.
Older Americans Act:
Background and Overview
Kirsten J. Colello
Specialist in Health and Aging Policy
Angela Napili
Information Research Specialist
May 4, 2015
Congressional Research Service
7-5700
www.crs.gov
R43414
c11173008
.
Older Americans Act: Background and Overview
Contents
Introduction ...................................................................................................................................... 1
Older Americans Act: Historical Development ............................................................................... 2
Major Amendments to the Older Americans Act ....................................................................... 3
1960s ................................................................................................................................... 3
1970s ................................................................................................................................... 3
1980s ................................................................................................................................... 4
1990s ................................................................................................................................... 4
2000s ................................................................................................................................... 5
Older Americans Act: Current Law ................................................................................................. 5
Title I. Declaration of Objectives; Definitions .......................................................................... 6
Title II. Administration on Aging .............................................................................................. 6
Senior Medicare Patrol ........................................................................................................ 7
Aging and Disability Resource Centers .............................................................................. 7
Title III. Grants for State and Community Programs on Aging ................................................. 8
Title IV. Activities for Health, Independence, and Longevity ................................................... 9
Title V. Community Service Employment for Older Americans ............................................. 10
Title VI. Grants for Services for Native Americans ................................................................ 11
Title VII. Vulnerable Elder Rights Protection Activities ......................................................... 12
Figures
Figure 1. The Aging Network .......................................................................................................... 7
Tables
Table A-1. Comparison of Changes to Definitions in Title I of the Older Americans Act:
Current Law and Older Americans Act Reauthorization Act of 2015 (S. 192) .......................... 21
Appendixes
Appendix. Older Americans Act Reauthorization Act of 2015, S. 192: Section-by-Section
Summary of Key Provisions ....................................................................................................... 13
Contacts
Author Contact Information........................................................................................................... 24
Congressional Research Service
c11173008
.
Older Americans Act: Background and Overview
Introduction
Originally enacted in 1965, the Older Americans Act (OAA) supports a wide range of social
services and programs for individuals aged 60 years or older. These services and programs
include supportive services, congregate nutrition services (i.e., meals served at group sites such as
senior centers, community centers, schools, churches, or senior housing complexes), home-
delivered nutrition services, family caregiver support, community service employment, the Long-
Term Care Ombudsman Program, and services to prevent the abuse, neglect, and exploitation of
older persons. Except for Title V, Community Service Employment for Older Americans
(CSEOA), all programs are administered by the Administration on Aging (AOA) in the
Administration for Community Living (ACL) within the Department of Health and Human
Services (HHS). Title V is administered by the Department of Labor’s (DOL’s) Employment and
Training Administration.
Congress has reauthorized and amended the OAA numerous times since it was first enacted in
1965. The last OAA reauthorization occurred in 2006, when Congress enacted the Older
Americans Act Amendments of 2006 (P.L. 109-365), which extended the act’s authorizations of
appropriations through FY2011. Thus, the authorizations of appropriations for most OAA
programs, including the senior nutrition programs, expired on September 30, 2011. However,
Congress has continued to appropriate funding for OAA activities.
In the 114th Congress, the Senate introduced a bipartisan bill to reauthorize the OAA for a three-
year period. The Older Americans Act Reauthorization Act of 2015 (S. 192) was introduced
January 20, 2015, and would authorize appropriations for most OAA programs through FY2018.
It also would make various amendments to existing OAA authorities, including changes to the
statutory funding formula for supportive services and centers, congregate nutrition, home-
delivered nutrition, and disease prevention and health promotion services under Title III of the
act. On January 28, 2015, the Senate Health, Education, Labor, and Pensions (HELP) Committee
ordered S. 192, the Older Americans Act Reauthorization Act of 2015, reported favorably. The
bill has been placed on the Senate Legislative Calendar. For a section-by-section summary of key
provisions under S. 192, see the Appendix.
Legislation to reauthorize OAA also was introduced during the 113th Congress, with legislative
action in the Senate HELP Committee. OAA reauthorization bills were introduced in the Senate
(S. 1028 and S. 1562), and the Senate HELP Committee ordered S. 1562, the Older Americans
Act Reauthorization Act of 2014, reported favorably with an amendment in the nature of a
substitute on October 30, 2013. The bill was subsequently placed on the Senate Legislative
Calendar but was not considered on the Senate floor. In the House of Representatives, OAA
reauthorization bills were introduced (H.R. 3850 and H.R. 4122). These bills were referred to the
Committee on Education and the Workforce but saw no further legislative action.
This report first provides information on the OAA’s historical development. Next, it briefly
describes the act’s titles, highlighting selected provisions. For more information on OAA
programs and services, see the following CRS reports:
• CRS Report R43423, Older Americans Act: FY2014 Appropriations Overview,
by Angela Napili and Kirsten J. Colello;
Congressional Research Service
1
c11173008
.
Older Americans Act: Background and Overview
• CRS Report RS22549, Older Americans Act: Funding Formulas, by Kirsten J.
Colello; and
• CRS Report RS21202, Older Americans Act: Title III Nutrition Services
Program, by Kirsten J. Colello.
