.9%

73 9.0%

24 3.0%

9 3.0%

128 42.8%

121 40.5%

8 2.7%

33 11.0%

Caregiver Coaching 25 3.1%

624 78.3%

83 10.4%

65 8.2%

2 0.7%

117 39.9%

81 27.6%

9 3.1%

84 28.7%

Caregiver Education 17 2.2%

607 77.9%

98 12.6%

57 7.3%

4 1.3%

119 40.1%

86 29.0%

10 3.4%

78 26.3%

Caregiver Support Groups 15 2.0%

564 75.6%

106 14.2%

61 8.2%

4 1.3%

129 42.9%

84 27.9%

12 4.0%

72 23.9%

Chore 34 4.1%

652 78.7%

104 12.6%

38 4.6%

7 2.4%

117 40.1%

70 24.0%

21 7.2%

77 26.4%

Congregate Meals 108 13.5%

524 65.6%

129 16.1%

38 4.8%

11 3.7%

197 65.7%

35 11.7%

9 3.0%

48 16.0%

Counseling 20 2.8%

480 66.1%

150 20.7%

76 10.5%

4 1.3%

139 46.6%

53 17.8%

9 3.0%

93 31.2%

Education 47 5.9%

539 67.7%

145 18.2%

65 8.2%

8 2.7%

158 53.0%

57 19.1%

4 1.3%

71 23.8%

Guardianship 35

4.3% 422

52.4% 244

30.3% 105

13.0% 1

0.3% 108

36.4% 55

18.5% 12

4.0% 121

40.7% Health Assessment 103

12.5% 617

75.0% 66

8.0% 37

4.5% 8

2.6% 194

64.2% 34

11.3% 3

1.0% 63


7.9% 578

71.2% 134

16.5% 36

4.4% 12

4.1% 158

53.6% 61

20.7% 4

1.4% 60


3.3% 631

79.4% 110

13.8% 28

3.5% 15

5.0% 204

67.8% 43

14.3% 8

2.7% 31


1.9% 525

70.9% 111

15.0% 91

12.3% 3

1.0% 88

30.2% 62

21.3% 14

4.8% 124

42.6%

31



Using

Consider Using

Not Consider

Don’t Know


Don’t know

Homemaker 34

4.1% 652

78.7% 104

12.6% 38

4.6% 11

3.6% 184

60.7% 42

13.9% 5

1.7% 61

20.1% Home Modification 20

2.5% 648

79.7% 94

11.6% 51

6.3% 1

0.3% 96

32.3% 95

32.0% 17

5.7% 88


4.1% 709

87.4% 38

4.7% 31

3.8% 17

5.6% 196

65.1% 44

14.6% 4

1.3% 40


2.5% 541

67.5% 146

18.2% 95

11.8% 2

0.7% 92

30.7% 79

26.3% 17

5.7% 110

36.7% Medication Management 49

6.1% 532

66.3% 150

18.7% 72

9.0% 7

2.4% 155

53.1% 56

19.2% 8

2.7% 31

10.3% Mental Health 28

3.5% 494

61.4% 191

23.8% 91

11.3% 1

0.3% 102

34.6% 86

29.2% 12

4.1% 91

31.9% Nutrition Counseling 54

6.7% 531

65.8% 166

20.6% 56

6.9% 7

2.4% 138

46.8% 58

19.7% 8

2.7% 84

28.5% Organizational Advocacy 25

3.1% 549

68.5% 134

16.7% 94

11.7% 9

3.1% 129

44.3% 45

15.5% 5

1.7% 103

35.4% PCA 20

2.4% 664

80.7% 85

10.3% 54

6.6% 20

6.6% 201

65.9% 33

10.8% 5

1.6% 46

15.1% Placement 14

1.8% 491

62.3% 189

24.0% 94

11.9% 3

1.0% 139

46.5% 46

15.4% 3

1.0% 108

36.1% Recreation 49

6.5% 556

73.7% 100

13.3% 49

6.5% 10

3.3% 158

52.7% 65

21.7% 7

2.3% 60

20.0% Respite – Facility Based 2

0.3% 542

69.7% 151

19.4% 83

10.7% 4

1.4% 113

38.3% 71

24.1% 20

6.8% 87

29.5% Respite – Home Based 9

1.1% 654

82.7% 78

9.9% 50

6.3% 1

0.3% 97

32.9% 103

34.9% 18

6.1% 76

25.8%

32



Using

Consider Using

Not Consider

Don’t Know


Don’t know

Respite – Out of Home 8 1.0%

579 73.9%

127 16.2%

69 8.8%

5 1.7%

107 35.7%

94 31.3%

17 5.7%

77 25.7%

Self-Directed Nutrition 81 12.2%

452 68.0%

79 11.9%

53 8.0%

1 0.3%

35.1 104%

62 20.9%

10 3.4%

119 40.2%

Senior Center 101 13.3%

524 68.8%

83 10.9%

54 7.1%

19 6.3%

191 63.7%

47 15.7%

9 3.0%

34 11.3%

Special Access 17 2.1%

391 49.2%

260 32.7%

126 15.9%

2 0.7%

99 34.0%

43 14.8%

5 1.7%

142 48.8%

Telephone Reassurance 49 6.2%

490 61.6%

177 22.3%

79 9.9%

4 1.3%

119 39.8%

64 21.4%

13 4.3%

99 33.1%

Transportation 37

4.8% 579

75.9% 76

