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Nevada Division for Aging Services
PERFORMANCE
INDICATORS
for Federal and State-Funded Aging Programs
(Revised January 10, 2003)
Programs that receive grant awards from the Nevada Division
for Aging Services are required to measure the effect of services on the quality
of clients’ lives. The use of
performance indicators is a national trend.
Numbers of clients and units of service alone are no longer an adequate
method to document the good works performed by agencies that serve the elderly.
In fact, the Administration on Aging is currently experimenting with
measurement tools similar to those contained on the following pages.
The trend is partially in response to Congressional demands
for more detailed information about how federal tax dollars are spent.
However, this mandate is not the only force driving the movement.
The information collected through performance indicators is expected to
help programs across the country determine ways to improve and enhance the
outstanding services they currently provide.
And it will also reinforce what aging service providers and advocates
have known for decades – that the provision of supportive services such as
nutrition, transportation and in-home assistance helps seniors enjoy more
independent, healthy, and meaningful lives.
In Nevada, when a program receives funding from the
Division for Aging Services, the director and his/her staff need to implement
the brief surveys that are the foundation of the required performance
indicators. Before service is
provided to a client, an initial survey must be completed to establish a
baseline. After the service is
provided, a follow-up survey must be completed in order to measure the impact of
the service. Unless otherwise noted
in this document, follow-up surveys should be completed six months after service
begins and every six months thereafter. Note
that if you wish to expand the survey with questions specific to your program,
you are free to do so.
The process should not be limited to new clients.
Existing clients should also be included.
Although the effects of the service may not be as remarkable, the
responses given by existing clients will be nonetheless valuable.
Therefore, the initial survey should be conducted with existing clients
as soon as reasonably possible and the follow-up surveys should be conducted at
the same interval as new clients.
Details of how the survey is conducted (i.e., by phone or
in person) may be developed by the program.
Completed surveys should be retained for the duration of the grant cycle
and a summary of results should (1) be provided to the Division for Aging
Services and (2) be attached to each group of surveys.
To
provide a summary of results to the Division for Aging Services, simply use a
blank copy of the survey to record the number of responses received for each
answer to each question. For
example:
1) How would you rate your health?
5
Excellent 13 Very Good
20 Good 27
Fair 19 Poor
As programs begin to use these performance indicators,
comments from staff will be welcomed. The
Division for Aging Services is interested in feedback that helps to determine
whether the surveys fit smoothly into the ongoing service process, whether the
questions are clear, and whether the information collected is considered useful
to programs.
The performance indicators in this document focus on
home-delivered meals, transportation, homemaker, personal care attendant, home
repair and modification, medical equipment loan, senior companion, and case
management/advocacy, and adult day care. This
document is available on diskette upon request.
Table of Contents
Home-Delivered Meals...............
3-4
Transportation..............................
5
Homemaker.................................
6
Personal Care Attendant............
7
Home Repair/Modification.........
8-9
Medical Equipment.....................
10
Senior Companion......................
11
Case Management/Advocacy....
12-13
Adult Day
Care.............................
14
Volunteer
Care.............................
15-16
1. Home-Delivered Meals
Initial Survey
1) How would you rate your health?
2) How often are you sick?
__Seldom __Once every three months
__Once a month
__Twice
a month __More than twice a
month
3)
How much of the time does your physical health or emotional problems
interfere with your ability to attend to your personal business, perform simple
household chores, or participate in social activities?
__All
of the time __Most of the
time __Some of the time
__A
little of the time __None of
the time
4) How would you rate your diet?
5) Do you ever feel hungry?
__Yes
__No
If
you answered “yes” to this question, what would you say is the reason(s)?
__Can’t
afford to purchase enough food
__Don’t
have a way to get groceries
__Difficulty
preparing meals due to a disability
__Don’t
know how to cook
__Don’t
have adequate food preparation equipment
__Am
alone and don’t want to go to the trouble just for myself
__Just
don’t feel up to cooking
__Have
health problems that interfere with eating (such as poor dental health or
digestive problems)
__Other
___________________________________
Follow-Up
Survey
To be conducted six months after service begins.
Preface questions with the phrase
“Since you have been receiving meals ...”
1) How would you rate your health?
__Excellent
__Very Good __Good __Fair
__Poor
2) How often are you sick?
__Seldom __Once every three months
__Once a month
__Twice
a month __More than twice a
month
3)
How much of the time has your physical health or emotional problems
interfered with your ability to attend to your personal business, perform simple
household chores, or participate in social activities?