Older Americans Act: Historical Development
Congress created the Older Americans Act (OAA) in 1965 in response to concern by
policymakers about a lack of community social services for older individuals. The original
legislation established authority for grants to states for community planning and social services,
research and development projects, and personnel training in the field of aging. The law also
established the Administration on Aging (AOA) within the then-Department of Health,
Education, and Welfare (DHEW) to administer the newly created grant programs and to serve as
the federal focal point on matters concerning older persons.
Although older persons may receive services under many other federal programs, today the act is
considered to be the major vehicle for the organization and delivery of social and nutrition
services to this group. It authorizes a wide array of service programs through a nationwide
network of State Units on Aging (SUAs), Area Agencies on Aging (AAAs), and tribal
organizations, as well as thousands of aging and social service providers in local communities.
The act also supports the sole federal job program targeting low-income older workers, and funds
training, research, and demonstration activities in the field of aging.
Prior to the creation of the act in 1965, older persons were eligible for limited social services
through some federal programs. However, with the recognition that older individuals were
becoming an increasing proportion of the population and that their needs were not being formally
addressed through existing programs, many groups began advocating on their behalf. Their
actions led President Truman to initiate the first National Conference on Aging in 1950.
Conferees called for government and voluntary agencies to accept greater responsibility for the
problems and welfare of older persons.
Further interest in the field of aging led President Eisenhower to create the Federal Council on
Aging in 1956 to coordinate the activities of the various units of the federal government related to
aging. The beginning of a major thrust toward legislation along the lines of the later-enacted OAA
was made at the 1961 White House Conference on Aging. The conferees called for a federal
coordinating agency in the field of aging to be set up on a statutory basis, with adequate funding
for coordinating federal efforts in aging, as well as a federal program of grants for community
services specifically for the elderly.1
In response to the White House Conference on Aging recommendations, legislation was
introduced in 1962 to establish an independent U.S. Committee on Aging to cut across the
responsibilities of many departments and agencies, and create a program of grants for social
services, research, and training that would benefit older persons. Legislation introduced in 1963
modified the 1962 proposal by creating within DHEW the AOA, which was to be under the
1 U.S. Department of Health Education and Welfare, Special Staff on Aging, The Nation and Its Older People, Report
of the White House Conference on Aging, Jan. 9-12, 1961, Washington, April 1961, http://hdl.handle.net/2027/
mdp.39015001657678.
Congressional Research Service
2
c11173008
.
Older Americans Act: Background and Overview
direction of a Commissioner for Aging, appointed by the President with the approval of the
Senate.
The OAA as introduced in 1965 paralleled the 1963 proposal. Sponsors emphasized how it would
provide resources necessary for public and private social service providers to meet the social
service needs of the elderly. The act received bipartisan support and was signed into law by
President Lyndon Johnson on July 14, 1965 (P.L. 89-73). In addition to creating AOA, the act
authorized grants to states for community planning and services programs, as well as for research,
demonstration, and training projects in the field of aging. In his remarks upon signing the bill, the
President indicated that the legislation would provide “an orderly, intelligent, and constructive
program to help us meet the new dimensions of responsibilities which lie ahead in the remaining
years of this century. Under this program every state and every community can now move toward
a coordinated program of services and opportunities for our older citizens.”2
Major Amendments to the Older Americans Act
Since the original legislation was enacted in 1965, the OAA has been amended numerous times.
The following provides a summary of major amendments to the OAA over the past four decades.
1960s
The first amendments to the act in 1967 (P.L. 90-42) extended authorization for the state grant
program and for research, demonstration, and training programs created in 1965. In 1969,
Congress added authority under P.L. 91-69 for a program of area-wide model projects to test new
and varied approaches to meet the social service needs of the elderly. The 1969 amendments also
authorized the foster grandparent and retired senior volunteer programs to provide part-time
volunteer opportunities for the elderly. (Authority for volunteer programs was subsequently
repealed and these programs were reauthorized under the Domestic Volunteer Service Act of
1973, P.L. 93-113).
1970s
Major amendments to the act occurred in 1972 with the creation of the national nutrition program
for the elderly (P.L. 92-258). The 1973 amendments (P.L. 93-29) represented a major shift in
federal law with the establishment of sub-state AAAs. For the first time, Congress authorized the
creation of local agencies whose purpose is to plan and coordinate services for older persons and
to act as advocates for programs on their behalf. These amendments also created legislative
authority for the community service employment program for older Americans which had
previously operated as a demonstration initiative under the Economic Opportunity Act. In 1974,
Congress passed legislation to extend the national nutrition program for the elderly (P.L. 93-351).
The 1975 amendments (P.L. 94-135) extended the OAA through 1978, specifying certain services
to receive funding priority under the state and area agency on aging program. In 1977, Congress
made changes to the OAA nutrition program under P.L. 95-65, which permitted states to receive
cash payments in lieu of donated food under the U.S. Department of Agriculture’s surplus
commodities food program.
2 Public Papers of the Presidents of the United States, Lyndon B. Johnson, vol. 2, Washington, 1965, p. 744.
Congressional Research Service
3
c11173008
.
Older Americans Act: Background and Overview
The 1978 amendments (P.L. 95-478) represented a major structural change to the act when the
separate grant programs for social services, nutrition services, and multipurpose senior center
facilities were consolidated into one program under the authority of SUAs and AAAs. The intent
of these amendments was to improve coordination among the various service programs under the
act. Among other changes were requirements for establishing state long-term care ombudsman
programs and a new Title VI authorizing grants to Indian tribal organizations for social and
nutrition services to older Native Americans.
