$$XID RFA AGNR9202 AG/NR-92-02 P1O1 ************************************ LONG-TERM CARE AND MINORITY AGING RFA: AG/NR-92-02 P.T. 34, FF; K.W. 0730000, 0710010, 0408006 National Institute on Aging National Center for Nursing Research Letter of Intent Receipt Date: February 4, 1992 Application Receipt Date: March 19, 1992 PURPOSE This Request for Applications (RFA) is to invite research on formal and informal long-term care patterns, determinants of such patterns, and emergent long-term care needs among African American, Asian, Pacific Islander, Hispanic, and Native American older people. Available national data show overall proportionally lower use of many formal long-term care services among minorities compared to the overall population. Use of other health and aging services, actual living arrangements of frail minority elders, and informal care networks of older minority individuals are poorly documented. Knowledge of, or data on, long-term care preferences among minority groups and subpopulations are similarly neglected. Other reasons that may contribute to ethnic and racial differences in long-term care patterns are attitudes, economic barriers, language, and institutional characteristics that are insensitive to minorities. Studies of minority long-term care have immediate practical and policy implications as well as importance for long range planning. HEALTHY PEOPLE 2000 The Public Health Service (PHS) is committed to achieving the health promotion and disease prevention objectives of "Healthy People 2000," a PHS-led National activity for setting priority areas. This RFA, Long-term Care and Minority Aging, is related to the priority area of older adults, specifically, key services and protection objectives targeting older adults, and to the priority area of special populations. Potential applicants may obtain a copy of "Healthy People 2000" (Full Report: Stock No. 017-001-00474-0) or Health People 2000" (Summary Report: Stock No. 017-001-00473-1) through the Superintendent of Documents, Government Printing Office, Washington, DC 20402-9325 (telephone 202-783-3238). ELIGIBILITY REQUIREMENTS Applications for research grants may be made by public or private, for-profit or non-profit organizations such as universities, colleges, hospitals, or laboratories. Minority and women investigators in particular are encouraged to apply. Where appropriate, applicants must demonstrate access to and ability to work with the selected minority research populations. Applications from or collaboration with minority institutions and organizations are also encouraged. Foreign institutions are eligible to apply but are advised to consult National Institute on Aging (NIA) or National Center for Nursing research (NCNR) staff, are encouraged to apply in association with a U.S. institution, and the research must deal with U.S. minority population. MECHANISM OF SUPPORT This RFA will use the National Institute of Health (NIH) traditional research project grant (R01) mechanism. Responsibility for the planning, direction, and execution of the proposed project will be solely that of the applicant. Awards will be administered under PHS grants policy as stated in the Public Health Service Grants Policy Statement. FUNDS AVAILABLE It is estimated that up to $2.05 million will be committed to fund the first-year total costs of up to nine grants in response to this RFA. Costs of each grant may vary according to research designs. This funding level is dependent on the receipt of a sufficient number of applications of high scientific merit and the availability of funds. The total project period for applications submitted in response to this RFA may not exceed four years. The anticipated award date will be September 30, 1992. This RFA is a one-time solicitation. Extensions may be proposed only through application as a competing continuation project. RESEARCH OBJECTIVES o Identify and understand current patterns of informal care and use of formal aging services among minority older people that differ from other populations. o Examine determinants (e.g., culturally related attitudes, cultural preferences, economic barriers, institutional characteristics) that account for patterns of use and access to formal and informal care services among minority older people. o Determine the consequences of variations in long-term care for the well being of minority older people (e.g., health status, continued community involvement), their families (e.g., quality of family relationships in multigeneration households, decisions about formal care), and for service delivery (e.g., institutional admission and placement policies, impact of special programs to reach minorities). BACKGROUND Little is known about the long-term care, use of formal services, actual living arrangements, and informal care networks of minority people as they age. However, national data suggest low rates of nursing home use by older minority individuals. For example, among those 85 years of age and older (individuals most likely to be in need of nursing home care) only 10 percent of Hispanics, 12 percent of African Americans, and 13 percent of Native Americans are in such care, compared with 23 percent of their non-Hispanic white counterparts. Data on other formal services such as nutrition services and home health care are less well documented, but suggest lower use by minority elders. Low utilization is particularly puzzling given the greater disability of some minorities compared to non-minorities even at the oldest ages. Some studies of minority aging suggest that low use of formal services and nursing homes reflects a preference for and reliance on family and informal care among ethnic minority intergenerational groups. Cultural traditions of filial piety and multigenerational household structure are among the reasons offered for continued community