Aging Network Effectiveness Survey

hor

Appendix B
Aging Network Partnerships and Effectiveness Survey

OMB NO. 0985-XXXX
Exp. Date MM/DD/YYYY

Aging Network Partnerships and
Effectiveness Survey
WELCOME SCREEN
Aging Network Partnerships and Effectiveness Survey
This survey is sponsored by the Administration for Community Living (ACL). It is part of a larger
study to learn about how the Aging Network collaborates to improve the lives of older adults,
and how it determines the value and effectiveness of the services it provides. Findings from this
survey will help ACL make informed decisions about ways to better support the Aging Network.
The information you provide will only be accessible to the evaluation team and ACL. Individual
responses will be grouped with others in published evaluation reports.
The survey will take about 15 minutes to complete. Please answer each question to the best of
your knowledge. If needed, ask others in your organization who have the content knowledge to
help answer the questions. You can save and exit the survey to complete it in more than one
sitting.
You may preview the questions covered in the survey here.
If you have any questions about the survey, please contact Mathematica at [TOLL FREE
NUMBER] or email [STUDY ADDRESS]@mathematica-mpr.com.

1

SECTION A –CHARACTERISTICS AND PARTNERSHIPS
ALL
The following questions are about [ENTITY NAME] characteristics.
A1.

Does [ENTITY NAME] also operate an Aging and Disability Resource Center
(ADRC) or function as a direct service provider?
ADRCs are designated to provide information, advice, counseling and assistance to help people
make decisions about long-term services and supports, and help accessing public and private
programs.
Direct service providers deliver home- and community-based services, meals, training, and
education to support older adults’ health and independence at home.
Select all that apply
 Aging and Disability Resource Center (ADRC) ................................ 1
 Direct Service Provider ................................................................ 2

 None of the above..................................................................... NA
IF A1 = 1 (ADRC)
A1a.

Does the ADRC also operate a center for independent living (CIL)?
CILs provide independent living services for people with
disabilities and are designed and operated by individuals with
disabilities.

 Yes ........................................................................................... 1
 No............................................................................................. 0

IF SAMPLETYPE = AAA
A2.

How would you classify [ENTITY NAME]?

(Question source: AAA National Survey Report -2020)

Select one only

 An independent, nonprofit agency ............................................. 1
 A part of county government .................................................... 2
 A part of a council of governments or regional planning
and development agency .......................................................... 3
 A part of city government .......................................................... 4
 Other (SPECIFY) ..................................................................... 99
Specify

(STRING 150)

2

IF SAMPLETYPE = AAA OR TITLE VI
A3.

Which of the following geographic areas does [ENTITY NAME] serve?
Select all that apply

 Frontier/remote ......................................................................... 1
 Rural ......................................................................................... 2
 Suburban .................................................................................. 3
 Urban........................................................................................ 4
ALL
A4Intro. The next questions are about partnerships [ENTITY NAME] has formed to
achieve the Aging Network mission. This mission promotes home and community-based
services that allow older adults to live where they choose, with the people they choose,
and with the ability to participate fully in their communities.

ALL
A4.

Which of the following does [ENTITY NAME] partner with?

Partners are organizations or groups of organizations with which you jointly engage in some of the
following activities: fundraising, shared resources, advocacy, strategic planning, public education, referrals,
service delivery, shared outreach, including outreach to special populations, training or technical
assistance, volunteer recruitment or retention. Partners may be formal or informal. (adapted from: Elderly
Nutrition Services Program State Unit on Aging (SUA) Survey)
Select all that apply

 Federal government agencies ................................................... 1
 State government agencies....................................................... 2
 Local government agencies ...................................................... 3
 Health care providers (public or private) ................................... 4
 Meal providers or food assistance providers (public or private) .. 5
 Housing providers (public or private) ......................................... 6
 Organizations that provide assistance with utilities (public or
private) ..................................................................................... 7
 Transportation providers (public or private)................................ 8
 Adult protective services or legal services (public or private) ..... 9
 Health insurance programs (public or private)............................ 10
 Private foundations .................................................................. 11
 Advocacy groups ...................................................................... 12
3

 Universities ............................................................................... 13
 Faith-based organizations ......................................................... 14
 Coalitions, collaboratives, or networks (e.g., multiple
organizations or agencies partnering to address the needs of
older adults) .............................................................................. 15
 Other (SPECIFY) ..................................................................... 99
Specify

(STRING 150)

IF A4 = 15
A5.