1980s
The 1981 amendments (P.L. 97-115) made modifications to give SUAs and AAAs more
flexibility in the administration of their service programs. These amendments also emphasized the
transition of participants to private sector employment under the community service employment
program. In 1984, Congress enacted a number of provisions (P.L. 98-459), including adding
responsibilities for AOA; adding provisions designed to target services toward low-income
minority older persons; giving more flexibility to states regarding service funds allocations; and
giving priority to the needs of Alzheimer’s patients and their families. The 1986 amendments
(P.L. 99-269) increased authorized appropriations to provide a higher per meal reimbursement
rate and directed the Secretary of Agriculture and the Department of Health and Human Services
(HHS) to inform states, AAAs, and meal providers of their eligibility to participate in the
National Commodity Processing Program.
The 1987 amendments (P.L. 100-175) expanded certain service components of SUAs and AAAs
to address the special needs of certain populations. Congress authorized the following six
additional distinct authorizations of appropriations for services: in-home services for the frail
elderly; long-term care ombudsman services; assistance for special needs; health education and
promotion services; services to prevent abuse, neglect, and exploitation of older individuals; and
outreach activities for persons who may be eligible for benefits under the supplemental security
income (SSI), Medicaid, and food stamp programs. Among other changes were provisions
designed to give special attention to the needs of older Native Americans and persons with
disabilities, emphasize targeting of services to those most in need, elevate the status of AOA
within HHS, and liberalize eligibility of community service employment participants for other
federal programs.
1990s
The 1992 amendments (P.L. 102-375) restructured some of the act’s programs. A new Title VII,
Vulnerable Elder Rights Protection Activities, was created to consolidate and expand certain
programs that focus on protection of the rights of older persons. Title VII incorporated separate
authorizations of appropriations for the long-term care ombudsman program; program for the
prevention of elder abuse, neglect, and exploitation; elder rights and legal assistance development
program; and outreach, counseling, and assistance for insurance and public benefit programs. In
addition, provisions were included to strengthen requirements related to targeting of Title III
services on special population groups. Other amendments authorized programs for assistance to
caregivers of the frail elderly; clarified the role of Title III agencies in working with the for-profit
sector; and required improvements in AOA data collection.
In 1993, Congress amended the OAA (P.L. 103-171) to establish an Assistant Secretary for Aging
(formerly the Commissioner on Aging) within HHS, extended the time frame for convening the
Congressional Research Service
4
c11173008
.
Older Americans Act: Background and Overview
White House Conference on Aging, and made technical amendments to the act and several other
acts.
2000s
The 2000 amendments (P.L. 106-501) were enacted after six years of congressional debate on
reauthorization. P.L. 106-501 extended the act’s authorizations of appropriations for programs
through FY2005. These amendments authorized the National Family Caregiver Support Program
under Title III; required the Secretary of Labor to establish performance measures for the senior
community service employment program; allowed states to impose cost-sharing for certain Title
III services older persons receive while retaining authority for voluntary contributions by older
persons toward the costs of services; and consolidated a number of previously separately
authorized programs. In addition, the amendments required the President to convene a White
House Conference on Aging by December 31, 2005.
In 2003, Congress amended the OAA (P.L. 108-7) to revise provisions for the Nutrition Services
Incentives Program, whereby maintaining access to commodities within USDA but transferring
authority for such program from the USDA, where it had been since its inception, to AOA.
The 2006 amendments (P.L. 109-365) extended the act’s authorizations of appropriations for
programs through FY2011. Among other things, P.L. 109-365 authorized the Assistant Secretary
for Aging to designate an individual within AOA to be responsible for prevention of elder abuse,
neglect, and exploitation and to coordinate federal elder justice activities. It revised the formula
for the allocation of Title III funds and revised the Title V community service employment
program to place more emphasis on training of older individuals, while maintaining emphasis on
placing them in community service activities. The law also required the Secretary of Labor to
conduct a national competition for Title V funds every four years. The 2006 amendments also
required states to conduct increased planning efforts related to the growing number of older
people in coming decades, and focused attention on the needs of older people with limited
English proficiency and those at risk of institutional placement. The law added authority for the
Assistant Secretary for Aging to conduct several new demonstration programs under Title IV.
Among these are demonstration projects for model projects to assist older people to age in place,
including supportive services programs in Naturally Occurring Retirement Communities
(NORCs).
Older Americans Act: Current Law
The OAA statutory language contains seven titles. Funding for OAA programs is provided in
annual HHS appropriations; OAA Title V is part of annual DOL appropriations. Final FY2015
funding for OAA programs totals $1.878 billion.3 Title III received the largest proportion of OAA
funding, with 71% of funding appropriated to nutrition, supportive services, family caregivers,
and health promotion activities. Almost one-fourth of OAA funding (23%) was allocated to Title
3 FY2015 funding data in this report is from Division G of the joint explanatory text to Rules Committee Print 113-59,
cited in “Explanatory Statement Submitted by Mr. Rogers of Kentucky, Chairman of the House Committee on
Appropriations Regarding Amendment to the Senate Amendment on H.R. 83, Consolidated and Further Continuing
Appropriations Act, 2015,” House of Representatives, Congressional Record, vol. 160, no. 151 Book II (December 11,
2014), pp. H9838, H9878-H9880.
