Services for Native Americans (OAA Title VI)

ACL funds programs that support American Indians, Alaska Natives and Native Hawaiians in the areas of nutrition, supportive services for older adults, and caregiver services under Title VI of the Older Americans Act. 

The nutrition and supportive services grants include congregate and home-delivered meals, information and referral, transportation, personal care, chores, health promotion and disease prevention, and other supportive services. The caregiver services grants include assisting families in caring for older relatives with chronic illness or disability, and grandparents caring for grandchildren. There are other necessary services provided by ACL grants so the people we serve have meaningful support to help them live independently in their communities.

Keep reading to learn more, or visit OlderIndians.ACL.gov to find resources to support programs for tribal elders!

History of Title VI Programs

In 1978, the Older Americans Act was amended to include Title VI which established programs for the provision of nutrition and supportive services for Native Americans (American Indians, Alaska Natives and Native Hawaiians).

The program has since expanded to include caregiver support services. Eligible Tribal organizations receive grants in support of the delivery of home and community- based supportive services for their elders, including nutrition services and support for family and informal caregivers. The Authorizing Legislation comes from Sections 613, 623 and 631 of the Older Americans Act of 1965, as amended.

The Purpose of the Programs and How They Work

Services for Native Americans programs were first established in 1978 with the provision of nutrition and supportive services. In 2000, services expanded to include caregiver support services. Programs provide grants to eligible Tribal organizations to promote the delivery of home and community-based supportive services, including nutrition services and support for family and informal caregivers, to Native American, Alaskan Native, and Native Hawaiian elders. These programs, which help to reduce the need for costly institutional care and medical interventions, are responsive to the cultural diversity of Native American communities and represent an important part of the communities’ comprehensive services.

Criteria Used to Determine Eligibility for Grants

Formula grants for the Services for Native Americans programs are allocated to Tribal organizations based on their share of the American Indian, Alaskan Native, and Native Hawaiian population aged 60 and over in their services area. To be eligible for funding, Tribal organizations of federally-recognized Tribes must represent at least 50 Native American elders age 60 and over. There is no requirement for matching funds. Separate formula grant awards are made for nutrition and supportive services and caregiver support services.

Tribal Organizations Have Flexibility on Allocation of Resources

After meeting program requirements, Tribal organizations have flexibility to allocate resources among the various activities funded by each program. Tribes may also decide the age at which a member is considered an elder and thus be eligible for services. In FY 2011, grants for nutrition and supportive services were awarded to 254 Tribal organizations (representing more than 400 Tribes) and two organizations serving Native Hawaiian elders.

Nutrition and Supportive Services

Grants provide funding to Tribal organizations for a broad range of services to older Native Americans, including:

• Congregate and home-delivered meals,
• Information and referral,
• Transportation,
• Personal care,
• Chores,
• Health promotion and disease prevention, and
• Other supportive services.

Caregiver Support Services

Grants assist American Indian, Alaskan Native, and Native Hawaiian families caring for older relatives with chronic illness or disability, and grandparents caring for grandchildren. The program offers a variety of services that meet a range of caregivers’ needs, including information and outreach, access assistance, individual counseling, support groups and training, respite care, and other supplemental services.

Tribal organizations coordinate with other programs, including the Volunteers In Service To America (VISTA) program, to help support and create sustainable caregiver programs in Native American communities (many of which are geographically isolated). A core value of the Native American Caregiver Support Services, as expressed by Tribal leaders, is that the program should not replace the tradition of families caring for their elders. Rather, it provides support that strengthens the a family's caregiver role.

Data Show Extensive Services Provided to Native American Elders and Their Caregivers

FY 2013 output data give details on the units of service that have been provided through funding for this program:

• Transportation Services provided approximately 657,287 rides to meal sites, medical appointments, pharmacies, grocery stores, and other critical daily activity locations.
• Home-Delivered Nutrition Services provided more than 2.5 million meals to more than 22,000 home-bound Native American elders, as well as critical social contacts that help to reduce the risk of depression and isolation experienced by many home-bound elders.
• Congregate Nutrition Services provided more than 2.3 million meals to nearly 52,000 Native American elders in community-based settings, which also provide opportunities for elders to socialize and participate in a variety of activities, including cultural and wellness programs.
• Information, Referral, and Outreach Services provided approximately 700,000 hours of outreach and information on services and programs to Native American elders and their families, thus helping to empower them to make informed decisions about their care needs.
• In-Home Services provided nearly 1.2 million units of service to assist Native American elders.
• Caregiver Counseling and Support Group Services provided more than 29,000 units of counseling and support group services to caregivers caring for elders or grandparents caring for grandchildren.
• Caregiver Respite Services provided close to 96,000 units of respite services to Native American caregivers caring for elders or grandparents caring for their grandchildren.

