OLDER AMERICANS ACT OF 1965, TITLE III: A POLICY ANALYSIS EMILEE J. COOK CALIFORNIA STATE UNIVERSITY, LONG BEACH SCHOOL OF SOCIAL WORK MAY 2013

Older Americans Act, Title III—Introduction Currently, the U.S. population of adults over the age of 60 is 57 million (U.S. Census Bureau, 2010). It is estimated that by the year 2050, the population of individuals 65 years or older will increase by 120% growing from 40 million to more than 88 million. Of older adults with lower income in the U.S., only a small percentage (9%) are receiving nutritional services, while many other low income elderly are not receiving these needed services (United States Senate, Special Committee on Aging, 2011). The Older Americans Act of 1965 was designed to address the social services needs for older adults, and aimed to help older adults remain independent in their homes and communities (National Health Policy Forum, 2012). The Act established the Administration on Aging, which was considered “the major vehicle for promoting the delivery of social services to the aging population” (National Health policy Forum, 2012, p.1).

Social Work Resonance Social work code of ethics includes standards of advocacy and social justice (National Association of Social Workers, 2008). Social workers planning to work with the older adult population should better understand the nutritional needs and the barriers their clients face, in order to both advocate for and deliver needed programs and services. Social work professionals can better help to advocate for any needed policy changes on behalf of clients, in order to help serve and better meet the needs of the older adult population. Being familiar with the experiences and challenges of this population is vital to effectively assist this population and in order to advocate for change.

Literature Review In response to the “urban hunger” that was occurring during the depression years ( ), President Franklin D. Roosevelt introduced a program in 1933 that would allow surpluses of agriculture to be given to the unemployed. This program was called the Federal Surplus Relief Corporation (FSRC), and became the responsibility of the United States Department of Agriculture (USDA) in 1935 (Moran, 2011, p. 1004). Later, the Food Stamp Plan of 1939 was developed and had been created specifically with the idea to shift the outlook of the poor and unemployed from a “recipient” to a “consumer” (Moran, 2011, p. 1009). In 1965, the Older Americans Act was signed into Law, and established programs specifically focused toward older adults’ nutritional needs. Through the Older Americans Act, seven separate titles were established, all of which, collectively, work toward improving the lives of older adults in terms of their retirement, opportunity for employment, physical and mental health, and for long-term supports and services. It was in 1972 that congress authorized the program that provides nutritional services as a separate title to the Older Americans Act (Collelo, 2011). In the early 50s, various agencies within the United States began to deliver meals to frail older adults (Meals on Wheels Foundation, 2012). As the United States recognized the growing need for home-delivered meals to be provided to homebound and isolated older adult populations, home-delivered nutrition services were added to the Older Americans Act provisions in 1978 (Meals on Wheels Foundation, 2012). Title III attempts to assist older individuals to “gain access to nutrition and other disease prevention and health promotion services” in order to delay the onset of health conditions resulting from poor nutritional health (OAA Amendments, 2006, section 330).

Methods This study used David Gil’s (1992) policy analysis framework Gil’s framework provides a set of standards to analyze aspects of a given social policy to understand its impact on society. SECTION A: ISSUES DEALT WITH BY THE POLICY I. Nature, scope, and distribution of the issues. 2. Casual theory(ies) or hypothesis(es) concerning the issues. SECTION B: OBJECTIVES, VALUE PREMISES, THEORETICAL POSITIONS, TARGET SEGMENTS, AND SUBSTANTIATIVE EFFECTS OF THE POLICY I. Policy Objectives: overt objectives and covert objectives. 2. Value premises and ideological orientations underlying the policy objectives: explicit and implicit value premises. 3. Theory(ies) or hypothesis(es) underlying the strategy and the substantive provisions of the policy. 4. Target segments(s) of society- those at whom the policy is aimed: Ecological, demographic, biological, psychological, social, economic, political, and cultural characteristics. Size of relevant subgroups and of entire target segments projected over time. 5. Short and long-range effects of the policy on target and nontarget segment(s) in ecological, demographic, biological, psychological social, economic, political, and cultural spheres Intended effects and extent of attainment of policy objectives. Unintended effects. Overall costs and benefits. SECTION C: IMPLICATIONS OF THE POLICY FOR THE OPERATING AND OUTCOME VARIABLES OF SOCIAL POLICIES

Methods Continued This framework was employed through a secondary review of the existing literature in order to explore the impact this policy has on older adults and whether this policy can continue to provide needed as the older adult population grows. Data sources included California State University, Long Beach library resources, including books, scholarly journals, law reviews, as well as public and government agency documents.

