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n4a Recommendations for the
2005 Reauthorization of the Older Americans Act

About n4a

The National Association of Area Agencies on Aging (n4a) is the leading voice on aging issues for the nation's 650 Area Agencies on Aging (AAAs) and 240 Title VI Native American aging programs in our nation's capital. Through its presence in Washington, D.C., n4a advocates on behalf of these local aging agencies to ensure that needed resources and support services are available to older Americans and their caregivers.

n4a's primary mission is to build the capacity of its members to ensure that older adults are valued and supported as they age. Through a broad range of services, AAAs and Title VI agencies help older adults remain active and contributing members of their communities for as long as possible. To achieve its mission, n4a provides advocacy, training and technical assistance support to its members in a number of critical areas. Current initiatives focus on the Medicare prescription drug program, health promotion and disease prevention, senior volunteerism and civic engagement, caregiver support, help for older adults in locating and accessing community resources, older driver safety and preparing communities for a growing aging population.

n4a is dedicated to enhancing the capacity of its members to:

Advocate on behalf of older adults, persons with disabilities and their caregivers;
Take action to ensure that communities are equipped to support and enhance the well-being of older adults, persons with disabilities and their caregivers; and
Serve as the focal point in their community for answers on aging.

Introduction

The National Association of Area Agencies on Aging (n4a) seeks the adoption of the following recommendations as part of the 2005 reauthorization of the Older Americans Act. The recommendations were developed by the n4a Research & Policy Development Committee with feedback from the n4a membership and were approved the n4a Board of Directors in April 2005.

The reauthorization of the Older Americans Act provides an ideal opportunity for Congress to ensure that the Aging Network can meet the needs of the current and future populations of older adults and their caregivers.

Since its inception in 1965, the Older Americans Act has evolved to meet changing needs and expectations and consequently the scope of the Act has expanded to better address and support the needs of older adults and their caregivers. To respond to the dramatic increase in the nation's aging population over the next three decades, the Act must evolve once again.

n4a believes that the Act's mission must be expanded to further support the role of the Aging Network as the focal point for aging services and to assist our nation's communities in meeting the challenges and opportunities of the coming "age wave."

In order to do so effectively, the reauthorization of the Older Americans Act should embrace the following recommendations.

Since it was enacted in 1965, the Older Americans Act (OAA) has served as the legislative vehicle for providing federal guidance and support to help older Americans stay in their homes and communities with maximum dignity and independence for as long as possible. The Act established the national Aging Network which has effectively and efficiently served as the infrastructure for aging service delivery at the federal, state and local level. For more than 30 years, Area Agencies on Aging (AAAs) and Title VI Native American aging programs, which serve as the local component of the Aging Network, have leveraged federal dollars with other federal, state, local and private funds to meet the needs and provide a better quality of life for millions of older adults.

In 2006, the first of the 77 million baby boomers reach the age of 60. The aging of the baby boomers over the next 25 years will impact every aspect of American society. The rapid increase in the aging population will challenge the Aging Network to meet the accompanying rise in demand for adequate health and supportive services.

The reauthorization of the Older Americans Act in 2005 provides an ideal opportunity for Congress to ensure that the necessary system of services is in place to meet the needs of the current aging population as well as the needs of the aging baby boomers.

Balancing the current and the future needs of the older population, the National Association of Area Agencies on Aging (n4a) seeks the adoption of the following principles into the Older Americans Act during the 2005 reauthorization:
 

NEW TITLE — Facilitate Community Preparedness to Meet the Needs of a Rapidly Aging Population

PROPOSAL: n4a proposes the establishment of a new title in the OAA which would support AAAs and Title VI Native American aging programs in helping county and city governments across the nation to prepare for the aging of the baby boomers. Funding for the new title would be non-formula based, with a minimum level of funding and additional formula-based funding to increase subsidies to more heavily populated service areas and have a 25 percent match requirement. The new title would include non-formula based funding to State Units on Aging to coordinate state-level preparedness planning. It would also establish a National Resource Center on Aging in Place to provide the necessary guidance, training and technical assistance to AAAs and Title VI Native American aging programs in their efforts to help communities develop livable communities for all ages. The new title would be evaluated and potentially sunsetted after ten years.

