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1995 State Program Report for Titles III an VII of the
Older Americans Act
Contents
Over thirty years ago the Older Americans Act (OAA) was passed. Since
its initial passage, the OAA has been an important force for change
for programs and services for older americans . The OAA fostered the
creation of a national network of state and area agencies on aging and
Indian Tribal Organizations. Through the development efforts of the
Aging Network and OAA funding, an infrastructure of home and community
based services has emerged in every state. While much has been accomplished,
the job ahead is still very large. OAA funds are small compared to the
need. Each OAA dollar must be well spent in order to address both current
demand and, at the same time, prepare for emergent needs of the elderly
in the 21st century.
This report summarizes programs and accomplishments reported by state
units on aging which were supported by Titles III and VII of the OAA
in Federal Fiscal Year 1995. The information provided in this report
are the result of new reporting requirements introduced by the Administration
on Aging (AoA) for Title III and VII in 1995. Implementation of the
new Title III program reporting requirements is a multi-year process,
with the 1995 performance report representing the first step toward
reporting by the Aging Network which is more client centered.
To comply with the new reporting requirements, states are making major
changes to long -standing reporting procedures. Every effort has been
made by states and the AoA to review the new data submitted for FY1995
and ensure its accuracy. Once states submitted the data, AoA prepared
summaries that were sent to states for review and concurrence. Still,
AoA fully expects it will take two to three years before all the reporting
procedures are in place to produce very accurate, comparable data.
This 1995 report is designed to provide summary highlights of Title
III and VII program performance, including persons served, services
provided, services expenditures, providers used, state and area agency
staffing, developmental accomplishments and the use of senior centers.
Both national and state specific summaries are included. This is the
first time the annual State Program Performance Report (SPR) includes
information on individual state activities and performance supported
by Titles III and VII.
It should be noted that the AoA is required to produce a separate report
to Congress on the Long Term Care Ombudsman Program supported by the
OAA. This report provides only a brief synopsis of the Ombudsman Program
accomplishments. See the separate Ombudsman Report for a more detailed
report on accomplishments for this program.
In 1995 AoA introduced a new set of reporting requirements for Titles
III and VII, including special reporting for the Long-Term Care Ombudsman
Program. The new Title III reporting requirements put more emphasis
on accurate client counts and additional descriptive information on
client characteristics. Key features of the new reporting requirements
include:
- Consolidation and elimination of service reporting from 30 separate
categories to 14;
- Addition of new service categories reflecting priorities of the
Aging Network -- case management and adult day care/adult day health;
- A requirement for client registration for nine services in order
to produce accurate, unduplicated client counts for the nine services
(to be implemented in FY1997);
- Elimination of reporting on clients and service units by individual
Title III Parts;
- Provision for optional reporting by states on Title III funded services
not included by the AoA list of 14 services;
- Inclusion of the requirement for client registration for selected
services; and,
- Electronic transmittal of the data by states to AoA.
In 1995 several new data elements for Title III reporting were introduced.
Additional data elements will be introduced in FY1997 tied to the requirement
for client registration of selected services. New data elements introduced
in 1995 include:
- Number of providers using Title III funds, by service;
- Number of minority providers, by service;
- Number of Area Agencies on Aging (AAAs) acting as direct service
providers;
- Program income for each listed service;
- Total estimated persons served -- all services and all Title III
parts;
- Summary descriptions of Aging Network developmental accomplishments;
- Staffing profiles for both state units on aging and area agencies
on aging.
Given these new requirements, many states are upgrading their reporting
systems at all levels. New procedures for client intake/registration
are being implemented along with the capacity to maintain a master client
registry that can be kept up-to-date as new clients are served, active
clients drop out and current clients receive new or different services.
AoA has encouraged the development of these new systems, recognizing
each state has distinctive requirements and needs for information systems.
New service definitions and terms were introduced as part of the amended
reporting requirements. Limited comparisons are possible of 1995 performance
data with performance data submitted by states for prior years. AoA
plans to use 1995 as a new base year against which future performance
data will be compared.
After thirty years, the Aging Network has put in place a program involving
diverse services and the use of thousands of providers. All fifty-seven
state level jurisdictions receive OAA funds awarded annually by the
AoA in the form of a grant, based on the size of the elderly population
in each state. With these funds, designated state units on aging, supported
by area agencies on aging in all but eight states, develop and administer
a diverse set of home and community-based services.
Even though funding has not kept up with demand, the Aging Network
has still been able to implement and operate a far reaching, diverse
program. Summary performance indicators for 1995 show the breadth of
services and capacities now in place:
- Programs and services supported by the OAA served an estimated 7,453,575
persons age 60 and over;
- Twenty percent of the program participants were minority;
- Thirty-nine percent of the program participants had incomes at or
below poverty;
- Twelve percent of the total count of program participants had incomes
below poverty who were also minority participants;
- Of the total clients in poverty, thirty-two percent were minority
participants; conversely, of those who were minority clients, 62%
had incomes at or below the poverty level;
- Thirty-five percent of the program participants lived in rural areas;
- The OAA puts a high priority on the provision of nutrition services
to the elderly. In 1995 a total of 123.4 million congregate meals
were provided and 119 million home-delivered meals;
- Title III federal expenditures reported by states totaled $673 million;
and,
- Title III federal funds comprised 39% of the total service expenditures
reported by the Aging Network in 1995.
- A total of 6,397 senior centers were supported by Title III funds:
- A total of 564 long-term care ombudsman program entities were in
place;
- A total of 1,182 staff in state units on aging were supported with
Title III funds, 32% of total state unit on agency staffing.
- A total of 9,110 area agency on aging staff were supported by Title
III funds, 48% of the total paid area agency on aging staff.
Three services account for the majority of OAA funding, congregate
meals, home-delivered meals and transportation. In 1995 Title III federal
expenditures for congregate meals reached $250 million and $134 million
for home-delivered meals. Transportation is the third largest services
in terms of Title III funding, $63 million. Together these three services
account for 66% of the total Title III federal funding.
In 1995, the Title III program provided services to an estimated 7,453,575
persons, approximately 16% of the population age 60 and over in the
U.S. This estimate takes into account all services supported by Title
III funds in the state. Five states (California, New York, New Jersey,
Illinois and Michigan) account for 34% of the total persons served.
These five states have 29% of the population aged 60 and over in the
U.S. in 1995. The five states reporting the highest percent of the 60+
population served by OAA programs include Wyoming (64%), New Mexico
(44%) Alaska (44%) North Dakota (43%) and Utah (39%). Twenty -three
states report 20% or more of their population aged 60 and over were
served through OAA supported programs.
Of the total participant population served, 1,497,916 persons were
reported to be minority participants (20.1%). The distribution by race
and ethnicity is estimated to be as follows:
Figure 1. Minority Participants
Race/Ethnicity |
Number Of Minority Participants
|
% of Total Minority Participants |
% of Total Participants |
|
|
|
|
African-American |
820,105 |
54.7% |
11.0% |
Hispanic-Origin, All Races |
434,674 |
29.0% |
5.8% |
American Indian/Alaskan Native |
76,999 |
5.1% |
1.0% |
Asian American/Pacific Islander |
166,138 |
11.1% |
2.2% |
California, New York, New Jersey, Texas and Illinois account for 39%
of the minority participants. All but three states had a percentage
of minority clients served which was equal to or greater than the percentage
of the total 60+ minority population in the state.