Congressional Research Service
5
c11173008
.
Older Americans Act: Background and Overview
V, the Community Service Employment for Older Americans (CSEOA) Program. The remainder
was allocated to OAA activities under Titles II, IV, VI, and VII. The following provides a brief
summary of each title of the act.
Title I. Declaration of Objectives; Definitions
Title I of the OAA sets out broad social policy objectives oriented toward improving the lives of
all older Americans, including adequate income in retirement, the best possible physical and
mental health, opportunity for employment, and comprehensive long-term care services, among
other things. Also, Title I provides definitions for various terms under the act. Title I does not
authorize appropriations.
Title II. Administration on Aging
Title II establishes the Administration on Aging (AOA) as the chief federal agency advocating for
older persons and sets out the responsibilities of AOA and the Assistant Secretary for Aging. The
Assistant Secretary is appointed by the President with the advice and consent of the Senate. Title
II also establishes State Units on Aging (SUAs), who serve as the state agency primarily
responsible for planning and policy development as well as administration of OAA activities. In
addition, the act authorizes the Assistant Secretary to make grants to eligible tribal organizations
for social and nutrition services to older Native Americans (see report section entitled, “Title V.
Community Service Employment for Older Americans”).
Title II also establishes Area Agencies on Aging (AAAs), which are designated by SUAs to
operate within specified planning and service areas. AAAs serve as local entities who, either
directly or through contract with local service providers, oversee a comprehensive and
coordinated service system for the delivery of social, nutrition, and long-term services and
supports to older individuals. Collectively, these 56 SUAs, 618 AAAs, 246 tribal and Native
Hawaiian organizations, and almost 20,000 aging and social service providers in local
communities comprise the Aging Network (see Figure 1).4 With respect to the distribution of
federal funding, AOA allocates federal funds authorized under OAA statutory funding formulas to
SUAs and tribal organizations. SUAs, in turn, award these funds to AAAs based on an intrastate
funding formula developed in accordance with AOA guidelines and approved by the Assistant
Secretary.
4 The 56 State Units on Aging include the 50 states, 5 U.S. territories, and the District of Columbia. U.S. Department of
Health and Human Services, Administration for Community Living, Fiscal Year 2015 Justification of Estimates for
Appropriations Committees, March 2014, p. 1, http://acl.gov/About_ACL/Budget/docs/FY_2015_ACL_CJ.pdf.
Congressional Research Service
6
c11173008
.
Older Americans Act: Background and Overview
Figure 1. The Aging Network
Source: Prepared by the Congressional Research Service.
Funding authorized under Title II goes toward program administration, the Senior Medicare
Patrol program, Aging and Disability Resource Centers (ADRCs), described in greater detail
below, and other authorized activities that support the Aging Network and Elder Rights activities
(see textbox entitled “OAA Title II: Aging Network and Elder Rights Support Activities”). In
total, Title II discretionary activities were funded at $50.0 million in FY2015, which includes
program administration funding for all Administration for Community Living (ACL) programs,
not just those authorized by the OAA.
Senior Medicare Patrol
The Senior Medicare Patrol Program funds projects that educate older Americans and their
families to recognize and report Medicare and Medicaid fraud. The program received $8.9 million
in discretionary funding for FY2015. The Senior Medicare Patrol program also receives
mandatory Health Care Fraud and Abuse Control (HCFAC) funds, which are distributed to
various anti-fraud activities from the Medicare Trust Fund at the joint discretion of the HHS
Secretary and Attorney General. HCFAC funding for the program was $6.6 million in FY2014.5
Aging and Disability Resource Centers
The aim of Aging and Disability Resource Centers (ADRCs) is to create “one-stop shop” single
entry points for information about the range of public and private long-term services and supports
(LTSS) available to consumers. ADRCs may provide options counseling regarding public and
5 Health Care Fraud and Abuse Control (HCFAC) funding amounts obtained by email from Steve Hagy, Director,
Office of Budget and Finance, Administration for Community Living, January 13, 2015. HCFAC funds included $3.2
million for State Medicare Patrol expansion grants and $3.4 million for infrastructure.
Congressional Research Service
7
c11173008
.
Older Americans Act: Background and Overview
private LTSS, and provide access to public programs such as Medicaid and Department of
Veterans Affairs programs. ADRCs may also provide discharge planning and care transition
services to help individuals remain in their own homes after a hospitalization, rehabilitation, or
skilled nursing facility visit. There are over 500 ADRC sites nationwide, operating in 50 states,
two territories, and the District of Columbia.6 Discretionary funding to ADRCs was $6.1 million
in FY2015.
OAA Title II: Aging Network and Elder Rights Support Activities
The fol owing OAA programs and activities are funded under OAA Title II:
Aging Network Support Activities
•
The National Eldercare Locator and Engagement assists individuals, through a nationwide
tol -free phone number and website, in identifying community resources for older
persons (http://www.eldercare.gov, or 1-800-677-1116). It also supports model
programs in senior civic engagement and volunteer engagement (FY2015 funding is $2.0
million).
•
The Pension Counseling and Information Program provides funds to six regional counseling
projects that help older Americans learn about and receive the retirement benefits to
which they are entitled (FY2015 funding is $1.6 million).
