About the National Aging Network

by Thomas Day

I. The Older Americans Act and the Aging Network

Why Is the Older Americans Act Important?
Benefits for Native Americans and Native Hawaiians

The National Aging Network

The Benefits Dilemma

"An Ounce of Prevention Is Worth a Pound of Cure"
What's Right with the Aging Network?
What Needs to Be Fixed With the Aging Network?

II. The Federal Government's Role in Managing the Aging Network

Administration on Aging
White House Conference on Aging

Services and Organizations and Their Web Sites

III. The State's Role in Managing the Aging Network

State Units on Aging
List of State Aging Units
Managing and Funding State Area Agencies on Aging

Managing Elder Rights Programs

IV. The Aging Network at the Local Level--Area Agencies on Aging

Area Agencies on Aging -- Purpose and Description
The Planning Process
How Services Are Provided
Senior Citizen Centers
Meal Programs
Targeting and Outreach Programs

Services Available Under the Older Americans Act

Broward County Area Agency on Aging Example

V. Community-Based Care Initiatives and Single-Source Care Services

The Impact of Olmsted
The ADRC Initiative
Example of Oregon's Community-Based Care Initiative
New York State Single Point Resource Example


I. The Older Americans Act and the Aging Network


Why Is the Older Americans Act Important?
The decade from 1960 to 1970 was a period of social unrest and change. We lived through an unpopular war which resulted in student protests and mass demonstrations. Hippies, it seems, were everywhere and we were experiencing the so-called sexual revolution. It was a exciting time when civil rights were being extended to all Americans.

During this same period a number of organizations were lobbying Congress for the rights of older Americans. An outcome of this effort was not only the 1965 creation of Medicare and Medicaid but also the passage of the Older Americans Act. The act was designed to protect elderly Americans, including Indians, from unfair discrimination in the workforce as well as providing protection and services to help older people stay independent and remain in their homes.

Although the initial emphasis was directed more towards civil rights and recognition of the dignity of the elderly, over the years, new provisions of the Older Americans Act have become more focused on providing long-term care services for older Americans. These benefits are designed to help frail, memory-impaired, disabled, poor and socially needy elderly remain in their homes and avoid the cost of elder care institutions. And more recently, funds were provided under the act to support caregivers of the elderly and elderly grandparents babysitting or raising minor children at home.

The OAA provides benefits to all Americans over the age of 60. And employment benefits are available for all Americans over the age of 55. The act itself stipulates reauthorization or amendment on an ongoing basis and since 1965 the OAA has been changed and updated 14 times. The year 2005 is designated as a reauthorization year and Congress is busily working on additions to the act. Because of the constant additions, the Older Americans Act has become a giant mishmash of thousands of words, redundant sentences and hundreds of rules and procedures. It's our guess that the complexity of the act probably requires states to hire attorneys to run their aging departments. Notwithstanding, members of the care community who provide administration and services with the Older Americans Act work around the complexity of its rules in serving the aging community.

Here is the declaration of purpose taken from the current version of the Older Americans Act.

"The Congress hereby finds and declares that, in keeping with the traditional American concept of the inherent dignity of the individual in our democratic society, the older people of our Nation are entitled to, and it is the joint and several duty and responsibility of the governments of the United States, of the several States and their political subdivisions, and of Indian tribes to assist our older people to secure equal opportunity to the full and free enjoyment of the following objectives:

  1. An adequate income in retirement in accordance with the American standard of living.
  2. The best possible physical and mental health which science can make available and without regard to economic status.
  3. Obtaining and maintaining suitable housing, independently selected, designed and located with reference to special needs and available at costs which older citizens can afford.
  4. Full restorative services for those who require institutional care, and a comprehensive array of community-based, long-term care services adequate to appropriately sustain older people in their communities and in their homes, including support to family members and other persons providing voluntary care to older individuals needing long-term care services.
  5. Opportunity for employment with no discriminatory personnel practices because of age.
  6. Retirement in health, honor, dignity-after years of contribution to the economy. Participating in and contributing to meaningful activity within the widest range of civic, cultural, educational and training and recreational opportunities.
  7. Efficient community services, including access to low cost transportation, which provide a choice in supported living arrangements and social assistance in a coordinated manner and which are readily available when needed, with emphasis on maintaining a continuum of care for vulnerable older individuals.
  8. Immediate benefit from proven research knowledge which can sustain and improve health and happiness.
  9. Freedom, independence, and the free exercise of individual initiative in planning and managing their own lives, full participation in the planning and operation of community based services and programs provided for their benefit, and protection against abuse, neglect, and exploitation."

Funding for the services required under the OAA is provided by Congress yearly. These funds are then distributed to states, territories, the District of Columbia , Indian tribes and native Hawaiians on a formula basis which provides minimum funding levels to small population groups and sparsely populated states and proportional funding levels based on state elderly populations of the majority of the other states. Because of its large elderly population, as an example, California receives almost 10% of the money. And because of its high proportion of older people, Florida is next. Ten states receive 52% of the money.

Funds are provided in the form of grants for various programs authorized under the act and states have some limited latitude in administering these monies in local areas. Certain of the mandated programs require matching funds from state and local governments. Other program funds do not require matching dollars. Many states chip in additional funds to maintain their programs and these funds often exceed matching requirements. States, counties and cities recognize the value of these services and are often generous in providing additional funds, buildings, office space and other in-kind economic benefits. For every dollar provided by Congress local governments provide about two dollars in direct money, in-kind services from volunteers, community voluntary contributions and cost sharing funds.

The federal appropriation for 2005 is $1,369,028,000 and the breakdown for specific spending categories is listed below. Notice that over half of the dollars goes towards nutrition services which are typically weekday meals provided in community settings or delivered at home as well as incentive programs to help the elderly maintain proper nutrition.

  • Congregate Nutrition Services, Home-Delivered Nutrition Services, and Nutrition Services Incentive Program (money from the Department of Agriculture), 52.1%
  • Home & Community-Based Services, 25.9%
  • National Family Caregiver Support Program, 11.7%
  • Grants for Native Americans, 1.9%
  • Program Innovations Grants, 1.7%
  • Preventive Health Services, 1.6%
  • Protection of Vulnerable Older Americans, 1.3%
  • Program Administration, 1.3%
  • Aging Network Support Activities Grants, 1%
  • Alzheimer's Disease Demonstration Grants, 0.8%
  • White House Conference on Aging, 0.3%
  • Senior Medicare Patrols (HCFAC), 0.2%

Benefits for Native Americans and Native Hawaiians
Title VI of the Act stipulates funding and services for Indian tribes. Approximately $26 million was distributed in 2005 to over 240 Indian tribes and native Hawaiians. Although some tribes are larger than others this amounts to an average of less than $1 million per tribal unit.

Title VI is divided into two parts:

Part A provides for meals and supportive services to Indian tribes. Supportive services include transportation, counseling and home assistance.

Part B provides for nutrition and supportive services to meet the exclusive needs of Native Hawaiians.

The National Aging Network
The Older Americans Act establishes an effective interrelationship between the federal government, State aging units and local service coordinators called Area Agencies on Aging. All three centers of service, the Federal, the state and the local engage in detailed future planning in order to accomplish their jobs. Input at the local level is received from diversified advisory boards representing stakeholders in the elder community. Community meetings and feedback from patrons of senior centers are also used in the planning process. Over the past 40 years, a great deal of thought and energy and research has gone into devising a delivery system that is both efficient and cost effective. In fact, the 29,000 service providers nationwide providing care under the act are the largest single network of long-term care providers in the country.

Local agencies on aging represent geographic areas in a state that can be serviced effectively by that local unit. Area agencies on aging normally contract with local for profit or nonprofit or public providers to deliver benefits. An agency may be allowed to provide directly, supportive services, nutrition services, or in-home services if it can prove a case for providing these services more effectively. An agency may also provide directly, case management services and information and assistance services depending on the methods used for such services in that state. Agencies may also use employees from cooperating or sponsoring counties or cities to staff and administer programs such as senior centers. Much of the work performed comes from dedicated volunteers who are both individuals and employer sponsored teams. This entire aging network system seems to work very well in accomplishing the goals of the Older Americans Act.

The Benefits Dilemma
The Older Americans Act was designed to provide benefits to all Americans over the age of 60. In the year 2003, there were approximately 50 million Americans over the age of 60. Based on an estimated $3,660,000,000 from federal appropriations and state and local matching, this means there was only about $74 available for each older American in that year. This could have bought a couple of hours of care services for each person that year or maybe paid for 10 meals for each person, but that's not very much. The fact is there is not enough money to provide adequate services for all older Americans. To adequately serve the needs of an individual under the act would probably require 20 or 30 times a paltry $74 each year.

Because of an extreme lack of funding, services for older Americans have to be rationed. Recognizing this dilemma, Congress has made provision in the act to target certain needy individuals. These individuals are defined as people having the greatest economic need and or social need. Economic need means inadequate income. Social need can include people who are frail and homebound, have severe disabilities, are institutionalized, live in disadvantaged areas, suffer from cognitive impairment, have language barriers, are members of a minority group or live in rural and underserved areas. The dilemma posed to providers of local services is the act prohibits using means testing -- asking questions about income and assets -- as a basis for providing services. So how do you discriminate without actually discriminating?

Local service providers have become adept in the technique of "targeting". There is no mass media advertising for Older American Act services. As a result, much of the general public is unaware of the availability of these services. Requests for benefits usually come from referrals from state social service units, elder care service groups, doctors offices, religious groups, contacts at elder fairs, lectures, encounter groups or providers of services under the act. Everyone involved in this referral network is well aware of the restrictions of funding and it is unlikely anyone with sufficient assets or income would be referred. In the event that someone with means calls and asks for services, local providers are skilled in recommending and directing those people to other programs not funded under the act.

A result of this selective targeting essentially makes the services of the older Americans act a program for disadvantaged and poor Americans. In essence the program has become a welfare service although it is intended not to be and should be available to everyone. In theory anyone requesting services under the older Americans act is entitled to receive them regardless of income or assets. In practice, wealthy people may be told that funds are lacking to help them or they may be told they will have to go on a waiting list until targeted individuals are covered.

Certain programs are not targeted. Even though many people with means may not receive benefits under the act, the following services are available to anyone on a first-come basis:

  • Use of senior centers
  • Legal services
  • Ombudsman
  • Elder abuse services
  • Other consumer protection services
  • Information and assistance, outreach, benefits counseling, or case management services.
  • Community served meals (Recipients may be encouraged to provide voluntary donations.)
  • Home delivered meals (Recipients may be encouraged to provide voluntary donations.)
  • Selected caregiver support services as designated by the state
  • Services provided through tribal units

Unfortunately, because of chronic under-funding some of the services above are inadequate or even lacking or in many cases there may be waiting lists. Community served meals, however, are typically available for all who want them. Home delivered meals often have waiting lists for recipients.

Many state providers allow for "cost sharing" on certain other services such as supportive programs in the home, thus making these services available to anyone as well. In this case a person's income can be asked for and services can be provided on a sliding scale, cost-sharing basis tied to income. Anyone below the poverty level must receive these services for free.

"An Ounce of Prevention Is Worth a Pound of Cure"
In 2003 Medicaid paid about $42,045,000,000 for an estimated 1,780,000 elderly nursing home residents who were unable to pay all or part of their nursing home bill. In the same year about 8,200,000 older Americans were served by Older Americans Act providers. The cost of providing these services is estimated to be $3,660,000,000. The chart below summarizes these numbers and also includes the per capita amount that would have been available for all older Americans with available funding from the act.

What is important to note is that the cost for maintaining one elderly person in a nursing home under Medicaid is about 50 times the cost of providing services to help an older American remain in the community. There is no question that directing government money to prevent people from having to go to a nursing home is much more cost effective than actually paying for nursing home care. One wise observer put it this way. . .

"Spending money to build a fence at the top of a cliff is much better than spending money on medical treatment and ambulance service to pick people up at the bottom of the cliff."

Or as Benjamin Franklin once wrote, "An ounce of prevention is worth a pound of cure".

It's an age old problem and occurs in many forms in the community. For instance, spending money on drug prevention programs is usually more cost effective than treating or incarcerating drug users. Programs to keep people healthy are much cheaper than paying for expensive medical treatments. Educating our youth and equipping them to be productive, taxpaying citizens is much less costly than providing welfare support.