10.0% 71

9.3% 6

2.0% 147

49.0% 115

38.3% 6

2.0% 26

8.7% Treatment 122

15.0% 629

77.2% 44

5.4% 20

2.5% 11

3.7% 172

57.3% 32

10.7% 6

2.0% 79

26.3% Visiting 34

5.0% 487

71.3% 105

15.4% 57

8.3% 7

2.3% 132

44.3% 84

28.2% 5

1.7% 70

23.5%

This report is available in pdf at www.cmcoa.org.

http://www.cmcoa.org/

33

Appendix A: Client Online Survey The following questions were asked via an online survey sent to seniors:

1. What is your age? 2. What county do you live in? 3. What is your marital status? 4. Which one or more of the following would you say is your race? 5. What is your gender? 6. What is your employment status? 7. What is your household income (single)? 8. What is your household income (married)? 9. In your opinion what are the two main reasons you or people in your community are

unable to remain in their own homes as they age and start to need help? 10. If you needed help to stay in your own home in your community, would you use the

following options? 11. If you have used, or would possibly use any of the above services, would you be willing

to pay a fee based on your own income or ability to pay? 12. If you needed help to provide care to your spouse, parent or someone close to you so

you could continue being a caregiver longer, would you use the following options? 13. As a caregiver, if you have used, or would possibly use any of the above services, would

you be willing to pay a fee based on your own income or ability to pay? 14. Are you currently providing help to someone? Keep in mind, caregiving can include

doing or organizing a wide range of service, like grocery shopping, preparing meals, rides to appointments, small or large chores around the house, helping with medications, financial support, or personal care for someone who is ill and the person you are caring for can be living with you, near you or even a long-distance away from you.

15. For whom do you provide care? Check all that apply. 16. In total, about how many hours per week do you spend providing care or help for this

person(s)? 17. How often in the past two months have you felt burdened or stressed by your

caregiving? 18. When you feel it is becoming difficult to continue your care giving, what kind of help

could you use in your care giving role? 19. In an ideal world, what would be most helpful to you as a caregiver? 20. Do you think you can continue providing care for the individual(s) for as long as is

necessary? 21. Is there anything else you would like us to know about you or about services or

programs for older adults in your community?

34

Appendix B: Provider Online Survey The following questions were asked via an online survey sent to providers:

1. Which of the following best describes your organization? 2. In which of the following counties do you provide services to older adults or family

caregivers? Please check all that apply. 3. How would you describe your existing service area’s supply of home and community

based services? (only services that are eligible for funding under the Older Americans Act are included on list)

4. In your opinion, what are the TWO MAIN REASONS people in your service area are unable to remain in their own homes as they age and start to need help?