States reporting the highest percentage of minority participants include
Hawaii (75%), Mississippi (47%), New Mexico (45%), and South Carolina
(45%). Puerto Rico reports 100% of its participants are minority and
the District of Columbia reports 82.1%. Approximately 55% of the total
minority participants are African-American with 29% being Hispanic-origin.
An estimated 39% of the total participants have incomes at or below
the federal poverty threshold. Among states, the poverty participant
rate ranged from a low of 17.2% to a high of 86.9%. Of those below poverty,
approximately 32% are minority participants. Low-income, minority participants
comprise 12.5% of the total participant population. States with the
highest percentage of poverty level participants included Mississippi
(86.9%), Oklahoma (68.8%) and Texas (68.7%). The District of Columbia
reports 88.5%. Mississippi has the highest percentage of participants
who are both in poverty and minority (44.3%). Twelve states report that
at least one-half of the participants have incomes at or below the poverty
threshold.
When the profile of clients served is compared to the state 60+ population,
based on poverty characteristics, every state is clearly targeting poverty
clients. For the U.S., in 1989, the Census reports approximately 12%
of the 60+ population with incomes at or below poverty. Each state reported
a substantially higher percentage of poverty clients than the equivalent
percentage of the 60+ population in the state whose incomes fell at
or below the poverty threshold. The same is true for targeting of minority
persons whose income is below poverty.
An estimated 2.6 million participants live in rural areas (35%). A
total of 20 states have at least 50% or more of the total Title III
participants who live in rural areas. States with the highest percentage
of rural participants include Wyoming (100%), Mississippi (84.6%), Montana
(80.9%), and Vermont (78.8%). States reporting the lowest percentage
of rural residents include Tennessee (6.4%), Rhode Island (7.9%), Connecticut
(7.1%), Massachusetts (11.1%) and California (11.9%).
Beginning in 1995 the SPR service reporting was changed. As already
noted, the list of services individually reported was reduced from thirty
to fourteen. States have different service priorities for Title III
funding so the mix of services and level of funding for services varies
somewhat from one state to another. States could, at their option, provide
information on other services supported by Title III and VII funding.
A. Scope of Services
Most states provide the majority of the listed services. To show the
extent of service coverage, see Figure 3.
Figure 3. Scope of Services Supported by Older Americans Act
Number of Listed Services
Supported With State Funding |
Number of States |
% of All States* |
All 14 Listed Svcs Plus Other Svcs |
5 |
11.5% |
All 14 Services |
10 |
19.2% |
13 Services |
14 |
26.9% |
12 Services |
6 |
11.5% |
11 Services |
4 |
7.7% |
10 Services |
6 |
11.5% |
9 Services |
4 |
7.7% |
8 Services |
2 |
3.8% |
* Includes Puerto Rico and the District of Columbia
Five states indicate all fourteen services are provided in their state
plus other services as well. Fifty-eight percent of the states fund
at least 13 of the listed services and/or other services. No state reported
providing less than eight of the listed services. Five states, Delaware,
Indiana, Michigan, Oklahoma, and Oregon did not provide any "other"
services with Title III funding support. Looking at service support
from a different perspective, the number of states using Title III funds
to support each listed service is shown in Figure 4.
Figure 4: State Support for Selected Services
Home and Community-Based Service |
# of States Funding the Service
|
% of All States (Inc DC and
PR) |
Personal Care |
41 |
78.8% |
Homemaker |
47 |
90.4% |
Chore |
38 |
73.0% |
Home-Delivered Meals |
52 |
100.0% |
Adult Day Care/Health |
40 |
76.9% |
Case Management |
41 |
78.8% |
Congregate Meals |
52 |
100.0% |
Nutrition Counseling |
17 |
32.7% |
Assisted Transportation |
31 |
59.6% |
Transportation |
50 |
96.2% |
Legal Assistance |
50 |
96.2% |
Nutrition Education |
29 |
55.8% |
Information and Assistance |
48 |
92.3% |
Outreach |
45 |
86.5% |
Other Services |
46 |
88.5% |
As expected, all the states provide home-delivered and congregate meals.
All of the states operate a long-term care ombudsman program supported
by the OAA. In 1995, for the U.S., there were a total of 564 designated
local ombudsman entities and a total of 1,546 paid staff (full time
equivalents) as well a 6,428 certified volunteers.
B. Levels of Service Provision
Levels of service provision vary by state due to both funding levels
and service priorities. The profile of service units is summarized in
Figure 5.
Figure 5. Levels of Service Provision
HCBC Service |
Measure |
Total Units (U.S.) |
Top 3 States - Highest # of
Units |
|
|
|
|
Personal Care |
Hour |
7,703,053 |
NY, PA, NC |
Homemaker |
Hour |
6,635,425 |
NY, OH, MI |
Chore |
Hour |
890,488 |
MN, IA, OH |
Home-Delivered Meals |
Meal |
119,000,053 |
NY, CA, TX |
Adult Day Care/Health |
Hour |
4,221,484 |
NY,FL, IA |
Case Management |
Hour |
2,976,149 |
NY, IL, CA |
Congregate Meals |
Meal |
123,387,303 |
NY, CA, TX |
Nutrition Counseling |
Hour |
100,069 |
MA,NY, TX |
Assisted Transportation |
1WayTrip |
2,232,027 |
OH, WY, MD |
Transportation |
1WayTrip |
39,496,946 |
NY, OH, TX |
Legal Assistance |
Hour |
1,396,519 |
AZ, CA, WI |
Nutrition Education |
Session |
1,142,379 |
FL, MD, TN |
Info and Assistance |
Contact |
12,526,537 |
NY, CA, FL |
Outreach |
Contact |
2,643,830 |
MN, CA, NM |
Levels of service use by individual participants were examined for
the nine registered services. Considerable variation exists from state
to state. See Figure 6.
Figure 6. Units per Participant for FY1995
HCBC Service |
Measure |
Avg. Units/Client U.S. |
Avg. Units/Client Highest State
|
Units/Client For the State
|
|
|
|
|
|
Personal Care |
Hour |
79.45 |
Virginia |
248 |
Homemaker |
Hour |
39.54 |
Arkansas/N. Car. |
*98 |
Chore |
Hour |
13.42 |
Georgia |
366 |
Home-Delivered Meals |
Meal |
120.36 |
Florida |
*204 |
Adult Day Care/Health |
Hour |
90.56 |
Arkansas |
634 |
Case Management |
Hour |
5.95 |
Massachusetts |
37 |
Congregate Meals |
Meal |
51.15 |
Florida |
*152 |
Nutrition Counseling |
Hour |
2.70 |
Texas |
13 |
Assisted Transportation |
1WayTrip |
27.39 |
Florida |
231 |
* Note: The District of Columbia estimates 213 units per person
for home delivered meals and 286 units per person for homemaker.
Puerto Rico reports 223 units per person for congregate meals.
States use Title III funds to provide services other than those individually
reported to AoA. At the option of each state, information can be provided
on these other services. The range of services optionally reported is
extensive including such diverse services as benefits counseling, senior
center activities, health promotion, home repair and modification, telephone
reassurance, friendly visiting, adaptive/assistive technology, volunteer
services coordination and more.
C. Service Providers
For the first time, the Title III State Program Report contains summary
information on the number and type of service providers funded with
Title III funds. Information was collected on the number of providers
for each of the 14 listed services. See Figure 7. Providers of other
services supported by Title III funding were not identified.
