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Older Americans Act for AAAsOlder Americans Act for AAAsTexas Dept of Aging and Disability Services

Austin, TXJune 6, 2006

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Older Americans Act of 1965, P.L. 89-73, July 14, 1965

Lyndon Johnson signing the OAA, 1965.

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1965 Older Americans Act, Historical Development

• 1965: Legacy of the Great Society– 10 broad national policy objectives on aging– Creation of AoA as federal focal point on aging– Grants to states for community planning &

services– Authority for research, demonstration, and training

projects

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OAA: Major Amendments

• 1965 Act was one of the foundation pieces for evolving public policy on aging– Creation of strategies, programs, and services to

meet needs of older persons– Provision of tangible and intangible help to

innumerable older persons– Continuous and dynamic identification of older

persons’ needs– Development of nationwide aging infrastructure– Recruitment of thousands of career professionals

to field of aging

Source: Robert Binstock. From the Great Society to the Aging Society—25 Years of the Older Americans Act. Generations, 1991

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OAA: Major Amendments, Cont’d

• 1967-73: Expansion of State Aging Infrastructure– Increased requirements and funding for statewide

planning and coordination (1967, 1969, 1973)– 1971 White House Conference on Aging: major

impetus for expansion of aging infrastructure– States are to develop a “comprehensive and

coordinated service system” in partnership with AAAs (1973)

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OAA: Major Amendments, Cont’d

• 1973: Creation of AAAs– Develop “comprehensive and coordinated service

system” in partnership with state agencies– Primary responsibility: coordinate services,

stimulate expansion of services, serve as advocates for, and exercise leadership on behalf of, older persons

– “Not intended” to be “primary provider of services”

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OAA: Major Amendments, Cont’d

• 1972-1978: Beginning of Specific Service Initiatives– National nutrition program (1972)– Multipurpose senior centers (1973)– Community service employment (1973)– Priority (mandatory) services under Title III: home

care, transportation, legal, residential repair (1975)

– Separate authorization for home-delivered meals (1978)

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OAA: Major Amendments, Cont’d

• 1978-1981: Consolidation, Coordination, and Streamlining– Consolidation of titles authorizing state/area agencies,

nutrition services, and senior centers (1978)– Consolidation of priority (i.e., mandatory) services: in-

home, access, legal (1978), but more flexibility in funding (1981)

– Flexibility in determining state and area agency planning cycles (1981)

• 1978: Begin Focus on Elder Rights Issues– Creation of long-term care ombudsman program

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OAA: Major Amendments, Cont’d

• 1984– Addition of legislative language on targeting on

persons with greatest need– State administration funded through % of service

dollars– Required AAAs to facilitate HCBS and case

management services– Authorized services to prevent elder abuse and

required congressional report – Focus on special population: Alzheimer’s disease

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OAA: Major Amendments, Cont’d

• 1987– Major Restructuring of Title III

• Separate authorizations under Title III– In-home services for frail elderly

– Long-term care ombudsman

– Assistance for special needs

– Health education & promotion services

– Service to prevent abuse, neglect, & exploitation

– Outreach activities for persons eligible for SSI, food stamps, & Medicaid

– Elevation of status of AoA within DHHS– Expanded language on targeting

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OAA: Major Amendments, Cont’d

• 1992– Major restructuring of Title III through creation of

Title VIII, Vulnerable Elder Rights Protection Activities: transferred and consolidated certain Title III services

• Ombudsman, elder abuse prevention, legal assistance, outreach on public entitlements

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OAA: Major Amendments, Cont’d

• 2000– National family caregiver support program– Title V restructuring– Cost-sharing allowed

• Optional for states• Not allowed for I&A, outreach, benefits counseling,

case management, ombudsman, elder abuse prevention programs, legal assistance, consumer protection services, congregate and home-delivered meals, services provided by tribal organizations, or services to low-income individuals

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Themes in Legislative Developments

• Participation of older persons in OAA programs– Universal vs. targeted participation– Cost-sharing (or not)

• Tension between federally designated services and state and local needs – e.g., congressional directives for mandatory services,

ability to transfer of funds between supportive and nutrition services

• Consolidation, simplification, flexibility vs. increasing number of state/area agency requirements

• Planning, coordination, & advocacy functions vs. management of service programs

“Dance of Legislation”

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Themes in Legislative Developments

• Title III and Title V formulae controversies

• How to “equitably” distribute fund

• Tension between requirements to develop “compre/coord” system, but limited control over non-OAA funds—has changed over time, e.g. HCBS waivers, outreach for benefits, Alzheimer’s grants

• AoA status in DHHS

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Policy Questions for Reauthorization

• How should Act be changed to prepare for baby boom population?– How should current programs be

changed to accommodate changing older population?

