ADMINISTRATION ON AGING ACTIVITIES BY PROGRAM For purposes of discussion, the programs assigned to the Administration on Aging by the Older Americans Act of 1965, as amended, are grouped as follows: (1) Programs directly affecting the elderly. (2) Programs supporting the concerns of the elderly. PROGRAMS DIRECTLY AFFECTING THE ELDERLY (State and community programs on aging) Title III: Coordinated, Comprehensive Service System for the Elderly Purpose Under the title III program, the Commissioner makes formula grants to each State with an approved State plan submitted by the Governor and developed by the designated State agency. Each State plan is designed to develop or strengthen at the State and sub-State or area level a system of coordinated and comprehensive services, which will enable older persons to live in their own homes as long as possible and to continue to participate in their communities. In 1973 and 1974 State agencies on aging conducted statewide surveys of their population to determine the concentration of older persons with the greater social and economic needs to assess resources available to meet these needs. State agencies then divided the States into planning and service areas (PSA's) based on these surveys and designated area agencies on aging within these PSA's. These State and area agencies on aging (and nutrition project agencies, which are discussed later) comprise the national network on aging. Title III resources in fiscal year 1976 were directed toward: -Establishing, at the State level, mechanisms for developing or strengthening coordination efforts between State agencies on aging and other public and private agencies at the State level; -Expanding access by older Americans to information and referral; and -Implementing nursing home ombudsman and legal services programs. Expanding number of area agencies on aging.-The 56 geographical jurisdictions within the United States have been divided by these jurisdictions into 596 planning and service areas. By the end of fiscal year 1976, States had approved the plans and budgets of 536* area agencies on aging. This is a significant increase in the number of area agencies in existence at the end of fiscal year 1975. By the end of fiscal year 1976, therefore, only 60 planning and service areas nationally are without an area agency on aging. These 536 area agencies on aging cover 90 percent of the Nation's older persons. Most of those areas not covered are highly rural, lightly populated planning and service areas. Coordination and program development at the State level.-State agencies on aging are responsible for establishing such procedures and mechanisms as are necessary to assure the effective coordination of all State planning and service activities related to the field of aging. Federal leadership and technical assistance influences State and local agencies which have discretionary authority on the expenditure of Federal resources. The Administration on Aging, therefore, has negotiated and signed 20 formal interagency working agreements with other Federal departments and agencies in order to assist State agencies to coordinate activities at the State level. Concurrently the activities of the national network on aging underlines and rein 1 Accomplishments are reported separately for State agencies on aging and area agencies on aging. Funds are provided on a formula grant basis to support the operation of each State agency on aging: $17 million was available for this purpose in fiscal year 1976 and $4.250,000 in the transition quarter. Note State-by-State allocations in appendix I-A. 3 Includes the 50 States plus American Samoa. Guam, Puerto Rico, the Trust Territory of the Pacific Islands, the Virgin Islands, and the District of Columbia. *This figure represents the most recent fiscal year 1976 count. forces the attention given to the field of aging by the counterpart agencies of Federal agencies. This dual-edge approach, with the interest being expressed to the respective controlling State or local agency from both its Federal counterpart and a State or area agency, should result in more resources being utilized for services for older persons. By the end of fiscal year 1976, 247 interagency agreements had been signed at the State level in the areas of: -Health, -Housing, -Employment and retirement, -Transportation, and -Social Services. This is an increase of 110 agreements over fiscal year 1975. Information and referral.-State agencies in cooperation with area agencies on aging also have a responsibility to assure the availability of information and referral sources in sufficient numbers so that all older persons have reasonably convenient access to such sources. It is estimated that 95 percent of all older persons in the Nation have access to information and referral services. The nursing home ombudsman program.