If Congress were to appropriate just another $446 for someone to receive services under the Older Americans Act, the government might be able to delay spending $23,515 on supporting that person in a nursing home. Multiply this by thousands of people and we could save billions of dollars directing the money where it would do the most good by helping people to remain in their homes in the community and delay their need for expensive nursing home care. Or looking at it differently, if Congress were to appropriate an additional $23,515 towards Older Americans Act services, instead of serving just one individual under Medicaid, about 50 people could be helped with the same money under OAA.

What's Right with the Aging Network?

Ability to Get the Job Done
The most impressive thing about the entire aging network is the ability to accomplish its goals in the face of scarce resources. Reading literature on the Internet from federal, state and local aging units gives one the impression there is very little complaining, at least in public. Almost all web sites leave a positive impression with the job that is being done. It is evident that most employees in the aging network enjoy their jobs and rise to the challenges given them.

Instead of hunkering down, punching a time clock and expecting status quo it appears that members of the aging network are interested in getting the job done regardless of the challenges. As a result, these people are constantly looking for new ways to achieve more with fewer resources. Area agencies on aging are particularly adept at getting cooperation from the general public, nonprofit organizations, other government organizations and employers. This often takes the form of a cadre of volunteers-- 500,000 of them nationwide-- to help with the goals of the aging network. A large amount of voluntary contributions are also collected from older Americans themselves, their families and the community.

Research, Innovation and Feedback
Numerous research and innovation grants from the Administration on Aging foster the achieving environment of the aging network. There is a constant effort to learn more about the challenges of aging Americans and as a result improve the system. The emphasis on two, three or four year planning cycles and the reliance on feedback from the community itself allows the aging network to stay close to the needs of older Americans. Unlike some organizations that work from the top down and tend to insulate themselves from the people they are serving, workers in the aging network are in the trenches rubbing shoulders with and learning from the people they serve.

What Needs to Be Fixed With the Aging Network?

Funding Is Stuck
Even though the population of older Americans is growing larger each year, funding on a national level is being held level or even declining from previous years. Neither Congress nor the President seem to understand the importance of the services offered through the aging network. Unfortunately few national organizations outside of the associations directly involved with the network seem to advocate on behalf of the aging network. Perhaps the aging network itself is too inward looking and needs to reach out and ask for more public support and recognition for its efforts.

Considerably More Funding Is Needed
Because area agencies on aging and state aging units do little in the way to use mass media to promote themselves to the public, the aging network is probably missing a large number of poor and socially disadvantaged people who should be receiving its services but who are not aware of these services. In addition, people who are being served are probably not receiving the level of service that will help them entirely remain independent in the community. Finally, there is no reason why these services can't be available to all older Americans. For instance many people who are not wealthy and not poor but who are struggling with the issues of aging in their communities are not receiving help. Both the National Association for Area Agencies on Aging and the National Association of State Units on Aging are urging Congress to provide an unprecedented 25% increase in funding for existing and vital new programs for fiscal year 2006. This is a start but funding levels should be going up at a much higher rate per year to get the job done.

Need for simplification
The Older Americans Act becomes more encumbered with each reauthorization and unfortunately the aging network advocates are probably the biggest culprits because with each reauthorization these people have Congress include more and more language and more programs specific to the needs of older Americans. Just the opposite should be happening. Recommendations should be made to streamline rules, give more latitude to local providers and cut back on time consuming reporting and over-extensive planning procedures. Perhaps the entire Older Americans Act should be rewritten and simplified.

Better Coordination with Other Government Programs
It is true that because of the Olmstead decision and the President's responding in 2001 with his New Freedom Initiative, much more emphasis is being placed on tying together federal services for the aging and encouraging states and local providers to do the same. But it shouldn't take a federal initiative to make states see the obvious. Medicaid, Medicare, local housing authorities, counties, cities, private organizations and state agencies should have been working together more closely in the past to meet the needs of an ever-growing older generation. Some states, such as Oregon have taken the lead without prodding from the federal government.

Better Outreach
States and local providers need to do a better job to make sure that needy recipients are not falling through the cracks. More funding should be made available for outreach programs and advertising campaigns to reach those in need. participants. NSCLC also convened governmental and community-based advocates in a New Mexico pilot project to assess and plan improvements in the state's elder rights advocacy and legal assistance systems.



II. The Federal Government's Role in Managing the Aging Network


Administration on Aging

Purpose and Organization
The Administration on Aging is established by the Older Americans Act as a separate agency under the Department of Health and Human Services. HHS has the largest single budget in the executive branch and includes the centers for Medicare and Medicaid services (CMS) , the FDA, Centers for Disease Control (CDC), the National Institutes of Health (NIH) and a number of other smaller agencies. The AoA is a small agency with only about 130 employees and compared to its huge sister agency, the CMS, its budget is very tiny. The work of the agency is carried out by a staff in Washington , DC and through 10 regional offices that serve the states, territories, the district of Columbia and about 250 tribal organizations throughout the country. The president appoints an Assistant Secretary of the Administration on Aging to manage its affairs.

The Administration on Aging has guided the development of the national aging services network that today consists of 56 State units on aging, 655 area agencies on aging, almost 250 Tribal organizations, 29,000 community-based provider organizations, over 500,000 volunteers, and a wide variety of national non-profit organizations. This nationwide infrastructure currently provides a wide array of home and community-based services to over 8 million elderly individuals each year, which is 17 percent of all people aged 60 and older, including 3 million individuals who require intensive services and meet the functional requirements for nursing home care. It also provides direct services to over 600,000 informal caregivers each year, who are struggling to keep their loved ones at home. The national aging network is the largest long-term care provider network in the country.

The AOA works closely with other agencies in the Department of Health and Human Services to help formulate and administer programs for the elderly. In fact over two thirds of state Medicaid programs for home care (home and community-based waivers) are administered by area agencies on aging. Investigative and demonstration grants and surveys are often jointly pursued by a number of agencies in the department. For fiscal year 2006 the agency has the following goals:

Empowering Consumers

All Americans should become informed on ways to provide long-term care for themselves without having to rely on government programs. Younger Americans should be encouraged to buy long-term care insurance and older Americans who own homes should be encouraged to use reverse mortgages to help them remain in their homes as long as possible. In addition, pre-retirement baby boomers need to be aware of the importance of long-term care planning. The AoA along with Medicaid has been sponsoring awareness programs in 24 states and will continue to provide funding for public awareness programs in the remaining states.

The Aging and Disability Resource Center (ADRC) Program, which was launched in 2003 by the Administration on Aging and the Centers for Medicare and Medicaid Services, is also designed to help people plan ahead for their long-term care, as well as address the immediate problems consumers face when they try to learn about and access needed care. This program provides competitive grants to States to assist them in developing and implementing coordinated access to information, individualized advice to consumers on their options, and streamlined eligibility determination for programs. The long-range vision is to have ADRCs serving as "visible and trusted" places at the community level nationwide where people of any age or income can go to get information on all available options. The program also reduces government fragmentation, duplication, and inefficiencies.

Targeting High-Risk Individuals

States will be encouraged to find ways to target individuals with few resources and help them remain independent and stay in the community in order to avoid using the more expensive institutional alternatives from Medicaid.

Building Prevention Into Long-Term Care

A growing body of evidence supports the fact that many of the chronic diseases and disabilities of old age can be mitigated or reversed by changing the lifestyle of the elderly. In particular, meaningful activities, exercise, weight loss and proper nutrition can go a long ways to improving health and mental clarity and avoiding costly long-term care expenses. In addition proper training programs can help the elderly navigate disability problems at home and avoid injuries and life-threatening falls. Also elderly people who are given responsibility for managing their own health instead of blindly entrusting it to others are more likely to maintain good health.

A program instituted in 2003 will be continued in future years to support this goal. The program is designed to demonstrate the effectiveness of the above issues at the community level through training from aging service provider organizations such as senior centers, nutrition programs, faith-based organizations, and senior housing projects. A dozen local projects are being funded for a three-year period. They focus on disease self-management, fall prevention, nutrition, physical activity, medication management, and depression.

Reauthorization: The Opportunity for Policy Changes in Long-Term Care

Quoting Secretary Josephina Carbonell.

"The 2005 reauthorization of the Older Americans Act provides a unique and timely vehicle for accelerating the long-term care policy development that is needed to fully prepare the United States for the aging of the baby boom and the emergence of long-term living as a common experience of life....

The single most important goal of the Older Americans Act reauthorization should be to strengthen the Act so it can play a more central role in helping our nation prepare for the baby boom and long-term living. Consistent with the Act's mission and the President's New Freedom Initiative, the reauthorization should reflect the values of consumer choice, control and independence, and the principle of providing care to people where they want it."

Funding and Operational Grants
Congress provides funding for services under the Older Americans Act for distribution through the Administration on Aging. It is the responsibility of the AoA to distribute this money to state aging units and tribal organizations in the form of grants for seven specific service categories authorized under the act. States and local agencies have some latitude in moving money around for other categories and it is possible to apply for and be granted waivers if the need for moving more money for specific programs can be justified. Within each spending category local units have a little more autonomy as to how to conduct their programs.

Money is divided up on the basis of the number of people in the state who are over the age of 60. For smaller states and territories a minimum amount of money is guaranteed to maintain their programs. Some of the programs such as supportive services and the national family caregivers support program require matching funds from state and local units. Supportive services require at least 15% and the national family caregivers support program requires a 25% match. Nutritional services consume about 52% of the national budget and although matching funds are not required, at the state and local level, matching funds for these services are provided primarily in the form of voluntary contributions, in-kind volunteer services and possibly some cash from sponsoring governments.

Training, Research and Discretionary Projects
Over the years the Administration on Aging has provided money for investigations, demonstrations and research concerning the aging and care delivery systems. Thousands of these grants have been funded from as little as $50,000 to a little over $1 million each per year. The purpose is to help the agency to improve the aging network and to help formulate policy at a national level. As of 2003 there were 466 active grants in 40 different categories. For fiscal year 2005 about $49 million has been set aside for grants of all kinds. Some are new but many are ongoing. Web Site The administration on aging has an outstanding web site that provides information and resources for professionals, the press and the public. It can be found at

White House Conference on Aging
The White House conference on aging occurs every 10 years and the last was conducted in 1995. Amendments to the older Americans act in 2000 authorized the President to convene a new conference before December 31, 2005. The current conference is scheduled for December 12, 2005 and will last for two days. The purpose of the conference is to bring together older Americans from the public, state administrators and experts in the field of aging to make recommendations to the President and Congress on administering the Older Americans Act. Hundreds of proposals will be entertained but no more than 50 such recommendations are to be part of the final submission. The majority of the delegates must be age 55 and older. No other presidential conferences have ever been held more than once. This one is the exception.

The Secretary of Health and Human Services will conduct the conference with the help of the Assistant Secretary of the Administration on Aging and several other related government agencies. The AoA has set aside $4.6 million to cover the cost of the conference. Over 1,200 delegates have been invited from all states, territories and tribal organizations. Over the past year, hundreds of pre-conference meetings have been held all across the country including a mini White House conference in the summer to formulate presentations and discuss issues for presentation in the main conference. It is hoped that because of the impending retirement of 77 million baby boomers starting in the next 10 years, significant directives affecting the elderly in America will come from this conference.

Services and Organizations and Their Web Sites
The Administration on Aging sponsors, works with or helps fund a number of national organizations and web sites that promote the goals of the Older Americans Act. Some of these are listed below.

Eldercare Locator
The Eldercare Locator connects older Americans and their caregivers with sources of information on senior services. The service links those who need assistance with state and local area agencies on aging and community-based organizations that serve older adults and their caregivers. You may speak to an Eldercare Locator information specialist by calling 1-800-677-1116.

National Institute of Aging NIA
One of the 27 Institutes and Centers of NIH, leads a broad scientific effort to understand the nature of aging and to extend the healthy, active years of life. In 1974, Congress granted authority to form NIA to provide leadership in aging research, training, health information dissemination, and other programs relevant to aging and older people. Subsequent amendments to this legislation designated the NIA as the primary Federal agency on Alzheimer's disease research.