Figure 7. Service Providers for Selected OAA Supported Services
HCBC Service |
Total Providers |
Total Minority Providers |
% Minority Providers |
Total Minority Providers (Less
D.C and P.R.) |
Personal Care |
1,856 |
210 |
11.3% |
116 |
Homemaker |
2,032 |
186 |
9.2% |
92 |
Chore |
755 |
151 |
20.0% |
56 |
Home-Delivered Meals |
3,614 |
397 |
11.0% |
298 |
Adult Day Care/Health |
905 |
210 |
23.2% |
111 |
Case Management |
821 |
71 |
8.6% |
61 |
Congregate Meals |
3,902 |
504 |
12.9% |
405 |
Nutrition Counseling |
505 |
138 |
27.3% |
39 |
Assisted Transportation |
896 |
203 |
22.7% |
108 |
Transportation |
2,965 |
433 |
14.6% |
325 |
Legal Assistance |
1,205 |
160 |
13.3% |
66 |
Nutrition Education |
1,595 |
254 |
15.9% |
153 |
Info and Assistance |
2,370 |
233 |
9.8% |
226 |
Outreach |
2,047 |
199 |
9.7% |
192 |
In 1995, AoA collected information on minority providers.
It should be pointed out that Puerto Rico alone accounts for 94 minority
providers in all but three services (case management, information and
assistance and outreach) where Puerto Rico reports seven minority providers.
The District of Columbia also has a high percentage of minority providers.
In Figure 7 the count of minority providers is shown both with and without
Puerto Rico and the District of Columbia.
As Figure 7 shows, the greatest number of providers are meals providers,
closely followed by transportation providers. Some of the meal providers
are likely to provide both home-delivered and congregate meals under
Title III. Likewise, providers are likely to be funded to provide more
than one home and community-based service.
Based on the reported data, the average level of service offered by
a Title III supported provider is relatively small. Two indicators were
developed to establish the level of service of Title III-funded providers:
1) average service units and average number of clients. See Figure 8.
Figure 8. Size of Provider Operations Supported in Whole or
Part by Title III
HCBC Service |
Measure |
Average Units Per Provider |
Average Clients Per Provider |
Personal Care |
Hour |
4,150 |
52 |
Homemaker |
Hour |
3,265 |
83 |
Chore |
Hour |
1,179 |
88 |
Home-Delivered Meals |
Meal |
34,010 |
283 |
Adult Day Care/Health |
Hour |
4,665 |
52 |
Case Management |
Hour |
3,625 |
NA |
Congregate Meals |
Meal |
32,634 |
638 |
Nutrition Counseling |
Hour |
632 |
198 |
Assisted Transportation |
1WayTrip |
2,491 |
90 |
Transportation |
1WayTrip |
13,321 |
* |
Legal Assistance |
Hour |
1,159 |
* |
Nutrition Education |
Session |
865 |
* |
Info and Assistance |
Contact |
5,228 |
* |
Outreach |
Contact |
1,292 |
* |
* Data on persons served are not collected for these services.
In certain cases area agencies on aging choose to provide services
directly rather than issue a contract with providers. The absence of
a viable local provider is often the reason. In other cases, direct
service provision helps the area agency on aging ensure a vital feature
of home and community-based care is in place; for example, the presence
of an independent, objective case management service. See Figure 9 for
a profile of AAA direct services provision.
Almost one-third of the AAAs are involved in the direct provision of
congregate meals (31%). Thirty percent of the AAAs are directly providing
home-delivered meals. AAAs are also likely to provide access services
directly. Of all the AAAs, 36% are providing some form of case management
directly and 61% provided information and assistance services and 40%
are involved in outreach activities.
Looking at AAAs as a percentage of total providers, AAAs represent
almost a third of the case management providers (29%). By contrast,
AAAs represent less than 5% of the providers of personal care, homemaker,
adult day care, transportation and assisted transportation.
Figure 9. Area Agency on Aging Service Provision, By Service
HCBC Service |
# of AAAs Directly Providing
Service |
% Of All AAAs in U.S. |
% AAAs Of Total Providers For
Svc |
Personal Care |
55 |
8% |
3% |
Homemaker |
76 |
12% |
4% |
Chore |
50 |
8% |
7% |
Home-Delivered Meals |
195 |
30% |
5% |
Adult Day Care/Health |
27 |
4% |
3% |
Case Management |
234 |
36% |
29% |
Congregate Meals |
205 |
58% |
5% |
Nutrition Counseling |
75 |
12% |
15% |
Assisted Transportation |
53 |
8% |
6% |
Transportation |
153 |
23% |
5% |
Legal Assistance |
106 |
16% |
9% |
Nutrition Education |
139 |
21% |
9% |
Inform and Assistance |
401 |
61% |
17% |
Outreach |
255 |
39% |
13% |
D. Senior Centers and Focal Points
Title III funds are an important source of support for senior centers.
Every year states report on the number of focal points designated in
the state, the number of senior centers considered focal points and
the number of senior centers supported by the Older Americans Act.
In 1995 for the U.S. a total of 11, 463 senior centers were identified
by states. Of those 6,397 were supported by OAA funding (55.8%). States
report a total of 8,341 designated focal points. Seventy-five percent
of the focal points are senior centers. For the U.S. there were a reported
1.85 senior centers for every 10,000 persons age 60 and over in 1995.
States with the highest percent of senior centers per 10,000 residents
include Alabama (52 per 10,000 persons 60 and over), New York (27/10,000)
and North Dakota (17/10,000).
Several states report that all of their senior centers receive some
level of Title III support. They include Alaska, Alabama, Arizona, Arkansas,
Maryland, Missouri, Pennsylvania, Utah, West Virginia and Wyoming. By
contrast three states report none of the senior centers in the state
received Title III funding -- Delaware, Idaho, and New Hampshire.
A. OAA Appropriations for State and Community and Tribal Programs
In 1965, total OAA funding was small and little funding was available
for services provision, approximately $5 million. However, in 1972 Congress
enacted the Nutrition Program for the Elderly and made available in
1973 $167 million in grants for state and community programs. By 1973
there were 30 million persons age 60 and over in the U.S. For 1973,
OAA service funding amounted to $5.44 per person age 60 and over. Since
1973 OAA funding for state and community programs has steadily increased.
By 1995 OAA funding for state and community programs had increased four
fold over the 1973 funding level. Despite these increases the effects
of inflation and population growth diminished the actual impact of the
increases in the annual OAA appropriation for state and community programs.
See Figure 10 for an analysis of actual appropriations relative to the
1973 benchmark appropriation.
Figure 10. Analysis of OAA Appropriations for State and Community
and Tribal Programs
FundingYear * |
Actual OAA Appropriation (In
Mill. $) |
OAA $/60+ (Uninflated) |
Inflation Rate Multiplier
(CPI) |
Inflation Adjusted OAA$/60+ |
OAA 1973 Parity $ (In Mill.