What is the focus of the coalitions, collaboratives, or networks that [ENTITY
NAME] partners with?
Select all that apply

 Community-based integration of health care and social
supports ................................................................................... 1
 Older adult hunger or food insecurity......................................... 2
 Elder abuse prevention ............................................................. 3
 Affordable housing with health and social services..................... 4
 Livable communities for older adults.......................................... 5
 Workforce development of home and community-based
service providers ...................................................................... 6
 Caregiver support ..................................................................... 7
 Social isolation .......................................................................... 8
 Advocacy .................................................................................. 9
 Other (SPECIFY) ..................................................................... 99
Specify

(STRING 250)

ALL
A6.

What factors have helped [ENTITY NAME] to form and maintain partnerships?
(Adapted from Title VI and Title III Grantee Collaboration Study Final Report-2020)
Select all that apply

 Continuity of leadership at my organization or partner
organizations ............................................................................ 1
 Funding availability .................................................................... 2
 Compatible visions (organizations share mutual goals
or missions) .............................................................................. 3
 Rules and regulations of my organization or partner
organizations ............................................................................ 4
4

 Successful communication between partners ............................ 5
 Previous good relationships ..................................................... 6
 Other (SPECIFY) ...................................................................... 99
Specify

(STRING 150)

ALL
A7Intro.In the past year, you may have participated in a survey about [ENTITY NAME]’s
response to the COVID-19 pandemic. That survey provided valuable information
about how agencies adapted to address rapidly emerging needs. The next few
questions are specifically about how [ENTITIY NAME]’s partnerships may have
changed to address emergent needs due to COVID-19.
ALL

A7.

Please indicate which emergent needs from COVID-19 [ENTITY NAME] and its
various partners are currently working together to address.
Select all that apply

 Assisting with nutrition services (e.g., grab and go
meals, prepared meal delivery, providing nutrition
education or counseling) ........................................................... 1
 Providing groceries, personal care and PPE supplies
(e.g., incontinence products, masks, hand sanitizer). ................. 2
 Medication delivery ................................................................... 3
 Addressing social isolation (e.g., telephone reassurance
program, tablets or smart devices for connecting with
friends and family)..................................................................... 4
 Assisting clients with telehealth access (e.g. providing
technology, Internet access) ..................................................... 5
 Supporting family caregivers ..................................................... 6
 Identifying home care aides or direct care workers to
support clients in their homes .................................................... 7
 Providing support, training, and PPE to home care
workers..................................................................................... 8
 Promoting or supporting vaccination.......................................... 9
 Facilitating hospital discharge.................................................... 10
 Assisting with health promotion programs (e.g.,
evidence-based workshops, health presentations, or
exercise classes) ...................................................................... 11
 Assisting with obtaining or maintaining public benefits ............... 12
5

 Assisting clients to maintain housing ......................................... 13
 Other change to address a need emerging from
COVID-19 (SPECIFY) ............................................................... 99
Specify

(STRING 150)

 None of the above..................................................................... NA
PROGRAMMER: LOOP THROUGH Q A8 FOR EACH NEED LISTED IN A7 (1-13, 99)

A7 = ANYTHING BUT NA
A8.

Is [ENTITY NAME] currently working to address this emergent need through new
partnership(s) that formed since March 2020, or partnership(s) that existed before
March 2020?
[DISPLAY RESPONSE FROM A7_[1-13, 99]
Select all that apply

 New partnership(s) that formed since March 2020 ..................... 1
 Partnership(s) that existed before March 2020 .......................... 2

ALL
In the following questions, we would like to learn more about a few of [ENTITY NAME]’s
closest partnerships. These are the partners that [ENTITY NAME] interacts with the most.
A9.

Please enter the names of up to two of [ENTITY NAME]’s closest partners.

Partners are organizations or groups of organizations with which you jointly engage in some of
the following activities: fundraising, shared resources, advocacy, strategic planning, public
education, referrals, service delivery, shared outreach, including outreach to special
populations, training or technical assistance, volunteer recruitment or retention. Partners may be
formal or informal.
[Open ended box for partner 1 name]
[Open ended box for partner 2 name]
Note: Partner names are only used to fill in the next survey questions and will not be used in any study
reports.

PROGRAMMER: LOOP THROUGH QS A10-A14 FOR EACH PARTNER LISTED IN A9
6

IF A9 ANSWERED (at least one close partner)
A10.

Which best describes [PARTNER 1/2]?
PROGRAMMER: DISPLAY LIST OF SELECTED PARTNER TYPES FROM A4
Select only one

IF A9 ANSWERED (at least one close partner)
A11.