Elder Rights Support Activities
•
The National Center on Elder Abuse provides information to the public and professionals
regarding elder abuse prevention activities, and provides training and technical assistance
to state elder abuse agencies and to community-based organizations
(http://www.ncea.aoa.gov, FY2015 funding is $765,000).
•
The National Long-Term Care Ombudsman Resource Center provides training and technical
assistance to state and local long-term care ombudsmen (http://www.ltcombudsman.org,
FY2015 funding is $516,000).
Source: FY2015 funding amounts obtained by email from Steve Hagy, Director, Office of
Budget and Finance, Administration for Community Living, January 13, 2015. Amounts
rounded to the nearest hundred thousand or thousand, where applicable.
Note: ACL reported combined program funding for the National Eldercare Locator and civic
engagement under National Eldercare Locator and Engagement; however, civic engagement
activities are authorized under OAA Title IV, Section 417, and included under Title II activities
for simplicity.
Title III. Grants for State and Community Programs on Aging
Title III authorizes grants to 56 SUAs and 618 AAAs to act as advocates on behalf of, and to
coordinate programs for, older persons. Title III accounted for 71% of the OAA’s total FY2015
funding ($1.328 billion out of $1.878 billion). States receive separate allotments of funds based
on a statutory funding formula for supportive services and centers, family caregiver support,
congregate nutrition, home-delivered nutrition, the nutrition services incentive grant program, and
disease prevention and health promotion services.7 The OAA allows states some flexibility to
6 U.S. Department of Health and Human Services, Administration for Community Living, Fiscal Year 2015
Justification of Estimates for Appropriations Committees, p. 195. A directory of ADRCs is at the Aging and Disability
Resource Center Technical Assistance Exchange website at http://www.adrc-tae.org/tiki-index.php?page=
ADRCLocator.
7 State allotments for Title III programs are listed at HHS, AOA, Funding Allocations to State and Tribal
Organizations, http://www.aoa.gov/AoA_programs/OAA/Aging_Network/State_Allocations/index.aspx.
Congressional Research Service
8
c11173008
.
Older Americans Act: Background and Overview
transfer funds among Title III programs. For example, in FY2012, states collectively transferred a
net total of $82.3 million from congregate nutrition to either supportive services or home-
delivered nutrition.8
Title III services are available to all persons aged 60 and older, but are targeted at those with the
greatest economic or social need, particularly low-income and minority persons, older individuals
with limited English proficiency, and older persons residing in rural areas. Means testing is
prohibited. Participants are encouraged to make voluntary contributions for services they receive.
States are allowed to implement cost-sharing policies for certain services on a sliding-scale fee
basis, but older persons must not be denied services due to failure to make cost-sharing payments.
State, local, and private funding sources also supplement federal OAA funds for these services.
In FY2012, the most recent year for which data are available, 11.7 million older persons were
served by Title III programs.9 Title III services included the provision of 137.4 million home-
delivered meals; 86.3 million congregate meals; 24.5 million rides to medical appointments,
grocery stores, and other activities; 29 million hours of personal care, homemaker, and chore
services; and 8 million hours of adult day care/adult day health services in FY2012.10
Title IV. Activities for Health, Independence, and Longevity
Title IV of the OAA authorizes the Assistant Secretary for Aging to award funds for training,
research, and demonstration projects in the field of aging.11 Over the years, Title IV has supported
a wide range of research and demonstration projects, including those related to income, health,
housing, retirement, and long-term services and supports, as well as projects on career preparation
and continuing education for personnel in the field of aging. Title IV activities received $12.9
million in FY2015. Funding provided under Title IV goes toward various activities that are
designed to support health, independence, and longevity of older individuals (see textbox entitled
“OAA Title IV: Activities for Health, Independence, and Longevity”).
8 U.S. Department of Health and Human Services, Administration on Aging, FY2012 Report to Congress, p. 15, 2012,
http://www.acl.gov/NewsRoom/Publications/docs/AOA_2012_AnnualReport.pdf.
9 HHS, AOA, Aging Network, Aging Integrated Database (AGID), 2012 State Program Reports, Clients, Totals - All
Services: 50 States + DC & Territories, http://www.agid.acl.gov/.
10 U.S. Department of Health and Human Services, Administration for Community Living, Fiscal Year 2015
Justification of Estimates for Appropriations Committees, pp. 45, 55.
11 A compendium of many past Title IV grant projects is at http://www.aoa.acl.gov/Grants/Compendium/index.aspx.
Congressional Research Service
9
c11173008
.
Older Americans Act: Background and Overview
OAA Title IV: Activities for Health, Independence, and Longevity
The fol owing programs and activities are funded under OAA Title IV authorities:
Aging Network Support Activities
•
The National Alzheimer’s Call Center is staffed by customer service workers and social
workers; it provides free information, referrals, and counseling for persons with
Alzheimer’s disease, their families, and caregivers (FY2015 funding is $946,000).
•
The National Education and Resource Center on Women and Retirement Planning provides
workshops and information on financial education and retirement planning for
women (FY2015 funding is $235,000).
•
National Resource Centers on Native American Elders provide research and technical
information on health, long-term services and supports, elder abuse, mental health,
and other issues relevant to older Native Americans (FY2015 funding is $655,000).
•
National Minority Aging Organizations Technical Assistance Centers provide culturally and
linguistically appropriate information on health promotion and disease prevention for
Asian-Pacific American, Native American, Hispanic, and African-American older
individuals, and older lesbian, gay, bisexual, and transgender (LGBT) persons (FY2015
funding is $1.2 million).