BACKGROUND: The country is facing the aging of the largest demographic cohort in its history. The aging of the baby boomers over the course of the next three decades will have a direct and dramatic impact on every community in the nation. The rise in the number of aging citizens will impact the social, physical and fiscal fabric of our nation's cities and counties, directly and dramatically affecting local aging, health, human services, land use, housing, transportation, public safety, workforce development, economic development, recreation, education/life-long learning, and volunteerism/civic engagement policies and programs.

Despite the demographic shift, few communities have begun to address the aging of their population. Given their existing mandated role under the OAA to create multi-year plans for the development of comprehensive, community-based services which meet the needs of older adults, AAAs and Title VI Native American aging programs are in a unique position to expand their support to communities to assess and assist in coordinating with other local agencies to address the challenges and opportunities posed by the growing numbers of older adults.

NEW TITLE — Strengthen Aging Network Role as Single Point of Entry

PROPOSAL: n4a seeks a new title that would permanently establish authorized Aging and Disability Resources Centers within every service area in the nation. AAAs should be allowed the right of first refusal to be designated as the Aging and Disability Resource Center within their service area.

BACKGROUND: The Older Americans Act and the Aging Network comprise the nation's non-Medicaid long-term care system, and many AAAs also manage Medicaid home and community-based long-term care services. In order to structure a system that reaches the entire long-term care population, AAAs and Title VI Native American aging programs should be established as the Aging and Disability Resource Centers for both Medicaid and non-Medicaid long-term care services.

Many individuals with disabilities, whether age-onset or life-long, need information on and access to basic supportive services that will enable them to become or remain active and contributing members of the community. Over the last 30 years, AAAs and Title VI Native American aging programs have developed the infrastructure that coordinates a host of programs that provide information on, access to and choices for individuals who seek such services.

AAAs have become the first and most trusted source for older Americans and their caregivers who seek information on home and community based services, both public and private, anywhere in the nation. The rising numbers of aging baby boomers will bring an attendant increase in the need and demand for a "one stop" source of information as well as a single point of entry into the aging services system.

TITLE III — Enhancing Community-Based Supports and Services

Increase Authorization Levels

PROPOSAL: n4a seeks to raise the authorized funding levels of all the titles of the Older Americans Act by at least 25 percent above FY 2005 over five years except for Title III E which should be authorized at $250 million. The increased authorization levels will ensure the Aging Network has the necessary resources to adequately serve the projected growth in the numbers of older adults, particularly the growing ranks of the 85 and older population who are the most frail, vulnerable and in the greatest need for aging supportive services.

BACKGROUND: The OAA is the major federal social services program for older adults in the United States. It has provided vital community-based supports to millions of older adults for almost forty years. Since 1980, however, there has been a substantial loss in the OAA program's capacity at the state and community levels to provide services to older Americans due to rising costs due to inflation, increasing numbers of older adults requesting services, and expanding service demands as life-spans have been extended.

As the aging population grows, so does the need for home and community-based services. The impending demographic shift will create an unprecedented level of demand for health and social services as millions of aging baby boomers begin seeking such supports. The OAA provides well-established, trusted, community-based infrastructure of services responsive to the needs of older people and their families.

Maximize Service Flexibility

PROPOSAL: n4a seeks the maximum amount of flexibility in the allocation of resources and the provision of services under Title III of the OAA so that AAAs and Title VI Native American aging programs can most efficiently and effectively meet the growing and changing needs in their own communities.

BACKGROUND: The latitude and flexibility allowed by the broadly defined Title III services categories have enabled and empowered AAAs and Title VI Native American aging programs across the country to develop innovative programs that best meet the needs of older adults and caregivers in their communities. This flexibility does not, however, always filter down to the local level, with either state or federal mandates on funding allocation and service provision.

