Title III of the Older Americans Act (OAA) provides funding for a wide range of long-term services and supports (LTSS), social, and nutritional services. Examples include home-care, case management, home delivered meals and many others. These include home-care and homemaker services, adult day services, case management, and health promotion. Also covered are congregate and home-delivered meals, family caregiver support, transportation, and to a lesser extent, elder abuse prevention and detection. Other provisions cover employment and training for people age 55 and older with low incomes or who are unemployed. Title III’s primary objectives are to enable people age 60 and older to live independently in their own homes, to remove individual and social barriers to older people’s economic independence, and to provide those who are vulnerable with an array of services.
In April 2012, the Department of Health and Human Services (HHS) created the Administration for Community Living (ACL) as a single HHS organization focused on community living and support of seniors and people with disabilities. The ACL was created by folding the Administration on Aging, the Office on Disability, and the Administration on Developmental Disabilities into a single agency. The reorganization establishes a formal infrastructure to ensure consistency and coordination in community living policy across the federal government. Among the government’s goals in making the change was increased access to community supports for children with developmental disabilities, adults with physical disabilities, and older adults in general. Increased participation in the community by older adults and people with disabilities is also a focus, as is the provision of greater resources for their needs.
The OAA is administered by the Administration on Community Living but is operated locally by state units on aging and area agencies on aging (known as AAAs) that coordinate service delivery by contracting with local providers. They are required not only to target services to people with the greatest social or economic need but also to make programs available to all older people in the community. The targeted populations include older adults, people with disabilities or low incomes, members of racial and ethnic groups that have experienced discrimination, people with limited English proficiency, rural residents, and others with special needs. Title III also authorizes services that support family caregivers, including grandparents or older caregivers, as part of the National Family Caregiver Support Program established in 2000. Continuing support for family caregivers is critical; the economic value of their contributions was valued at $470 billion per year in 2013. The program gives each state funds to provide services to caregivers such as information about available services, assistance in gaining access to services, caregiver training, respite care, and a limited amount of supplemental services. Overall an estimated 12 million people in the U.S. and its territories were served under Title III in 2016. In 2016, almost 1.6 million received congregate meals and almost 860,000 received home-delivered meals.
The OAA funds the long-term care (LTC) ombudsman program in each state. The LTC ombudsman is responsible for identifying, investigating, and resolving complaints made by or on behalf of residents in LTSS facilities. Although funding has never been adequate, states have historically been able to count on receiving an appropriation dedicated to ombudsman programs.
In 2006, service providers and business community members were added to area agencies on aging advisory councils. Previously all members were private citizens or from consumer groups. This dilutes the influence of consumers on advisory boards and could significantly expand the group of stakeholders in policy debates over service to local older people.
Amendments to the act in 2016 made several important changes, including:
- improved coordination between Aging and Disability Resource Centers and other community-based organizations to provide information and referral services for home- and community-based services for those who live in or are at risk of entering an institutional setting;
- eligibility of older adults caring for adult children with disabilities to participate in the National Family Caregiver Support program;
- modifications to statutory funding allocations whereby states with population growth in residents age 60 and older will receive increased funding, but losses in funding will be minimized for states with a decline in this population; and
- the addition of improved training on elder abuse prevention and screening for those working in the aging field.
THE OLDER AMERICANS ACT: Policy
Maintaining and improving funding for Older Americans Act (OAA) programs
Federal and state governments should continue to provide public funding for Older Americans Act programs and outreach designed to increase participation by diverse communities in low-income benefit programs.
Congress should leave intact OAA language that targets the most vulnerable populations, especially people with low incomes and seniors from racial and ethnic groups that have experienced discrimination.
States should enact legislation establishing the State Unit on Aging (SUA) as an independent entity. SUAs should have the prominence and funding necessary to promote independence in accordance with the objectives and functions stipulated in the OAA.
Congress should adjust appropriations for all Title III programs to reflect both growth in the older population and the effects of inflation, earmark funding for the ombudsman program, and significantly increase funding appropriations for the National Family Caregiver Support Program.