$) |
Shortfall (Actual to Parity
- In Mill. $) |
% Shortfall Relative to 1973 |
1973 |
$167.0 |
$5.44 |
100.0 |
|
|
|
|
1974 |
172.8 |
5.51 |
104.9 |
$5.78 |
$181.3 |
$8.5 |
4.67 |
1975 |
207.0 |
6.45 |
109.4 |
7.06 |
226.5 |
19.5 |
8.59 |
1976 |
285.5 |
8.72 |
112.5 |
9.81 |
321.2 |
35.7 |
11.11 |
1977 |
325.7 |
9.73 |
116.2 |
11.31 |
378.5 |
52.8 |
13.94 |
1978 |
423.0 |
12.37 |
120.8 |
14.95 |
511.0 |
88.0 |
17.22 |
1979 |
443.0 |
12.66 |
128.2 |
16.23 |
568.0 |
124.9 |
22.00 |
1980 |
572.9 |
15.98 |
138.0 |
22.05 |
790.6 |
217.7 |
27.54 |
1981 |
630.1 |
17.23 |
146.5 |
25.24 |
923.2 |
293.0 |
31.74 |
1982 |
612.4 |
16.39 |
152.1 |
24.94 |
931.4 |
319.0 |
34.25 |
1983 |
649.4 |
18.03 |
155.4 |
28.02 |
1,009.1 |
359.8 |
35.65 |
1984 |
666.9 |
18.23 |
159.5 |
29.08 |
1,063.7 |
396.8 |
37.30 |
1985 |
676.4 |
17.65 |
163.2 |
28.81 |
1,103.9 |
427.5 |
38.73 |
1986 |
647.3 |
16.65 |
165.2 |
27.51 |
1,069.3 |
422.0 |
39.47 |
1987 |
700.5 |
17.34 |
169.2 |
29.33 |
1,185.2 |
484.7 |
40.90 |
1988 |
701.3 |
17.14 |
173.9 |
29.81 |
1,219.6 |
518.3 |
42.50 |
1989 |
726.0 |
17.54 |
179.6 |
31.50 |
1,304.0 |
577.9 |
44.32 |
1990 |
722.1 |
17.25 |
186.3 |
32.14 |
1,345.3 |
623.2 |
46.32 |
1991 |
766.6 |
18.10 |
191.8 |
34.72 |
1,470.3 |
703.7 |
47.86 |
1992 |
802.1 |
18.78 |
195.8 |
36.79 |
1,571.3 |
769.2 |
48.95 |
1993 |
797.0 |
18.53 |
200.1 |
37.07 |
1,594.8 |
797.8 |
50.02 |
1994 |
828.2 |
19.16 |
203.8 |
39.04 |
1,687.9 |
859.7 |
50.93 |
1995 |
830.9 |
19.07 |
206.3 |
39.33 |
1,714.1 |
883.2 |
51.53 |
Taking into account both annual inflation, as measured by the CPI,
and net increases in the 60 and over population, the 1995 appropriation
for state and community programs should have been $1.7 billion dollars
to maintain parity with the 1973 funding level. Adjusting for inflation,
per capita appropriations should have been $39 per person in 1995. Actual
per capita funding was $19 per person. As a result actual appropriations
have shrunk by just over 50% relative to the equivalent level in 1973.
(NOTE: Figure 11 not shown in html version.)
B. Expenditures by Service
Total federal Title III expenditures for 1995 reported by states were
$673 million. Typically Title III expenditures represent but a portion
of the total expenditures for services supported through the OAA. State
units on aging, area agencies on aging and service providers are able
to leverage the federal Title III funding in the form of match resources,
program income, and other state and federal funding sources. Total services
expenditures for OAA supported services are estimated to be $1.714 billion
for 1995. Title III federal expenditures in 1995 were 39% of the total
service expenditures which were either contractually or administratively
linked to Title III funding.
Beginning in 1995, AoA is examining service expenditures by service
category. Fourteen listed services are divided into three categories
(clusters) plus an "other category. Cluster 1 services include
personal care, homemaker, chore, home-delivered meals, adult day care/health
and case management. Cluster 2 services include congregate meals, nutrition
counseling and assisted transportation. Cluster 3 services include information
and assistance, transportation, legal assistance, nutrition education
and outreach.
As can be seen in Figure 12 below, the 14 listed services account for
the large majority of federal Title III expenditures (87.8%). The same
14 services account for 88.5% of total services expenditures reported
by states.
Figure 12. Title III Expenditures by Service, U.S.
HCBC Service |
Title III Federal Expenditures |
% of Total Title III $ |
Total Service Expenditures * |
% Title III Exp. of Total Service Expenditures
|
Cluster 1 Services: |
$203,377,533 |
30.3% |
$679,580,533 |
29.9% |
Personal Care |
11,572,841 |
1.8 |
87,850,174 |
13.2 |
Homemaker |
23,775,356 |
3.5 |
68,792,393 |
34.6 |
Chore |
4,406,215 |
0.7 |
8,726,806 |
50.5 |
Home-Delivered Meals |
134,119,129 |
19.9 |
396,689,611 |
33.8 |
Adult Day Care/Health |
7,084,660 |
1.1 |
30,659,639 |
23.1 |
Case Management |
22,239,332 |
3.3 |
86,861,910 |
25.6 |
Cluster 2 Services: |
253,915,539 |
37.7% |
536,309,087 |
47.4% |
Congregate Meals |
249,687,321 |
37.1 |
523,043,994 |
47.7 |
Nutrition Counseling |
1,284,944 |
0.2 |
2,303,275 |
55.8 |
Assisted Transportation |
2,943,274 |
0.4 |
10,961,818 |
26.9 |
Cluster 3: |
133,288,911 |
19.8% |
297,874,198 |
44.8% |
Transportation |
62,657,467 |
9.3 |
158,007,250 |
39.7 |
Legal Assistance |
20,134,558 |
3.0 |
36,903,429 |
54.6 |
Nutrition Education |
3,267,008 |
0.5 |
4,685,252 |
69.7 |
Info. and Assistance |
31,765,708 |
4.7 |
69,871,060 |
45.4 |
Outreach |
15,464,170 |
2.3 |
28,407,206 |
54.4 |
Other |
82,024,622 |
12.2% |
200,411,675 |
40.9% |
Total |
$672,606,605 |
100.0% |
$1,714,175,492 |
39.2% |
*See definitions in Appendix II of the full report for an explanation
of total service expenditures.
Cluster one services account for approximately 30% of the Title
III expenditures. Registered services (clusters 1 and 2 services) account
for two thirds (67%) of Title III expenditures.
Data were collected on total services expenditures and the portion
of total service funding provided through Title III. Figure 12 data
show that Title III expenditures are approximately 40% of the total
expenditures. Some services rely more heavily on Title III funding to
cover the costs of services. Title III funding for nutrition education
approaches 70% for the U.S. Approximately 56% of the nutrition counseling
expenditures are attributable to Title III. By contrast Title III funding
covers only 13% of the total services expenditures for personal care.
Figure 14. Distribution of Title III Funding by Service Category
and Cluster
|
|
State With Highest % Of Title III $ |
|
State With Lowest % for The Cluster |
|
HCBC Services |
U.S. % |
State |
State % |
State |
State % |
Cluster 1 Services: |
30.2% |
Delaware |
65.2% |
New Mexico |
11.9% |
Personal Care |
1.8% |
Delaware |
15.7% |
|
|
Homemaker |
3.5% |
Nevada |
10.6% |
|
|
Chore |
0.7% |
Minnesota |
5.1% |
|
|
Home-Del. Meals |
19.9% |
Massachusetts |
43.6%. |
|
|
Adult Day Care/Hlth |
1.1% |
Dist of Col. |
10.7% |
|
|
Case Management |
3.3% |
S. Dakota |
18.7% |
|
|
Cluster 2 Services: |
37.7% |
Kansas |
66.3% |
Maine |
18.1% |
Congregate Meals |
37.1% |
Kansas |
66.2% |
|
|
Nutrition Counseling |
0.2% |
Alabama |
2.4% |
|
|
Assisted Transport. |
0.4% |
Alaska |
11.6% |
|
|
Cluster 3: |
19.8% |
Maine |
45.2% |
Delaware |
2.9% |
Transportation |
9.3% |
S. Carolina |
31.0% |
|
|
Legal Assistance |
3.0% |
Vermont |
7.9% |
|
|
Nutrition Education |
0.5% |
Oklahoma |
4.5% |
|
|
Info. and Assistance |
4.7% |
Rhode Island |
22.7% |
|
|
Outreach |
2.3% |
Maine |
30.1% |
|
|
Other |
12.2% |
Pennsylvania |
35.4% |
DE, IN, MI, OK, OR |
0.0% |
Total |
100.0% |
|
|
|
|
There are notable differences in the distribution of Title III funding
by service cluster and individual service by state. Figure 14 shows
the variation.