Flexibility in OAA service design and delivery translates into an increased ability of AAAs and Title VI Native American aging programs to pool funding sources and coordinate services with other programs that benefit older adults. Many AAAs and Title VI Native American aging programs manage a variety of funding sources in addition to the OAA, including Medicaid waivers for home and community-based care, social service block grants, transportation funds, and state-funded in-home service programs. Allowing community-level determination of OAA funding allocation among services would avoid service duplication with other federal, state or local programs.

Our nation's older adult population is more diverse than ever before. In order for AAAs and Title VI Native American aging programs to appropriately, effectively, and efficiently serve the geographically, racially, culturally, and ethnically diverse populations among the states and even within a state, they must be able to tailor services to meet the specific needs of older adults in their community.

Strengthen the Aging Network's Role in Health Promotion and Disease Prevention

PROPOSAL: n4a seeks an authorization level of $50 million for the Title III D program and proposes that $10 million of the appropriation be set aside to pilot, through the AAAs, a community-based collaborative between local aging and healthcare providers to promote disease prevention services.

BACKGROUND: Title III D of the OAA provides funding for disease prevention and health promotion services. This program has become increasingly valuable as recent evidence-based research continues to prove that health promotion and disease prevention not only contribute significantly to an individual's quality of life, but also are a cost effective means of reducing acute or chronic care costs.

As the coordinators and providers of home and community-based services at the local level, AAAs and Title VI Native American aging programs have long recognized the critical importance of health promotion and disease prevention. Agencies across the nation have maximized limited Title III D funding to develop innovative programs that improve the physical and mental well-being of older adults, while reducing the need for more intensive chronic and acute care services.

Older adults overwhelming report that they want to remain in their homes and communities for as long as possible. To achieve that goal, they need to engage in activities that promote healthy living. Good nutrition and physical activity both have been proven to play important roles in preventing or forestalling the onset of chronic conditions.

Expand Definition of Kinship Care

PROPOSAL: n4a seeks the expansion of Title III E to allow agencies to serve grandparents and older adults who are providing care to adult children with disabilities. n4a also seeks the expansion of the definition of "kinship" in the National Family Caregiver Support Program to include non-blood relationships.

BACKGROUND: The National Family Caregiver Support Program (NFCSP), established in 2000, provides essential support services such as information and referral assistance, counseling and training, and respite to provide relief to millions of Americans who serve as the primary caregiver for an aging relative or friend.

Current age eligibility guidelines for the NFCSP precludes assistance to a caregiver 60 years of older who is caring for a disabled individual between the ages of 19 to 60. The majority of individuals with disabilities live at home and, in many cases, depend on a primary caregiver who is over 60. This caregiver constituency could greatly benefit from the financial, physical and emotional supports provided through the NFCSP and, in turn, their care recipients could avoid unnecessary institutionalization which can result from caregiver burnout.

Strengthen Senior Mobility/Transportation Services

PROPOSAL: n4a seeks the inclusion of statutory language in the Older Americans Act that increases support to the Aging Network to promote senior mobility and to facilitate coordination of human services transportation.

BACKGROUND: Mobility is essential for an individual to live at home and in the community. Transportation provides necessary access to medical care, employment, shopping for daily essentials and the ability to participate in cultural, recreational, and religious activities. As the population ages, enhanced efforts are needed to help older drivers remain on the road for as long as safely possible and to provide safe, reliable and convenient alternative means of transportation for those for whom driving is no longer an option.

Transportation is a priority service under Title III of the Older Americans Act. Many AAAs across the country either provide directly or contract for a variety of transportation services for their older adult clientele. However, transportation competes for limited funding against many other support services. Coordination of transportation services among human service providers has been identified as a means of increasing the capacity of AAAs to provide, in the most cost-efficient means possible, their older adult clients with the transportation services necessary to maintain their independence and quality of life.

