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MAJORITY STAFF REPORT: OLDER AMERICANS

ACT: 25 YEARS OF ACHIEVEMENT

INTRODUCTION

The Older Americans Act (OAA) (the Act), enacted in 1965, is the major Federal vehicle for the organization and delivery of supportive, nutrition, and other social services to older individuals. To provide these services, the OAA created and subsequently nurtured the development of the Aging Network-a nationwide system of Federal, State, and local agencies dedicated to providing services to senior citizens.

At the Federal level, the Network consists of the Administration on Aging (AoA) within the Department of Health and Human Services, which administers the majority of the OAA programs and is charged with acting as the chief Federal agency advocate for the elderly. AoA, in turn, oversees a network of State and area agencies on aging. The State and area agencies on aging maintain responsibility for funding, coordinating, and managing the broad array of services, programs, and other initiatives for the elderly authorized by the OAA. Except for priority areas specified in the Act (access services, in-home services, and legal assistance), OAA services are designed and funded in response to the needs of the elderly in individual communities.

Under the the OAA structure, State units on aging (SUAs) receive Federal funds for implementation of State plans on aging which the AoA has approved. Area agencies on aging (AAAs) then develop and fund services based upon State-approved area plans on aging. Primarily through subgrants and contracts with local service providers, AAAs deliver social services to the elderly population within their jurisdictions.

The Aging Network has grown dramatically since 1965, and now includes an aging unit in each State, approximately 670 area agencies on aging, 193 Native American grantees, and more than 25,000 local service providers. The OAA also supports the sole federally sponsored job creation program benefitting low-income older persons (Senior Community Service Employment Program) and has served as the vehicle for the education and training of thousands of professionals in the field of aging.

Budget constraints coupled with past Administrations' opposition to expanding or even maintaining funding for OAA programs in the last three reauthorizations have hampered the Act's ability to serve an ever increasing number of elderly persons. As a result, funding for the OAA slowed dramatically during the 1980's and has remained virtually static for the last few years (for current funding see Appendix B). The fact that services were not subject to

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severe cuts can be attributed to widespread bipartisan Congressional support, especially for nutrition and senior employment. This broad Congressional support for the Act continued during the 1987 reauthorization and is expected to continue through the 1991 reauthorization.

FINDINGS AND POLICY RECOMMENDATIONS OF THE 1990

WORKSHOPS

FINDINGS

A. INFORMATION AND REFERRAL (I&R): The OAA specifically requires area agencies on aging to provide elderly persons and their caregivers with information about existing social and health services available in their communities and to assure that such persons are referred to appropriate provider agencies. Although designated a priority service under Title III of the Act, many workshop participants stated that State and area agencies on aging fail to devote sufficient resources to I&R, one of the most vital functions of the OAA, i.e., linking older Americans to the services they need.

Finding 1: Despite the priority status afforded information and referral under Title III of the Act, current statutory language provides no clear definition of what I&R should be. As a result, I&R services, in practice, range anywhere from providing an elderly individual with a telephone number to offering extensive case management and assessment. (General Accounting Office, Summary of Major Findings of Study on OAA I&R Programs, June 10, 1991.) Specific concerns include:

Current provisions of the Act pertaining to I&R fail to provide area agencies on aging with sufficient direction for developing programs which can assist individuals in finding and obtaining the services they need.

● Current provisions of the Act pertaining to I&R fail to emphasize the importance of determining individual needs when linking older Americans to appropriate services.

I&R systems currently fail to employ effective mechanisms for tracking individuals who enter their systems in order to ensure that these individuals are linked to the services they need, as well as to facilitate the collection of accurate data pertaining to characteristics of program participants.

RECOMMENDATIONS

Recommendation 1: The definition of I&R should be expanded to emphasize the critical importance of linking older individuals and their caregivers to the services they need.

Recommendation 2: The term "information and referral" should be renamed "information and assistance", in order to draw attention to the crucial role that the Aging Network should play in providing "assistance" to elderly persons who need information about available services.

FINDINGS

B. LONG-TERM CARE AND THE PEPPER COMMISSION: According the U.S. Bureau of the Census, by the year 2050, there will be 67.5 million persons over 65 years of age. The rapid aging of our population will only exacerbate the long-term care dilemma and underscores the importance of planning for the future of our nation's elderly.

In 1990, the U.S. Bipartisan Commission on Comprehensive Health Care (Pepper Commission) released its blueprint for developing a nationwide long-term care system. A major component of the Pepper Commission Report's recommendations was the establishment of a service infrastructure which would assess individuals and manage and coordinate their long-term care services.

For the past 25 years, the Aging Network established by the OAA has served as the focal point for providing services to senior citizens. Many interested persons contend that the Aging Network may be well-suited to serve as the infrastructure for a national long-term care system.

Finding 1: There is no coordinated system of providing longterm care services to America's elderly. (Testimony before the Special Committee on Aging, Workshop #1, January 31, 1990, OAA Reauthorization.)

Finding 2: Coordination and cooperation among public and private service providers would be required in order to reduce unnecessary duplication of services and programs, to increase efficiency and to establish an effective, nationwide long-term care system.

Finding 3: Congress has not fully explored what role the already established Aging Network could play in the development of a long-term care system that begins to meet the many needs of the Nation's chronically ill. (Testimony before the Special Committee on Aging, Workshop #1, January 31, 1990, OAA Reauthorization; Testimony before the Senate Labor and Human Resources Subcommittee on Aging, April 26, 1991, Long-Term Care and the Aging Network.)

RECOMMENDATIONS

Recommendation 1: In order to evaluate the appropriate role of the Aging Network in any future national long-term care system, demonstration projects should be authorized to determine whether the Network can serve as the infrastructure for implementing some of the recommendations for long-term care developed by the Pepper Commission. Any such demonstration projects should:

Evaluate the ability of area agencies to serve as a central point for older Americans to access a long-term care system, providing assessment, referral, and management of services, as well as coordination with other appropriate public and private entities that fund long-term care services;

Explore area agencies' ability to serve the disabled and under-60 population; and

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