•
Program Performance and Technical Assistance supports the development of outcome
measures and performance measurement tools to assess the results of OAA
programs (FY2015 funding is $799,000).
•
Holocaust Survivor’s Assistance provides supportive services for aging Holocaust
survivors living in the United States (FY2015 funding is $2.5 million).
Elder Rights Support Activities
•
Model Approaches to Statewide Legal Assistance Systems assists states to integrate senior
legal helplines into broader state legal service delivery networks (FY2015 funding is
$1.9 million).
•
National Legal Assistance and Support Projects provide services such as case
consultation, training, technical assistance, and information dissemination for aging
and legal services networks (FY2015 funding is $705,000).
•
The Elder Justice Initiative provides competitive grants to states to test and evaluate
innovative approaches to elder abuse (FY2015 funding is $4.0 million).
Source: FY2015 funding amounts obtained by email from Steve Hagy, Director, Office of
Budget and Finance, Administration for Community Living, January 13, 2015. Amounts
rounded to the nearest hundred thousand or thousand, where applicable.
Note: FY2015 funding for a new Elder Justice Initiative may also be used for activities
authorized under OAA Sections 751 and the Elder Justice Act (§2042(a) of the Social
Security Act).
Title V. Community Service Employment for Older Americans
Title V, Community Service Employment for Older Americans (CSEOA), also known as the
Senior Community Service Employment Program (SCSEP), has as its purpose the promotion of
useful part-time opportunities in community service activities for unemployed low-income12
persons who are 55 years or older and who have poor employment prospects. The Title V
program is administered by DOL’s Employment and Training Administration; it is the only OAA
12 Participants’ incomes must be no greater than 125% of the federal poverty guidelines, 20 C.F.R. §641.500.
Congressional Research Service
10
c11173008
.
Older Americans Act: Background and Overview
program not administered by ACL. For FY2015, Title V represented 23% of OAA funding
($434.4 million out of $1.878 billion). DOL allocates Title V funds for grants based on a statutory
funding formula to state agencies in all 50 states, the District of Columbia, Puerto Rico, and the
U.S. territories, and to national organizations. There is a 10% nonfederal match requirement for
Title V grant activities.
SCSEP participants are placed in part-time positions working in a variety of community service
activities, such as in day care centers, senior centers, schools, and hospitals.13 Participants work
part-time and receive on-the-job experience and skills. The program operates on a program year
(PY) basis from July 1 through June 30.14 For PY2012 (ending June 30, 2013), the CSEOA
program supported 46,221 job slots, serving 70,718 participants, at a cost of $6,339 per
participant.15 Enrollees are paid no less than the highest of the federal minimum wage, the state or
local minimum wage, or the prevailing wage paid by the same employer for similar public
occupations. In addition to wages, enrollees receive training, physical examinations, personal and
job-related counseling, transportation for employment purposes (under certain circumstances),
and placement assistance into unsubsidized jobs. In PY2012, 42% of participants who exited the
program found employment in the following quarter; of those, 73% remained employed through
the next two quarters.16
On September 1, 2010, DOL promulgated a final rule implementing changes made by the 2006
OAA amendments.17 These changes include a 48-month limit on individual participation,
increases in funds available for training and supportive services, and a requirement that national
grants be recompeted every four years, among other changes. The most recent competition for
national grantees was conducted in FY2012.
Title VI. Grants for Services for Native Americans
Title VI authorizes funds for supportive and nutrition services to older Native Americans. Funds
are awarded directly by ACL to Indian tribal organizations, Native Alaskan organizations, and
non-profit groups representing Native Hawaiians. To be eligible for funding, a tribal organization
must represent at least 50 Native Americans aged 60 and older. In FY2012, the most recent year
for which data are available, grants were awarded to 256 tribal organizations representing 400
Indian tribes, including two organizations serving Native Hawaiian elders.18 The program
provides services such as transportation, home-delivered and congregate nutrition services,
13 U.S. Department of Labor, Senior Community Service Employment Program, http://www.doleta.gov/Seniors/.
14 Program Year 2014 allotments were announced in DOL, Employment and Training Administration, Program Year
(PY) 2014 Planning Instructions and Allotments for Senior Community Service Employment Program (SCSEP)
Grantees, Training and Employment Guidance Letter No. 21-13, http://wdr.doleta.gov/directives/attach/TEGL/
TEGL_21-13.pdf. Per OAA Section 517(b), CSEOA is forward funded; for example, dollars appropriated in FY2014
(October 1, 2013 to September 30, 2014) are used for PY2014 (July 1, 2014 to June 30, 2015).
15 There are more participants than job slots in a given program year; as participants leave the program their job slots
can be filled by new participants. U.S. Department of Labor, Fiscal Year 2015 Congressional Budget Justification,
Employment and Training Administration, Community Service Employment for Older Americans, p. CSEOA-12,
http://www.dol.gov/dol/budget/2015/PDF/CBJ-2015-V1-07.pdf.
16 Ibid., p. CSEOA-12.
17 U.S. Department of Labor, Employment and Training Administration, “Senior Community Service Employment
Program; Final Rule,” 75 Federal Register 53786, September 1, 2010. The rule’s effective date was October 1, 2010.
