United States General Accounting Office / ‘+a / 2 7 Testimony llllllllllllllll 142177 For Release OLDER AHERICANS ACT: On Delivery DISSlU4INATION OF RESEARCH AND Expected at DEMONSTRATION FINDIWGS COULD 9:30 a.m. EDT BE II'4PROVED Tuesday September 11, 1990 Statement of Joseph F. Delfico, Director of Income Security Issues Human Resources Division Before the Subcommittee on Human Services Select Committee on Aging House of Representatives GAO/T-I-W-90-53 GAO Form 160 (12/87) CYWRO / F/ZU’7 Summary Congress intended Title IV research and demonstration programs in the Older Americans Act as an innovative source of ideas to improve services for the elderly. Translating these ideas into practice, however, requires dissemination of results to agencies serving the elderly. We are reporting preliminary findings on dissemination of Title IV results obtained for a broader study we are doing on Older Americans Act reauthorization issues. GAO surveyed state agencies in all 50 states and the District of Columbia regarding their use of Title IV results sponsored by the Administration on Aging (AOA). We found that all but a few state agencies on aging are aware of some AOA research and demonstration results. Moreover, most state agencies use this information to shape their programs and operations, and also think that increased AOA dissemination would help them improve their programs. State agencies believe that AOA can improve dissemination by publishing a summary of completed Title IV projects' results and by conducting more conferences and seminars. AOA does not systematically disseminate Title IV results or monitor how these results are used. AOA officials told us that dissemination efforts were reduced in the 1980s, and that AOA relies mostly on others to disseminate results. No single official or office in AOA currently is accountable for dissemination. While Title IV dissemination is having some positive impact, it is not achieving maximum results because AOA does not have a comprehensive dissemination strategy. Based on responses from the state agencies and AOA officials, results appear to be disseminated in an ad hoc and haphazard manner. AOA officials acknowledge that more needs to be done to disseminate results and indicate that AOA is considering ways to improve its efforts. Mr. Chairman and Members of the Subcommittee: I am pleased to be here today to discuss the dissemination of research and demonstration results under Title IV of the Older Americans Act. You asked us to .discuss the extent and effectiveness of Administration on Aging (AOA) and Title IV grantee efforts to disseminate these results. To respond, we collected information on how state agencies on aging obtain and use AOA research and demonstration results. (See appendix I for details on our scope and methodology.) Congress intended Title IV research and demonstration programs in the Older Americans Act to be an innovative source of new ideas to improve services for the elderly. The importance of new ways to serve the elderly is increasing as fiscal constraints and changing demography strain the capacity of existing programs. Projections of increasing needs for services and growing stress on conventional sources of informal care for the disabled elderly will make innovative service ideas even more important in the future. The results of Title IV projects are of little use if agencies serving the elderly do not have access to them in a readily usable form. Accordingly, among Title IV’s stated purposes is the dissemination of results from research and 1 demonstration projects to organizations serving the elderly.1 Thus, each grant and contract is required to contain appropriate provisions for dissemination.2 These provisions include distribution of written reports, as well as other means of dissemination targeted to different users. For example, work sponsored by AOA and others emphasizes the importance of interactive dissemination methods, such as meetings, presentations, and other oral and visual media to supplement written products. We found that state agencies on aging are receiving Title IV research and demonstration results from many different sources and are using the information to shape their programs. State agencies believe that better AOA dissemination of these results would help them improve their operations and they suggested several ways that AOA can improve dissemination. AOA currently does not systematically disseminate information, monitor its dissemination, or evaluate its effectiveness. AOA officials IA purpose of the act is the ‘I. dissemination of information on aging and the aging process acqiired through such [Title IV] programs to public and private organizations or programs for older individuals.” Title 42 U.S.C., Section 3030aa(4) (1990 Supp.). 2The act requires that “Appropriate provisions for the dissemination of resulting information shall be a requirement for all [research and development] grants made under this section.” Title 42 U.S.C., Section 3035(a) (1990 Supp.). A similar provision, applicable to demonstration projects, requires that “Grants made and contracts entered into under this section [demonstration projects] shall include provisions for the appropriate dissemination of project results.” Title 42 U.S.C., Section 3035a(d) (2) (1990 Supp.). 