__All
of the time __Most of the
time __Some of the time
__A
little of the time __None of
the time
4) How would you rate your diet?
__Excellent
__Very Good __Good __Fair
__Poor
5) Do you ever feel hungry?
__Yes __No
If
you answered “yes” to this question, what would you say is the reason(s)?
__Can’t
afford to purchase enough food
__Don’t
have a way to get groceries
__Difficulty
preparing meals due to a disability
__Don’t
know how to cook
__Don’t
have adequate food preparation equipment
__Am
alone and don’t want to go to the trouble just for myself
__Just
don’t feel up to cooking
__Health
problems that interfere with eating (such as poor dental health or digestive
problems)
__Other
___________________________________
If
you answered “yes” to this question before you began receiving meals and
“no” to this question now, what would you say has changed?
(Note that program staff may need to review the client’s initial
answers to help him/her with this question.)
__Home-delivered
meals
__Increase
in income
__Someone
shops for me now
__Someone
cooks for me now
__Learned
how to cook
__Obtained
food preparation equipment
__No
longer live alone
__Generally
feel better and am more able to cook
__Health
problems that interfered with eating have improved
__Other
____________________________________
2.
Transportation
Initial
Survey
1)
What kind of transportation do you currently use?
(Check all that apply)
__Drive
self __Driven by others
__Assisted bus or van service
__Taxi __None
2)
How many times in the last three months were you able to find
transportation to a medical appointment?
__0 __1-2 __3-4
__5 or more
3)
How many times in the last three months were you able to find transportation so
that you could attend a social function such as a church service or community
activity?
__0
__1-2 __3-4
__5 or more
4)
How many times have you used our transportation service in the past three
months? (For new clients, programs should enter “0.”)
__0
__1-2 __3-4
__5 or more
Follow-up Survey
1)
What kind of transportation do you currently use?
(Check all that apply)
__Drive
self __Driven by others
__Assisted bus or van service
__Taxi __None
2)
How many times in the last three months were you able to find
transportation to a medical appointment?
__0 __1-2 __3-4
__5 or more
If
the frequency has decreased or increased, state the reason.
3)
How many times in the last three months were you able to find transportation so
that you could attend a social function such as a church service or community
activity?
__0
__1-2 __3-4
__5 or more
If
the frequency has decreased or increased, state the reason.
4)
How many times have you used our transportation service in the past three
months?
__0
__1-2 __3-4
__5 or more
3.
Homemaker
Initial Survey
Programs
may answer the first question on behalf of the client.
1) Do you currently receive homemaker services?
__Yes __No
If
yes, how often? __Once a week __2-3 times a week
__4-5
times a week __6-7 times a
week
2)
How many times in the last three months did you feel worried, anxious or
depressed because you were unable to complete household tasks?
__0 __1-2 __3-4
__5 or more
3)
How many times in the last three months did you decline to welcome guests
into your home because you did not feel it was presentable?
__0
__1-2 __3-4
__5 or more
4)
Would you say that your home is safe, free of hazards, and is a healthy
environment?
__Strongly
agree __Agree
__Somewhat agree __Don’t Agree
Follow-up Survey
Programs
may answer the first question on behalf of the client.
1) Do you currently receive homemaker services?
__Yes __No
If
yes, how often? __Once a week __2-3 times a week
__4-5
times a week __6-7 times a
week
2)
How many times in the last three months did you feel worried, anxious or
depressed because you were unable to complete household tasks?
__0 __1-2 __3-4
__5 or more
3)
How many times in the last three months did you decline to welcome guests
into your home because you did not feel it was presentable?
__0
__1-2 __3-4
__5 or more
4)
Would you say that your home is safe, free of hazards, and is a healthy
environment?
__Strongly
agree __Agree
__Somewhat agree __Don’t Agree
4.
Personal Care Attendant
Initial Survey
1)
How many times are you able to take a bath or shower during the course of
a month?
__0
__1-2 __3-4
__5 or more
2)
In the past three months, have you worried about losing your independence
because you did not have someone to assist with personal care?
__Yes
__No
3)
How many times in the past three months have you been hospitalized?
__0
__1-2 __3-4
__5 or more
Follow-up Survey
1)
How many times are you able to take a bath or shower during the course of
a month?
__0
__1-2 __3-4
__5 or more
2)
In the past three months, have you worried about losing your independence
because you did not have someone to assist with personal care?
__Yes
__No
3)
How many times in the past three months have you been hospitalized?