Why did [ENTITY NAME] form a partnership with [PARTNER 1/2]?
Select all that apply

 To serve the needs of older adults............................................. 1
 To jointly leverage funding opportunities.................................... 2
 To work toward shared goals ..................................................... 3
 To target specific underserved populations................................ 4
 To address emergent needs due to COVID-19 .......................... 5
 To promote organizational sustainability .................................... 6
 Because the partnership is required as part of the Aging
Network or other requirements in my state ................................. 7
 Other (SPECIFY) ...................................................................... 99
Specify

(STRING 150)

 Don’t know ................................................................................ d

IF A9 ANSWERED (at least one close partner)
A12.

Which of the following best describes [ENTITY NAME]’s relationship with
[PARTNER 1/2]?
Mark all that apply

 We have a contractual relationship with [PARTNER 1/2] (IF
A9 = 15 (PARTNER IS A COALITION), FILL “or members of
[PARTNER 1/2]”) ...................................................................... 1
 We have a Memorandum of Understanding that describes
each of our roles ....................................................................... 2
 We have an informal relationship (“handshake” agreement)....... 3
 Other (SPECIFY) ...................................................................... 99
Specify

(STRING 150)

 Don’t know ................................................................................ d
7

IF A9 ANSWERED (at least one close partner)
A13.

Which of the following activities does [ENTITY NAME] jointly engage in with
[PARTNER 1/2]? (Adapted from ENSP State Unit on Aging (SUA) Survey)
Select all that apply

 Fundraising............................................................................... 1
 Advocacy .................................................................................. 2
 Strategic planning ..................................................................... 3
 Public education........................................................................ 4
 Referrals................................................................................... 5
 Service delivery ........................................................................ 6
 Shared outreach ....................................................................... 7
 Training or technical assistance ................................................. 8
 Volunteer recruitment or retention ............................................. 9
 Respond to public health emergency......................................... 10
 OTHER ..................................................................................... 99
Specify

(STRING 150)

IF A9 ANSWERED (at least one close partner)
A14.

What resources does [PARTNER 1/2] contribute toward shared goals with [ENTITY
NAME]?
Select all that apply

 Funding .................................................................................... 1
 Physical space, equipment, or goods ........................................ 2
 Knowledge or expertise ............................................................ 3
 Information/data........................................................................ 4
 Paid staff time ........................................................................... 5
 Volunteers ................................................................................ 6
 Connections to people, organizations, or groups ....................... 7
 Showing support for programs or services ................................. 8
 Convening necessary stakeholders ........................................... 9
 Other ....................................................................................... 99
Specify

(STRING 150)

 None of the above..................................................................... NA

8

SECTION B – RETURN ON INVESTMENT
ALL
We are also interested in how [ENTITY NAME] determines the value and effectiveness of
services and non-service activities (e.g. advocacy, streamlining access) to support older
adults and family caregivers in achieving the goals of the Older Americans Act. This
includes promoting health and wellness so that persons can live and fully participate in
their communities.
When determining the effectiveness of services and non-service activities, cost and
benefit analyses please consider not only the person receiving services but also their
caregivers, families, and the broader community.
ALL
The next questions are about how [ENTITY NAME] may evaluate the costs and benefits of
services and non-service activities.
B1.

Has [ENTITY NAME] ever conducted or participated in an assessment to
determine how much value or benefit a program provides relative to the cost of
program services? This often referred to as a “return on investment” (ROI) or
“cost-benefit” analysis.
 Yes ........................................................................................... 1
 No............................................................................................. 0

B1 = 1
B2.

Did [ENTITY NAME] or another organization/entity collect and analyze the data for
the ROI assessment?
Select all that apply

 [ENTITY NAME] collected and analyzed the data ....................... 1
 Another organization/entity collected and analyzed the
data........................................................................................... 2
 [ENTITY NAME] and another organization/entity
collaborated to collect and analyze the data ............................... 3

9

B1 =1
B3.

Please indicate all of the services included in any ROI assessment your agency
has participated in during the past three years.
Select all that apply

 Case management, care coordination, or service coordination... 1
 Evidence-based programs (e.g., falls prevention programs,
Chronic Disease Self -Management, medication management)... 2
 Care transitions or discharge planning....................................... 3
 Personal care ............................................................................ 4
 Homemaker services ................................................................ 5
 Chores...................................................................................... 6
 Home delivered meals ............................................................... 7
 Congregate meals ..................................................................... 8
 Nutrition counseling .................................................................. 9
 Assisted transportation.............................................................. 10
 Adult day care ........................................................................... 11
 Legal services ........................................................................... 12
 Home modifications or repairs ................................................... 13
 Services and programs to address social isolation ..................... 14
 Family caregiver support services (e.g. identifying and
accessing services, counseling and training, respite care) ......... 15
 OTHER ..................................................................................... 99
Specify

(STRING 150)

10

B1 =1
B4.

