ADVOCACY - Add to Sec. 306, Area Plans, (a) (6) (D) "serve as the advocate and focal point for the elderly within the community in cooperation with agencies, organizations and individuals participating in the area plan, by monitoring, evaluating and commenting upon all policies, programs, hearings, levies and community actions which will affect the elderly." POSITION STATEMENT OF THE NATIONAL INSTITUTE ON COMMUNITY-BASED LONG-TERM CARE A DELEGATE COUNCIL OF THE NATIONAL COUNCIL ON THE AGING ON THE 1991 REAUTHORIZATION OF THE OLDER AMERICANS ACT GENERAL ISSUES 1. There should be continued emphasis within the Act on serving all older persons, with special emphasis on outreach. 2. To provide for continuity and stability in the programs and services authorized, the Act should be reauthorized for at least a three year period. 3. Authorization levels of appropriations should be realistically set to reflect 1) yearly increases for inflation; an 2) the expansion of resources required to meet the needs of a Lupidly growing vulnerable older population. TITLE II 4. The position of Commissioner of the U.S. Administration on Aging should be elevated to the level of Assistant Secretary within the Department of Health and Human Services. 5. Any new responsibilities or special mandates introduced into the Title III programs must be accompanied by additional funding. 6. The programs authorized under the Act should continue to rely on the input of older persons, community leaders, and providers. Therefore, public planning, hearing, and appeals procedures should be in place at the local and state levels. 7. Mandatory cost sharing and income testing for eligibility for Title III services should not be allowed. Voluntary cost sharing should be allowed for in-home and other services under OAA. 8. Increased funding in the nutrition program should be focused on the home delivered meals program, targeting services to the most vulnerable and difficult to reach older persons. 9. Title III-D In-Home Services, should have significantly increased authorization and appropriation levels, without decreasing funding to other titles to meet the unmet service needs of the frail elderly. 10. The Long-Term Care Ombudsman Program should be transferred to a new legal and protective services Title. Elder abuse prevention and legal assistance services should also be included under the new title. 11. The Act should underscore the importance of securing for persons with dementia access to a range of services and benefits, quality of care in long term care institutions, elder rights such as guardianship, and the development of research and demonstration projects. 12. While an abundance of information is being collected from the aging network, little is useful in determining unmet needs. Program reporting requirements should be streamlined and the National Data Base on Aging should be reactivated to gather unmet needs data. 13. Emphasis should be focused on health promotion and prevention through increased funding. TITLE IV 14. Federally financed research, demonstration and training projects need to be developed with input from states, area agencies, and provider associations to assure current needs and issues are being reflected. TITLE 15. There should be continued implementation of the memorandum of understanding regarding coordination and cooperation between the Administration on Aging and the Department of Labor. TITLE VI 16. As new tribes are added to Title VI, current grantees should be held harmless. Efforts should be made to restore funding lost by the original grantees. 17. Provisions should be developed to strengthen coordination between the Title III and Title VI service delivery systems recognizing the sovereignty of tribal nations. SUMMARY The elderly are the primary users of home and community-based and institutional long-term care services. The Older Americans Act is one of several Federal programs that provide support for long-term care services. Many of the services supported under title III of the Act assist functionally impaired older persons to remain independent in home and community-based settings. In addition, the Older Americans Act is the only source of Federal support for ombudsman services on behalf of elderly who reside in nursing homes and board care homes. Although the Older Americans Act does not focus exclusively on long-term care, development of programs for persons in need of both home and community-based and institutional long-term care services has been a focus in various amendments to the Act. Home care services have been considered a priority service for title III funding since 1975, and in 1987 Congress authorized a distinct program under title III for in-home services for the frail elderly. The amount of funding devoted to home care services under title III represents a small fraction of the amount spent for such services under Medicaid and Medicare; however, the title III program has the flexibility to provide home care services to impaired older persons without certain restrictions that apply under these programs, for example, the skilled care requirements under Medicare, and the income and asset tests under Medicaid. Title III also authorizes separate programs for home-delivered and congregate meals. National data on the use of home and community-based services indicate that about 6 percent of the estimated 5.6 million functionally impaired elderly used congregate and home-delivered meals, respectively. Recent trends in the nutrition program indicate that State and area agencies have given increased attention to funding meals for the homebound through the title II program. In recent years, some States have undertaken initiatives to restructure their long-term care systems in order to reduce or/or control costs of institutional care and to create more opportunities for home and community-based care. These initiatives have included creation of case management systems and consolidation of funding for long-term care services. Some State and local agencies created under title III have played substantial roles in these initiatives. The role that State and area agencies on aging play in long-term care in the future may depend upon what action Congress takes with respect to changing the current system of Federal financing for long-term care. Some observers are concerned that the development of long-term care services for the frail elderly through the title III network may compromise support for other services supported by title III, such as advocacy and outreach, on behalf of a broader elderly constituency. Because the title III program supports a wide range of services for a diverse elderly population, there is likely to be continuing competition to use portions of title III funds to respond to specific needs of the elderly. THE ROLE OF THE OLDER AMERICANS ACT INTRODUCTION Long-term care refers to a wide array of medical, social, personal, supportive, and specialized housing services needed by individuals who have lost some capacity for self-care because of a chronic illness or condition. Long-term care services range from skilled medical and therapeutic services for the treatment and management of these conditions to assistance with basic activities and routines of daily living, such as bathing, dressing, eating, and housekeeping. These services are provided by skilled personnel, such as registered nurses, therapists, and social workers as well as other personnel, such as homemakers and home health aides. Long-term care services are often differentiated by the settings in which they are provided. In general, services are provided either in nursing homes or in home and community-based care settings. Home and community-based care includes a broad range of skilled and personal care services, as well as a variety of home management activities, such as chore services, meal preparation, and shopping. Home care services are provided formally by home care agencies, visiting nursing associations, and day care centers. Most home and communitybased care is provided informally by family and friends. Research has shown int more than 70 percent of severely disabled elderly persons living in the community needing long-term care assistance rely exclusively on non-paid sources of assistance for their care.1 The elderly are the primary users of long-term care services. About 1.3 million older persons reside in nursing homes. For every disabled elderly person residing in a nursing home, from 3 to 5 times as many such persons live in the community-an estimated 4 to 7 million older persons.2 There are many Federal programs that support long-term care services for the elderly in a variety of ways. Five Federal programs are generally considered to constitute the major sources of Federal support for long-term care-Medicaid, Medicare, the Older Americans Act, the Social Services Block Grant Program (SSBG), and the Supplemental Security Income (SSI) program. None focus exclusively on long-term care. Each has different program goals, administrative 'US. Bipartisan Commission on Comprehensive Health Care. The Pepper Commission. A Call for Action Final Report. Sept. 1990. These data are based on estimates of the number of nursing home residents from the National Nursing Home Survey and estimates of the impaired elderly population living in the community from the National Health Interview Survey and the National Medical Expenditure Survey. |