On July 14, 1965, President Lyndon B. Johnson signed The Older Americans Act (OAA). Many of the comments he made at that event about increasing life expectancy and the growing proportion of the population over the age of 65 continue to be true today.
The mission of the OAA was (and is) to help older adults live at home and in their communities for as long as possible. Before the OAA there were very few community-based programs for older adults. Today, one in five older adults receives services from an OAA program. The act established the Administration on Aging within the Department of Health and Human Services. It also established the aging services network made up of state agencies on aging and over 600 Area Agencies on Aging (AAA).
The AAAs are a key mechanism through which the OAA provides services to older adults and their caregivers. They take a consumer-centered approach that focuses on information, supported decision making, and streamlined and centralized access to services. Over 70% of OAA funds are spent on grants for state and community programs managed through AAAs. The largest proportion of these grants are for nutrition services, followed by supportive services, family caregiver support, and disease prevention and health promotion. All services offered by the AAAs are available to anyone aged 60 or older, although many are targeted toward those with the lowest incomes and the most limited social support.
The use of OAA funds is up to individual states, and the AAAs are as diverse as they states they serve. On average, states have about twelve AAAs. Some of these are independent nonprofits, some are part of county or city government, and some are part of regional planning groups or government councils. They serve urban, rural, and suburban areas. They vary greatly in terms of the size of their budgets; the proportion of their budgets that come from OAA, Medicaid, or through contract services; and the amount of full-time staff, part-time staff, and volunteers. The range of services varies too, but typically includes some combination of individual information and support (e.g., health insurance counselling, transportation, caregiver support), community-based services (e.g., senior centers, congregate meals), and in-home services (e.g., meals-on-wheels, health and personal care) as well as legal assistance and elder abuse prevention programs.
When the OAA was reauthorized in 2000, the National Family Caregiver Support Program was added. Many AAAs have also expanded their consumer-base over time to include disabled individuals who are younger than 60 years old. Long-term services and supports, whether for older adults or younger people with disabilities, are generally accessed through Aging and Disability Resource Centers (ADRCs), but because of their overlap in their approaches and missions, in 2013, over 70% of AAAs were also designated ADRCs.
Most AAAs are also involved in federally funded initiatives to address health issues at the system level, particular around coordination of care. In 2013, for example, 32% of AAAs were part of the Medicaid Manager Long-Term Services and Supports Initiative, typically providing care management, caregiver support, and care transitions services in collaboration with a range of health care providers. In addition, 102 AAAs were awarded federal contracts for the Community-based Care Transitions Program. The goal of this program is to reduce the number of hospital readmissions for high-risk Medicare patients. (In 2013, nearly one in five Medicare patients discharged from hospital were readmitted within thirty days). AAAs involved in those program help older adults and their families as they transition between hospital, rehab, and home. These are difficult times when people often fall through the cracks. By making sure they have the supports and information they need, CCTP programs hope to reduce rehospitalizations and improve quality of life. The strength of AAAs involvement in these types of programs is their ability to leverage their existing resources and connections to provide additional services for which they are not necessarily directly reimbursed.
It’s not clear, however, how much of these efforts AAAs will be able to sustain. The OAA is up for reauthorization – only four years late. Its’ current authorization expired in fiscal year 2011 and many AAAs have had to reduce programs and services as well as put new initiatives on hold. The 2015-2016 reauthorization has made it out of committee and been placed on the legislative calendar.
For more information on OAA services in California, here is a list of AAAs by county: https://www.aging.ca.gov/ProgramsProviders/AAA/AAA_Listing.asp