To obtain more information about the services provided to Native American elders and their caregivers, visit the AGing, Independence, and Disability (AGID) Program Data Portal, an online query system based on ACL-related data files and surveys as well as population characteristics from the Census Bureau for comparison purposes. The system allows users to produce customized tables in a step-by-step process and output the results in print or spreadsheet form. Information on Title VI Services by Tribal Organization is available through this data portal.

Ongoing Evaluation Updates

In 2016 ACL/AoA contracted ICF International (ICF) to conduct a participatory evaluation of the Title VI Grant Program, which provides home and community-based supportive services for older American Indian, Alaskan Native, and Native Hawaiian populations. The evaluation seeks to answer the following questions:

- How do tribes/organizations operate their Title VI Programs?
-  What is the impact of Title VI programs on elders in the community? Are there differences nationally or by tribe/organization?
- Do Title VI programs that are sole-sourced funded have a different impact than programs that are funded through multiple sources?

The evaluation, still ongoing, has released its Evaluation of the ACL Title VI Programs: Year 1 Interim Report outlining the approach to and the design of the evaluation. In addition, the report provides information on the evaluation participants, timeline of the project, and initial findings.

In the second full year of the Title VI Evaluation, the ICF evaluation team focused on understanding the Title VI Programs from the perspective of program staff and elders. The evaluation uses mixed methods, including quantitative (primary and secondary) and qualitative (primary) data sources to understand the context and the impact of the Title VI Program through an implementation and outcomes study. The evaluation team analyzed multiple data sources to present a first look at the Title VI Programs. Emerging themes include elders’ met and unmet needs, social connectedness, and independence and quality of life. The evaluation found that Title VI Evaluation grantees were representative of the overall population of Title VI grantees across several components including elders’ health characteristics, health and nutrition status, and level of services they receive. Further, the evaluation uncovered how important the nutritional, social, and cultural aspects of the Title VI program are for Native elders. View the Evaluation of the ACL Title VI Programs: Year 2 Interim Report.

 

In the third year of the Title VI Evaluation, the evaluation team focused on understanding the Title VI Part C, Native American Caregiver Support Program, from the perspective of caregivers. Multiple data sources were analyzed, including interviews and focus groups with informal (unpaid) caregivers, in order to understand the implementation and impact of the Pact C Caregiver Support Program. The evaluation found that the Caregiver program is implemented in uneven ways across grantees, an issue that ACL began to address immediately. Emerging themes from this year’s findings were that caregiving is a rewarding but challenging experience, that caregivers do not always see themselves as caregivers, but that the services received through Title VI Part C provide important support to improve caregiver’s overall quality of life.  

Attachments include:

- Title VI Evaluation Year 3 Interim Report
- Title VI Evaluation Appendix A – Medicine Wheel
- Title VI Evaluation Appendix B – Methods
- Title VI Evaluation Appendix C – In Their Own Words: Caregiver Quotes
- Title VI Evaluation Appendix D – Focus Group Summary

Funding History

Funding for the Services for Native Americans programs during the past four years is as follows:

Fiscal Year	Part A/B	Part C	Total
FY 2012	$27,601,000	$6,364,000	$33,965,000
FY 2013	$26,157,052	$6,031,076	$32,188,128
FY 2014	$26,158,000	$6,031,000	$32,189,000
FY 2015	$26,158,000	$6,031,000	$32,189,000
FY 2016	$31,158,000	$7,531,000	$38,689,000

Funding Allocations to States and Tribal Organizations

Resources and Useful Links

The AoA is currently funding three Resource Centers for Older Indians, Alaska Natives, and Native Hawaiians. These centers provide culturally competent health care, community-based long-term care, and related services. They serve as the focal points for developing and sharing technical information and expertise for Native American organizations, Native American communities, educational institutions, and professionals working with elders.

