1. 1 Older Americans Act for AAAs Texas Dept of Aging and Disability Services Austin, TX June 6, 2006

2. 2 Older Americans Act of 1965, P.L. 89-73, July 14, 1965 Lyndon Johnson signing the OAA, 1965.

3. 3 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

4. 4 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 Society25 Years of the Older Americans Act. Generations, 1991

5. 5 OAA: Major Amendments, Contd 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)

6. 6 OAA: Major Amendments, Contd 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

7. 7 OAA: Major Amendments, Contd 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)

8. 8 OAA: Major Amendments, Contd 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

9. 9 OAA: Major Amendments, Contd 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: Alzheimers disease

10. 10 OAA: Major Amendments, Contd 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

11. 11 OAA: Major Amendments, Contd 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

12. 12 OAA: Major Amendments, Contd 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

13. 13 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

14. 14 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 fundshas changed over time, e.g. HCBS waivers, outreach for benefits, Alzheimers grants AoA status in DHHS

15. 15 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?

16. 16 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

17. 17 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

18. 18 Titles Of the OAA, Contd 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

19. 19 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

20. 20 Declaration of Objectives, Contd 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

21. 21 Declaration of Objectives, Contd 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

22. 22 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 Alzheimers 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

23. 23 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

24. 24 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.

25. 25 Adequate Proportion: Legal Services (2%) Legal Services: Legal Assistance & Legal Awareness 2% of IIIB must be expended in these services

26. 26 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

27. 27 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

28. 28 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

29. 29 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

30. 30 For More Information: www.aoa.gov (keyword: Older Americans Act)www.aoa.gov