5. Does your organization charge a fee for the services you provide? 6. Which of the following describes your service fee structure? (Check all that apply). 7. In your work with caregivers of older adults, what would you consider to be most

helpful to the caregiver? 8. The following have been identified as important ways to improve conditions and

services for older adults in Minnesota. (Mark the top 3 priority areas only). 9. As you think about the work you do to support older adults and their caregivers what

other comments or concerns would you like to share with the Central MN Council on Aging?

35

Appendix C: Interactions Between Age and Services The following interactions were found significant between age and services. Analytic Note: Age was treated as an ordered categorical variable. All probability values (p-values) are the result of Kendell’s Tau-b test for ordinal variables. Only findings that were statistically significant at the p<.05 level are reported. Age*Legal Assistance: Younger respondents (i.e., 59 and younger, or 60-74years) were less likely to indicate that they would NOT consider using legal assistance than older respondents (75-84 years, and 85+) (Kendall’s tau-b .081 p=.015). Age*Home Modification/Repair: Respondents who were 60-74 years were less likely to indicate that they would NOT consider using home modification/repair than other age groups (Kendall’s tau-b .073 p=.032). Age*Legal Education: 10_12 (Kendall’s tau-b .106 p=.001) younger respondents (i.e., 59 and younger, or 60-74years) were less likely to select this option than older respondents (75-84 years, and 85+). In other words, respondents who were older were more likely to indicate that they would NOT consider using legal education. Age*Recreation: (Kendall’s tau-b .080 p=.015) younger respondents (i.e., 59 and younger, or 60-74years) were less likely to select this option than older respondents (75-84 years, and 85+). Respondents from the oldest two age categories were more likely to indicate that they would NOT consider using recreation. Age*Senior Center Facilities/Administration: Younger respondents (i.e., 59 and younger, or 60-74years) were less likely to indicate that they would NOT consider using senior center facilities/administration than older respondents (75-84 years, and 85+) (Kendall’s tau-b .068 p=.041). Age*Education/Training: Younger respondents (i.e., 59 and younger, or 60-74years) were less likely to indicate that they would NOT consider using education/training than older respondents (75-84 years, and 85+)(Kendall’s tau-b .143 p<.001). Age*Placement: Younger respondents (i.e., 59 and younger, or 60-74years) were less likely to indicate that they would NOT consider using placement services than older respondents (75-84 years, and 85+)(Kendall’s tau-b .192 p<.001). Age*Special Access: younger respondents (i.e., 59 and younger, or 60-74years) were less likely to indicate that they would NOT consider using special access than older respondents (75-84 years, and 85+) (Kendall’s tau-b .128 p<.001).

36

Age*Counseling/Support Planning: Younger respondents (i.e., 59 and younger, or 60-74years) were less likely to indicate that they would NOT consider using counseling/support planning than older respondents (75-84 years, and 85+)(Kendall’s tau-b .114 p<.001). Age*Organizational Advocacy: Younger respondents (i.e., 59 and younger, or 60-74years) were less likely to indicate that they would NOT consider using organizational advocacy than older respondents (75-84 years, and 85+)(Kendall’s tau-b .098 p=.003). Age*Nutritional Counseling: Younger respondents (i.e., 59 and younger, or 60-74years) were less likely to indicate that they would NOT consider using nutritional counseling than older respondents (75-84 years, and 85+) (Kendall’s tau-b .078 p=.012). Age and 10_22 (Kendall’s tau-b .139 p<.001) younger respondents (i.e., 59 and younger, or 60-74years) were less likely to select this option than older respondents (75-84 years, and 85+) Is this 23 or 24? Age*Mental Health Screening/Referral: Younger respondents were less likely to indicate that they would NOT consider using mental health screening/referral than older respondents (75-84 years, and 85+) (Kendall’s tau-b .085 p=.009). Age*Medication Management and Screening: Younger respondents were less likely to indicate that they would NOT consider using medication management and screening than older respondents (75-84 years, and 85+) (Kendall’s tau-b .103 p=.001). Age*Home-delivered Meals: Younger respondents were less likely to indicate that they would NOT consider using home delivered meals than older respondents (75-84 years, and 85+) (Kendall’s tau-b .085 p=.012). Age*Congregate Meals: Younger respondents were less likely to NOT consider using congregate meals than older respondent groups (75-84 and 85+) (Kendall’s tau-b .092 p=.006) Age*Self-Directed Nutrition: Younger respondents were less likely to NOT consider self-directed nutrition than older respondents (75-84 years, and 85+) (Kendall’s tau-b .092 p=.006) Age*Nutrition Education: Younger respondents were less likely to NOT consider using nutrition education than older respondents (i.e., those who were 75-84 years, and 85+) (Kendall’s tau-b .132 p<.001).