__0
__1-2 __3-4
__5 or more
5.
Home Repair and Modification
Initial
Survey
1)
How many times did you fall in the last three months?
__0
__1-2 __ 3-4
__5 or more
2)
How many times per month are you able to take a bath or shower without
having someone stand by to assist you?
__0
__1-2 __3-4
__5 or more
3)
How many times in the last three months have you been able to leave your
home without someone to assist you?
__0
__1-2 __3-4
__5 or more
4)
During the last three months have you been able to use all the rooms in
your home?
__Yes __No
5)
How many times in the last three months did you feel worried, anxious or
depressed because your home did not have the necessary modifications to enable
you to use the bath or shower, walk up and down steps, or move from one room to
another without assistance?
__0 __1-2 __3-4
__5 or more
Follow-up
Survey
To
be conducted three months after home repair or modification is complete.
1)
How many times did you fall in the last three months?
__0
__1-2 __ 3-4
__5 or more
2)
How many times per month are you able to take a bath or shower without
having someone stand by to assist you?
__0
__1-2 __3-4
__5 or more
3)
How many times in the last three months have you been able to leave your
home without someone to assist you?
__0
__1-2 __3-4
__5 or more
4)
During the last three months have you been able to use all the rooms in
your home?
__Yes __No
5)
How many times in the last three months did you feel worried, anxious or
depressed because your home did not have the necessary modifications to enable
you to use the bath or shower, walk up and down steps, or move from one room to
another without assistance?
__0 __1-2 __3-4
__5 or more
6.
Medical Equipment
Initial
Survey
1)
How many times in the last three months did you feel worried, anxious or
depressed because you could not perform one or more of the following functions?
·
Take a bath or shower without assistance (bath seat or grab bars)
·
Perform toileting functions without assistance (potty seat)
·
Walk without assistance (cane, walker, crutches)
·
Maneuver inside or outside your home (wheelchair)
__0
__1-2 __3-4
__5 or more
2)
How many times in the past three months have you fallen?
__0
__1-2 __3-4
__5 or more
3) How many times in the past three months have you been
hospitalized?
__0
__1-2 __3-4
__5 or more
Follow-up
Survey
To
be conducted three months after the medical equipment is provided.
1)
How many times in the last three months did you feel worried, anxious or
depressed because you could not perform one or more of the following functions?
·
Take a bath or shower without assistance (bath seat or grab bars)
·
Perform toileting functions without assistance (potty seat)
·
Walk without assistance (cane, walker, crutches)
·
Maneuver inside or outside your home (wheelchair)
__0
__1-2 __3-4
__5 or more
2)
How many times in the past three months have you fallen?
__0
__1-2 __3-4
__5 or more
3) How many times in the past three months have you been
hospitalized?
__0
__1-2 __3-4
__5 or more
4)
Since receiving your medical equipment, would you say that it is easier
for you to:
·
Take a bath or shower without assistance (bath seat or grab bars)
·
Perform toileting functions without assistance (potty seat)
·
Walk without assistance (cane, walker, crutches)
·
Maneuver inside or outside your home (wheelchair)
__Strongly
agree __Agree
__Somewhat agree __Don’t agree
7.
Senior Companion
Initial
Survey
1)
In general, how would you describe your emotional well being?
__Excellent
__Very Good __Good __Fair
__Poor
2)
During the past three months, have you felt lonely?
__Often
__Sometimes __Never
3)
During the past three months, have you had suicidal thoughts?
__Often
__Sometimes __Never
4)
During the past three months, how many times have you been able to attend
to personal errands such as banking, postal services, shopping, and hairdresser?
__0
__1-2 __3-4
__5 or more
Follow-up
Survey
1)
In general, how would you describe your emotional well-being?
__Excellent
__Very Good __Good __Fair
__Poor
2)
During the past three months, have you felt lonely?
__Often
__Sometimes __Never
3)
During the past three months, have you had suicidal thoughts?
__Often
__Sometimes __Never
4)
During the past three months, how many times have you been able to attend
to personal errands such as banking, postal services, shopping, and hairdresser?
__0
__1-2 __3-4
__5 or more
8.
Case Management / Advocacy
Initial
Survey
1)
If you needed help understanding or finding a service, would you know of
someone to ask or call? __Yes __No
2)
In the past three months, have you experienced a problem that you could
not find help to resolve? __Yes
__No
If yes, please specify what type of problem.
3)
Are you aware of the following services?