University of North Dakota. Since 1994 the AoA has funded the National Resource Center on Native American Aging, University of North Dakota. A culturally sensitive staff and national steering committee govern the resource center, which provides education, training, technical assistance, and research. It also assists in developing community-based solutions to improve the quality of life and the delivery of related support services to the Native elderly population. A major project of this Resource Center has been the development of an elderly needs assessment tool to assist Tribes in planning for elder care services.

University of Alaska-Anchorage. In 2003, AoA funded the National Resource Center on Native American Aging at the University of Alaska-Anchorage to: 1) empower Native communities to incorporate traditional and contemporary health practices that have the potential to effectively support and treat elders within community health care systems; 2) provide technical information to promote culturally sensitive and functionally appropriate services to maintain social well-being; and 3) provide an arena for discussions about the increasing problems of elder abuse to help Native communities in developing their own plans to reduce and control occurrences.

University of Hawaii. The National Resource Center for Native Hawaiian Elders was established in 2006 under a grant from AoA to the University of Hawaii School of Social Work. With the nation’s largest enrollment of Native Hawaiian students, the University of Hawaii has as its mission the development and transmission of knowledge for the betterment of all Native Hawaiians. The National Resource Center seeks to continue this commitment with a focus on improving the well-being of Native Hawaiian elders by forging stronger collaborative relationships among the University and Native Hawaiian and gerontology communities.

Other resources available to Title VI Programs include the Title VI Evaluation Tool (Excel) and Tool Guide (PDF) to help Title VI programs create and customize client feedback surveys for Part A/B and Part C services.

Other Federal Programs

Indian Health Services Elder Care Initiative. The goal of the Elder Care Initiative is to promote the development of high-quality care for American Indian and Alaska Native elders by acting as a consultation and liaison resource for IHS, Tribal, and urban Indian health programs.

Centers for Medicare & Medicaid Services. Medicare, Medicaid, and the State Children's Health Insurance Program (SCHIP) play a critical role in determining the type and quality of healthcare received by American Indians/Alaska Natives (AI/AN). This site provides information on these programs and highlights aspects of specific interest to AI/AN.

Administration for Native Americans. The Administration for Native Americans (ANA) is a division of the Administration for Children and Families. The mission of ANA is to promote economic and social self-sufficiency for American Indians, Alaska Natives, Native Hawaiians, and other Native Pacific Islanders. ANA provides community-based project funding to improve the lives of native children and families thereby reducing long-term dependency on public assistance. Funding is provided to eligible Tribes and nonprofit Native American organizations through three competitive discretionary grant programs .

Other Data Resources:

Title VI Evaluation Tool

One resource available to Title VI Programs include the Title VI Evaluation Tool (Excel) and Title VI Evaluation Tool User Guide (PDF) to help Title VI programs create and customize client feedback surveys for Part A/B and Part C services.

The Administration for Community Living (ACL) encourages all Title VI grantees to participate in regular program evaluation. Evaluation is the ongoing and systematic process of gathering information to provide useful feedback that can be used to refine program services. Routinely evaluating program services and participant satisfaction can help Title VI programs ensure the needs of their elders and caregivers are being met.

Evaluation can sometimes feel like a challenge. As program directors, you likely have questions about your program but may not know where or how to start with evaluation. As part of the Evaluation of the ACL Title VI Programs, ICF, in partnership with ACL, worked with a group of Title VI grantees to understand the kinds of questions local Title VI programs have about their program and what types of resources would be most helpful in answering those questions. A common concern shared by program staff was how to know if program services are meeting the needs of elders and caregivers and what other needs elders and caregivers may have. To help with that, ICF developed the Title VI Evaluation Toolkit (under Resources and Useful Links). The toolkit, developed with input from local Title VI program staff, is a ready to use resource designed to help Title VI programs better understand how nutrition services, supportive services, and caregiver support services are meeting the needs of elders and caregivers. The Title VI Evaluation Toolkit includes:

User Guide – provides step-by-step guidance to help program staff evaluate their program. The User Guide includes sections on preparing for evaluation, collecting feedback from elders and caregivers, and analyzing and using findings.

