Legislation
The Role of the Older Americans Act in Providing Long-Term Care
Fact Sheet
Enid Kassner, AARP Public Policy Institute
February 2001
Table of Contents: Introduction | Funding | Role in Providing Long-Term Services and Supports | Policy Issues
Introduction
The Older Americans Act (OAA) was enacted in 1965 to promote the well-being of older persons and help them remain independent in their communities. The OAA distributes federal funds to states, which, in turn, establish centers for information about services available to older persons. Title III of the OAA provides funds to help states organize and pay for meals and a broad range of social services. All persons age 60 and older are eligible to participate, but states are required to target services to persons with the “greatest social or economic need.”
Funding
Federal funds are distributed to the states using a formula based on the state's share of the US population age 60 and over. In fiscal year 2004, the total federal appropriation for the OAA is $1.4 billion, up from $1.1 billion in 2001. Funding generally has increased slightly each year, but has not kept pace with inflation and the growth of the older population. Appropriations for selected OAA services are listed below.
Role in Providing Long-Term Services and Supports
A major function of the OAA within each state is to coordinate and enhance access to long-term services and supports. In many states, OAA-funded Area Agencies on Aging (AAAs) coordinate closely with other state or federally funded long-term care programs (such as Medicaid or the Social Services Block Grant). AAAs provide a single point of access to long-term care in many, but not all, states.
In-home services are designated by the OAA as a priority service for states to provide. In fiscal year 2002, about 34 percent of Title III funds were spent on: personal care; homemaker services; chore services; home-delivered meals; adult day care; and case management. Ten percent of Title III funds paid for assisted transportation. About one-third (33 percent) of Title III funds paid for congregate meals, which also can help maintain independence.
Figure 1 illustrates the number of persons receiving selected OAA services in fiscal year 2002 (the most recent year for which these data are available).
Figure 2 illustrates the federal expenditure on these same services in fiscal year 2002. However, total expenditures on these services were augmented by state funds and contribu- tions (both corporate and individual).
Top of PageWhen the OAA was reauthorized in 2000, Congress approved an initiative to provide support to informal caregivers. This program funds each state to provide: information to caregivers about available services; assistance in gaining access to services; caregiver training; respite care; and a limited amount of supplemental services.
Support for family caregivers is critical, given that some 78 percent of adults living in the community rely solely on informal help. While most of the funding for caregiver support will help people who care for older relatives, states may spend up to 10 percent of these funds to support older people who care for their grandchildren.
The OAA also plays a small but critical role in long-term care in institutional settings through its ombudsman program. Each state operates a long-term care ombudsman program that monitors the quality of care provided in nursing homes and board and care homes. State ombudsmen also investigate and resolve complaints. Of the $19 million Congress appropriated for elder rights for fiscal year 2004, $14 million is earmarked for the ombudsman program.
Policy Issues
The major funder of long-term services and supports – Medicaid – serves people with low incomes and minimal assets. Many people are ineligible for Medicaid, but cannot afford the cost of long-term services on their own. The OAA is able to serve some of those who might otherwise “fall through the cracks.”
Many people with disabilities need primarily non-medical services such as personal care or help with chores. These are precisely the type of services that the OAA can fund. Appropriations for the OAA are miniscule, however, compared to the approximately $28 billion provided through Medicaid for home and community-based long-term services and supports in 2003.
Written by Enid Kassner, AARP Public Policy Institute
November 2004
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Pub ID: FS12R