-By the end of September 1976 49 States had established a statewide nursing home ombudsman program. The purpose of the nursing home ombudsman program, which is funded by AoA model projects funds $1,087,234 in fiscal year 1976), is to enable State agencies to develop a process at the local or area level which is responsive to complaints made by or on behalf of the elderly in nursing homes and to work in a variety of ways to improve the quality of care and quality of life of nursing home patients. Significant findings due to the ombudsman effort revealed complaints dealing with: -Need for frequent investigations involving financial difficulties, including overcharges, and determination of Federal benefits; -Problems of overdrugging, prolonged use of restraints, improper diets, lack of baths, physical abuse; -Complaints of feelings of isolation, neglect, and loneliness; and Resolution of complaints often defy accurate documentation. Many resolutions are only temporary, some are partial, and others go unreported. Yet, reports presently being collected show evidence of major policy changes directly related to ombudsman activity. This is observable in: -The increased enactment of State legislation for the granting of access to nursing homes and provision of appropriation for employment of ombudsmen-often designated as advocates; -Increasing interest and support manifested by Governors of States in encouraging the location of the ombudsman program in their offices; -Growing support of area agencies in seeking new resources to support the programs; and -The growing support from private and governmental sectors. Legal services program.-AoA announced in July 1976 a program to provide support to each State agency to develop, working through area agencies on aging increased legal services for the elderly. The program will become operative in January 1977. Its objective is to provide the capacity for leadership within each State agency for the promotion of statewide legal services to the elderly. The promotion and development of legal services for the elderly includes: (1) Working with area agencies on aging in order to help them design legal services programs for older persons and to assist them in developing plans for the implementation of such programs by public or private agencies; (2) Assisting, working through area agencies on aging, Legal Services Corporation offices, and/or legal aid programs to expand services and outreach efforts to eligible elderly clients and to design and secure funding for programs which would serve all older persons; (3) Assisting area agencies on aging in involving the private bar in increasing legal representation to older people; (4) Stimulating law schools and other educational institutions to provide research, law-related training, and/or direct client services to the elderly; (5) Designing and coordinating through State and area agencies on aging legal and aging training programs for State and area agency staff and grantees, paralegals, lawyers, and older persons; (6) Providing, working through the area agencies on aging, assistance in developing legal backup to the nursing home ombudsman programs at the area level; and (7) Working with the State agency, area agencies, and other interested parties on research, drafts, testimony, advocacy, and monitoring for legislation at all levels that benefits the elderly. Areas of particular legislative concern could include for example, SSI, social security, food stamps, medicaid, medicare, veterans benefits, public and private pensions, nursing homes, real property taxation, Federal taxation, housing, and welfare. The promotion and development of legal services for the elderly does not include: (1) Acting as house counsel to the State agency. (2) Litigation. (3) Direct client counseling and representation. AoA made several grants to organizations to provide technical assistance to the States in developing and implementing this program. These were: -Legal research and services for the elderly (Washington, D.C.). -Legal services for the elderly poor (New York, N.Y.). -National Senior Citizens Law Center (Los Angeles, Calif.). -National Paralegal Institute (Washington, D.C.). -National Retired Teachers Association/American Association of Retired Persons (Washington, D.C.). Area agencies on aging Federal funds are available through a formula grant to each State to pay part of the cost of the operations of area agencies on aging and the funding of social services by the State agency where there is no area agency.' Area agencies on aging are public or private nonprofit agencies, designated by the State agencies on aging, which receive Federal support through the State agencies to develop and implement an annual area plan and budget to : -Serve as the focal point and advocate on aging for a State-designated planning and service area, identifying the needs and problems of older people in the area, establishing goals and priorities, mobilizing resources from other public and private agencies to meet the needs and problems, and negotiating interagency cooperative agreements to expand and coordinate services; -Maintain and increase levels of social services available to older persons by providing leadership, technical assistance, and funding to foster the development of a comprehensive and coordinated service system for the area involving all available public and private agencies and funds: To assure that the needs of older persons are met; to assure that resources are used effectively and efficiently; and to invest area agency funds strategically to facilitate access to existing services and to fill priority service gaps; and -Engage in a continuing process of reassessment of priorities and approaches in terms of progress toward the development of a comprehensive and coordinated service system within the area to meet the needs of older persons. Area planning and social services funds are available at different matching ratios for three types of use: -Up to 15 percent of the State's allotment is available for the operations of the area agencies, at a Federal matching rate of up to 75 percent; -The