States should supplement Administration for Community Living (ACL) funds to ensure adequate support for their long-term care ombudsman programs
Integration of services
Administrative links between state plans for Social Services Block Grants and state plans under the OAA should be strengthened through interagency agreements designed to include cost-effectiveness and improve service delivery and coordination.
Strengthen the Administration for Community Living
The ACL’s authority to approve state plans and intrastate funding formulas should be clearly stated in both law and regulation.
The ACL should ensure that states adequately deliver services to the most vulnerable populations
The Administration on Aging (AoA) should enforce the OAA provision that prohibits state and area agencies on aging (AAAs) from directly providing supportive, nutrition, and in-home services except when necessary to ensure an adequate supply of services related to the agency’s administrative functions or when the services would be more economical.
Overseeing cost-sharing and voluntary contributions
States and the AoA should carefully monitor the implementation of cost-sharing and make a publicly available report of the results to ensure the adequacy of services to target populations.
Congress should amend the OAA to require that the ACL approve all state cost-sharing plans prior to their implementation. State cost-sharing plans should be approved only if they contain all the elements designed to protect beneficiaries with low incomes, including sliding-scale fees, payment-accounting policies, and written materials that explain cost-sharing.
The ACL should rigorously monitor and evaluate states’ implementation of cost-sharing provisions and states’ expanded authority to solicit voluntary contributions.
Before expanding the use of voluntary contributions or implementing cost-sharing, states should obtain public input, focusing especially on people with low incomes and participants from racial and ethnic groups that have experienced discrimination.
States should carefully consider the impact of such changes on their ability to deliver services to the most vulnerable populations, including the possible effects of requesting payment for a multiplicity of services.
States that enact cost-sharing requirements should exempt individuals with incomes below 185 percent of the federal poverty level.
Services for rural areas
Data collection and metrics
The AoA’s data collection efforts should be used to evaluate the effects of provisions regarding service delivery to rural residents, the expansion of voluntary contributions, and the authority to implement cost-sharing.
The AoA should monitor and evaluate its data collection effort, particularly as it pertains to the participation of racial and ethnic groups that have experienced discrimination and populations with special needs in OAA programs.
Improvements to the data collection system should be made, based on the findings of the Office of Inspector General at the Department of Health and Human Services. Improvements could include the addition of new data, such as the number of people who request and receive each type of OAA service.
States should establish statewide clearinghouses to collect and disseminate data on the older adult population, including age, race, and gender.
States also should collect data on, document, and report annually the adequacy of services for older people who are poor, members of racial and ethnic groups that have experienced discrimination, frail individuals, or otherwise vulnerable populations. They should use this information to improve service delivery and promote more consumer choice and independence in all social services and long-term services and supports, irrespective of program or payer source.
States should publish yearly expenditure reports containing age-specific, uniform data on program activities and should make the findings available to the public. Lawmakers and regulators should use the data in planning for, and filling gaps in, service needs.
Data collection should include determining how much OAA services save Medicaid and Medicare on an annual basis.
Competitive bidding for services
State and AAA contracts with direct service providers under the OAA should be opened periodically for competitive bidding or reviewed to ensure quality.
Current and prospective service providers should be evaluated on the basis of standardized criteria, including quality and effectiveness of service provision, capacity, and other factors.
The AoA and the entire aging network should ensure that all states engage in a comprehensive long-range planning process that spans all relevant state departments, agencies, and entities (such as those pertaining to health, housing, transportation, aging, etc.) in order to prepare for a rapidly aging and increasingly diverse population.
Increasing support for family caregivers
The ACL should increase the capacity of the National Family Caregiver Support Program, expand respite services, allow more hours per client, make eligibility guidelines more flexible, and increase training offerings.
States and the AoA should strengthen the National Family Caregiver Support Program. States should perform family caregiver assessments to determine the needs of the individual family caregivers.
Substance abuse and mental health
States should expand programs that identify and increase awareness of (and heighten providers’ sensitivity to) depression, suicide risk, and substance abuse among older people. These programs should particularly target health and social service providers.