Community Aging Services and Senior Centers
Community Aging Services and Long Term Care
Community Aging Services and Long Term Care
There are many private, religious and government organizations across the country that provide supportive services for older people. Many of these services center around helping people stay in their homes and avoid having to go to live in an institution or perhaps move in with family. Because of the emphasis on helping people remain independent, many community aging programs could be viewed as long-term care programs. In fact it's probably just a matter of semantics; long-term care and community aging services are just two sides of the same coin. Other communityservices may provide socialization or training opportunities. Community aging programs might include:
Private support groups might be the Red Cross, women's auxiliaries or foundations. Many religious communities support activities for their elderly members as well as nonmembers. Both private and religious groups often provide services for free to people with little income and few assets. They may, however, charge people for services who have adequate income or assets. Many of these groups may also operate nursing homes and assisted-living facilities.
Senior centers are often the focal point for all aging services in a community. Experts or contact people are housed in senior centers and can provide many services in the center itself or refer out to other organizations that can help. The community served meals or congregate meals in senior centers are a means for attracting older people into the centers. Seniors can then be exposed to the many services that are available.
Government support for aging services comes from the Older Americans Act, passed in 1965. This act, over the years, has produced a large network of care providers and local government managers called Area Agencies on Aging. This network also includes federal agencies, state agencies as well as local area agencies and is called the "national aging network". Although currently area agencies on aging do not usually track and direct people to non-government services, in the future, the Government intends on being the single source coordinator of all aging services in the community. Therefore, if you're looking for any services in the community, public or private, you should contact your area agency on aging first. We have provided a list of all 655 area agencies on aging in the United States . Click on the appropriate link above.
Why Is the Older Americans Act Important?
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.
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.
The National Aging Network
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
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:
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"
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.
Administration on Aging
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.
State Units on Aging
List of State Aging Units
(State Aging Units and Area Agencies on Aging)
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.
Cost Sharing and Voluntary Contributions
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.
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
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
"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.
We have provided a list of all states' online adult protective services sites at http://www.longtermcarelink.net/eldercare/ref_adult_protective_services_elder_abuse.htm
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
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 http://www.longtermcarelink.net/eldercare/ref_ombudsman.htm
Health Insurance Counseling.
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 http://www.aoa.gov/smp/grantee/grantee_state.asp
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.
Area Agencies on Aging -- Purpose and Description
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.
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 http://www.longtermcarelink.net/eldercare/ref_state_aging_services.htm
How Services Are Provided
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
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:
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:
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:
Profile of a Congregate Participant:
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 .
Congregate (Community) Meals
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
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
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
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.
Supportive Services and Senior Centers (Title III, Part B) -- 27.9% of total grants
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)
Disease Prevention and Health Promotion Services (Title III, Part D) -- 1.7% of total grants
National Family Caregiver Support Program (Title III, Part E) -- 12.2% of total grants
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.
Allotments for Vulnerable Elder Rights Protection Activities ( Title VII ) 1.5% of total grants
1. The long-term care ombudsman program,
Other Important Titles under the Act
Grants to Native Americans (Title VI) -- $26,610,000, 1.9% of federal budget
Community Service Employment for Older Americans (Title V) no direct grant money
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.
Broward County Area Agency on Aging Example
The Impact of Olmsted
"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.
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.
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;
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 web site on how these states are progressing with their programs can be found at http://www.adrc-tae.org/
The goal is to create a local community, single entry point for
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:
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.
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
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 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's list of aging services is very large and extensive and your state may not offer as many services, but it will give you a good idea of the types of services available when you contact your local area agency on aging.
The following was taken from the following URL http://aging.state.ny.us/findhelp/guide/index.htm
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:
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)