remainder is available for the purchase of any services that promote the general welfare of older persons, at a Federal matching rate of up to 90 percent for services that are part of an area agency annual plan, and up to 75 percent for services in an area where no area agency has been established and there is no approved area plan (a maximum of 20 percent of the State's allotment is available for services in areas that are not part of an area plan). Pooling resources to increase services to the elderly: A recent study (1976) 5 reported that by the end of fiscal year 1975 area agencies were successfully pooling resources from other public and private sources : $93 million was available in fiscal year 1976 and $31,250,000 in the transition quarter for this purpose. Note State-by-State allocations in appendix I-A. Raymond M. Steinberg, A Longitudinal Analysis of 97 Area Agencies on Aging, Social Policy Laboratory, Andrus Gerontology Center, University of Southern California, May -55 percent of the area agencies on aging have obtained non-AoA sources of funds beyond the required local match by the end of 1975 (twice as many as one year earlier); -Almost one-fourth of the area agencies on aging have obtained more than one non-AoA dollar for each AoA dollar; the average was 80 cents, including match and in-kind contributions, for each AoA dollar; -72 percent have had local government cash, 43 percent have had State appropriated funds, 40 percent have channeled title VII nutrition funds, 28 percent have had general revenue sharing dollars, 26 percent have had private cash, and 15 percent have channeled title XX (late 1975); -High levels of contact with local elected officials and comunity leaders were established. During fiscal year 1976 State and area agencies made substantive progress in pooling resources. 6 The estimated total dollars pooled by State and area agencies on aging during fiscal years 1975 and 1976 are: Fiscal year 1975. Fiscal year 1976 $122, 541, 000 215, 190, 000 This increase of $92,649,000 in pooled resources has undoubtedly had an impact on the level of services provided to older persons. Serving the elderly. The emphasis in the purchase of services is on priority services (listed below) identified in title III of the Older Americans Act. The proportion of service funding during fiscal year 1976 is as follows: In 1976, an estimated 7,086,210 elderly persons were served under area plans approved by State agencies. Of these, 17 percent were minority and 43 percent low-income. They received the following services: 8 Involving the elderly.-Area agencies on aging also have the responsibility to meaningfully involve older persons in programs that serve older persons. Area agencies have demonstrated their commitment to this responsibility through the significant employment or use of older volunteers in area agency activities. • Other than title III and title VII resources. Duplicated count-total served with all funds. 8 Low income definition is based on Department of Commerce, Bureau of the Census poverty threshold-1975 estimates, and established by each State. Number served under title III funds only. *Duplicate count. Title V, section 501 authorizes the Commissioner to make grants or contracts to units of general purpose or other public or private nonprofit agencies or organizations and to make contracts with any agency or organization for the purpose of acquiring, altering, or renovating existing facilities to serve as multipurpose senior centers. The term "multipurpose senior centers" means a community facility for the organization and provision of a broad spectrum of health, social, educational, and other services for older persons. Accomplishments The program was funded for the first time during the July-September 1976 transition quarter. A total of 549 grant awards were made from the $5 million appropriated for this period.10 It is estimated that the senior centers supported during fiscal year 1976 will serve approximately 2.5 million older persons. Newly established senior centers through acquisition, alteration, or renovation 210 The nutrition program authorized by title VII of the Older Americans Act, as amended, began operations early in fiscal year 1973. Under the provisions of title VII, the Commissioner on Aging is authorized to make formula grants to States to establish and maintain community-based nutrition program project sites for the delivery of low-cost, hot nutritious meals, served primarily in congregate settings and with supportive services to persons 60 years of age and over and their spouses. Each nutrition program project must provide hot meals 5 or more days a week, 52 weeks a year. The project must also provide supportive services necessary to facilitate participation of eligible individuals in the meals program. Such services include outreach, transportation and escort services. In addition, projects are encouraged to provide other supportive services, including health and welfare, education and counseling, information and referral services, shopping assistance, and recreational services. Under the terms of the 1973 amendments to the Older Americans Act, the U.S. Department of Agriculture provides commodity and product support to the nutrition program. Such assistance was to be at a minimum level of 15 cents per meal for fiscal year 1976 and 25 cents per meal for fiscal year 1977. In fiscal year 1976 10 The amount of funds awarded within each State is noted in appendix II-F. |