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(7) Evaluate the need for social services (including legal services), nutrition services, and multipurpose senior center facilities, and determine the extent to which existing public or private programs meet such need; and

(8) Reserve from its social service allotment an additional five percent above that which the State spent in rural areas in the previous year to increase rural services. A waiver provision is authorized, however, for those States which show that there are insufficient numbers of rural elderly to warrant such additional expenditures or that the needs of the rural elderly already are being met.

Planning and service areas.-In designating a planning and service area, the State agency must consider (1) the areawide need for social services, nutrition services, multipurpose senior centers; (2) the geographic distribution of the age 60 and older population; and (3) existing boundaries designated for the planning and administration of other public programs.

A State may designate any region recognized for purposes of areawide planning which includes one or more units of general purpose local government, or any local government which represents a population of 100,000 or more. Planning and services areas also may cross State boundaries to encompass geographic areas of two States when appropriate. Indian reservations also may be designated.

Area agencies on aging.-The State may designate any unit of local government or private nonprofit agency as the area agency on aging, but "shall give preference to an established office on aging." Area agencies also may be an agency representing any combination of units of government.

Area agencies have been designated by State agencies on aging in 568 of the 612 planning and service areas. They cover approximately 92 percent of the Nation's population 60 years of age and older.

Area organizations and area plans.-The area agency on aging is responsible for developing and implementing a 3-year plan for a comprehensive and coordinated social service delivery system for older persons residing within the State-designated planning and service area. The plan must set forth objectives for the provision of social services, congregate meal programs, home-delivered meals when appropriate, and multipurpose senior center facilities when necessary. Toward fulfillment of the area plan, the area agency is encouraged to work with its advisory council, local service providers and individuals in the community to coordinate existing service providers for the elderly and foster the expansion of needed services. Area agencies also may purchase through grants and contracts social services when such services are not otherwise available. These services generally are provided by local service providers some of which serve all age groups and some which exclusively serve the elderly. The 3-year plan must be approved by the State agency on aging.

Area agencies also must:

(1) Provide technical assistance to providers of social services;

(2) Enter into agreements, where feasible, with agencies administering vocational rehabilitation programs, social services programs authorized under title XX of the Social Security Act, and medicaid to meet the transportation needs of older persons;

(3) Establish or maintain information and referral sources to assure that all older persons within the planning and service area have reasonably convenient access to services;

(4) Provide assurances that preference will be given to providing services to persons with the greatest economic or social needs;

(5) Enter into arrangements with day care centers for children for creating volunteer opportunities for older people in such centers; and (6) Enter into arrangements with educational institutions and nonprofit private organizations to provide education services for the elderly.

Social services-Grants are made available to State and area agencies for services developed in accordance with a local determination of need for such services. The act requires the development of information and referral services if not otherwise available in the community. It also identifies other categories of acceptable services such as:

Outreach activities: Community Services.-Transportation and escort services, legal and financial counseling, health screening and other health-related services, employment services, preretirement and second career counseling, and recreational and educational services.

In-home services.-Transportation and escort services, home renovation and home repair services, and fuel and utility-related services, chore services, shopping assistance, telephone reassurance services, letter writing and reader services, and health screening and healthrelated services.

Services for the institutionalized.-Letter writing and reader services, ombudsman services in behalf of residents, and telephone reassurance and visiting services.

Priority social services.-At least 50 percent of each area agency's social service allotment must be targeted for three categories of services: access services (transportation, outreach, and information and referral); in-home services (homemaker, home health aid, visiting services, telephone reassurance and chore-maintenance); and legal services. Some funds must be expended in each category of service, but the percentage of the funds targeted for a specific category is a matter of local determination.

Background. Priority services first were mandated under the 1975 amendments. These amendments established four services (transportation, home care, legal services, and home renovation and repair) for which at least 20 percent of a State's social service allotment had to be expended so that resources could be concentrated in areas of apparent greatest need. The 1978 amendments changed the priority services and targeted a significant proportion of the area agency's social service allotment for such services. The reasons for this were explained in the Committee on Human Resources bill report.