Delaware leads all states in funding for cluster 1 services (65%),
while Kansas tops all states in funding for cluster 2 services (66%)
and Maine leads in funding for cluster 3 services (45%). Besides Pennsylvania,
three other states spend more than 20% of Title III funds for other
services -- Vermont (34.86%), Arizona (34.6%) and New Jersey (20.72%).
Pennsylvania puts most of the "other" services expenditures
toward senior centers reporting Title III expenditures of approximately
$12 million. The Pennsylvania senior centers report serving approximately
194,000 persons and providing over 7.3 million client days of service.
By contrast, Vermont lists 22 different "other" services that
are supported by Title III funds ranging from assistive technology to
utility assistance.
Various performance measures related to expenditures can be calculated
based on the reported data. However, such measures should be used with
caution. The data systems used to support Title III reporting are still
under development and the data being reported are still subject to refinement.
Furthermore, there are many factors which can contribute to the comparability
of performance measures from one state to another such as different
interpretation of service definitions, different cost determination
methodologies and different cost factors which are specific to a state
or region within the state. Figure 15, 16, 17 and 18 provide several
basic performance measures.
Figure 15. Service Expenditure Measures, U.S.
|
Title III Fed $ |
Title III Fed $ |
Total Svc $ |
Total Svc $ |
HCBC Service |
Avg. Unit Cost |
Avg. $/Client |
Avg. Unit Cost |
Avg. $/Client |
Personal Care |
$1.53 |
$121 |
11.40 |
$906 |
Homemaker |
3.58 |
142 |
10.37 |
409 |
Chore |
4.95 |
66 |
9.80 |
132 |
Home-Delivered Meals |
1.13 |
136 |
3.33 |
401 |
Adult Day Care/Health |
1.68 |
153 |
7.26 |
658 |
Case Management |
7.47 |
45 |
29.19 |
174 |
Congregate Meals |
2.02 |
104 |
4.24 |
216 |
Nutrition Counseling |
12.84 |
35 |
23.02 |
63 |
Assisted Transportation |
1.32 |
36 |
4.91 |
134 |
Transportation |
1.59 |
* |
4.00 |
* |
Legal Assistance |
14.42 |
* |
26.43 |
* |
Nutrition Education |
2.86 |
* |
4.10 |
* |
Inform and Assistance |
2.56 |
* |
5.64 |
* |
Outreach |
5.85 |
* |
10.74 |
* |
* No data are collected on the unduplicated count of persons served
for these services.
Unit costs in Figure 15 are shown for both Title III federal expenditures
and total service expenditures. Unit costs are lower for Title III only
because of the way the unit data are reported. States were asked to
report total service units associated with total service expenditures,
not just those attributable to the federal Title III resources used
in the provision of the services. The unit costs, as calculated, reflect
new service definitions and refined unit definitions introduced in 1995
by AoA and should be used with caution. Unit costs based on total service
expenditures are the most useful performance measure for state comparison
purposes. State and area agencies may only use small amounts of Title
III funds to support a particular service. As a result, unit costs based
on Title III expenditures reflect as much or more the funding strategies
of the Aging Network as they do the relative efficiency of the service
providers.
Figure 16. Unit Costs (Excluding Upper and Lower 5% of the
Reported Unit Costs)
Service |
Mean Unit Cost |
Median Unit Cost |
Standard Deviation |
Personal Care |
$15.35 |
$13.0 |
$9.30 |
Homemaker |
11.54 |
11.50 |
5.30 |
Chore |
9.83 |
9.03 |
5.64 |
Home-Delivered Meals |
3.35 |
3.31 |
0.87 |
Adult Day Care/Health |
18.53 |
7.20 |
38.30 |
Case Management |
43.79 |
20.12 |
75.27 |
Congregate Meals |
4.13 |
3.89 |
1.15 |
Nutrition Counseling |
21.62 |
19.39 |
17.56 |
Assisted Transportation |
5.79 |
3.98 |
4.83 |
Transportation |
3.79 |
3.48 |
1.83 |
Legal Assistance |
39.16 |
33.99 |
24.05 |
Nutrition Education |
12.33 |
4.90 |
18.56 |
Inform. and Assistance |
6.81 |
5.39 |
4.82 |
Outreach |
13.74 |
11.30 |
9.86 |
There is substantial variation in unit costs based on total service
expenditures across states for individual services. The extent of variation
depends on the service. Outliers exist; some of which may be reporting
inconsistencies. To compensate for the outliers (both high and low)
the unit costs were reviewed by computing both the standard deviation
and the variance. The results of this analysis are summarized in Figure
16.
To address outliers, the data in Figure 16 for mean, median and standard
deviation exclude the upper and lower 5% of the reported unit cost data,
basically the two states with the most extreme values. The average unit
cost includes all states. It should also be noted that average unit
costs reported in Figure 14 were computed using the total service expenditures
for the service for the U.S. and the total reported units for all states.
The mean and median unit costs are based on the average unit costs computed
for each state. Except for meal services, there remains considerable
variation in reported total unit costs by service.
A similar profile was developed for another basic performance measure
-- units per person served. The results are summarized below in Figure
17. The data in Figure 17 are organized and computed in the same way
as the data in Figure 16. The variance is substantial for units per
person.
Figure 17. Units Per Person Served (Excluded Upper and Lower
5%)
Service |
Mean Units/Client |
Median Units/Client |
Standard Deviation |
Personal Care |
60.19 |
49.18 |
41.38 |
Homemaker |
44.00 |
38.05 |
26.56 |
Chore |
14.26 |
12.55 |
8.58 |
Home-Delivered Meals |
124.33 |
120.48 |
29.63 |
Adult Day Care/Health |
200.06 |
115.61 |
117.91 |
Case Management |
8.26 |
6.11 |
6.18 |
Congregate Meals |
58.65 |
48.44 |
26.73 |
Nutrition Counseling |
2.88 |
1.57 |
2.66 |
Assisted Transportation |
27.29 |
16.43 |
23.67 |
Another expenditure measure is the average level of funding for providers
of individual services. See Figure 18.
Average Title III expenditures per provider are quite low except for
home-delivered meals and congregate meals. Even the total service expenditures
are relatively small for most services. While the average expenditures
per provider are small, on a service specific basis, it is likely that
many of the providers offer more than one service. Consequently the
expenditures per provider, considering all services they provide, is
likely to be higher.