National Council on Aging
Founded in 1950, The National Council on the Aging is a national network of organizations and individuals dedicated to improving the health and independence of older persons and increasing their continuing contributions to communities, society and future generations. Its 3,800 members include senior centers, adult day service centers, area agencies on aging, faith congregations, senior housing facilities, employment services, and other consumer organizations. NCOA also includes a voluntary network of more than 11,000 leaders from academia, business and labor who support our mission and work.

National Center on Elder Abuse
The National Center on Elder Abuse (NCEA) is a national resource for elder rights, law enforcement and legal professionals, public policy leaders, researchers, and the public. The Center's mission is to promote understanding, knowledge sharing, and action on elder abuse, neglect, and exploitation. The NCEA is administered under the auspices of the National Association of State Units on Aging.

National Long-Term Care Ombudsman Resource Center
The National Long Term Care Ombudsman Resource Center provides support, technical assistance and training to the 53 State Long Term Care Ombudsman Programs and their statewide networks of almost 600 regional (local) programs. The Center's objectives are to enhance the skills, knowledge and management capacity of the State programs to enable them to handle residents' complaints and represent resident interests (individual and systemic advocacy). Funded by the Administration on Aging (AoA), the Center is operated by the National Citizens' Coalition for Nursing Home Reform (NCCNHR), in cooperation with the National Association of State Units on Aging (NASUA).

National Association of Area Agencies on Aging
The National Association of Area Agencies on Aging (N4A) is the umbrella organization for the 655 area agencies on aging (AAAs) and more than 230 Title VI Native American aging programs in the U.S. Through its presence in Washington , D.C. , N4A advocates on behalf of the local aging agencies to ensure that needed resources and support services are available to older Americans. The fundamental mission of the AAAs and Title VI programs is to provide services which make it possible for older individuals to remain in their home, thereby preserving their independence and dignity. These agencies coordinate and support a wide range of home- and community-based services, including information and referral, home-delivered and congregate meals, transportation, employment services, senior centers, adult day care and a long-term care ombudsman program.

National Association of State Units on Aging
Founded in 1964, the National Association of State Units on Aging (NASUA) is a non-profit association representing the nation's 56 officially designated state and territorial agencies on aging. The mission of the Association is to advance social, health, and economic policies responsive to the needs of a diverse aging population and to enhance the capacity of its membership to promote the rights, dignity and independence of, and expand opportunities and resources for, current and future generations of older persons, adults with disabilities and their families. NASUA is the articulating force at the national level through which the state agencies on aging join together to promote social policy in the public and private sectors responsive to the challenges and opportunities of an aging America.

Alzheimer's Association National Contact Center
Our Nationwide Contact Center serves people with memory loss, caregivers, health care professionals and the public. The Alzheimer's Association Nationwide Contact Center Helpline provides reliable guidance and information to all those who need. Call us 24 hours a day, seven days a week at 1.800.272.3900.

The National Family Caregiver Support Program
The Caregiver Resource Room is where families, caregivers, and professionals can find information about The National Family Caregiver Support Program, including: where you can turn for support and assistance, and providing services to caregivers.
President George W. Bush's New Freedom Initiative directed federal agencies to create This interagency Web site connects people with disabilities to the information and resources they need to pursue their personal and professional ambitions - delivering on America 's promise of equal access to opportunity for all citizens.

Senior Community Service Employment Program
An initiative by US Department of Labor for the enhancement of employment opportunities for older Americans and the promotion of older workers as a solution for businesses seeking a trained, qualified, and reliable workforce. The strategy is to utilize a service approach that can respond quickly and effectively to the changing needs of business.

Volunteer Centers
In addition to the many volunteer opportunities open to older persons through Federal programs, community level agencies and organizations welcome the talents of the elderly. Many communities have Volunteer Centers that offer information about the types of volunteer opportunities available and the agencies and organizations that are seeking volunteer assistance. Volunteer Centers refer an estimated 800,000 new volunteers each year. Volunteers assist a wide variety of community organizations which provide services to such populations as the elderly, youth, people with AIDS, and the homeless. Opportunities are also available in areas such as the arts and the environment. To locate the Volunteer Center in your community call 1-800-VOLUNTEER or visit:

The National Senior Service Corps (Senior Corps)
Senior Corps is a network of programs that tap the experience, skills, and talents of older citizens to meet community challenges. Through its three programs - Foster Grandparents, Senior Companions, and RSVP (the Retired and Senior Volunteer Program) - more than half a million Americans age 55 and over assist local nonprofits, public agencies, and faith-based organizations in carrying out their missions. Senior Corps is administered by the Corporation for National and Community Service. Foster Grandparents offer support to children with special needs; Senior Companions provide assistance to help elderly individuals live independently; and Retired and Senior Volunteers provide a variety of services that range from leading local museum tours to teaching adult education computer classes. Foster Grandparents and Senior Companions meet income eligibility requirements, serve 20 hours per week and receive small stipends. RSVP volunteers serve without compensation, but may be reimbursed for such expenses as transportation. Insurance protection is provided to volunteers while on assignment. For information on the Senior Corps programs call 1-800-424-8867 or visit:

Senior Medicare Patrol
The Senior Medicare Patrol projects teach volunteer retired professionals, such as doctors, nurses, accountants, investigators, law enforcement personnel, attorneys and teachers, to help Medicare and Medicaid beneficiaries to be better health care consumers, help identify and prevent billing errors and potential fraud. Since 1997, these Administration on Aging funded projects have trained more than 48,000 volunteers and conducted more than 60,000 community education events reaching nearly 10 million people. To learn more about Senior Medicare Patrol volunteers go to:

Older Americans Act Volunteer Programs
Each year about seven to nine million older people use Older Americans Act (OAA) services, whose delivery largely depends upon the efforts of half a million volunteers. These volunteers work through State and Territorial Units on Aging, Area Agencies on Aging, and more than 20,000 local organizations that offer opportunities and services to active older persons as well as those elderly who need help.

Volunteer activities include: assisting at group meals sites and delivering meals to the home-bound elderly; escorting frail older persons to health care services, on shopping errands and to other needed services; visiting homebound older persons and providing telephone reassurance to help ensure their well-being through regular social contacts; repairing and weatherizing the homes of low-income and frail older persons to ensure their safety and improve their mobility; counseling older persons in a variety of areas including health promotion, nutrition, legal and financial concerns; serving as a nursing home ombudsman to resolve resident facility disputes and to help ensure the safety and well-being of residents; providing homemaking assistant to frail older persons; and assisting in senior center, day care, and other group programs for seniors.

Anyone interested in volunteering in Older Americans Act Programs should contact their Area Agency on Aging. To locate an Area Agency on Aging near you contact the Eldercare Locator: 1-800-677-1116 at:

ABA Commission on Law and Aging (COLA)
COLA provides elder law attorneys and aging network personnel with technical assistance on substantive legal issues. The project also works to improve legal assistance delivery systems, with a focus on collaborations among public programs and the private bar. This past year project staff produced elder law fact sheets, and they managed a listserv that connects over 350 elder law attorneys and other advocates from across the country. COLA also posted the following items on its web site: the 250-page ABA Legal Guide for Older Americans, Consumer's Tool Kit for Health Care Advance Planning, and Spanish and English versions of Health and Financial Decisions: Legal Tools for Preserving Your Personal Autonomy.

The Center for Social Gerontology (TCSG)
TCSG helps states to improve their legal services delivery systems. Last year TCSG visited five states to provide in-depth technical assistance in areas such as targeting of legal services to seniors in the most social and economic need, implementing statewide legal services standards and reporting/outcome measures, and creating state elder rights coalitions. TCSG also hosted a guardianship/caregiver mediation training conference.

AARP Foundation's National Training Project (NTP)
NTP provides legal services attorneys and aging network personnel with in-depth training and technical assistance in areas such as Medicare, nursing home law, advance directives, SSI, Social Security, elder abuse, coalition building, and strategic planning. NTP also offers an intensive "Training-of-Trainer" program to enhance the skills of field trainers in legal and social services organizations. In FY 03, NTP conducted 29 training events with a total of 46 training days in 22 different states, and it coordinated the National Aging and Law Conference. Project staff also developed downloadable overheads on elder law topics for community-based organizations, and they developed an on-line version of NTP's Nursing Home Law Module.

National Senior Citizens Law Center (NSCLC)
NSCLC provides in-depth case consultations to senior legal services providers, and it conducts substantive training sessions at state and national conferences. In FY 03, NSCLC staff responded to approximately 500 requests for in-depth case consultations, and they conducted at least 75 training sessions and related technical assistance sessions benefiting no fewer than 2,000

National Consumer Law Center (NCLC)
NCLC improves legal assistance to older Americans whose finances and economic independence are threatened by scams and abuses in the marketplace. The project addresses the most pressing consumer problems faced by the elderly, including challenges to sustaining home ownership, fraudulent and exploitive sales practices, and debt management and financial decision-making. This past year NCLC provided training, legal practice aids, and in-depth case consultations to elder law attorneys and other advocates serving the elderly. The project also produced and disseminated a consumer education brochure on predatory lending and translated it into Spanish and Chinese.



III. The State's Role in Managing the Aging Network


State Units on Aging
State Units on Aging (SUAs) are agencies of state and territorial governments designated by governors and state legislatures to administer the Older Americans Act in their area. No state uses the term "State Unit on Aging" and each state has devised its own title for its agency. Also each state has chosen to organize its aging department differently. In some states, services are spread across several departments and in other states they are integrated together. Alaska , The District Of Columbia, Delaware , New Hampshire , North Dakota , Rhode Island and South Dakota do not have Area Agencies on Aging and services are provided directly by the state. Nevada and Wyoming have a hybrid system where most services are provided by the state. A few states have chosen to assign the responsibility to an elected official. We have included a list of all 50 states and the District of Columbia with their respective titles.

List of State Aging Units

(State Aging Units and Area Agencies on Aging)

Managing and Funding State Area Agencies on Aging
State aging units administer the older Americans act in their area. With the exception of protective services and the ombudsman program, states coordinate and oversee the services offered through area agencies on aging in their particular state. Many State units administer protective services and ombudsman services at a state level. If a native Indian tribe shares state boundaries, one of the states will be responsible for making sure there are services provided to that organization and in this rare case, state jurisdiction may extend to another state. State units also divide up federal funds among the area agencies. They also make sure that required planning is done, settle disputes and act as an advocate with the state Legislature and governor.

State aging departments are also responsible for making sure Older Americans Act programs are coordinated with other state services that benefit older individuals and they sponsor opportunities for the elderly to work with children and young adults.

Designating Service Areas for Area Agencies on Aging
The State aging unit identifies service and planning areas of 100,000 or more people to be managed by an area agency on aging. Counties and cities and regional planning commissions consisting of more than one county are to be given preference as being designated a service and planning area. In general this process of dividing up the state into service areas has already been accomplished in the past. However demographics are always changing and State aging units may have to realign boundaries and designate new areas from time to time. This does not happen on a very regular basis. Once established a service area becomes part of the State aging network and participates in funds and periodic strategic planning requirements. A handful of states, because of small population or small territory do not have designated service and planning areas. For these states the entire territory is managed and services provided through the state as one large service and planning area.

When designing or changing a service area, particular attention must be paid to being able to service the needs of disadvantaged and minority populations as well as people living in rural areas who may be underserved. For any new service areas designated by a State agency, local governments must be given first right of refusal for becoming a service area and providing area agency on aging services.

Who Can Be an Area Agency on Aging?
The following can be designated as an area agency on aging to manage a service and planning area:

  • An already established entity that is meeting the requirements of the state.
  • A city, a county or a regional planning commission in the service and planning area where the elected official in charge has designated an agency or office in its government organization to act as an area agency on aging.
  • A public or nonprofit private agency in a planning and service area which can meet the requirements from the state as an area agency on aging.

Any of these organizations must be able to meet the statutory requirements and state requirements and operate as an area agency on aging.

Dispersing Funds
States receive federal grants based on the number of residents over the age of 60. The federal money is divided up proportionately among states and territories. Small population states and US territories under this formula might not get enough money to operate their programs, so the Administration on Aging provides a minimum funding floor for these aging units. Federal grants provide specific amounts of funding to the states for each of the seven service categories listed below.