Please indicate all of the benefits that were included in the ROI assessment(s).
If your agency has conducted or participated in more than one ROI assessment, include
assessments from the past three years.
Select all that apply

 Improved management of chronic conditions (e.g.,
diabetes, high blood pressure, high cholesterol) ........................ 1
 Improved or maintained functional status (ADLs/IADLs)............. 2
 Greater independence, or delaying or avoiding entry
into long-term care facilities ....................................................... 3
 Increased socialization or reduced loneliness ............................ 4
 Reduced use of costly health and social services (e.g.,
fewer avoidable hospital admissions and ED visits).................... 5
 Improvements in self -reported physical or mental health ............ 6
 Increased life expectancy ......................................................... 7
 Improved quality of life .............................................................. 8
 Organizational benefits (e.g. improved member retention in
health plan) ............................................................................... 9
 Other (e.g., increased employment or economic security,
consumer satisfaction, food security, caregiver ability to
retain employment or conserve time off ).................................... 99
Specify

(STRING 250)

B1 =1
B5.

Please indicate all of your agency’s costs that were included in the ROI
assessment(s).
If your agency has conducted or participated in more than one ROI assessment, include
assessments from the past three years.
Select all that apply

 Staff costs (e.g., salaries and fringe benefits, volunteer
support) .................................................................................... 1
 Direct service costs (e.g., service contracts, support services,
partner and provider service costs) ........................................... 2
 Supply and equipment costs (e.g., supplies and/or leases on
purchase of equipment) ............................................................ 3
 Overhead and operating costs (e.g., overhead, facilities,
utilities, marketing, indirect costs) .............................................. 4
11

 Development and maintenance of data systems ........................ 5
 Other (SPECIFY) ...................................................................... 99
Specify

(STRING 250)

B1 =1
B6.

Please indicate how [ENTITY NAME] used or plans to use the results of the ROI
assessment(s).
Select all that apply

 To determine whether to continue (or discontinue), expand, or
improve a program .................................................................... 1
 To demonstrate the value of our services, or make a business
case, to potential private partners ............................................ 2
 To justify funding requests from government or foundation
funders ..................................................................................... 3
 Other (SPECIFY) ...................................................................... 99
Specify

(STRING 250)

ALL
B7.

Please mark up to three of the main challenges [ENTITY NAME] faces assessing
the benefits and costs of program services.
Select up to three

 Lack of agreement on how to monetize benefits ........................ 1
 Lack of technical skills to conduct an assessment ...................... 2
 Lack of data on costs ................................................................ 3
 Lack of data on benefits ............................................................ 4
 Lack of funding to conduct an assessment ................................ 5
 Lack of time or staff to conduct an assessment .......................... 6
 Assessing benefits and costs is not a current interest of my
organization .............................................................................. 7
 Other (SPECIFY) ...................................................................... 99
Specify

(STRING 250)

12

B1 =1
B9.

What lessons have you learned from conducting or participating in a return on
investment or cost-benefit assessment that would be helpful to other Aging
Network members seeking to do the same?
(STRING 500)

13

SECTION C: CONTACT INFORMATION
B1 = 1 (has conducted an ROI assessment)
C1.

Would you be willing to participate in an interview to learn more about how your
agency calculates the value or benefit of program services relative to their cost?
The purpose of the interview is to inform recommendations to ACL about how the
Aging Network might value costs and benefits of services. It is not an audit. It will
last about one hour.
 Yes ........................................................................................... 1
 No............................................................................................. 0

IF C1 = 1 (willing to be contacted for IDI)
C2.

Please confirm or update your name, title, organization, telephone number, and
email address below.
First Name:
Last Name:
Title:
Organization:
Telephone:
Email Address:

PROGRAMMER NOTE: ALLOW A STRING OF 150 CHARACTERS FOR EACH TEXT
FIELD.
CLOSING SCREEN 1.
[IF RESPONDENT ENTERS A SURVEY WITH A FINAL CODE; Our system shows that your
survey is complete.] Thank you for completing the survey! If you have any questions about the
survey, please contact Mathematica at [TOLL FREE NUMBER] or email [STUDY
ADDRESS]@mathematica-mpr.com.

Public Burden Statement:
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of
inf ormation unless such collection displays a valid OMB control number (OMB 0985-xxxx). Public
reporting burden for this collection of information is estimated to average .25 hours per response,
including time for gathering and maintaining the data needed and completing and reviewing the collection
of information. The obligation to respond to this collection is voluntary.
14