Figure 18. Average Expenditures Per Provider, U.S.
|
Total Providers |
Average Title III
$
Per Provider |
Average Total Svc
$
Per Provider |
HCBC Service |
|
Cluster 1 Services |
|
|
|
Personal Care |
1,856 |
$13,502 |
$50,560 |
Homemaker |
2,032 |
13,553 |
47,623 |
Chore |
755 |
9,676 |
19,866 |
Home-Delivered Meals |
3,614 |
56,348 |
155,947 |
Adult Day Care/Health |
905 |
12,145 |
50,510 |
Case Management |
821 |
46,745 |
142,738 |
Cluster 2 Services |
|
|
|
Congregate Meals |
3,902 |
106,435 |
219,758 |
Nutrition Counseling |
505 |
877 |
2,220 |
Assisted Transportation |
896 |
7,799 |
63,406 |
Cluster 3 Services |
|
|
|
Transportation |
2,965 |
21,088 |
55,752 |
Legal Assistance |
1,205 |
35,994 |
70,205 |
Nutrition Education |
1,595 |
2,439 |
3,848 |
Inform and Assistance |
2,370 |
19,499 |
34,596 |
Outreach |
2,047 |
11,276 |
22,528 |
Differences in average expenditures per provider are attributable to
both available levels of funding and different approaches to use of
providers. One area agency on aging may choose to bundle funding for
a service or a group of contracts into a single contract. Another area
agency on aging may find it necessary to award several contracts, in
lesser amounts, to account for such issues as access issues and cultural
diversity of the participants.
C. Generation of Program Income
OAA-supported programs have historically benefited from substantial
generation of program income. Until 1995 program income has been reported
in aggregate. For 1995 data on program income are identified by individual
service. Both home-delivered meals and congregate meals stand out in
terms of development of program income. For the balance of the services,
program income is a small portion of the total revenues used to support
services operations. In terms of program reporting, 1995 is the first
year that states reported program income by specific service. In the
past, program income has only been reported by Title III Part -- III
B, C1, C2 etc. For this first year, no attempt has been made to reconcile
the program income reported by states in their quarterly financial reports
with the annual program report data reported here.
Based on fiscal (SF269) data, states generated approximately $200 million
in program income from Title III related grant activities. The breakdown
by Title III part, excluding Part F, was:
- Title III B. Supportive Services -- $30,898,999
- Title III C.1. Congregate Meals -- $98,503,924
- Title III C.2. Home-Delivered Meals -- $70,074,608
- Title III D. In-Home Services -- $7,427,249
Figure 19. Program Income by Type of Home/Community Service
Type of HCBC Service |
% of Total Program Income |
% of Federal Title III $ For
the Service |
Supportive Services |
14.9% |
10.6% |
Congregate Nutrition Services |
47.6% |
39.4% |
Home-Delivered Nutrition Services |
33.9% |
53.4% |
|
|
|
Total |
100.0% |
30.8% |
For all but home-delivered meals and congregate meals, the level of
program income generated relative to the Title III expenditures appears
quite limited, 1-2% of Federal Title III funding.
D. Expenditures by Part
Individual Parts of Title III of the OAA have specific legislative
mandates that identify the nature of services to be supported. Titles
C1 and C2 are for nutrition related-services, Title III B for supportive
services and centers, Title III D for in-home services and III F for
preventive health services. In 1995, total U.S. Title III expenditures
by part were reported to be:
- Title III B -- 37%
- Title III C1 -- 39%
- Title III C2 -- 20.1%
- Title III D -- 1.1%
- Title III F -- 2.0%
Another way to look at expenditures by part is to determine the distribution
of expenditures for each Title III part by service; for example the
percent of Title III B expenditures used for personal care. See Figure
20.
Figure 20. Distribution of Expenditures by Part for Each Service
Service |
Total Title III Expenditures |
Title III B |
Title III C1 |
Title III C2 |
Title III D |
Title III F |
Cluster 1 Services |
30.2% |
|
|
|
|
|
Personal Care |
1.8% |
3.77% |
0.00% |
0.00% |
21.83% |
0.20% |
Homemaker |
3.5% |
8.14% |
0.00% |
0.00% |
28.82% |
0.00% |
Chore |
0.7% |
1.58% |
0.00% |
0.00% |
3.18% |
0.01% |
Home-Del. Meals |
19.9% |
0.64% |
0.29% |
98.36% |
12.73% |
0.41% |
Adult Day Care |
1.1% |
2.38% |
0.01% |
0.01% |
8.30% |
0.66% |
Case Management |
3.3% |
8.09% |
0.18% |
0.05% |
2.44% |
2.08% |
Cluster 2 Services |
37.7% |
|
|
|
|
|
Congregate Meals |
37.1% |
1.88% |
95.74% |
0.06% |
0.00% |
0.03% |
Nutrition Counseling |
0.2% |
0.07% |
0.22% |
0.12% |
0.00% |
3.32% |
Assisted Transport.. |
0.4% |
1.07% |
0.03% |
0.00% |
0.65% |
0.00% |
Cluster 3 Services |
19.8% |
|
|
|
|
|
Transportation |
9.3% |
23.12% |
0.71% |
0.16% |
0.00% |
0.07% |
Legal Assistance |
3.0% |
7.39% |
0.29% |
0.00% |
0.06% |
0.05% |
Nutrition Education |
0.5% |
0.11% |
0.70% |
0.43% |
0.00% |
4.45% |
Info. and Assistance |
4.7% |
11.76% |
0.21% |
0.01% |
0.04% |
2.33% |
Outreach |
2.3% |
4.58% |
0.91% |
0.51% |
0.58% |
2.85% |
Other Services |
12.2% |
25.41% |
0.72% |
0.30% |
21.36% |
83.26% |
|
100.0% |
100.00% |
100.00% |
100.00% |
100.00% |
100.00% |
Part III B and D funding predictably fund cluster 1 services other
than home-delivered meals. Cluster 2 services are supported principally
by Title III C 1 funds and Cluster 3 services are largely funded through
Title III B funding.
As Figure 20 shows, the fourteen services account for 74% of the expenditures
supported by Part III B versus 99% of III C1 funding, 99% of C2 funding,
79% of Part D funding and 17% of Part F funding. The greatest amount
of Title III B is used for transportation and a range of "other"
services. Case management and I&A comprise 20% of Title III B funding.
E. Transfers
Each state has a transfer authority which permits states to transfer
funding between Title III, Parts B (supportive services), Subpart C-1
(congregate nutrition services) and Subpart C-2 (home-delivered nutrition
services) with certain limitations specified in the law. For FY1995,
no more than 30% may be transferred between Subparts C-1 and C-2 and
no more than 25% may be transferred between Part B and Part C. A state
may request a waiver from the AoA to increase the amounts transferred.
In this report the focus is on transfers between Title III B (supportive
services), Title III C1 (congregate meals) and Title C2 (home-delivered
meals). See Figure 21.
Figure 21. 1995 Transfers between Title III Subparts, U.S.
Summary
Transfers |
To Title III B |
To Title III C1 |
To Title III C2 |
Total |
Subpart Funding After Reallotment |
$304,340,980 |
$372,584,827 |
$93,331,778 |
$770,257,585 |
Transfers: |
|
|
|
|
From III B |
|
0 |
1,050,916 |
1,050,916 |
From III C1 |
22,971,599 |
|
43,879,836 |
66,851,435 |
From III C2 |
352,889 |
0 |
|
352,889 |
Total |
23,324,488 |
0 |
44,930,752 |
68,255,240 |
Final Allotment After Transfers |
$327,665,468 |
$305,734,457 |
$138,262,530 |
$770,347,585 |
Source: AoA, Division of Grants Management, 1996.
As can be seen, Subpart transfers, in aggregate, are principally between
Title III C1 and Title III C2. All but four states (including D.C. and
Puerto Rico) transferred funds out of Title III C1. The highest transfer
percentages were for the following states:
- To Title III B -- Minnesota (33% increase)
- Twenty-six states were able to double Title III C2 funding through
transfers.
No state transferred funding to Title III C1.