  1. Supportive Services
  2. Congregate (community served) Meals
  3. Home Delivered Meals
  4. Preventive Health
  5. National Family Caregiver's Support Program
  6. Elder Abuse Prevention
  7. Ombudsman

State units have the responsibility of dividing up the federal money among service and planning areas. Money is usually divided proportionately among service areas by population of older Americans but the state has discretion to put money where it will target people in most need. There is also a responsibility to make sure that local area agencies are securing the federal matching requirements under the Older Americans Act. Supportive services require a 15% match in money or in-kind services or assets. The national family caregivers support program requires a 25% matching requirement. There are numerous and complicated rules for moving money around between categories, for administrative costs and in meeting matching requirements. Here are a few of these. The state must use at least $150,000 but not more than 4% of supportive services money for outreach programs. Not more than 85% of supportive services money can be used for a combination of supportive services, senior centers and nutrition programs. State may transfer up to 40% of funds in the two meal programs between congregate meals and home delivered meals as it sees fit.

The federal grants to states and their amounts for 2005 are listed below. The Administration On Aging also provides the states with about $149 million under the nutrition services incentive program for meal programs from the Department Of Agriculture, which is not included above.

Strategic Planning
The older Americans act requires state agencies and area agencies on aging to do advance planning for either a 2, 3 or four year planning cycle. The State agency can determine the frequency of planning. The act specifies 26 reporting procedures and a summary of some of the salient features is listed below.

  • The state will submit at its discretion either a two-year, three-year or four year strategic plan to the administration on aging.
  • Area agencies on aging will submit either a two-year three-year or four year strategic plan as determined by the state.
  • An evaluation of the need for supportive services, legal assistance, information and assistance, transportation, nutrition services and multipurpose senior centers will be conducted and money will be budgeted for area agencies on aging to support the identified services.
  • A statewide budgeting process shall be followed with expenditure based on previous years budgets.
  • The state will conduct hearings and perform evaluations to make sure targeted individual's needs are being met.
  • The state will have a procedure for grievance by providers or recipients of services.
  • The state will require reporting forms from area agencies on aging and comply with reporting forms from the administration on aging.
  • Programs shall be carried out with proper fiduciary responsibility.
  • No supportive services, nutrition services or in-home services will be directly provided by State agencies or area agencies on aging unless the state or area agency on aging can prove a case for providing these services directly.
  • The State shall provide a long-term care ombudsman program and expend funds at least equal to or more than previous years budgets.
  • The state will coordinate legal assistance plans and area agencies on aging will follow procedures and guidelines to make sure people who contract for legal services are appropriate. Legal services should focus assistance related to: income, health care, long-term care, nutrition, housing, utilities, protective services, defense of guardianship, abuse, neglect, and age discrimination.
  • If the state funds for prevention of abuse of older people, area agencies on aging shall help identify, report and educate in regard to elder abuse.
  • State shall appoint a legal assistance developer to help with legal assistance programs.
  • Require area agencies on aging to hire people who can communicate with those who have limited English-speaking ability.
  • Identify low income minority people and how to reach them.
  • Will perform outreach for people in rural areas, with the greatest economic need, low income minority, with severe disabilities, with limited English and with cognitive impairment.
  • The state will provide care assessment services for people with severe disabilities.
  • Coordinate community-based care services for people in institutions or who are at risk for being in institutions.
  • Provide activities for older people to interact with children and youth such as helping with day care or youth care, education, intervention or families support.
  • Coordinate with other public programs to obtain transportation, counseling and legal assistance

Cost Sharing and Voluntary Contributions
Recipients of services provided through state agencies or area agencies on aging can be asked to share in the cost of those services if the state implements a policy to do so. Cost sharing is based strictly on income and a sliding scale based on income is charged. Recipients below the poverty level do not participate in cost sharing. Cost sharing is not allowed for the following programs.

  • Information and assistance, outreach, benefits counseling, or case management services.
  • Ombudsman, elder abuse prevention, legal assistance, or other consumer protection services.
  • Congregate and home delivered meals.
  • Any services delivered through tribal organizations.

Voluntary contributions can be solicited for all services offered in the state as long as the method of solicitation is non-coercive. Recipients are to understand that contributions are not an obligation and that income is not a test for those contributions. Some area agencies have become quite adept at innovative ways to get people to contribute to community served meals. Such things as reservations or meal tickets that remind people they can contribute work quite well.

Matching funds
It has already been noted that certain service categories require matching funds from states or area agencies on aging. But many state and local government and private organizations typically provide money for other programs not requiring matching. This may be in the form of dollars from other federal programs, state legislatures, counties and cities or it may be in the form of equivalent assets or services. For instance a county acting as an area agency on aging may use its own employees for the agency. Or offices and buildings as well may be provided. The value of these in-kind services and assets is counted towards matching.

A large contributor of matching funding to help with the aging program are title XX block grants from the Social Security Administration. Federal grants to states and territories from these funds amount to $1,700,000,000 a year. Some of this money is used by states and applied to its aging programs including area agencies. These funds are earmarked for such things as adult protective services, home-delivered meals, transportation, in-home services and community mental health. One of the biggest contributors to matching are the 500,000 nationwide volunteers whose services are also counted as in-kind matching.

Managing Elder Rights Programs
In Title VII of the Older Americans Act Congress established a vision and unique mission for state aging networks. The Act requires State Units on Aging to assure that older individuals have access to and assistance in securing and maintaining benefits, rights, opportunities and protections promised to them through public programs. These programs include the ombudsman program, elder abuse services, legal assistance and health insurance counseling.

The long-term care ombudsman program is required to be coordinated at a state level and a state long-term care ombudsman is to be appointed to manage other ombudsman and volunteer ombudsman throughout the state. Most states have elder abuse laws and management of elder abuse is often combined with state aging units. States are also required to have a legal assistance development person at the state level who coordinates the services with local agencies. Finally many states provide health insurance counseling at the state level.

Elder Abuse Services
All states have laws regarding the physical and sexual abuse of minors. Most states feel it is important to protect vulnerable adults from abuse as well. As a result most states have passed legislation to protect older individuals, mentally incompetent adults and severely disabled adults from abuse. The definition of abuse for adults is typically a little more broad than the definition for minor abuse and might include misconduct such as sexual abuse, emotional abuse, financial exploitation, active and passive neglect by caregivers and self-neglect which means an individual is failing to care for his or her own self needs. Most of these abuse descriptions are self explanatory; however for those who question it, here is an explanation of what active and passive neglect means:

"Active neglect is the willful failure by a caregiver to fulfill care-taking functions and responsibilities. This includes, but is not limited to, abandonment, deprivation of food, water, heat, cleanliness, eyeglasses, dentures, or health-related services. Passive neglect is the non-willful failure to fulfill care-taking responsibilities because of inadequate caregiver knowledge, infirmity, or disputing the value of prescribed services."

Vulnerable adult and elder abuse can occur in any setting and in recent years there has been much concern about the treatment of residents in nursing homes. But most abuse occurs in the home and is most generally perpetrated by family members. Estimates are that 5% to 10% of the elderly and vulnerable adults in America are suffering abuse. The public knows little about elder abuse at home because this kind of treatment goes mostly unreported. It is the so-called "dirty little secret" of caregiving. Workers in this field often refer to elder abuse as being like an iceberg; we are only seeing the tip of it and 90% of it is hidden from our view.

The term commonly used by most states to describe the department responsible for adult abuse is "adult protective services". But not all states use this term. A few states have put adult protective services under their social service, health or human service or children and family services departments. But most states have put protective services under the state aging units described above. This is because the Older Americans Act already requires services for elder abuse and also some funding. In addition, local area agencies on aging are in a good position to report abuse and help with abuse problems. Many states that have elder abuse laws combine legislative funding and other federal funding with OAA funding and give the responsibility for elder and vulnerable adult abuse to the state unit on aging.

State laws require that reports of abuse must be investigated. A few states require anyone aware of elder or vulnerable adult abuse must report it to authorities. Failure to do so can be a criminal offense. But most states only require mandatory reporting from people or professionals who deal with a vulnerable adult population. Here is an example of one state's list of mandatory reporters.

  • Medical professionals
  • Employees of hospitals and home health agencies
  • Social workers
  • Coroners
  • Law enforcement employees
  • Adult or juvenile probation officers
  • Department of Human Resources' employees
  • Clergy
  • Attorneys
  • Mortuary or funeral home employees
  • Employees of the facilities providing care for older persons

We have provided a list of all states' online adult protective services sites at

Legal Services
The Older Americans Act requires state aging units and area agencies on aging to provide legal services for older Americans. There is also a requirement for the state to appoint a person known as a "legal assistance developer" to coordinate legal services in the state. The administration on aging has also formed coalitions with various national groups to help states and local agencies implement legal services. Not only is there concern for the elderly about dealing with issues relating to estate planning, income and long-term care planning but there is a great deal of concern that the elderly may be vulnerable to exploitation by con artists and unscrupulous businesses. The OAA specifically directs legal services for the following issues: income, health care, long-term care, nutrition, housing, utilities, protective services, defense of guardianship, abuse, neglect, and age discrimination.

There may only be enough money for most states to hire a legal assistance developer and other staff attorneys may only be possible for larger states. States and local area agencies on aging must rely on the volunteer services of the legal community. Some states and federal government agencies may also provide money for this program. Licensed attorneys may donate some of their time for assessments and law students may be used to help identify problems and offer solutions. Extensive legal help is only available without recipient out-of-pocket cost in a few cases.

Long-Term Care Ombudsman
A long-term care ombudsman is a sounding board for residents of long-term care facilities such as nursing homes, assisted living or board and care facilities. Residents or families of residents can contact an ombudsman if there is concern about services or treatment from staff in a facility. The ombudsman investigates and if necessary resolves the problems.

Each state, under the older Americans act, is required to have a state long-term care ombudsman program that is managed at the state level. About 38 states include the office of ombudsman under the state aging unit and 15 other states or territories manage the office under a different state agency or use a private contractor. The state office manages a corps of local volunteers who respond to complaints or, time allowing, visit with residents of long-term care facilities to gain feedback. In 2002 more than 261,000 complaints were handled by about 8,000 volunteer ombudsmen nationwide.

We have provided a list of all states' online ombudsman services sites at

Health Insurance Counseling.
Many elderly have difficulty understanding their Medicare coverage and many unscrupulous health care providers may be preying on the system by charging for services not actually provided. The elderly may also have questions about whether to buy Medicare supplement policies or buy into Medicare advantage plans. In the fall of 2005 Medicare is introducing part D, the new drug prescription program. The aging network has been given responsibility by the Centers for Medicare and Medicaid services to counsel the elderly about this program. The health insurance counseling services, typically coordinated at the state level, are designed to deal with these issues.

Senior Medicare Patrols-- administration on aging grants to 47 states have provided seed money for volunteer programs to prevent Medicare fraud. The AoA maintains a web site to support this activity at

Here is a statement from the site detailing the purpose for the program.

"The U.S. General Accounting Office (GAO) estimates that billions of dollars are lost annually from the Medicare and Medicaid programs due to improper payments through error, fraud, or abuse. While the vast majority of health care providers are honest, the efforts of a small number of unscrupulous individuals are causing our health care programs to lose hundreds of millions of dollars per year and reducing the quality of care provided to many older and disabled Americans.

Since 1997, the U.S. Administration on Aging (AoA) has worked in partnership with the Department of Health and Human Services' Office of Inspector General, the Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration), the Department of Justice, community-based grantees, retired professionals, service and health care providers, AARP, and other interested individuals and organizations to address this serious national problem.

In the initial phase of this initiative, known as ORT, $23 was returned in improper payments, fines and settlements for every dollar spent on the effort. Today, AoA provides grants to community-based agencies in nearly every state to train volunteers how to educate Medicare and Medicaid beneficiaries and their families how to protect their Medicare number as they would their credit card, how to take a more active role in protecting their health care programs, and how to detect and report potential instances of error, fraud, and abuse.

You may also interact with AoA by sending comments and suggestions to"



IV. The Aging Network at the Local Level--Area Agencies on Aging


Area Agencies on Aging -- Purpose and Description
Area agencies on aging are the designated managers for state service and planning areas. A service and planning area is a geographic area of the state with more than 100,000 people and containing a significant number of elderly over the age of 60 that can be effectively served by the area agency under the Older Americans Act. The following can be designated as an area agency on aging to manage a service and planning area:

  • An already established entity that is meeting the requirements of the state.
  • A city, a county, a council of government or a regional planning commission in the service and planning area where the elected official in charge has designated an agency or office in its government organization to act as an area agency on aging.
  • A public or nonprofit private agency in a planning and service area which can meet the requirements from the state as an area agency on aging.