Policy Analysis OAA Nutritional Programs were created: To assist older adults in maintaining independence within communities and homes by providing supportive services (O’Shaughnessy, 2008). Through authorization, congress intended to address both the physical and social needs of older adults (National Health Policy Forum, 2012). To promote socialization, and to allow older adults to gain access to other disease prevention and health promotion services (Colello, 2011). Nature and scope of the issue: The U.S. population includes over 57 million older adults (U.S. Census Bureau, 2010) and is expected to grow at a rate of 120% within the next 40 years (Lipman et al., 2012). Of these 57 million older adults, 1 of every 7 (14.85%) faces the threat of hunger. This amount has increased since 2005 when 1 out of every 9 seniors faced the threat of hunger (Ziliak & Gundersen, 2012). Since 2001, the threat of hunger has actually increased by nearly 80% among older adults, and the beginning of the recession in 2007 contributed to 34% of that increase (Ziliak & Gundersen, 2012). Overt objective: The policy influenced the beginning of the congregate and home delivered meals to older adults (Nutrition Act for the Elderly, 1973). Seeks to promote healthy aging and fight food insecurity (Colello, 2011). Covert objective: the federal government, through providing funding to states for congregate and home delivered meal programs, can be positively impacting older adults’ health and nutritional status. to reduce the stigma often associated with public assistance programs, such as food stamps, for example. This objective allows the older adult to be in a consumer role and contribute if they are able to.

Policy Analysis (Continued) Intended effects & Impact: Statistical data on the unmet need for nutritional services for older adults in general are elusive and there has not been a statistical evaluation on the nutrition program in the past 17 years, since 1995 (Collelo, 2011). The effects and impacts cannot be measured according to data due to lack of an evaluation. Unintended effect: In the early years since the policy’s enactment in 1965, the older adult population did not have the same life expectancy they do today, meaning that services that were once intended to be provided for a shorter period of time are now being provided much longer than before, and funding is not increasing at a rate to keep up with this length of need (Colello, 2011). Overall costs and benefits: In order to address the needs, this policy has increased funding over the past years, from $410 million in fiscal year 2008 to $439 million in fiscal year 2012 for congregate nutrition programs, and has increased funding from $193 million in fiscal year 2008 to 216 million in fiscal year 2012 for home- delivered nutrition programs (AOA, 2012). However, in the past year alone, from fiscal year 2011 to fiscal year 2012, funds decreased to both congregate and home-delivered services by $1 million (combined). officials of various agencies on aging explained that one of the reasons that older adults do not receive access to nutritional services funded by Title III are that the need for home-delivered meals is far greater than the funding available. Twenty two percent of agencies responding to the survey stated that they were “unable to serve all clients who requested home-delivered meals” (United States Senate, Special Committee on Aging, 2011, p. 18).

Summary Strengths of the Policy : Home delivered meals are often the very first in-home service an older adult receives, and also helps older adults sustain as much independence as possible (AoA, 2012). The Older Americans Act’s Title III Nutrition Program was designed to assist older adults in a way that had not been done before (Colello, 2011). It attempts to provide nutritional services to older adults in a way that maintains their dignity and avoids the perception of stigma that is often associated with participating in an assistance program. It aims to view the participants as consumers and to be mindful of cultural and religious factors. Challenges of the Policy: The Administration on Aging does not currently provide standardized definitions and procedures for states to use to measure the unmet need for nutritional services (United States Special Committee on Aging, 2011). The United States Senate Special Committee on Aging (2011) determined that while the Title III nutritional service programs are helping to meet the nutritional needs for certain target groups, many additional older adults are not receiving the services they need. This policy was enacted over 45 years ago, at a time when older adults did not have as long of a lifespan, and would not have accessed nutritional services for as many years as they may do now. Of older adults with lower income, only a small percentage (9%) are receiving nutritional services, while many other low income elderly are not receiving these services (United States Senate, Special Committee on Aging, 2011). The older adult population was not growing as rapidly at that time, and it is now projected to increase over 100% in the next forty years (Lipman et al. 2012). While the policy has produced nutritional health benefits to its current participants, the lack of funding does not support the increased need as more adults continue to age, as well as continue to experience food insecurity.

References Administration on Aging. (2012) Older Americans Act of Retrieved from Collelo (2011). Older Americans Act: Title III Nutrition Services Program, (CRS Report for Congress RS ). Washington, DC: Congressional Research Service. Retrieved from Gil, D.G. (1992). Unraveling social policy: Theory, analysis, and political action towards social equality (rev. 5 th ed.). Rochester, VT: Schenkman Books. Lipman, B., Lubell, J., & Salomon, E. (2012). Housing an aging population: Are we prepared? Washington, DC: National Housing Conference, Center for Housing Policy Report. Meals on Wheels Foundation (2012). History of Meals on Wheels. Retrieved from toki.com/timeline/entry/75991/Meals-On- Wheels/ Moran, R. (2011). Consuming relief: Food stamps and the new welfare of the New Deal. Journal of American History, 97(4), doi: /jahist/jaq067 National Health Policy Forum. (2012). The basics: Older Americans Act of 1965, program and funding. Washington DC: George Washington University. Nutrition Act for the Elderly, Pub. L. No , Title III, 86 Stat. 88 (1973). Older Americans Act Amendments of 2006, Pub. L. No , 120 Stat (2006). O’Shaughnessy, C. (2008). The aging services network: Accomplishments and challenges in serving a growing elderly population. Washington, DC: National Health Policy Forum. U.S. Census Bureau. (2010) Census data. Retrieved October 2nd, 2012 from United States Senate, Special Committee on Aging. (2011). Older Americans Act: More should be done to measure the extent of unmet need for services. A report to the Chairman. Retrieved from Ziliak, J., & Gundersen, C. (2012). Senior hunger in America 2010: An annual report. Alexandria, VA: Meals on Wheels Research Foundation.