– How to balance universal participation issues versus special populations?

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Possible Issues for 2006 Reauthorization

• Timing of reauthorization• Elder Justice• Choices for Independence vs. IIID • Respite and caregiving

– Service adult disabled children under NFCSP

• Options for consumer-directed services• NORCS• Cost Sharing for Nutrition Services

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Titles of the OAA

• Title I: Declaration of Objectives; Definitions• Title II: Administration on Aging• Title III: Grants for State and Community Programs

on Aging– Part A: General Provisions– Part B: Supportive Services and Senior Centers– Part C: Nutrition Services– Part D: Disease Prevention and Health Promotion

Services– Part E: National Family Caregiver Support Program

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Titles Of the OAA, Cont’d

• Title IV: Training, Research, and Discretionary Projects and Programs

• Title V: Community Service Employment Program for Older Adults

• Title VI: Grants for Native Americans

• Title VII: Vulnerable Elder Rights Protection Activities

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Declaration of Objectives

• An adequate income in retirement

• Best possible physical and mental health – without regard to income status

• Obtaining and maintaining suitable housing available at costs older citizens can afford

• Full restorative services for those who require institutional care, and a comprehensive array of community-based long-term care services including support to family members

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Declaration of Objectives, Cont’d

• Opportunity for employment

• Retirement in health, honor and dignity

• Participating in and contributing to meaningful activity

• Efficient community services – which provide choice- with emphasis on maintaining a continuum of care

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Declaration of Objectives, Cont’d

• Immediate benefit from proven research knowledge which can sustain and improve health and happiness

• Freedom, independence, and the free exercise of individual initiative – and protection against abuse, neglect and exploitation

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Older Americans Act Goes Into Action

• Targeting: Those in greatest social and economic need with particular attention to low-income minority elderly, native Americans, persons with Alzheimer’s disease and related disorders and their families, those in rural areas (in 2006, may add “those with limited English-speaking ability”)

• Service Provision: – Direct Services, Contract Services, Vendored

Services

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Older Americans Act Goes Into Action

• Access to Services: relates to targeting, focal points, service provision arrangements, outreach, transportation

• Budgeting: relates to maintenance of effort, adequate proportion, , allowable transfers, match

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Maintenance of Effort (MOE)

• Definition: A requirement contained in legislation, regulations or administrative policies that a recipient must maintain a specified level of financial effort in an area for which federal funds will be provided in order to receive the federal grant, has base-year dollar amount.

• The Ombudsman Program has an MOE requirement. AAAs may not budget less in federal (IIIB, EAP, OAG) funds in this program than spent in FY2000.

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Adequate Proportion: Legal Services (2%)

• Legal Services: Legal Assistance & Legal Awareness

• 2% of IIIB must be expended in these services

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Adequate Proportion: In-Home (10%)

• Homemaker• Personal Assistance• Emergency Response• Caregiver In-Home

Respite• Chore Maintenance• Telephone

Reassurance

• Visiting• Hospice• Residential Repair• Adult Day Care• Caregiver Institutional

Respite• Caregiver Non-

institutional Respite• 10% of IIIB must be

expended in these services

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Adequate Proportion: Access and Assistance (25%)

• Information, Referral & Assistance

• Care Coordination

• Transportation Demand Response

• Assisted Transportation

• Fixed Route Transportation

• 25% of IIIB must be expended in these services

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Allowable Transfers

• Between IIIB and IIIC1 or IIIC2: 30%

• Between IIIC1 or IIIC2: 40%

• From Administration to Services (IIIB, C, E): Allowed

• From Services (IIIB, C, E) to Administration: Not allowed

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Match

• Administration: 25%• IIIB Supportive Services: 15% (In Texas:10% AAA,

5% State*)• IIIIC Nutrition Services: 15% (In Texas:10% AAA,

5% State*)• IIID Health: 15% (In Texas:10% AAA, 5% State*)• IIIE Caregiver Services: 25%

• *DADS allocates State General Revenues (SGR) to the AAAs for their portion of the match

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For More Information:

• www.aoa.gov (keyword: Older Americans Act)