The committee (still) is concerned that very few services are provided indepth in local communities. Rather, there appears to be a scatter-gun attempt to provide a wide array of services, none of which adequately serves the needs of the elderly in the community. It is an escapable fact that there is a finite amount of Federal dollars, and that those dollars are not sufficient to meet all of the needs of our senior citizens. Within the fiscal limitation, the committee believes that there should be a concentrated effort to better meet the most crucial needs of the elderly.12

Multipurpose senior center facilities.-Grants for multipurpose senior center facilities may be awarded through State or area agencies on

12 U.S. Senate. Committee on Human Resources. Older Americans Act Amendments of 1978. Committee Rept. No. 95-855. May 15, 1978: 10.

aging to public or private nonprofit agencies and organizations to pay part of the cost of acquiring, altering, or renovating existing facilities to serve as senior centers. Authority also is provided for the construction of such facilities on a limited basis when no existing facility in the community can otherwise be acquired. Multipurpose senior centers facility funds are made available from a State's social service allotment. The amount of the allocation is determined by the State.

Background. The 1973 amendments authorized the Commissioner on Aging to award grants, mortgage insurance and annual interest subsidies to grantees for developing senior center facilities. Senior centers were viewed as an important location where services and activities could be made accessible both to older people who gather at the facility and to those homebound in the community. Many observers questioned, however, whether State agencies were encouraging the provision of services at senior centers.

The 1978 amendments, therefore, clarified the function of senior centers and their relationship to programs for social and nutrition services. Grants are to be channeled from State or area agencies on aging to grantees. The Conference report on the amendments stated that:

The conferees emphasize the importance of multipurpose senior centers in developing a comprehensive social services network, and expect that area agencies will continue to place appropriate emphasis on their development and expansion."

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The 1978 amendments reauthorized mortgage insurance and annual interest subsidies under title IV of the Act so that additional funding support for centers could be made available.

Currently there are approximately 5,000 senior centers in the country ranging from small programs with budgets under $20,000 to those with annual budgets over $1 million dollars. Many of these centers could provide expanded services with improved facilities.14

Congregate and home-delivered meal services.-Grants are awarded through State and area agencies on aging to public and private nonprofit sponsors for establishing and operating primarily congregate, but also home-delivered meal projects for persons age 60 and older and their spouses of any age. Participants pay for meals based on what they feel they can afford. Income derived from fees is used by project sponsors to increase the number of meals.

State agencies on aging rather than area agencies may award grants to project sponsors directly in fiscal years 1979 and 1980. Beginning in fiscal year 1981, area agencies are to award project grants to nutrition service sponsors.

There is a separate funding authorization for congregate and homedelivered meals. States however, may transfer funds from one allocation to the other as they deem appropriate. As specified in the Conference report:

The conferees intend that every effort be made for participants to take part in a congregate setting unless homebound by reasons of illness, an incapacitating disability, or extreme transportation problems. The conferees expect the Admin

13 U.S. House. Committee on Conference. Comprehensive Older Americans Act Amendments of 1978 Conference Rept. No. 95-1236. Sept. 23, 1978: 64.

14 U.S. Senate. Committee on Human Resources. Hearings on the proposed 1978 Older Americans Act Amendments. National Council on the Aging. Feb. 8, 1978.

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istration to follow carefully the development of this program, and discourage its use unless necessary.15

Congregate meals are provided at a setting known as a "meal site” such as a senior center, school, church, apartment dwelling or other community facility. The meals are served at least once each day on at least 5 days a week along with services, such as outreach, transportation, counseling, recreation, nutrition, education, information and referral, and other support services. During fiscal years 1979 and 1980 each State agency may use up to 20 percent of its nutrition program allotment for supportive social services (50 percent in States with unusually high supportive service costs). Beginning in fiscal year 1981, social services are to be funded through the State's social services allotment.

Home-delivered meals are provided on a determination of need set forth by the State agency on aging, area agency on aging or project sponsor. Home-delivered meals are served at least once per day to those who are homebound by reason of illness, an incapacitating disability, or an extreme transportation problem.

The meals are provided on a limited basis to make certain that they are not delivered solely for the convenience of the elderly, which could increase dependency, but are furnished only where such meals are truly necessary.