·
Assistance to pay your Medicare premium __Yes
__No
·
Assistance to pay your energy bill
__Yes __No
·
Assistance with prescription drug costs
__Yes __No
·
Senior citizen’s tax relief and rent rebate __Yes
__No
·
Transportation
__Yes __No
·
Senior or community center meals __Yes
__No
·
Home-delivered meals
__Yes __No
·
Homemaker
__Yes __No
·
Senior companion
__Yes __No
·
Personal care
__Yes __No
Follow-up
Survey
To
be conducted three months after service was initially provided.
1)
If you needed help understanding or finding a service, would you know of
someone to ask or call? __Yes __No
2)
In the past three months, have you experienced a problem that you could
not find help to resolve? __Yes
__No
If yes, please specify what type of problem.
When
we asked you these questions previously, you told us about a problem you had
that you could not find help to resolve. (Remind
the client of the problem if necessary.) Since then, have you received help
with this problem? __Yes
__No
3)
Are you aware of the following services?
·
Assistance to pay your Medicare premium __Yes
__No
·
Assistance to pay your energy bill
__Yes __No
·
Assistance with prescription drug costs
__Yes __No
·
Senior citizen’s tax relief and rent rebate __Yes
__No
·
Transportation
__Yes __No
·
Senior or community center meals __Yes
__No
·
Home-delivered meals
__Yes __No
·
Homemaker
__Yes __No
·
Senior companion
__Yes __No
·
Personal care
__Yes __No
9.
Adult Day Care
These
questions should be directed toward the caregiver.
Initial
Survey
1)
How many times in the last three months have you missed work because you
did not have someone to care for your loved one?
__0
__1-2 __3-4
__5 or more
2)
Would you be able to work if you did not have adult day care services?
__Yes
__No
3)
How many times in the last three months have you been able to attend a
social function (dinner with friends, bowling, movies) or run errands (banking,
post office, shopping) without worrying about your loved one?
__0
__1-2 __3-4
__5 or more
Follow-up
Survey
1)
How many times in the last three months have you missed work because you
did not have someone to care for your loved one?
__0
__1-2 __3-4
__5 or more
2)
Would you be able to work if you did not have adult day care services?
__Yes
__No
3)
How many times in the last three months have you been able to attend a
social function (dinner with friends, bowling, movies) or run errands (banking,
post office, shopping) without worrying about your loved one?
__0
__1-2 __3-4
__5 or more
4)
Considering your loved one’s medical condition, do you believe he/she
has benefited from the activities and services offered at the adult day care
center?
__Yes
__No
If
yes, in what way? (Check all that
apply)
__More
sociable __More
mentally alert __Less
dependent on you
10. Volunteer Care
1) How would you rate your health?
2) How often are you sick?
__Seldom
__Once every three months __Once
a month
__Twice
a month __More than twice a
month
3)
In general, how would you describe your emotional well-being?
__Excellent
__Very Good __Good __Fair
__Poor
4)
During the past three months, have you felt lonely?
__Often
__Sometimes __Never
5)
How many times in the last three months were you able to attend to a
medical appointment? (not by program transportation)
__0 __1-2 __3-4
__5 or more
6)
During the past three months, how many times have you been able to leave
your home to attend to personal errands, such as banking and shopping? (not
by program transportation)
__0
__1-2 __3-4
__5 or more
7)
How many times have you used our transportation service in the past three
months? (For new clients, programs should enter “0.”)
__0
__1-2 __3-4
__5 or more
8)
During the past three months, have you experienced a problem that you
could not find
help to resolve? __Yes
__No
If
yes, please specify what type of problem.
Follow-up
Survey
1) How would you rate your health?
2) How often are you sick?
__Seldom
__Once every three months __Once
a month
__Twice
a month __More than twice a
month
3)
In general, how would you describe your emotional well-being?
__Excellent
__Very Good __Good __Fair
__Poor
4)
During the past three months, have you felt lonely?
__Often
__Sometimes __Never
5)
How many times in the last three months were you able to find
transportation to a medical appointment?
By
program transportation
__0 __1-2 __3-4
__5 or more
By
other means
__0 __1-2 __3-4
__5 or more
6)
During the past three months, how many times have you been able to leave
your home to attend to personal errands, such as banking, shopping and/or social
events?
By
program transportation
__0
__1-2 __3-4
__5 or more
By
other means
__0
__1-2 __3-4
__5 or more
7)
During the past three months, did the program assist you to resolve a
problem?
__
Yes __ No __ Not
applicable/No problem
If
yes, please specify what type of problem.