residence among minority older people. If this were true, research might explain the lower use of formal care as the choice of minority elderly even when formal assistance is available. Other studies suggest that family caregiving is more likely a realistic response to an inability to obtain or pay for institutional care. Another explanation is that cultural and language barriers to formal services combine with attitudes among minority groups to reduce use of formal long-term care. Research on the causes of informal and formal care for dependent older minority individuals is needed. There is only speculation about future changes in the informal network (particularly family care) available to minority older people and how that might alter patterns of care. Immigrants and their offspring may take on norms of the dominant population, patterns of marital stability may change, and economic influences may modify options for long-term care. Studies supported by this RFA must be designed to amplify scientific knowledge of current long-term care patterns and also provide a base for planning for long-term care for the increasing proportion of older people who are members of minority groups. EXAMPLES OF APPROPRIATE RESEARCH TOPICS The following is an illustrative and non-exhaustive listing of topics appropriate to the objectives of this solicitation: o Studies of patterns of informal support networks, including extended family and non-kin support, and differences among these for various geographical settings or sub-populations. o Smaller scale, in-depth research to address questions of barriers to access to services, particularly for subgroups for whom few data are available (e.g. new immigrants or specific American Indian tribes). o Studies of institutions and other formal services to discern racial differences in patterns of use, institutional characteristics, and type of care available in formal care compared with population and demographic variables. o Research to identify and test hypotheses that might explicate the causes of specific formal and informal care patterns including cultural preferences and barriers to care. o Investigations of how economic differences determine or contribute to patterns and preferences for care among or within minority populations. o Research using large national samples of minority individuals, including late middle-age and young-old where need disparities may be greatest, to determine both current living arrangements and unmet needs for long-term care. o Studies of minority attitudes toward, expectations for, and changes in expectations for long-term care arrangements. METHODOLOGICAL ISSUES A wide spectrum of research designs and analyses are acceptable under this solicitation. Differences among minority groups in the degree of already existing data needs and the stage of data development suggest differing levels of research for each group and for selected topics. In preparing an application the investigator must develop specific hypotheses or research questions. The target minority population(s) must be clearly defined and the selection of that population(s) justified. Research must address variations within a minority population, propose comparisons between minority populations, or use comparisons with a non-minority population. SPECIAL REQUIREMENTS It is anticipated that Principal Investigators of funded applications will meet yearly to share progress and findings. Applicants should include plans for one round-trip travel to Bethesda, MD and appropriate expenses for two-days in each year's budget request. Applicants must document willingness to participate in such activities. STUDY POPULATIONS SPECIAL INSTRUCTIONS TO APPLICANTS REGARDING IMPLEMENTATION OF NIH POLICIES CONCERNING INCLUSION OF WOMEN IN CLINICAL RESEARCH STUDY POPULATIONS NIH and ADAMHA policy is that applicants for NIH/ADAMHA clinical research grants and cooperative agreements will be required to include women in study populations so that research findings can be of benefit to all persons at risk of the disease, disorder or condition under study; special emphasis should be placed on the need for inclusion of women in studies of diseases, disorders and conditions which disproportionately affect them. This policy is intended to apply to males and females of all ages. If women are excluded or inadequately represented in clinical research, particularly in proposed population-based studies, a clear compelling rationale should be provided. The composition of the proposed study population must be described in terms of gender as well as race or ethnic groups. In addition, gender issues should be addressed in developing a research design and sample size appropriate for the scientific objectives of the study. This information should be included in the form PHS 398 in Section 2, A-D of the Research Plan AND summarized in Section 2, E, Human Subjects. For the purpose of this policy, clinical research includes human biomedical and behavioral studies of etiology, epidemiology, prevention (and preventive strategies), diagnosis, or treatment of diseases, disorders or conditions, including but not limited to clinical trials. For foreign awards, the policy on inclusion of women applies fully. The applicant must discuss the relevance of research involving foreign population groups to the United States' populations including minorities. If the required information is not determined to be contained within the application, the application will be returned. Peer reviewers will address specifically whether the research plan in the application conforms to these policies. If the representation of women in a study design is inadequate to answer the scientific question(s) addressed, or the justification for the selected study population is inadequate, it will be considered a scientific weakness or deficiency