In each state there is a designated state unit on aging responsible
for administering the Older Americans Act. The OAA funding pays for
state unit on aging staffing to carry out administrative, development,
advocacy and related activities. Area agencies on aging are funded to
perform similar activities within planning and service areas of the
state. Forty-four states, including Puerto Rico, have designated planning
and service areas. In 1995 there were 655 area agencies on aging.
In many states, the state unit on aging and the area agencies on aging
have assumed additional responsibilities for aging services programs.
Over half the state units on aging have a role in administration of
a Medicaid waiver program. Many state units administer state-funded
programs that support the provision of home and community-based care
services. As a result, the total staffing of state units on aging is
frequently substantially more than the staff paid for with the OAA funding.
Many area anagencies on aging have similar staffing arrangements.
In 1995 data were collected on the staffing profile of both state units
on aging and area agencies on aging. In aggregate, state units on aging
report a total of 3,676 staff. Of those, 32% are supported by Title
III funds. Of the total staff, 17% are minority and 83% are paid professional
staff. Few state units report the use of volunteers. The state staffing
profile by functional responsibility is shown in Figure 22.
Figure 22. State Unit on Aging Staffing, All States
Type of Staff And Functional
Responsibility |
Total Staff |
% of Total Staffing |
Minority Staff |
% Minority Staff (By Resp.)
|
Paid By Title III |
% Paid By Title III (By Resp.)
|
Paid Professionals: |
|
|
|
|
|
|
1. Admin/Develop |
|
|
|
|
|
|
Executive/Mgt. |
349 |
11.5% |
61 |
17.5% |
166 |
47.6% |
Other* |
1303 |
43.7% |
265 |
20.3% |
621 |
47.7% |
2. Services Provision |
|
|
|
|
|
|
Access |
537 |
17.6% |
60 |
11.2% |
61 |
11.4% |
Dir. Svcs Delivery |
868 |
13.1% |
90 |
10.4% |
99 |
11.4% |
Other Staff: |
|
|
|
|
|
|
Clerical |
565 |
18.2% |
148 |
26.2% |
236 |
41.7% |
Volunteer |
53 |
1.7% |
8 |
15.1% |
|
|
Total Staff: |
3,676 |
100.0% |
631 |
17.2% |
1,182 |
32.2% |
* Includes planning, development, administration, and other professional
staff assigned to management and administrative responsibilities.
Approximately 31% of the SUA staff are reported to be providing access/care
coordination or direct services. This is almost exactly the same percentage
of area agency on aging staff who are reported to be providing access/care
coordination services and/or direct services. It should be noted that
Alaska accounts for 55% of the total state agencies on aging staff reported
to be involved in direct service provision. Alaska is a single PSA state
with no area agencies on aging. Arizona reports a high number of staff
in direct services provision (134) as well. In Arizona, these staff
are responsible for adult protective services.
Twenty-seven states report staff involved in direct services provision
(e.g., transportation and meals.) Twenty-nine states report staff involved
in the provision of access/care coordination functions.
Looking at paid staff, ten states report more than 100 full time equivalent
staff -- Alaska, Arizona, California, Florida, Illinois, Missouri, New
Hampshire, New York, Ohio, and Pennsylvania.
For comparison purposes, a similar staffing profile has been prepared
in Figure 23 for area agencies on aging. There were 655 identified area
agencies on aging in 1995.
Figure 23. Area Agency on Aging Staffing, All States
Type of Staff |
Total Staff |
% of Total Staffing |
Minority Staff |
% Minority Staff |
Paid By Title III |
% Paid By Title III |
Paid Professionals: |
|
|
|
|
|
|
1. Admin/Develop |
|
|
|
|
|
|
Executive/Mgt. |
1,289 |
3.3% |
154 |
11.9% |
838 |
65.0% |
Other* |
3,970 |
10.2% |
934 |
23.5% |
2,246 |
56.6% |
2. Access/Svcs Del |
11,341 |
29.1% |
2,397 |
21.1% |
5,006 |
44.1% |
Other Staff: |
|
|
|
|
|
|
Clerical |
2,221 |
5.7% |
461 |
20.8% |
1,020 |
45.9% |
Volunteer |
20,137 |
51.7% |
1,918 |
9.5% |
|
|
Total Staff: |
38,958 |
|
5,864 |
15.1% |
9,110 |
23.4% |
* Includes planning, development, administration, and other professional
staff assigned to management and administrative responsibilities.
Area agencies on aging report a total of 38,958 staff. Of this total,
52% are volunteers. There were 18,821 paid area agency on aging staff.
Of the total staff, 23% are paid by Title III and 15% are minority staff.
Looking just at paid staff, 48% of the staff are supported by Title
III funding.
At the AAA level, almost 30% of the staff are either providing access/care
coordination services or other home and community services such as meals
and transportation. Of the 11,341 staff involved in the provision of
access/care coordination or direct services, a total of 3,219 are providing
access services and 8,122 are providing direct services.
Of the total staff involved in access/care coordination and direct
services delivery, Title III funds 44% of the staff -- less than what
Title III pays for administrative/developmental staffing of area agencies
on aging. Of the total staff, 3% are considered executive/management
personnel. Taking out volunteers, executive/management personnel comprise
7% of the total staff.
State and area agency on aging staff are a primary source of development
and advocacy on issues affecting the elderly in every state. States
are required to report on three significant developmental accomplishments
in each of two areas: 1) development of home and community-based programs
and 2) development of systems of elder rights. Clearly, the Aging Network
in each state is responsible for many different developmental initiatives
each year. As such, the data on developmental accomplishments submitted
by states is not a complete inventory of Aging Network accomplishments.
The accomplishments which are reported are those considered as important
achievements and provide a sense of the diversity and type of developmental
accomplishments of the Aging Network in each state.
As an overview, examples of the developmental accomplishments are summarized
below in each of the two major categories of development:
A. Home and Community-Based Programs
Development of enhanced home and community-based services is a continuing
priority of the national Network on Aging. A diverse set of developmental
activities was pursued with many successes and accomplishments. Seven
different types of development activities were used to classify developmental
accomplishments related to home and community-based care: they were:
- Public Education/Awareness
- Resource Development
- Training/Education
- Research and Development
- Policy Development
- Legislative Development
- Other
Of those states reporting developmental accomplishments accompanied
by codes for developmental type, almost half of the states reporting
had accomplishments which were consider either public education or resource
development in nature. About 30% of the states reporting indicated accomplishments
which were training and education or research and development projects;
Policy development was also an activity in which 30% of the states reported
accomplishments. Few states singled out legislative accomplishments
during 1995, although some states reported what were essentially legislative
activities under the resource development category.
Examples of developmental accomplishments by category and type of assistance
include the following:
Public Education/Awareness
- New Mexico initiated a three-part Alzheimer's Disease Program: respite,
consultation, and information and referral through an 800 number.
- Puerto Rico developed a health promotion/disease prevention program
including 8 radio programs, a teleconference, 2 health campaign promotions
and a training session.
Resource Development
- South Carolina continued its senior center development initiative,
adding $1 million in state funds to support the development of three
new centers in 1995.
- Utah applied for and received Medicaid Waiver renewal, including
provision for two new services - companion services and respite care
outside the home.
- Iowa's successful advocacy with the General Assembly expanded the
case management program by 35% allowing it to expand into additional
counties.
- Nevada obtained increased funding from $72,000 to $320,000 for home
and community -based services.
Training/Education
- Kansas convened a conference on managed long-term care.
- North Carolina co-sponsored a six-day workshop series entitled "
Improving the Management and Supervision of In-Home Aide Services".
- Oklahoma trained and certified 600 OAA network staff in the implementation
of the Uniform Comprehensive Assessment Tool as its single entry tool.