2 indicate they are aware of inadequacies in dissemination, and are considering ways of improving it. State Agencies on Aging Frequently Use Title IV Results Our telephone survey of state agencies on aging showed that almost all state agencies on aging are aware of AOA research and demonstration results. All but two of the 51 state agencies surveyed said that they had become aware of some AOA research and demonstration results during the last two years. State agencies receive results through many different sources, including AOA, organizations partly sponsored by AOA, other federal agencies, and private agencies as shown in appendix II. The sources most frequently used by state agencies are the Older Americans Report, a private organization newsletter not affiliated with AOA; the National Association of State Units on Aging (NASUA), whose National Community-Based Long-Term Care Resource Center and National Center for State Long-Term Care Ombudsman Resources are funded by AOA; and other AOA-sponsored national resource centers.3 30ther National Aging Resource Centers include programs at Brandeis University, the University of Minnesota, the University of South Florida, a joint effort at the University of California at Los Angeles and the University of Southern California, Indiana University, San Diego State University, the American Association of Retired Persons, and the National Aging Resource Center on Elder Abuse. National resource centers that receive grants or contracts under the Older Americans Act are required to perform research and policy analysis and provide technical assistance for 3 State agencies on aging report taking many types of actions to access multiple sources of information, as shown in appendix III. The most frequent actions are reviews of the Older Americans Report, AOA memos and.correspondence, and professional literature. Perhaps the most significant finding related to the use of Title IV dissemination is that all but five state agencies on aging consider AOA research and demonstration results in making decisions about their programs and services. Of these, 32 have made program decisions based on such results. Nine states report they have used results to make changes in long-term care community-based systems, nine states have made changes in case management, five in programs for persons with Alzheimer’s disease, and five others in planning service delivery (see app. IV) . Forty-one states report that they value information on these results from a moderate to a great extent. Thirty-nine say that increased AOA dissemination would help moderately or greatly in carrying out their programs. the Commissioner, policy makers, service providers, and the Congress. Title 42 U.S.C., Section 3032(a) (1990 Supp.). 4 State Agencies See Room for Improved Dissemination Although most states currently are able to use Title IV results, almost all state agencies believe AOA could take action to make results easier to access and understand. They suggested specific ways that AOA can improve dissemination. Twenty-nine states suggested that AOA compile a summary of final results of projects to complement its compendium of active grants. Seventeen states suggested that AOA increase its interactive dissemination of results. Nine of these suggestions related to more direct contact with regional offices, and eight to more AOA conferences and seminars. In addition, 11 states expressed support for improving or enhancing grantee dissemination of results. AOA Agrees Dissemination Efforts Should Be Strengthened AOA does not systematically disseminate Title IV results or monitor how these results are used. Agency officials told us that dissemination activities have been cut back in the 1980s and that AOA has relied on others to disseminate results. No single official or agency unit is accountable for ensuring the adequacy of Title IV dissemination efforts, AOA officials told us. But, AOA officials indicated that they are aware of shortcomings in i) 5 dissemination and are considering ways to improve dissemination of research results. AOA used to disseminate more results directly through a clearinghouse, which was eliminated because of budget reductions, and through more active AOA staff participation in dissemination. Appropriations for Title IV grants have dropped from $54 million in 1980 to $26 million today. AOA officials told us that Title IV staff also decreased from about 50 full-time equivalents (FTEs) in 1983 to about 25 today, further reducing AOA's in-house capacity to disseminate. At this time, none of the current Title IV staff work exclusively on dissemination, according to AOA officials, and no single official or office is responsible for the dissemination of Title IV results. AOA officials also said that staff have little time to devote to dissemination because almost all of their time is required to prepare grant announcements, evaluate applications, and monitor the progress of work. AOA publishes the Compendium of Active Grants,4 but relies primarily on others to disseminate findings, particularly on Title IV grantees. AOA plans to rely even more on “knowledge 4The annual compendium contains listings and descriptions of projects underway, generated through an automated production system in which project descriptions and information are keyed in from grant awards materials. 