Any of these organizations must be able to meet the statutory requirements and state requirements and operate as an area agency on aging.

In many states, area agencies on aging operate as an office of a county and county employees are used to run the organization. In large urban areas cities may manage an area. In areas that are sparsely populated, area agencies may operate under a regional planning commission or a council of government with multi-county employees or with a nonprofit company providing the management. A number of states have chosen to divide their states into multi-county regions or service areas. Where none of these natural subdivisions fit, a large rural area may be defined as a service and planning area and receive a suitable name to identify it. Where county or city governments are unwilling or unable to provide management, a number of states have chosen to contract with nonprofit organizations to run those particular area agencies in their states. Of the 655 AAAs across the country, approximately 67 percent are public agencies such as cities, counties, councils of government or regional planning commissions and 33 percent are private, non-profit organizations.

Area agencies do not always call themselves an "area agency on aging" and may use other names to identify themselves. Many nonprofits that receive their operating funds from state aging units typically use their nonprofit name instead of identifying themselves as an area agency on aging. Large county and large city AAA's often disguise themselves under government designated aging departments. States divided into multi-county regions may identify themselves as region one or planning area 2 and so forth. These many name conventions can be confusing to the public since using another name may not alert seniors or their families to the services they would expect under the Older Americans Act, national aging network. On the other hand, many nonprofit agencies that except money under the older Americans act and operate service areas are required to offer the same services as government-sponsored agencies. Here are some examples of some of the names.

  • Northwest Alabama Council of Local Governments
  • Southern Alabama Regional Council on Aging
  • South Alabama Regional Planning Commission
  • Middle Alabama Area Agency on Aging Central
  • Alabama Aging Consortium
  • Division of Aging and Community Services/Aging and Adult Administration - Regions 1 to 8
  • Central Coast Commission for Senior Citizens
  • San Francisco Department of Aging and Adult Services
  • Los Angeles City Department of Aging
  • Los Angeles County Aging and Adult Services
  • Denver Regional Council of Governments Aging Services Division
  • South-Central Colorado Seniors, Inc.
  • Senior Resources
  • Senior Resource Alliance
  • Alliance for Aging
  • Southern Crescent Region
  • Metro Atlanta Region Commission
  • Heart of Georgia Region
  • Chicago Department on Aging
  • Northwest Indiana Community
  • Action Corp.
  • REAL Services, Inc.
  • Aging and In-Home Services of Northeast Indiana, Inc.
  • Senior Spectrum
  • (and the list goes on and on)

The older Americans act funding is not the only source of money for area agencies on aging. Agencies may also manage other government programs such as Medicaid waivers for home care, social service block grants, transportation programs and other state home care service programs. Currently about two thirds of all Medicaid home and community waivers are managed by area agencies on aging. Many agencies may have 10 or more different government funding sources for programs under their management. Nonprofit organizations acting as area agencies on aging may also be receiving community donations as well. And on the other hand many nonprofits who are not area agencies may be accepting funding under the older Americans act to furnish programs such as community meals or homes served meals.

For a complete list of state units on aging and area agencies on aging across the country go to

The Planning Process
Federal rules require an extensive planning process at the state and local level. The state can designate a two, three or four year planning cycle for local agencies and for the state. Rules require public input meetings, feedback from recipients of the services, use of a diversified advisory board, surveys and so forth. This detailed process may be overkill but it may also demonstrate that careful planning has resulted over the last 40 years in producing an efficient caregiving network. State and local agencies pride themselves on the fact that management and services are driven from a bottom up philosophy rather than from the top down.

How Services Are Provided
Area agencies normally contract with local for profit or nonprofit or public providers to deliver benefits. The 29,000 contract service providers nationwide, providing care under the act, are the largest single network of long-term care providers in the country. An agency may be allowed to provide directly, supportive services, nutrition services, or in-home services if it can prove a case for providing these services more effectively. An agency may also provide directly, case management services and information and assistance services depending on the methods used for such services in that state. Much of the work performed for area agencies on aging comes from 500,000 dedicated volunteers nationwide who are both individuals and employer sponsored teams.

The typical beneficiary served by an Area Agency on Aging is a woman over age 75, with limitations in activities of daily living, such as bathing, eating and dressing. AAAs throughout the country find that they are working more and more with vulnerable and "hard-to-reach" populations, as well as persons with chronic disabilities of all ages.

Senior Citizen Centers
The first Senior Center in the country opened in 1943 in the Bronx, New York and was called the William Hodson Community Center . By 1961 about 218 senior centers had opened all across the country. The first Senior centers were operated by cities or nonprofit or religious organizations. Funding came from government, community donations and fees from people using the facilities. In the early days some federal funding came from Title XX of the Social Security act but funding for Title XX has been decreasing and much of that money today is being used for other programs. In 1972, the Older Americans Act was amended to provide funding for senior centers as this was considered to be an important piece of the aging network. Today, there are estimated to be about 15,000 senior centers across the country serving about 10 million older Americans annually. About 6,000 of these centers receive part or all of their funding through the Older Americans Act.

Senior centers act as a focal point for older Americans to receive many aging services. They are a vital part of the aging network. For Area Agencies on Aging, the senior center has become a place where many AAA services can be provided, where outreach and targeting can occur and where feedback can be received from the elderly. The most common services offered at a senior center are:

  • Health and wellness programs
  • Arts and humanities activities
  • Intergenerational programs
  • Employment assistance
  • Community action opportunities and social networking opportunities
  • Transportation services
  • Volunteer opportunities
  • Educational opportunities Information and referral
  • Financial assistance
  • Senior rights counseling and legal services
  • Meal and nutrition programs
  • Leisure travel programs

Larger senior centers in major cities may offer additional specific services because they serve a large and diverse group of patrons. Here are some examples:

  • Education classes, perhaps through a local college
  • Foot care
  • Health clinics
  • Haircuts
  • Daily exercise
  • Telephone friends
  • Support groups for Alzheimer's caregivers
  • Support for Parkinson's disease
  • Low vision and diabetes services
  • Weekly health speakers
  • Grocery shopping
  • Many and varied classes for personal growth and learning
  • Special events and fundraisers such as auctions, raffles, sales, bazaars, rummage sales, bingo, special meals and parties, fashion shows and facility rentals

Most elderly people are aware of senior centers in their neighborhoods but for those who are not familiar with the program, senior centers are listed under that title in the Yellow Pages.

Meal Programs
The Administration On Aging provided state agencies with about $719 million in 2005 for nutrition programs.(Meal programs) A certain percentage of $569 million of that money can be transferred to other programs by state and local agencies. (The balance is money or commodities from the agricultural Department that must be used for nutrition.) But assuming states don't do a lot of transferring, at least 50% or more of federal grants to states is earmarked for meals. And a great number of volunteers who help area agencies on aging are also involved in the meal program. In addition, state and local governments, direct public contributions and the United Way may provide additional money to run nutritional programs. It is obvious that the meal program is one of the most important and largest components of the aging network.

It is felt by all who serve elderly Americans that providing at least one meal a day, which is equivalent to at least a third of the daily recommended caloric intake and nutritional needs, is important in helping the elderly remain independent in the community. Just making sure that older Americans receive proper nutrition and nutrition counseling has probably kept a large number of people out of long-term care institutions. Also the congregate or community served meal program, which is designed for people who are not homebound, is an incentive for the elderly to get together in groups for not only a daily meal but also for social stimulation, awareness of the other aging programs, caregiver training and input from other supportive programs. Some programs can afford to offer more than one meal a day and also offer meals on weekends as well.

But area agencies on aging aren't the only programs providing nutritional service to elderly Americans. A diverse number of organizations from local government, church groups or nonprofit groups serve meals everyday to a large number of elderly Americans, all over this country. Some of these groups may accept money from area agencies but many do not. Although the number of meals served by other groups may exceed that provided directly through area agencies, Older Americans Act meal services are by far the largest single program in the United States . Since the meal program's authorization in the Older Americans Act in 1972, approximately 7 billion meals have been served. Here are some numbers for older Americans act nutrition programs.

During 2001, 112,000,000 congregate meals were served to 1,750,000 older adults. Services provided in addition to meals:

  • Nutrition assessment
  • Nutrition education and counseling when appropriate
  • Social activities

Profile of a Congregate Participant:

  • 80% are at 200% of poverty
  • 60% live alone
  • 70% women
  • 28% rural
  • 25 % minority
  • Average age 76 years

During 2001, 143,000,000 home-delivered meals were served to 927,000 older Americans. These were mostly homebound people who greatly appreciated the services.

Here's a list of some of the organizations directly involved in meal programs throughout the United States .

The Nutrition Services Incentive Program (NSIP)
NSIP is the new name for the United States Department of Agriculture (USDA) cash or commodity program, known as the Nutrition Program for the Elderly (NPE). The NPE is administered by the Administration on Aging (AoA), but receives commodity foods and financial support from USDA's Food and Nutrition Service (FNS). The program is funded through an appropriation to USDA and administered by the FNS. For additional information, refer to AoA's website, Nutrition Frequently Asked Questions, #36, What is the Nutrition Services Incentive Program?

The Seniors Farmers' Market Nutrition Program (SFMNP)
SFMNPP is a new program established by USDA's Commodity Credit Corporation (CCC). Under the program, CCC will make grants to States and Indian tribal governments to provide coupons to low-income older adults that may be exchanged for eligible foods at farmers' markets, roadside stands, and community supported agriculture programs.

The purposes of the Seniors Farmers' Market Nutrition Program are to (1) provide resources in the form of fresh, nutritious, unprepared, locally grown fruits, vegetables, and herbs from farmers' markets, roadside stands and community supported agriculture programs to low-income older adults, (2) increase the domestic consumption of agricultural commodities by expanding or aiding in the expansion of domestic farmers' markets, roadside stands, and community support agriculture programs, and (3) develop or aid in the development of new and additional farmers' markets, roadside stands, and community support agriculture programs.

The Food Stamp Program
The Food Stamp Program provides benefits to low-income people that they can use to buy food to improve their diets. Food stamp recipients spend their benefits (in the form of paper coupons or electronic benefits on debit cards) to buy eligible food in authorized retail food stores. The purpose of the Food Stamp Program is to end hunger and improve nutrition and health. It helps low-income households buy the food they need for a nutritionally adequate diet. The program is operated by State and local welfare offices, and the Federal Government oversees the State operation of the Program. Nutrition services not furnished under the older Americans act can receive payment for meal programs with food stamps.

National Association of Nutrition and Aging Services Programs (NANASP)
NANASP is a professional membership organization with members drawn primarily from persons working in or interested in the field of aging, community-based services, and nutrition and the elderly. Founded in the 1970s, NANASP is one of the leadership organizations in that it helps shape national policy, trains service providers, and advocates on behalf of older adults.

Meals on Wheels Association of America (MOWAA)
MOWAA represents those who provide congregate and home-delivered meals services to people in need. Most members are executive directors, Registered or Licensed Dietitians, volunteer coordinators, or nutrition directors at Meals On Wheels and congregate programs. Membership in MOWAA is diverse and also includes AIDS nutrition programs, soup kitchens, Area Agencies on Aging and State Units on Aging. MOWAA works in partnership with many for-profit companies to provide products and/or services to MOWAA members at a reduced rate.

Congregate (Community) Meals
This meal program is usually offered in senior centers which may be sponsored by area agencies on aging or sponsored by other community organizations or churches. Area agencies may also make arrangements with religious groups or other providers of gathering places for the elderly to serve these meals in places other than senior centers. Organizations not receiving funds from area agencies might be offering meals in churches, non-OAA senior centers, local government and community gathering places and so forth.

The older Americans act does not allow providers receiving its funds to charge for these meals, although voluntary donations are encouraged and often received. This creates a dilemma for organizations that may want to use these funds but typically charge for meals on a sliding scale fee, based on income. Even by charging, most of these organizations only receive about a third of the cost of the meal from cost sharing. Some of the organizations providing meals will accept money from area agencies but have to segregate their programs into voluntary contribution meals and cost sharing meals. In order for area agencies to have a greater impact on the congregate meal programs in the United States , the rules must change to allow for cost sharing.