Background-Nutrition services evolved from nutrition demonstration projects first funded under the Older Americans Act in 1968, to develop techniques for improving diets, fostering social interaction, and facilitating the delivery of social services for the elderly. Aspects of these demonstration projects were incorporated into a new title. VII nutrition program for the elderly under the 1972 amendments to the Older Americans Act.

The enabling legislation specified that the program was to serve those persons who:

Do not eat adequately because (1) they cannot afford to do so; (2) they lack the skills to select and prepare nourishing and well balanced meals; (3) they have limited mobility which may impair their capacity to shop and cook for themselves; and (4) they have feelings of rejection and loneliness which obliterate the incentive necessary to prepare and eat a meal alone. These and other physiological, social, and economic changes that occur with aging result in a pattern of living, which causes malnutrition and further physical and mental deterioration.16

Nutrition projects today are intended to meet both the nutritional and social service needs of older people, with an emphasis on providing daily, nutritious meals. The meals are intended to improve the health of the program participants, and also to attract isolated people to a place where services and opportunities are available. There are approximately 554,000 persons daily participating in the congregate meals program.

Surplus commodities.-The Department of Agriculture is authorized to make available to nutrition projects surplus commodities or cash in lieu of commodities at a minimum payment level per meal of 30 cents in fiscal years 1979 through 1981. These payment levels are adjusted annually to reflect changes in the cost of food.

15 U.S. Senate. Committee on Conference. Comprehensive Older Americans Act Amendments of 1978. Rept. No. 95-1236. Sept. 23, 1978: 64.

16 Public Law 92-258. Nutrition Program for the Elderly. Section 701.

The Secretary of Agriculture must give special emphasis to furnishing commodities consisting of high protein foods including meats and meat alternatives.

Nursing home ombudsman program.-State agencies on aging are required to use at least 6 percent of their social services allotment to establish an ombudsman program for nursing home residents. The agencies are to operate the program directly or by contract with a public agency or private nonprofit organization or agency. The director of the program is responsible for investigating and resolving complaints relating to any action which may adversely affect the health, safety, welfare and rights of nursing home residents. More specifically, the director is responsible for:

Monitoring Federal, State, and local laws, regulations and policies with respect to long-term care facilities;

Providing information to public agencies regarding problems of older persons in long-term care facilities; and

Establishing procedures for appropriate access by his staff to longterm care facilities and patients' records, including procedures to protect the confidentiality of such records.

Background.-The 1973 amendments authorized funds for nursing home ombudsman demonstration projects. Certain aspects of these projects were given a statutory basis under the 1978 Older Americans Act amendments as described above.

Disaster relief reimbursement.-The 1978 amendments authorized the U.S. Commissioner on Aging to reimburse States for the delivery of social services by area agencies on aging during any major disaster declared by the President. The reimbursement amount may not exceed 5 percent of the State's title III social services allocation. The Commissioner shall withhold funds appropriated under title IV (demonstration projects) for this purpose.

Federal allotment for State administration and area agency activities. As specified earlier, there is a separate appropriation authorized for social services, congregate meals, and home-delivered meals. Funding for multipurpose senior center facilities and the Statewide nursing home ombudsman program is allotted from the State's social services allotment.

The title III appropriation is allocated to the States under two separate allotment formulae: (1) State administration, and (2) area planning, social services, and nutrition services.

State administration funds are allocated on the basis of each State's proportionate share of the Nation's population aged 60 and over. Each State, however, is to receive at least one-half of 1 percent of the annual appropriation or $300,000, whichever is greater (outlying areas are to receive at least one-fourth of 1 percent or $75,000, whichever is greater). The State may use its allotment to pay up to 75 percent of the cost of developing and administering its State plan on aging.

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Funds for area agency activities are allocated to the States based on the State's proportionate share of the Nation's age 60 and older population, except that each State is to receive at least one-half of 1 percent of the annual appropriation (outlying areas are to receive at least one-fourth of 1 percent).

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17 Guam, American Samoa. Virgin Islands, Trust Territory of the Pacific Islands.

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