in the study design and will be reflected in assigning the priority score to the application. All applications for clinical research submitted to NIH are required to address these policies. NIH funding components will not award grants or cooperative agreements that do not comply with these policies. Due to the nature of this solicitation, all applications responsive to the RFA will include minorities. REVIEW CONSIDERATIONS Applications will be received by the NIH Division of Research Grants and will be assigned to the NIA with secondary assignment to the NCNR. Responsive applications will be assigned to a special Institute review group for review. Applications judged to be non-responsive (those not directed at the goals of this RFA) will be administratively withdrawn and returned to the applicant without review. Applications may first receive a preliminary review by a subcommittee of the review panel to establish those applications deemed to be competitive. Those applications judged non-competitive will be so designated, and an abbreviated summary statement noting the major areas of concern will be sent to the Principal Investigator. Applications judged to be competitive will be given full review. Following review by the initial review group, the applications will be considered by the appropriate Advisory Council. Review criteria for applications include: o scientific merit, significance, and originality of proposed research; o appropriateness and adequacy of the proposed research approach; o qualifications and research experience of the Principal Investigator and staff; o availability of resources necessary to perform the research; o appropriateness of the proposed budget; and o demonstrated access to and ability to work with the target population(s). Applications may be strengthened by participation of minority researchers and the formation of collaborative arrangements with minority institutions or organizations. Interdisciplinary research teams may be appropriate. APPLICATION PROCEDURES Applicants must use the research project application form (PHS 398, revised 10/88, reprinted 9/89) that is available at the applicant's institutional research office and from the Office of Grants Inquiries, Division of Research Grants, NIH, Westwood Building, Room 449, 5333 Westbard Avenue, Bethesda, MD 20892, telephone (301-496-7441). The RFA label provided in the PHS 398 application form must be affixed to the bottom of the face page. Failure to use this label could result in delayed processing of the application such that it may not reach the review committee in time for review. In addition, the RFA title and number must be typed on line 2 of the face page of the application form and check the YES box. Submit a signed, typewritten original of the application, including the Checklist, and four signed, exact photocopies, in one package to: DIVISION OF RESEARCH GRANTS National Institute of Health Westwood Building, Room 240 Bethesda, MD 20892** At time of submission, two additional copies of the application must also be sent: Chief, Scientific Review Office National Institute on Aging Gateway Building, Room 2C-212 7201 Wisconsin Avenue Bethesda, MD 20892 Applications must be received by March 19, 1992. If any application is received after the date, it will be returned to the applicant. Also, the Division of Research Grants (DRG) will not accept any application in response to this announcement that is essentially the same as one currently pending initial review, unless the applicant withdraws the pending application. Nor will the DRG accept any application that essentially the same as one already reviewed. This does not preclude the submission of substantial revisions of applications already reviewed, but such applications must include an introduction addressing the previous critique. LETTER OF INTENT Prospective applicants are asked to submit, by February 4, 1992, a letter of intent that includes a descriptive title of the proposed research, the name, address, and telephone number of the Principal Investigator, the indentites of other key personnel and participating institutions, and the number and title of the RFA in response to which the application is being submitted. Although a letter of intent is not required, is not binding, and does not enter into the review of subsequent applications, the information that it contains is helpful in planning for the review of applications. It allows institute staff to estimate the potential review workload and to avoid possible conflict of interest in the review. INQUIRIES Written and telephone inquiries concerning this RFA are encouraged. The opportunity to clarify issues or questions from potential applicants is welcome. The inquiries and letter of intent are to be sent to: Katrina W. Johnson, Ph.D. National Institute on Aging Gateway Building, Room 2C-234 7201 Wisconsin Avenue Bethesda, MD 20892 Telephone: (301) 496-3136 or to: Patricia Moritz, R.N., Ph.D. National Center for Nursing Research Building 31, Room 5B-03 Bethesda, MD 20892 Telepnone: (301) 496-0523 Direct inquiries regarding fiscal matters to: Ms. Linda Whipp National Institute on Aging Gateway Building, Room 2N-212 7201 Wisconsin Avenue Bethesda, MD 20892 Telephone: (301) 496-1472 Ms. Sally Nichols National Center for Nursing Research Building 31, Room 5B05 9000 Rockville Pike Bethesda, MD 20892 Telephone: (301) 496-0237 AUTHORITY AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance No. 93.866. Awards are made under authorization of the Public Health Service Act, Title IV, Part A (Public Law 79-410, as amended by Public Law 99- 158, 42 USC 241 and 285) and administered under PHS grants policies and Federal Regulations 42 CFR 52 and 45 CFR Part 74. This program is not subject to the intergovernmental review requirements Executive Order 12372 or Health Systems Agency review.