18 U.S. Department of Health and Human Services, Administration for Community Living, Fiscal Year 2015
Justification of Estimates for Appropriations Committees, p. 86.
Congressional Research Service
11
c11173008
.
Older Americans Act: Background and Overview
information and referral, and a wide range of home care services. Title VI also authorizes
caregiver support services to Native American elders. Respite, caregiver training, information and
outreach, counseling, and support groups are among the services provided. For FY2015, these
programs received $32.2 million ($26.2 million for supportive and nutrition services, and $6.0
million for Native American family caregivers).
Title VII. Vulnerable Elder Rights Protection Activities
Title VII authorizes the Long-Term Care (LTC) Ombudsman Program as well as Elder Abuse,
Neglect, and Exploitation Prevention Programs. For FY2015, these programs received a total of
$20.7 million.19 The majority of Title VII funding ($15.9 million, or 77%, in FY2015) is directed
at the LTC Ombudsman Program, which investigates and resolves complaints of residents in
nursing facilities, board and care facilities, and other adult care homes.20 In FY2013, ombudsmen
handled almost 191,000 complaints and provided almost 465,000 consultations to individuals and
long-term care facilities.21
19 State allocation tables are at AOA, Funding Allocations to States and Tribal Organizations, http://www.aoa.gov/
AoA_programs/OAA/Aging_Network/State_Allocations/index.aspx.
20 FY2015 funding amounts obtained by email from Steve Hagy, Director, Office of Budget and Finance,
Administration for Community Living, January 13, 2015.
21 U.S. Department of Health and Human Services, Administration for Community Living, “Administration on Aging
(AOA), Long-Term Care Ombudsman Program,” http://www.aoa.acl.gov/AoA_Programs/Elder_Rights/Ombudsman/
index.aspx.
Congressional Research Service
12
c11173008
.
Older Americans Act: Background and Overview
Appendix. Older Americans Act Reauthorization
Act of 2015, S. 192: Section-by-Section Summary of
Key Provisions
The following is a section-by-section summary of key provisions in S. 192, as reported to the
Senate on February 3, 2015.
Section 1. Short Title
States the title of the bill as Older Americans Act Reauthorization Act of 2015.
Section 2. Definitions
The bill would add or amend terms and definitions under OAA Title I. Specifically, it would
replace the term “abuse” with a new definition and would add a new term and definition for
“adult protective services.” It would also amend the definition of “Aging and Disability Resource
Center” and “elder justice,” and it would establish that the term “exploitation” also includes
“financial exploitation.” It would further amend the definition of “disease prevention and health
promotion services” to include oral health as a part of routine health screening. For a comparison
of these current law definitions and proposed changes to the term or definition, see Table A-1,
which follows the section-by-section summary.
Section 3. Administration on Aging
The bill would make the following amendments to Title II of the act, which sets forth
requirements for the Administration on Aging (AOA).
Best Practices
The bill would add a new requirement for the AOA Director of the Office of LTC Ombudsman
Programs to collect and analyze best practices related to responding to elder abuse, neglect, and
exploitation in LTC facilities, and publish a report. It would further require that the Assistant
Secretary, acting through the designee responsible for elder abuse prevention and services,
coordinate with the heads of state adult protective services programs and the Director of the
Office of LTC Ombudsman Programs in fulfilling specified responsibilities.
Technical Assistance and Training
The bill would amend the function of the Assistant Secretary for Aging to include the term
“health and economic” in requiring the AOA to (1) assist in the establishment of programs
designed to meet the health and economic needs of older individuals; and (2) prepare, publish,
and disseminate educational materials dealing with the “health and economic” welfare of older
individuals. It would also include reference to the Health Resources and Services Administration
(HRSA) in requiring the AOA to coordinate with other agencies in developing a national plan
regarding specified training needs in the field of aging.
Congressional Research Service
13
c11173008
.
Older Americans Act: Background and Overview
The bill would add a new provision requiring the AOA to provide information and technical
assistance to states, AAAs, and service providers, in collaboration with relevant federal agencies,
on providing efficient, person-centered transportation services, including across geographic
boundaries. It would add a new provision requiring the AOA to identify model programs and
provide information and technical assistance to states, AAAs, and service providers to support the
modernization of senior centers. It would also require the AOA to provide technical assistance
and share best practices with states, AAAs, and ADRCs on how to collaborate and coordinate
services with health care entities such as Federally Qualified Health Centers (FQHCs) in order to
improve care coordination for individuals with multiple chronic illnesses.
It would require the Assistant Secretary in providing for the AOA to play a lead role with respect
to issues concerning home and community-based long-term care to include, when feasible,
developing a consumer-friendly tool to assist older individuals and their families in choosing
home and community-based services with particular focus on ways for consumers to assess how
providers protect the health, safety, welfare, and rights of older individuals including the rights
provided under OAA Section 314 (regarding Rights Related to In-Home Services for Frail
Individuals).
In requiring the Assistant Secretary to implement ADRCs in all states, the bill would amend
language with respect to ADRCs providing personalized and consumer-friendly assistance to
empower individuals to “identify and articulate goals of care” and to help individuals “respond
to” or plan ahead for their “long-term care needs.” It would also add a new provision requiring
ADRCs to provide information and referrals regarding available home and community-based
services for individuals who are at risk for residing in, or who reside in, institutional settings, so
that the individuals have the choice to remain in or return to the community.