Home Delivered Meals
Home delivered meals are commonly known under the name , "meals on wheels". The first American home-delivered meal program in the United States began in Philadelphia , Pennsylvania , in January of 1954. With help from a local grant, Margaret Toy, a social worker, started providing meals for homebound elderly people and other "shut-ins" who were in dire need of nutritional support. She solicited local high school students to volunteer to prepare and deliver meals to the needy homebound people. These young volunteers were called "Platter Angels." Platter angels were so reliable in their duties that the people receiving meals often jokingly chided them if they were but a few minutes late.

There is great demand for home delivered meals and in some cases people are put on waiting lists for months before they can receive the services. There is typically not enough money and not enough volunteers to go around. And with chronic budget shortages, increased insurance premiums and higher fuel costs it is becoming more and more difficult to provide meals to those who want them. As with community served meals, home served meals through area agencies on aging cannot require cost sharing. And this creates a dilemma for organizations wanting to receive money through the older Americans act. And as with community served meals many of the organizations providing home-based nutritional services are not associated with area agencies on aging.

Meals are typically delivered between 11 a.m. and noon, five days a week. They are typically prepared in community kitchens or by catering companies. They are likely to be designed by nutritionists to offer at least one third of the daily recommended nutritional intake. If a recipient is not at home the meal is returned to the kitchen. Many providers are now delivering frozen meals as well and these can be used on weekends or at other times of the day.

Meals on Wheels
The "Meals on Wheels" name is well recognized across the nation as a provider of home delivered meals for the elderly. The name does not represent a specific organization or a business but is simply a way of identifying meal services. "Meals On Wheels" derived its name during World War II in England . A woman's volunteer organization would deliver snacks and other treats to servicemen on duty and this service became affectionately dubbed by the soldiers as "Meals on Wheels".

Many cities, area agencies on aging, church groups and nonprofit organizations that provide nutritional services have adopted the name, "Meals on Wheels", to afford the public a recognition of trusted services provided by volunteers and community donations. People dealing with Meals on Wheels programs have the assurance of knowing from the name what is provided and how it is going to be administered. There is also a national association called the Meals on Wheels Association of America that coordinates efforts and provides training for over 900 meal programs across the country. Any entity can use the name and does not have to be a member of the Association and some members of the Association do not even use the name "Meals on Wheels". And of course not all organizations providing meals are members of the national Association. It should also be noted that many local nutritional services may use another name and not the Meals on Wheels moniker.

Home delivered meals have their origin in hundreds of difference scenarios across the country. Over the past 50 years government organizations as well as religious communities and private nonprofit groups have all recognized the need for providing meals for homebound elderly people or younger people who are able to take care of themselves at home but are disabled and unable to get out. Incorporation of meal services into the older Americans act in 1972 has given some administrative and national organization to meal programs. And many of these programs, as a result, receive a portion of their funding through the older Americans act.

Older people living by themselves at home often have a tendency to deprive themselves of proper nutrition. Perhaps because of depression, loneliness or a medical condition, many older people lose their appetites and do not eat properly. In addition a large number of older people are living in poverty and cannot afford to buy nutritious food. They may also not have transportation to get out and go shopping or they may not have the desire to prepare meals for themselves. Additionally, many older people, because of frailty or because of fear, cannot leave their homes and are often trapped at home for days or weeks at a time without ever seeing anyone else. All of these problems can lead to a situation where because of improper nutrition, older people will decline in health and mobility. Proper nutrition is essential in helping people remain independent in the community.

The majority of individuals receiving home delivered meals are elderly, single women with chronic health conditions. These women are often confined to their homes because of lack of transportation or their own inability to walk very far. A noon meal delivered by a volunteer, five days a week not only provides these shut-ins a nutritious meal , but also provides them contact with another person. And many of these people cherish the attention from the volunteer much more than the availability of a hot meal.

Meals are typically delivered between 11 a.m. and noon, five days a week. They are typically prepared in community kitchens or by catering companies. They are likely to be designed by nutritionists to offer at least one third of the daily recommended nutritional intake. If a recipient is not at home the meal is returned to the kitchen. Some organizations will allow seniors to order extra meals for the weekend when that service is not provided. Many providers are now delivering frozen meals as well and these can be used on weekends or at other times of the day.

Volunteerism and public contributions are an essential cornerstone of Meals on Wheels programs. With the exception of the cost of food, transportation, key kitchen workers preparing the meals and administrators, all other services are provided by volunteers. These can be older individuals themselves who have a desire to serve in the community or oftentimes teenagers especially enjoy serving the elderly or in many cases volunteers come from employer-sponsored volunteer programs. Perhaps more than any other form of volunteering, hand delivering meals to a needy person at home can be the most satisfying public service a healthy person can perform. Many companies recognize the power and compassion of this form of service and they readily embrace programs for their employees to provide volunteer hours. Many other organizations seeking employer supported volunteers may have a more difficult time receiving the attention of corporate decision-makers because their services are not as profound as home delivered meals to the elderly. Companies are also often generous in providing funds for the cost of administration, transportation and meal preparation.

Funding for Meals on Wheels programs typically comes from a variety of different sources. Cities and local governments may provide funds and as has been mentioned before, money can also be provided under the older Americans act. In fact, some area agencies on aging support home delivered meals entirely under their agency administration. In some cases home delivered meals may not have any connection with government programs. Many funds come from community donations either directly or through programs such as United Way or Red Cross. Fundraisers are also a large part of some programs. With the exception of programs provided with older Americans act funds, most Meals on Wheels organizations charge the recipients for their meals. The cost is based on income. If a person receiving a meal is impoverished, generally no money is charged. Otherwise, costs are almost always based on a sliding scale based on a person's income. Depending on a person's income, the cost of a meal could vary from $.80 to $4.00. Due to a chronic lack of funding, over 40% of all home delivered meal programs have waiting lists. Much more government and community support is required to reach those in need.

In recent years many Meals on Wheels organizations have been providing other services to the elderly at home. This is because many homebound older people have needs in addition to proper nutrition and because of contact through the nutrition service, the Meals on Wheels program has been able to identify those people in greatest need. Case managers may come into the home and make an assessment of the needs and coordinate in-home services from other community programs. Visiting nurses and home health aides may be provided to help with medical problems or with activities of daily living. Arrangements for the installation of emergency response systems or GPS location bracelets for those who might wander can also be made.

Targeting and Outreach Programs
Area agencies on aging are required to design programs to identify and service those older Americans in the community most in need. Programs are designed to "reach out" and identify those people who are in need. As a general rule area agencies do not advertise or use mass media to locate people needing their services. This may be due to the fact that advertising would be very costly and it may also have the inadvertent effect of bringing in people who are not considered needy. The fact remains that many needy older Americans, those who have low income or are disadvantaged, simply do not know about the services of area agencies on aging. This presents a constant and ongoing dilemma for area agencies because many people in need may be falling through the cracks.

Most people are attracted to aging services by referral. These referrals may come from doctor's offices, senior centers, government agencies who service the elderly, home health agencies, home delivered meals programs, senior fairs, seminars and from a host of other providers who rub shoulders with elderly Americans. It is a constant challenge for agencies to develop adequate outreach programs and there is constant pressure from state and federal administrators to not leave anyone behind.

Another challenge posed for area agencies on aging is being able to bring to bear all the services necessary to help older Americans in need. Some programs such as protective services, community meal programs and legal help must be provided to all Americans over the age of 60 on a first-come, first-serve basis. On the other hand, there is never enough funding to provide help for all Americans in the area of supportive services and caregiver support. Targeting scarce funds to those most in need is a particular challenge for many area agencies on aging. This often means that some people requesting services may not be able to receive those services because they have too much income or they are not identified as someone having a pressing social need.

Services Available Under the Older Americans Act
The Older American Act authorizes 23 categories of services that are to be administered through state aging units and local agencies on aging. These are listed below.

1. Health (including mental health) services, education and training services, welfare services, informational services, recreational services, homemaker services, counseling, or referral services;

2. Transportation services to facilitate access to supportive services or nutrition services, and services provided by an area agency on aging, in conjunction with local transportation service providers, public transportation agencies, and other local government agencies, that result in increased provision of such transportation services for older individuals;

3. Services designed to encourage and assist older individuals to use the facilities and services (including information and assistance services) available to them, including language translation services to assist older individuals with limited-English speaking ability to obtain services under this title;

4. Services designed

• to assist older individuals to obtain adequate housing, including residential repair and renovation projects designed to enable older individuals to maintain their homes in conformity with minimum housing standards;

• to adapt homes to meet the needs of older individuals who have physical disabilities;

• to prevent unlawful entry into residences of older individuals, through the installation of security devices and through structural modifications or alterations of such residences; or

• to assist older individuals in obtaining housing for which assistance is provided under programs of the Department of Housing and Urban Development;

5. Services designed to assist older individuals in avoiding institutionalization and to assist individuals in long-term care institutions who are able to return to their communities, including-

• client assessment, case management services, and development and coordination of community services;

• supportive activities to meet the special needs of caregivers, including caretakers who provide in-home services to frail older individuals; and

• in-home services and other community services, including home health, homemaker, shopping, escort, reader, and letter writing services, to assist older individuals to live independently in a home environment;

6. Services designed to provide to older individuals legal assistance and other counseling services and assistance, including-

• tax counseling and assistance, financial counseling, and counseling regarding appropriate health and life insurance coverage;

• representation-(a) of individuals who are wards (or are allegedly incapacitated); and (b) in guardianship proceedings of older individuals who seek to become guardians, if other adequate representation is unavailable in the proceedings; and

• provision, to older individuals who provide uncompensated care to their adult children with disabilities, of counseling to assist such older individuals with permanency planning for such children;

7. Services designed to enable older individuals to attain and maintain physical and mental well-being through programs of regular physical activity, exercise, music therapy, art therapy, and dance-movement therapy;

8. Services designed to provide health screening to detect or prevent illnesses, or both, that occur most frequently in older individuals;

9. Services designed to provide, for older individuals, pre-retirement counseling and assistance in planning for and assessing future post-retirement needs with regard to public and private insurance, public benefits, lifestyle changes, relocation, legal matters, leisure time, and other appropriate matters;

10. Services of an ombudsman at the State level to receive, investigate, and act on complaints by older individuals who are residents of long-term care facilities and to advocate for the well-being of such individuals;

11. Services which are designed to meet the unique needs of older individuals who are disabled, and of older individuals who provide uncompensated care to their adult children with disabilities;

12. Services to encourage the employment of older workers, including job and second career counseling and, where appropriate, job development, referral, and placement, and including the coordination of the services with programs administered by or receiving assistance from the Department of Labor, including programs carried out under the Workforce Investment Act of 1998;

13. Crime prevention services and victim assistance programs for older individuals;

14. A program, to be known as ''Senior Opportunities and Services'', designed to identify and meet the needs of low-in-come older individuals in one or more of the following areas:

• development and provision of new volunteer services;

• effective referral to existing health, employment, housing, legal, consumer, transportation, and other services;

• stimulation and creation of additional services and programs to remedy gaps and deficiencies in presently existing services and programs; and

• such other services as the Assistant Secretary may determine are necessary or especially appropriate to meet the needs of low-income older individuals and to assure them greater self-sufficiency;

15. Services for the prevention of abuse of older individuals in accordance with chapter 3 of subtitle A of title VII and section 307(a)(12) (of the Older Americans Act);

16. Inservice training and State leadership for legal assistance activities;

17. Health and nutrition education services, including information concerning prevention, diagnosis, treatment, and rehabilitation of age-related diseases and chronic disabling conditions;

18. Services designed to enable mentally impaired older individuals to attain and maintain emotional well-being and independent living through a coordinated system of support services;

19. Services designed to support family members and other persons providing voluntary care to older individuals that need long-term care services;

20. Services designed to provide information and training for individuals who are or may become guardians or representative payees of older individuals, including information on the powers and duties of guardians and representative payees and on alternatives to guardianships;

21. Services to encourage and facilitate regular interaction between school-age children and older individuals, including visits in long-term care facilities, multipurpose senior centers, and other settings;

22. In-home services for frail older individuals, including individuals with Alzheimer's disease and related disorders with neurological and organic brain dysfunction, and their families, including in-home services defined by a State agency in the State plan submitted under section 307, taking into consideration the age, economic need, and noneconomic and nonhealth factors contributing to the frail condition and need for services of the individuals described in this paragraph, and in-home services defined by an area agency on aging in the area plan submitted under section 306.