6 transfer" projects, which focus on better dissemination of existing information rather than development of new information. AOA also provides results to disseminating agencies for their databases, including the American Association of Retired Persons' AGELINE, the National Technical*Information Service, the Department of Health and Human Services' Project Share, the Government Printing Office, and other agencies. AOA officials do not know, however, what information is disseminated to whom because AOA does not systematically monitor dissemination of results. Conclusions While Title IV dissemination is having some positive impact, it is not achieving maximum results because AOA does not have a comprehensive dissemination strategy. Based on responses from the state agencies and AOA officials, results appear to be disseminated predominantly in an ad hoc and haphazard manner. State agencies also told us that increased dissemination by AOA would make it easier for them to be aware of and apply results. For example, they suggested AOA prepare a summary of completed Title IV projects' results and expand use of conferences, seminars, and other interactive forums. - - - - - In a broader study of Older Americans Act reauthorization issues*, we are focusing on ways AOA can better manage the Title 7 IV dissemination process. In the near future, we will be reviewing AOA efforts: -- to designate responsibility for dissemination within AOA, -- to monitor and evaluateSdissemination efforts, -- to communicate results of completed Title IV projects, and -- to provide interactive dissemination of results through conferences, workshops and other activities. Mr. Chairman, this concludes my remarks. I will be glad to answer any questions at this time. 8 4 . APPENDIX I APPENDIX I Objectives, Scope, and M ethodology Our objectives today are to (1) provide users’ perspectives on AOA’s dissem ination of research and dem onstration results, (2) describe the current system of dissem ination, and (3) present the views of AOA officials and other experts on the effectiveness of this system . The inform ation we are providing represents our prelim inary analysis of data we obtained as part of a broader study we are doing on Older A m ericans Act reauthorization issues. We collected inform ation on AOA dissem ination efforts from a num ber of sources. We obtained the views of AOA officials regarding their dissem ination efforts. We interviewed outside experts, some Title IV grantees, and officials in other agencies carrying out sim ilar dissem ination efforts. We also conducted a telephone survey of state agencies on aging in the 50 states and the District of Colum bia, and analyzed their responses regarding the accessibility of Title IV results and the usef m ade of the m aterial dissem inated. 9 APPENDIX II APPENDIX II Frequent Sources of Information for State Agencies on Aging Concerning AOA Research and Demonstration Results Number of states Source reporting frequent use Older Americans Report 32 National Association of State Units on Aging (NASUA) 31 Other AOA-Sponsored National Resource Centers 28 AOA Memos and Correspondence 21 State and Area Agencies on Aging 14 National Council on Aging (NCOA) 12 American Association of Retired Persons (AARP) 12 AOA's Aging Magazine 11 Colleqes and Universities 8 Other-Research and Demonstration Grantees 7 Government Printing Office (GPO) 3 National Technical Information Service (NTIS) 2 Project Share 2 Source: GAO Telephone Survey, August 1990. 10 APPENDIX III APPENDIX III Actions Taken Most Frequently by State Agencies on Aging to Obtain AOA Research and Demonstration Results Number of states frequently Action taking action Review Older Americans Report 41 Review AOA memos and correspondence 40 Review professional literature 35 Review AOA's Aging Maqazine 20 Request information from National Association of State Units on Aging (NASUA) 18 Attend conferences, seminars, or meetings 13 Request information from any other AOA national rsource center 9 Request information from AOA 8 Request information from state and area agencies on aging 7 Request information from the American Association of Retired Persons (AARP) 7 Request information from colleges and universities 5 Use consultants or experts 5 Request information from other Older Americans Act Research and Demonstration Grantees Request information from the Government Printing Office (GPO) Request information from the National Council on Aging (NCOA) Request information from the National Technical Information Service (NTIS) Request information from Project Share Source: GAO Telephone Survey, August 1990. 11 APPENDIX IV APPENDIX IV Programs/Services in Which State Agencies on Aging Have Made Change As a Result of AOA Research and Demonstration Results Number of states making changes Program/services in last 2 years Long-term care 9 Case management Alzheimer's disease Planningb Targeting minorities Elder abuse Quality assurancec 2 Public/private activities 2 Source: GAO Telephone Survey, August 1990. aAlthough health is not specifically disaggregated, it was reported as an integral part of many of the social services the elderly receive; health was specifically mentioned by nine states. bPlanning functions reported include needs assessment, unnet needs determination, coordination and health provider regulations, and housing. cTwo other states mentioned quality assurance factors of in-home and case management services. 12
Older Americans Act: Dissemination of Research and Demonstration Findings Could Be Improved
Published by the Government Accountability Office on 1990-09-11.
Below is a raw (and likely hideous) rendition of the original report. (PDF)