TITLE IV — Reinforce and Broaden the Capacity of the Aging Network

PROPOSAL: n4a proposes the inclusion of a national education and training program for AAA and Title VI Directors and aspiring Directors under Title IV that would reinforce and broaden the capacity of Aging Network leaders. The program would provide a history of network and aging policy and offer qualified individuals training in advocacy, ethics, strategic planning, leadership and empowerment competence, communication, grant writing and corporate outreach, and skills in working with boards and advisory committees. Additionally, to encourage educational training in gerontology and geriatrics in the health and social service professions, and to ensure that an adequate force of skilled service providers are available to provide aging network services, n4a advocates that Title IV Part A Education and Training be sufficiently funded and actively promoted.

BACKGROUND: Over the next ten years, the Aging Network is forecast to lose over a third of it local leaders as a result of retirement, attrition and other factors. Many of these leaders have been involved with the OAA since its inception and with their departure goes a wealth of institutional knowledge and experience in providing aging services. Given the increased demographic demands on aging services in the next 10 to 20 years, it is crucial that a pool of highly trained, effective leaders remain available to continue the critical work of AAAs and the local aging network.

TITLE V — Assess Senior Employment Needs for the Future

PROPOSAL: n4a seeks the inclusion of a provision under Title V requiring a comprehensive study of current and future senior employment needs. The study would include an examination of Title V, Workforce Investment Act programs and all federal employment programs, and recommend procedures to coordinate these programs to best promote and support the recruitment, training and retention of the growing ranks of older adults who wish to remain employed.

BACKGROUND: Along with the encroaching demographic explosion is an attendant shift in our nation's workforce. Future trends predict that the highest growth rate in the workforce will be among persons aged 55 to 64. Older workers are valuable resources in maintaining an experienced, skilled and competitive workforce. However, these individuals will need work skills training or retraining, more flexible work options and employee benefits comparable to their younger colleagues. The aging workforce will bring challenges to employers as well. Businesses of all sizes will need to review and modify employment practices and policies, improve recruitment efforts, and provide training opportunities to attract and retain older workers.

Currently, there are two federally supported programs that provide assistance to older workers. Title V of the Older Americans Act provides low-income job seekers age 55 and older with job training and paid temporary work assignments with non-profit organizations, as well as placement assistance with local employers. This program is invaluable to low-income older adults who want or need to enter or return to the workforce. Additionally, while the Workforce Investment Act contains provisions to assist in older worker job retraining and placement in recent years most of the funding for WIA programs has been focused on taking younger individuals from welfare to work.

Given the importance that older workers will play in the workforce and the needs to support a growing older population, the nation needs to take a comprehensive look at the impact of aging demographics on the workforce.

TITLE VII — Strengthen Coordination to Prevent Elder Abuse

PROPOSAL: n4a seeks an increase in authorization of Title VII provisions and services to enhance the Aging Network's capacity to increase training of law enforcement officials and medical staff, broaden public education and community involvement campaigns, and facilitate coordination among all professionals and volunteers involved with the prevention, detection, intervention and treatment of abuse and neglect of vulnerable older adults.

BACKGROUND: Abuse, exploitation and neglect are common occurrences for far too many of today's older adults and this problem will only be exacerbated by the rapid growth of the aging population over the next decade.

To date there is no federal law that comprehensively addresses elder abuse and neglect, from prevention to intervention through prosecution. Individuals and agencies, including AAAs, that are dedicated to protecting older adults against abuse, exploitation and neglect, often do so within a fragmented system and with limited resources.

AAAs are mandated to serve as the advocate for older individuals within the community. Title VII of the Older Americans Act was created as part of the 1992 Amendments to the OAA to provide protections to vulnerable older adults both in the community and in institutional settings through the long term care ombudsman programs. AAAs also utilize Title VII funding to promote public education and inter-agency coordination to address elder abuse.