23. Any other services necessary for the general welfare of older individuals; if such services meet standards prescribed by the Assistant Secretary and are necessary for the general welfare of older individuals.

The administration on aging funds a budget for its own operation, for state grants and for research and demonstration. The categories below outline the federal budget portion for state programs and their percentage of the total budget.

  • Congregate Nutrition Services, Home-Delivered Nutrition Services, and Nutrition Services Incentive Program (money from the Department of Agriculture), 52.1%
  • Home & Community-Based Services, 25.9%
  • National Family Caregiver Support Program, 11.7%
  • Other State operational grants, research and demonstration projects, 3.2%
  • Preventive Health Services, 1.6%
  • Protection of Vulnerable Older Americans, 1.3%

State Operational Grants under the Older Americans Act
At the state level, grants are provided from federal funds for six specific title authorizations under the older Americans act. Most of the 23 state programs authorized under The Older Americans Act are financed from the six funding grants with some additional money provided from the Administration on Aging and other government programs. These funds are earmarked for these specific areas of service but there is allowance to transfer funds from one area to another on a limited basis. The administration on aging also kicks in additional funds from the Department of Agriculture, from CMS and from other government programs both for operational expenses at the state level as well as research and demonstration grants. A state-by-state breakdown of the grants for 2005 has been listed in a previous section These title grants are as follows:

  1. Title III, Part B, Supportive Services and Senior Centers , 27.9% of total grants
  2. Title III, Part C, Congregate Nutrition Service, see below
  3. Title III, Part C, Home Delivered Nutrition Services (56.7% of total grants with USDA)
  4. Title III, Part D, Disease Prevention and Health Promotion Services, 1.7% of total grants
  5. Title III, Part E, National Family Caregiver Support Program, 12.2% of total grants
  6. Title VII, Allotments for Vulnerable Elder Rights Protection Activities, 1.5% of total grants

Below is a brief description of each title grant under the act.

Supportive Services and Senior Centers (Title III, Part B) -- 27.9% of total grants
States and local agencies provide a large number of supportive services based on need and available funding. States are also required to provide an additional 15% in matching funds for this section of the act. Most of these services fall under three broad categories and include a great many of the 23 authorized services presented above:

Access Services , such as transportation, outreach, information and assistance, case management and so on

In-Home Services , including homemaker and home health aides, chore and maintenance, supportive services for families of older individuals who have Alzheimer's disease and so on

Community Services such as adult day care, senior centers, legal assistance, recreation and so on

As an example, supportive services funding allows a community to provide rides to medical appointments, grocery stores and drug stores. It provides handyman and chore services so that older persons can stay in their homes. It also is used for community services such as adult day care, health education activities and information and assistance.

Senior centers may be sponsored under the older Americans act but funds for construction and administration may come from a large variety of sources in addition to agency funds. Also many existing senior centers that were not built under the Older Americans Act may receive support and partial funding through the act. The purpose and scope of senior centers have been outlined in a section above.

Nutrition Service, Subpart 1-Congregate Nutrition Services, Subpart 2-Home Delivered Nutrition Services (Title III, Part C) -- 56.7% of total grants (includes USDA funds)
Federal funding for these services represents 52% of the total federal budget and represents 56.7% of state direct title grants. This also includes some money for nutrition counseling and other nutrition service programs. Also a large block of this money comes from the Department of Agriculture in the form of cash or commodities. At the state and local level these programs also represent the greatest part of matching funds and the largest share of volunteer hours. Nutritional services have been thoroughly discussed in sections above.

Disease Prevention and Health Promotion Services (Title III, Part D) -- 1.7% of total grants
Preventive Health Services programs provide health screenings and risk assessments for a range of preventable illnesses and chronic diseases. Programs are designed to prevent some of the key health issues affecting older individuals. Funding for 2005 for the entire country is about $22 million. These programs include efforts to:

  • Prevent and reduce alcohol and substance abuse
  • Smoking cessation
  • Manage the many medications seniors often take
  • Guard against dangerous drug interactions and
  • Highlight the importance of remaining physically fit as a means of preventing the onset of chronic disease and maintaining good health.

National Family Caregiver Support Program (Title III, Part E) -- 12.2% of total grants
This program was added to the Older Americans Act in the revision of 2000. These services have experienced the largest year-to-year increase of any services under this act and are currently at about $162 million. Proposals for the year 2006 are for $250 million of funding. States are required to chip in an additional 25% in matching funds. It is apparent the aging network has put a huge priority on supporting family caregivers.

About 10% of the funds are earmarked to support a grandparent or older individual, 60 years of age or older, who is the primary caregiver of a grandchild or a child directly related by blood or marriage. Many older people are caring for their grandchildren or other children in the family because the parents are either unwilling or unable to do so. There is a proposal in the upcoming revision of the act to also support older adult caregivers for anyone related by blood or marriage not just for minors. Many parents are still caring for their grown developmentally disabled or mentally retarded children. They need support as well.

The term ''family caregiver'' means an adult family member, or another individual, who provides informal care in the home or in the community for an older individual. The act defines the following services for family caregivers to be provided by a state program, a local area agency on aging or by a contract service provider.

  1. Information to caregivers about available services;
  2. Assistance to caregivers in gaining access to the services;
  3. Individual counseling, organization of support groups, and caregiver training to caregivers to assist the caregivers in making decisions and solving problems relating to their caregiving roles;
  4. Respite care to enable caregivers to be temporarily relieved from their caregiving responsibilities; (Some states are providing a certain number of hours of respite care per year for all caregivers on a first-come first-served basis.)
  5. Supplemental services, on a limited basis, to complement the care provided by caregivers. (Operating practices are to use about 20% of available funds for these services)

Allotments for Vulnerable Elder Rights Protection Activities ( Title VII ) 1.5% of total grants
As has been outlined above these are programs that are administered typically at the state level or are required to be administered at the state level. But all of these programs require volunteers or contract service providers at the local level to carry them out. They include the following:

1. The long-term care ombudsman program,

2. Programs for the prevention of abuse, neglect and exploitation, (may be part of adult protective services)

3. State elder rights and legal assistance development programs, and

4. Insurance and benefits outreach, counseling and assistance programs

Other Important Titles under the Act

Grants to Native Americans (Title VI) -- $26,610,000, 1.9% of federal budget
This money is provided to over 240 tribal units and native Hawaiians to administer the 23 authorized service programs under the older Americans act.

Community Service Employment for Older Americans (Title V) no direct grant money
This section is one of the largest and most complicated titles in the act. Most of the verbiage is directed to specific procedures and cooperation with other government agencies. If we were to distill the essence of this title here is our offering.

This title covers a part-time job employment program for low-income persons age 55 or over who are unemployed or whose prospects for employment are limited. Program participants work at community and government agencies and are paid the federal or state minimum wage whichever is higher. They may also receive training and can use their participation as a bridge to other employment positions that are not supported with Federal funds.

The title also provides incentives for job fairs and other initiatives to help people over age 55 find employment.

Broward County Area Agency on Aging Example
The Broward County area agency on aging has one of the largest elderly populations of any AAA in the country. The agency is also one of the most completely organized of any of the 655 AAA's nationwide. Broward County has adopted a single source service initiative as outlined below and has become an Aging and Disability Resource Center (ADRC) for all residents of Broward County , Florida . All aging and disability services in the county are tied together through this one government agency. We urge you to go to the web site at and see an example of the future goal for aging services nationwide.



V. Community-Based Care Initiatives
and Single-Source Care Services


The Impact of Olmsted
The 1999 Supreme Court Olmstead decision in the case of Olmstead v. L.C. and E.W. has had a major impact on the delivery of government-sponsored long-term care services. Two women with mental disabilities, Lois Curtis, 31, and Elaine Wilson, 47, were, against recommendation by state mental health employees, shuttled by the state of Georgia , over a period of 20 years, between hospitals, mental institutions and other settings that were in many cases determined, not appropriate for their treatment. A lawsuit brought by an Atlanta Legal Aid attorney, Susan Jamieson, in 1995, eventually lead to a Supreme Court ruling in favor of the rights of the two women and against the Georgia Department of Human Resources. According to the Center for an Accessible Society:

"Under Title II of the federal Americans with Disabilities Act, said Justice Ruth Bader Ginsburg, delivering the opinion of the court, "states are required to place persons with mental disabilities in community settings rather than in institutions when the State¹s treatment professionals have determined that community placement is appropriate, the transfer from institutional care to a less restrictive setting is not opposed by the affected individual, and the placement can be reasonably accommodated, taking into account the resources available to the State and the needs of others with mental disabilities.

" The 'integration mandate' of the Americans with Disabilities Act requires public agencies to provide services "in the most integrated setting appropriate to the needs of qualified individuals with disabilities." The high court upheld that mandate , ruling that Georgia's department of human resources could not segregate two women with mental disabilities in a state psychiatric hospital long after the agency's own treatment professionals had recommended their transfer to community care."

Since 1999, all states, in order to avoid future lawsuits, have been struggling with providing appropriate settings for disabled adults under their care. Although the emphasis has been on integrating state services in order to offer appropriate care settings for non-aged adults who are mentally retarded or developmentally disabled, many older Americans also have varying degrees of disabilities and must be considered under the Olmstead ruling as well.

As a general rule, states have done little in a practical way to solve the problem of identifying appropriate settings and providing appropriate care for disabled Americans. Much time has gone into commissions, grants and government appointed community action groups to study the problem and provide recommendations but only recently have a few states organized their care systems around compliance with the Olmstead decision. The major problem is a lack of funding at the state level to provide integration of services necessary to provide appropriate community settings for disabled people.

The biggest problem with implementing Olmstead seems to be that the responsibility for state care delivery services is spread out among many departments and is funded from a variety of federal, state and local funding sources, each with their own complicated rules and restrictions. In addition many nonprofit community organizations offer services that could be integrated into a state's care delivery system but, at present, may not be. The challenge is to find a way to structure all care delivery systems so that care decisions and services are coordinated by one central, point of entry for people needing these services. By providing such a one-stop-shopping concept, care can be delivered more efficiently, effectively and in the proper setting. Because of its low cost and growing use by the public, the Internet is being used by many state programs who are providing web sites loaded with single source resources. But this does not solve the organizational and administrative problem of a disparate number of agencies spread through a number of departments who are not communicating with each other or who have their own set of rules.

In 2001, President George W. Bush issued an executive order called the New Freedom Initiative. Although the emphasis was on providing access, transportation, education, homeownership, employment and voting accessibility mostly for disabled non-aged Americans, the president also reiterated his commitment to implementing the Olmstead decision for the disabled and the providing of long-term care in suitable community settings, primarily by moving people out of institutions and into community care settings. As part of his initiative President Bush signed an order directing the Department of Health and Human Services and its agencies, the Centers for Medicare and Medicaid Services and the Administration on Aging to begin providing funds to help states provide more community-based care settings for older Americans.

A great deal of this national effort is in integrating Medicare and Medicaid services with services of state aging units and area agencies on aging. The primary long-term care provider for mentally retarded and developmentally disabled and older Americans over age 65 is Medicaid. Federal Medicaid rules require the use of nursing home care for these eligible groups and home and community-based care can only be offered through federally granted waivers to a state's Medicaid program -- a cumbersome and inefficient system. Medicaid is outdated and inappropriate for implementing Olmstead and should be revised. In lieu of a revision of Medicaid, numerous demonstration grants and study grants have been awarded by the Department to investigate and implement the best ways to integrate services. HHS has adopted the following four goals to implement its new policy of increasing the use of home and community-based services.

  1. Providing comprehensive information about available services, designing simplified eligibility requirements, and implementing single access points of service.
  2. Giving consumers more choice in the types of settings and providers they can receive.
  3. Coordinating various funding sources and providing single-pool funding for consumers to choose among a variety of home and community services.
  4. Establishing procedures to ensure quality control of services across various care settings.