37

Appendix D: Interactions Between Income and Services The following interactions were found significant between income and services. Income for Couples*Chore: Coupled individuals from the $1,226-$1,839 income category were more likely to indicate that they would NOT consider using chore services than persons from any other income category (χ2 = 10.590, df 3, p=.014). Income for Couples*Home Modification/Repair: Those from the three lower income categories (i.e., <$1,226/mo, $1,226-$1,839, and $1,839-$2,442) were more likely to indicate that they would NOT consider using home modification/repair than respondents in the highest income group (χ2 = 8.815, df 3, p=.032). Income for Couples*Treatment: Coupled respondents from the three lower income categories (i.e., <$1,226/mo, $1,226-$1,839, and $1,839-$2,442) were more likely to indicate that they would NOT consider using treatment than respondents in the highest income group (χ2 = 8.110, df 3, p=.044). Income for Couples*Guardianship: Coupled persons from the two lowest income categories (i.e., <$1,226/mo and $1,226-$1,839) were more likely to indicate that they would NOT consider using guardianship services than responders from the two highest income groups (χ2 = 8.257, df 3, p=.041). Income for Couples*Senior Center Facilities/Administration: Coupled persons from the two lowest income categories were more likely to indicate that they would NOT consider using senior center facilities/administration than respondents in the two highest income groups (χ2 = 10.174, df 3, p=.017). Income for Couples*Education/Training: Coupled individuals from the two lowest income categories were more likely to to indicate that they would NOT consider using education/training than respondents from the two highest income groups (χ2 = 9.249, df 3, p=.026). Income for Couples*Health Promotion Programs: Those from the $1,839-$2,442 income group were less likely to indicate that they would NOT consider using health promotion programs than persons from any other income category (χ2 = 8.157, df 3, p=.043) . Income for Couples*24Home Injury Control Services: Coupled responders from the two lowest income categories were more likely to indicate that they would NOT consider using home injury control services than responders from the two highest income groups (χ2 = 10.822, df 3, p=.013). Income for Couples*Home-delivered Meals: Coupled persons from the two lowest income

38

categories were more likely to indicate that they would NOT consider using home-delivered meals than respondents in the two highest income groups (χ2 = 11.781, df 3, p=.008). Income for Couples*Q10_27???? (N=521) (χ2 = 13.129, df 3, p=.004) Those from the $1,839-$2,442 income group were less likely to select this response than those in the other income categories Income for Couples*Coaching of Caregivers: Coupled responders from the three lowest income categories (i.e., <$1,226/mo, $1,226-$1,839, and $1,839-$2,442) were more likely to indicate that they would NOT consider using coaching of caregivers than respondents in the highest income group (χ2 = 16.822, df 3, p=.001). Income for Couples*Support Groups for Caregivers: Coupled persons from the two lowest income categories were more likely to indicate that they would NOT consider using support groups for caregivers than respondents from the two highest income groups (χ2 = 12.346, df 3, p=.006). Income for Couples*Education/Training: Couples from the highest income group were less likely to indicate that they would NOT consider using education/training than those from the three lowest income categories (i.e., <$1,226/mo, $1,226-$1,839, and $1,839-$2,442) (χ2 = 9.842, df 3, p=.020). Income for Couples*Supplemental Services for Caregivers: Couples from the three lower income categories (i.e., <$1,226/mo, $1,226-$1,839, and $1,839-$2,442) were more likely to indicate that they would NOT consider using supplemental services for caregivers than couples in the highest income group (χ2 = 8.646, df 3, p=.034).

Documents

2012 Needs Assessment Survey - CMCOA2012 Needs Assessment Survey . 2 Table of Contents ... Individuals will be connected with a Senior LinkAge Line® Advocate if more assistance is