Research and Development
- Florida developed a screening and counseling program utilizing audiologists
to conduct screening sessions in 14 counties, 269 seniors were screened,
and 90 clients received volume control telephones from Florida Telecommunications
Relay.
- North Carolina implemented a pilot project in two counties to establish
a single point of entry for non-Medicaid eligible older adults who
are at risk of out of home placement.
- Virginia began the development of the Virginia Aging Information
System with three components - client assessment, service utilization
and service spending.
- North Dakota developed a computerized Title III service assessment
to assess quality in service delivery.
- South Dakota developed an Intervention Care Program designed to
respond to families and individuals that need overnight care after
a brief illness or hospitalization.
Policy Development
- Nevada implemented a Group Care Waiver Program, providing support
services in group homes for older adults at risk of nursing home care.
- Arkansas developed regulations for assisted -living facilities.
- Kentucky developed and implemented an adult day care certification
process.
Legislative Development
- Missouri developed the Elderly Health and Nutrition Act that is
designed to stimulate collaboration among state and private agencies.
- Virginia conducted a study for the state legislature on the feasibility
of developing a program using volunteers to assist older adults in
time of crisis.
Other
- Ohio Department of Aging eliminated the Medicaid Waiver waiting
list. ODA served 15,282 clients and ended the year with 10,000 active
clients.
Figure 24. Developmental Accomplishments for Home and Community -Based
Care, By Development Type
Public Education |
Resource Development |
Training and Education |
Research and Development |
Policy Development |
Legislative Development |
Other |
|
|
|
|
|
|
|
Colorado |
Alabama |
Alabama |
Colorado |
Alabama |
Colorado |
Arkansas |
Connecticut |
Alaska |
Hawaii |
Connecticut |
Alaska |
Illinois |
Dist of Col. |
Delaware |
Arkansas |
Delaware |
Delaware |
Arkansas |
Iowa |
Florida |
Georgia |
Colorado |
Dist of Col. |
Georgia |
Colorado |
Nevada |
Kansas |
Hawaii |
Florida |
Florida |
Hawaii |
Illinois |
S. Dakota |
Ohio |
Idaho |
Georgia |
Hawaii |
Maine |
Iowa |
Vermont |
|
Kansas |
Iowa |
Idaho |
Maryland |
Maine |
|
|
Maine |
Missouri |
Maryland |
New Jersey |
Minnesota |
|
|
Maryland |
Nevada |
Missouri |
N. Carolina |
Missouri |
|
|
Missouri |
N. Carolina |
New Mexico |
N. Dakota |
Nevada |
|
|
New Jersey |
Pennsylvania |
N. Carolina |
Ohio |
New Mexico |
|
|
New Mexico |
Puerto Rico |
W. Virginia |
Vermont |
N. Dakota |
|
|
New York |
S. Carolina |
|
Virginia |
S. Carolina |
|
|
North Dakota |
S. Dakota |
|
|
S. Dakota |
|
|
Puerto Rico |
Utah |
|
|
|
|
|
Rhode Island |
Virginia |
|
|
|
|
|
S. Carolina |
Washington |
|
|
|
|
|
Washington |
W. Virginia |
|
|
|
|
|
Wyoming |
Wyoming |
|
|
|
|
|
New York |
|
|
|
|
|
|
B. System of Elder Rights
The Older Americans Act encourages the development of improved systems
of elder rights. States enhance elder rights through a number of services
such as the long-term care ombudsman programs, legal assistance, benefits
counseling and programs addressing abuse and neglect. Many states are
active in the promotion of improved service delivery for elder rights.
The accomplishments focus on activities undertaken to prevent abuse
and neglect and to uphold/advocate for the rights of older adults.
States with accomplishments in elder rights are listed in Figure 25.
Figure 25. Developmental Accomplishments for A System of Elder
Rights, By Development Type
Public Education |
Resource Development |
Training and Education |
Research and Development |
Policy Development |
Legislative Development |
Other |
Alabama |
Alabama |
Alaska |
Alabama |
Colorado |
Colorado |
Virginia |
Arkansas |
Alaska |
Arkansas |
Colorado |
Georgia |
Dist of Col |
|
Colorado |
Arkansas |
Colorado |
Delaware |
Hawaii |
Georgia |
|
Connecticut |
Colorado |
Connecticut |
|
New Jersey |
Iowa |
|
Delaware |
Connecticut |
Dist of Col |
|
New Mexico |
Maine |
|
Georgia |
Dist. of Col. |
Hawaii |
|
N. Dakota |
Missouri |
|
Illinois |
Hawaii |
Illinois |
|
Puerto Rico |
Nevada |
|
Iowa |
Idaho |
Iowa |
|
Rhode Island |
Puerto Rico |
|
Kansas |
Kansas |
Kansas |
|
S. Dakota |
Virginia |
|
Maryland |
New Mexico |
Minnesota |
|
Virginia |
|
|
Minnesota |
N. Carolina |
Missouri |
|
Wyoming |
|
|
Missouri |
Ohio |
N. Jersey |
|
|
|
|
Nevada |
Pennsylvania |
N. Carolina |
|
|
|
|
New Mexico |
Vermont |
N. Dakota |
|
|
|
|
N. Carolina |
Washington |
Pennsylvania |
|
|
|
|
Ohio |
Wyoming |
S. Carolina |
|
|
|
|
Puerto Rico |
|
S. Dakota |
|
|
|
|
S. Carolina |
|
Washington |
|
|
|
|
S. Dakota |
|
W. Virginia |
|
|
|
|
Utah |
|
|
|
|
|
|
Vermont |
|
|
|
|
|
|
Washington |
|
|
|
|
|
|
Wyoming |
|
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|
Examples of state initiatives are reported by category.
Public Education/Awareness
- Connecticut's information and referral program implemented the BOSS
System to screen and determine eligibility for elders seeking benefits
information,
- Hawaii developed plans and activities with the Elder Rights Section
of the Hawaii Bar Association.
Resource Development
- Washington DC Office on Aging supported the establishment of an
imprest fund and legal consultation fund for abused adults served
by Adult Protective Services, when no other resources are available.
- Pennsylvania expanded the Abuse Intervention Program with $686,000
of state lottery funds, a 10% increase.
Training/Education
- Illinois' Statewide Elder Abuse and Neglect Program utilized multi-disciplinary
teams to provide support to the program's service delivery activities.
- Pennsylvania provided Protective Services Training for all staff
involved in the provision of Adult Protective Services - 700 persons
attended.
- Hawaii co-sponsored a training conference for nurses aides on elder
abuse and neglect, over 200 persons attended.
Research and Development
- Alabama co-chaired with the Department of Human Resources the Governor's
Special Commission on Elder Abuse and submitted policy recommendations
to the Governor for his consideration.
- Colorado collected statistical and descriptive data to enhance the
Elder Rights System.
Policy Development
- New Mexico expanded the Qualified Medicare Beneficiary outreach
efforts statewide, using simplified enrollment forms and on-site enrollment,
screened approximately 2,200 persons.
- New Jersey proposed regulations for Adult Protective Services.
Legislative Development
- Nevada advocated for revision of Elder Rights Statutes. The bill
was drafted by the Division Chief of Elder Rights. Division Staff
discussed elder abuse issues with a variety of professionals.
- District of Columbia Office on Aging Adult Prevention Committee
revised the District's Guardianship legislation.
Other
- Arkansas took over direct administration of Adult Protective Services
Last Modified: 2/24/2009 11:42:04 AM |
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