Some of the more significant federal programs to achieve these goals include

• The program, "Money Follows the Person"; providing monies for this program to fully fund one year of the cost of helping Medicaid nursing home residents return to the community;

• Continued implementation of the National Family Caregiver Support Program (Already covered in sections above);

• Replication in other states of the successful "Cash and Counseling" model (An experiment in some states where Medicaid recipients receive cash payments and make decisions for and pay for their own Medicaid authorized services.);

• The Aging and Disability Resource Center Initiative (Explained in more detail below);

• The " Own Your Future Campaign " (An initiative to be funded for all states by 2006 to make the public aware of the need for long-term care planning).

Because of the national emphasis on coordinating care programs and providing a single source point of service, the national aging network now administers and manages almost two-thirds of this nation's Medicaid waiver programs. Also all State units on aging have been given responsibility to administer State revenue programs; over 30 State units administer Medicaid Waiver Programs and State Health Insurance Counseling Programs; over 25 States have expanded the authority of the State aging units to serve younger populations with disabilities; and 24 States have authorized their State units to administer the Aging and Disability Resource Center program.

The ADRC Initiative
A major focus of the federal initiative programs is the goal of establishing "Aging and Disability Resource Centers " (ADRC's) at state and local levels all over the country. Federal grants from the Administration on Aging and the Centers for Medicare and Medicaid Services have provided, to date, demonstration grants to 24 states for resource centers. These states are using the money to demonstrate the concept in a small number of in-state designated service areas. Florida has been more enthusiastic. The Florida legislature expanded its program in 2004 and appropriated money for statewide centers for all older Florida residents. Starting dates for demonstration grants have been staggered over the years. Regardless of when the grant starts, the state will receive ongoing funding for a three-year period at which time the state is expected to have a fully mature test program. States participating in the project are

  1. Alaska
  2. Arkansas
  3. California
  4. Florida
  5. Georgia
  6. Illinois
  7. Indiana
  8. Iowa
  9. Louisiana
  10. Maine
  11. Maryland
  12. Massachusetts
  13. Minnesota
  14. Montana
  15. New Hampshire
  16. New Jersey
  17. New Mexico
  18. North Carolina
  19. North Marianna Islands
  20. Pennsylvania
  21. Rhode Island
  22. South Carolina
  23. West Virginia
  24. Wisconsin

A web site on how these states are progressing with their programs can be found at

The goal is to create a local community, single entry point for information, counseling, qualification and services for all aging, disability and long-term care programs in the state, both public and private. Services are to be integrated not only for the elderly but for all physically and mentally disabled adults in the state as well as their caregivers. Long-term care planning services for healthy people will also be offered. The intent is to provide a comprehensive service source with input from all interested public, private and faith-based groups in the state. This list of input providers might include the following:

  • State Medicaid uptake, qualification and services agencies
  • Aging and disability associations and nonprofit organizations
  • Public and private providers such as nursing homes, assisted living, independent living, adult day care, medical equipment suppliers, assistive technology suppliers and home health agencies
  • State and private mental health organizations
  • State adult protective services organizations
  • State assistive technology organizations
  • Public and private housing agencies
  • Public and private transportation services
  • Hospitals and hospice services
  • Legal services
  • And the list could go on and on

Here is a list of the services a resource center is expected to provide.

• Actively promote public awareness of both public and private long-term support options, as well as awareness of the Resource Center , especially among underserved and hard-to-reach populations.

• Provide information, and counseling as needed, on all available long-term support options.

• Help people assess their potential eligibility for public long-term support programs and benefits.

• Determine eligibility for public long-term support programs and benefits, including level of care determinations for Medicaid nursing home and Medicaid home and community-based services, waiver programs.

• Assist people with the Medicaid eligibility determination process (in collaboration or coordination with Medicaid eligibility determination staff).

• Provide short-term assistance or case management to stabilize long-term support individuals and their families in times of immediate need and before they have been connected to ongoing support (e.g., enrolled in a home or community-based waiver). Resource Centers may also provide on-going case management to public- and/or private-pay individuals.

• Provide information and referral to other programs and benefits that can help people remain in the community, such as disease prevention and health promotion programs, transportation services, and income support programs.

• Help people plan for their future long-term support needs.

• Organize, simplify, and ensure “one-stop shopping” for access to all public long-term support programs.

One of the biggest challenges of this program is going to be making the public aware that the program exists. A general lack of funds will simply not allow for very much if any television, radio, magazine or newspaper advertising or for direct mail campaigns. Besides, such campaigns could bring in droves of people who would overload the system and who might not qualify as a targeted group and money would be lacking to help them. As with aging programs, this program, as well, will have to reach out and identify low income and socially needy individuals.

Based on a description of outreach efforts in a previous section, recipients would probably come through a referral process from organizations serving the elderly and disabled. All of the 24 test programs are using web sites that list services and contact information. This is obviously the cheapest, easiest to implement and most direct method of promotion. But many of the needy or their families may not even have computers or if they do, they may not be using Internet services. It also takes a lot of time and effort to get a web site linked to other pertinent sites and to achieve a high profile on search engines. The Internet can only be a source that other marketing methods will direct people to. This means that without other forms of promotion to provide outreach, the Internet approach by itself, will miss a large number of potential recipients.

Example of Oregon's Community-Based Care Initiative
A number of states have seen the need to give their citizens more choice with long-term care settings without the prodding of the federal government or without the Olmstead decision hanging over their heads. These states recognized well before Olmstead, that the undue emphasis on providing care in nursing homes is neither cost effective nor fair to care recipients and their families.

Of all states attempting to change the system, Oregon has been the most effective in keeping developmentally disabled and mentally retarded and elderly long-term care recipients out of nursing homes. Oregon's program started in the late 1970s as a result of concern over escalating costs for long-term care Medicaid recipients. Unlike most states where more than 70% or 80% of Medicaid long-term care recipients are in nursing homes or intermediate care facilities, Oregon has more than 80% of its recipients in community care homes or receiving home-based care. In addition Oregon has been successful in allowing people receiving care to make their own choices through a consumer directed payment program where these people receive monthly allowances and purchase their own care. Many states are participating in this concept of giving money to eligible participants and allowing them to use the money as they see fit for their care, but these programs may be giving only small monthly allowances of $200-$400 a month. In Oregon, many recipients are given discretion to spend well over $2,000 a month for their care.

This quote is taken from the national conference of State legislatures, 2000:

"This year, for the first time ever, a state will spend more on home and community-based services than on nursing home care. In Oregon, nearly 80 percent of Medicaid patients needing long-term care are getting help in their homes or in the community, while only 20 percent are in nursing homes.

The key to Oregon's success, according to Roger Auerbach of the Oregon Senior and Disabled Services Division, is legislative policy that directed agencies to serve seniors in their homes and in the community and keep them out of nursing homes. Nursing home care per patient costs the state roughly $2,800 a month. Home and community-based care runs around $1,200. With the savings reinvested in services that keep seniors in their homes, Oregon "can serve thousands more," Auerbach says.

Also important to the state's success is the legislature's move to consolidate services into one department-the Senior and Disabled Services Division-which licenses caregivers and nursing homes, monitors quality of care and determines eligibility for people with disabilities and seniors. Another key, according to Auerbach, is that the state now allows in-home caregivers who receive training to do certain tasks without a home health nurse.

Oregon will continue to develop ways to encourage informal caregiving, Auerbach says. To help citizens caring for their relatives as well as paid caregivers, the state is developing an educational television special, planning for an 800 phone number, establishing registries for trained respite caregivers and piloting a closed-circuit broadcast to educate people who run adult foster homes."

The state has demonstrated what others in the country have been saying all along, that it is less expensive to maintain care recipients in the community or at home than paying for nursing home care. The state has been able to serve an increasing number of younger disabled and elderly people than it could have only by utilizing nursing home care. Options available to recipients under comprehensive Medicaid waivers in the state include: respite care, adult day services, adult foster care, assisted living facility care, residential care, and in-home care. Oregon also offers services in a range of settings to people who need assistance with activities of daily living. In addition, case management staff helps clients select the option that is right for them. One negative note, however, is the state has not effectively integrated mentally ill people into this system and that program has not been as successful in providing community-based care.

In the late 1970s and early 1980s, the state adopted a policy of combining budgets for Medicaid and aging services together under one roof. Area agencies on aging were given responsibility to act as single entry points for all long-term care elderly services. During the 1990s, the state discontinued using institutions for mentally retarded and developmentally disabled persons and went to a community care and home-based care system. Responsibility for these people was also given to the county, single source entry systems. In 2001 the state reorganized its health Department and included services for younger disabled people, mental health, aging services and vocational rehabilitation under one department called the Seniors and People with Disabilities Office. All moneys for these services are under one budget. Another important innovation was the recognition that disability and aging services should be managed and budgeted at the local level and not at the state level. Local area agencies on aging manage their own programs for Medicaid, disabled adults and aging services including applying for and receiving Medicaid waivers.

Early in its program the state experienced considerable opposition from nursing homes who were unwilling to give up patients. One of the solutions to this problem was that nursing homes were encouraged to purchase or add assisted-living and home health services to their programs. This helped considerably since nursing homes could now participate in the transition to community-based care. Another effort that helped direct people to home and community care was educating doctors on the benefits of not sending people directly to nursing homes unless it was absolutely necessary.

One drawback in Oregon is that even though services for younger disabled, the elderly and mentally ill are all housed within the same department and they share the same budget, they are still in separate offices and communication and cooperation is still lacking. Mental health particularly has not been integrated effectively into the system. Another drawback is that so much emphasis has been put on moving people into the community that feedback and control procedures in monitoring community care have been late in coming. For community care, the state uses assisted-living facilities with six or more residents and over 2,000 foster homes with five or fewer residents. Oversight for foster homes is on a county level and the handling of inspections and complaints is not as thorough as it should be.

New York State Single Point Resource Example
New York offers an Internet site and a published book called the "New York State Senior Citizen Resource Guide". These booklets are made available throughout the state and New York also has a television station devoted to promoting the services of the State Office of Aging.

The following was taken from the following URL

The New York State Office for the Aging was created by Executive Order of the Governor in 1961 and was one of the first State Units on Aging in the nation. In 1965 the office was made an independent agency in the Executive Department and became the central state agency to plan and coordinate programs and services for the aging at all levels in both the public and private sectors. Since its beginning, the Office for the Aging has been in the forefront of special initiatives for older people, and many of the concepts and programs which began in New York have been adopted nationally.

It is the mission of the New York State Office for the Aging to help older New Yorkers to be as independent as possible for as long as possible through advocacy, development and delivery of cost-effective policies, programs and services which support and empower the elderly and their families, in partnership with the network of public and private organizations which serve them.

The New York State Office for the Aging serves as an advocate for over 3.2 million New Yorkers age 60 and older. The office advocates for older people at all levels of government and the private sector with the cooperation of concerned organizations and older New Yorkers.

Under Executive Order No. 12, Governor Pataki has empowered the office to review and comment on all state agencies’ programs, policies and legislative proposals which would affect aging people.

In addition, the office:

  • advises and assists the Governor in developing policies to help meet the needs of older New Yorkers and to encourage their full participation in the community;
  • coordinates state programs and services for our older residents;
  • stimulates community interest in problems of the aging;
  • promotes public awareness of resources available for aging persons;
  • ensures the development of local programs; and,
  • fosters and supports studies, research and education on issues and concerns of older New Yorkers.

The New York State Office for the Aging administers various titles under the federal Older Americans Act of 1965, as amended, and a variety of state-funded programs which serve mature citizens. In these programs preference is given to older persons who have been historically underserved, including those with the greatest economic or social need, with special emphasis on the needs of low income minority seniors.

The majority of programs are administered through local offices for the aging. There are 59 local offices which serve each county, the City of New York, the St. Regis Mohawk Indian Reservation and the Seneca Nation of Indians which includes the Cattaraugus and Allegany Reservations. These are the only Indian Reservations with offices for the aging east of the Mississippi River.

As people age, legal issues arise that need their attention. Some face age discrimination in the workplace; others become victims of fraud. The following examples are provided to assist seniors in determining where to turn for help."

(The state and local agencies coordinate all of the services below through one central clearinghouse or through referral to local agencies on aging)

The New York State Office for the Aging’s award-winning cable TV program