Surveys – two surveys, one for Title VI elders and one for Title VI caregivers, to help program staff assess elder and caregiver use and satisfaction with program services. Each survey (Part A/B and Part C) includes questions designed to gather demographic information (e.g., gender, age, living status) and information specific to either Part A/B (nutrition and supportive services) or Part C (caregiver support services) including participation, satisfaction, and unmet needs.
 
Survey Response Spreadsheet – to help program staff analyze their survey responses with auto-generating tables and charts. After entering the survey results in the pre-built spreadsheet (step-by step directions are in the User Guide), the spreadsheet will automatically create graphs to help program staff better see and understand their data.

Evaluation is an important tool to help ensure our programs are meeting the needs of the elders and caregivers in our communities. The Title VI Evaluation Toolkit can help you better understand who your program is serving, how program services are being used, and identify opportunities to strengthen program services. We encourage you to download your free copy of the Title VI Evaluation Toolkit –the User Guide will walk you step-by-step through using the surveys to gain valuable information from your elders and using that information to inform your program planning. For more information, contact: Kristen Hudgins at kristen.hudgins@acl.hhs.gov or 202-795-7732.

“I honestly love the Graph Charts, it is a very helpful tool for our program and shows us exactly what our elders needs are.” – Title VI grantee

Title VI Data Infographic Tool

Another resource available to Title VI Programs is the Title VI Data Infographic Tool (PPT) and Title VI Data Infographic Tool User Guide (PDF) and Title VI Data Infographic Tool Calculations Worksheet (Excel) to help Title VI programs create and customize data-based infographics for their programs. (Note: Since the Title VI Data Infographic Tool is a large file due the nature of graphics it cannot be downloaded from ACL.gov, but can be requested by contacting: Kristen Hudgins at kristen.hudgins@acl.hhs.gov or 202-795-7732.)

As a Title VI program director, you know you are doing critical work in your community, and you may be looking for an impactful way to share with others what your program is doing. As part of the Evaluation of the ACL Title VI Programs, ICF, in partnership with ACL, developed the Title VI Infographic Toolkit.

Infographics are highly visual representations of program information and data that together tell a story. The Title VI Infographic Toolkit is designed to help you tell your Title VI program’s story using information you already have. To develop the Title VI Infographic Toolkit, ICF worked with a group of Title VI grantees to understand what kinds of program information you already collect and what kinds of information key stakeholders typically want to understand.

As a Title VI grantee, you already collect program information (data) for your annual Program Performance Report (PPR). Many of you also participate in the Elder Needs Assessment (ENA) through the National Resource Center on Native American Aging. The Title VI Infographic uses your PPR and ENA data to tell the story of your Title VI program.

The infographic describes the Title VI program service categories and uses data visualizations to show the health status of the elders in your community along with a snapshot of your program services including the percent of elders using each of your services and the number of services used by elders. The infographic also includes a section for you to highlight your outreach services and special events as well as key program partners. The infographic combines all of this in a way that is easy to understand and share with others.

The Title VI Infographic Toolkit includes:

User Guide – provides step-by-step guidance to help you find your program data and how to update the infographic with your data. The User Guide also includes tips on how to use your infographic for program monitoring and to engage stakeholders.

Title VI Infographic – a highly visual display of your program data. The infographic can be updated with new program data annually and can help you track your program over time.  (Note: Since the Title VI Data Infographic Tool is a large file due the nature of graphics it cannot be downloaded from ACL.gov, but can be requested by contacting: Kristen Hudgins at kristen.hudgins@acl.hhs.gov or 202-795-7732.)

Data Calculations Worksheet – to help you prepare your data to be entered into the infographic. Just enter your PPR and Elder Needs Assessment data directly into the Data Calculations Worksheet (step-by-step directions in the User Guide), and the worksheet will automatically calculate your data for you. You can then enter that information directly into the infographic.

Title VI program directors do incredibly important work. Providing nutrition and supportive services to elders is critical for their health and wellbeing, and it is important to be able to share that story with others in your community. The Title VI Infographic Toolkit can help you see the story of your Title VI program year by year and help you share that story with others. We encourage you to download your free copy of the Title VI Infographic Toolkit – the User Guide will walk you step-by-step through updating the infographic with your program data. For more information, contact:  kristen.hudgins@acl.hhs.gov.

“The infographic … will help me paint a picture for leadership. Data such as numbers, raw data, is good but to have visualizations for them to relate to is awesome.” – Title VI grantee