It would further add a new provision requiring the Assistant Secretary to ensure that programs
authorized under the OAA include appropriate training in the prevention of abuse, neglect, and
exploitation and provision of services that address elder justice and exploitation of older
individuals.
Authorization of Appropriations
It would authorize the appropriation of such sums as may be necessary for each of FY2016
through FY2018 for the following activities: administration, salaries, and expenses for AOA; the
eldercare locator service; and pension counseling and information programs.
Section 4. State and Community Programs on Aging
The bill would make the following amendments to OAA Title III, which provides grants for state
and community programs on aging.
Authorizations of Appropriations
The bill would authorize the appropriation of such sums as necessary for each of FY2016 through
FY2018 for OAA Title III Part B, Supportive Services; Part C, Subpart 1, Congregate Nutrition
Services; Part C, Subpart 2, Home-Delivered Nutrition Services; and Part D, Disease Prevention
and Health Promotion. It would also authorize the appropriation of $187 million for each of FYs
2016 through 2018 for Part E, National Family Caregiver Support Program.
Congressional Research Service
14
c11173008
.
Older Americans Act: Background and Overview
Statutory Funding Formula Allocations
The bill would change the statutory funding allocations for OAA Title III, Parts B, C, and D,
which allocate funding to supportive services, congregate nutrition, home-delivered nutrition, and
preventive services. It would retain the same state and territory minimum amounts allotted under
current law and the same population-based formula factor (aged 60 and over), but would reduce
state and U.S. territory hold harmless amounts (currently referenced to FY2006 funding levels)
by 1% from the previous fiscal year as follows:
• For FY2016, no state would receive less than 99% of the annual amount allotted
to the state in FY2015.
• For FY2017, no state would receive less than 99% of the annual amount allotted
to the state in FY2016.
• For FY2018, no state would receive less than 99% of the annual amount allotted
to the state in FY2017.
• For FY2019 and each subsequent fiscal year, no state would receive less than
100% of the annual amount allotted to the state in FY2018.22
Area Plans
The bill would include the term “modernization” in requiring that each plan provide for certain
specified services through a comprehensive and coordinated system for the establishment,
maintenance, modernization, or construction of multipurpose senior centers (including a plan to
use the skills and services of older individuals in paid and unpaid work, including
multigenerational and older individual to older individual work). It would also add a new
provision that would require the area plan to provide that the AAA will, in coordination with the
state agency and with the state agency responsible for elder abuse prevention services, increase
public awareness of elder abuse, neglect, and exploitation, and remove barriers to education,
prevention, investigation, and treatment of elder abuse neglect and exploitation education, as
appropriate. It would include protection from elder abuse, neglect, and exploitation among a list
of topics that AAAs may make recommendations to government officials in the planning and
service area as well as recommendations to the state on actions to build capacity to meet the
needs of older individuals in the planning and service area.
Supportive Services and Senior Centers Program
The bill would include chronic condition self-care management and falls prevention to the list of
supportive services that state grant programs may provide. It would also add behavioral health
screening and falls prevention services screening, and screening for elder abuse, neglect, and
exploitation to this list. It would amend language to add senior center modernization to a list of
grant activities the Assistant Secretary must make to states. It would further require the AAAs to
make efforts to coordinate the services with agencies and organizations carrying out
22 For further information about OAA statutory funding formulas and analysis of proposed change to certain Title II
Program’s statutory funding formula under S. 192, see CRS Report RS22549, Older Americans Act: Funding
Formulas, by Kirsten J. Colello.
Congressional Research Service
15
c11173008
.
Older Americans Act: Background and Overview
intergenerational projects to pursue opportunities for the development of intergenerational shared
site models for programs or projects, consistent with the OAA’s purposes.
Nutrition Services
The bill would authorize the appropriation of such sums as necessary for each of FY2016 through
FY2018 for the Nutrition Services Incentive Program (NSIP). It would also replace the term
“solicit” with “utilize” in requiring the state to ensure that a nutrition project “utilize” the
expertise of a dietician or other individuals with equivalent education and training in nutrition
science, or an individual with comparable expertise. It would further amend this section to add
that, where feasible, the state should ensure that the nutrition project encourages the use of locally
grown foods in meals programs and identifies potential partnerships and contracts with local
producers and providers of locally grown foods.
Disease Prevention and Health Promotion Services Program
The bill would amend Part D to establish an “Evidence-Based” Disease Prevention and Health
Promotion Services Program and require the Assistant Secretary to provide grants to states for
“evidence-based” disease prevention and health promotion services and information.
National Family Caregiver Support Program
The bill would replace the definition of “child” (which currently includes an individual with a
disability) with separate definitions of the terms “child” and “individual with a disability.”
Specifically, it would define the term “child” to mean an individual who is not more than 18 years
of age. It would define the term “individual with a disability” to mean an individual with a
disability, as defined in Section 3 of the Americans with Disabilities Act (ADA), who is not less
than 18 and not more than 59 years of age.
It would also replace the term “grandparent or older individual who is a relative caregiver” with
the term “older relative caregiver.” It would define “older relative caregiver” to mean a caregiver
who is 55 years of age or older and who lives with, is the informal provider of in-home
community care to, and is the primary caregiver for a child or an individual with a disability. In
the case of a caregiver for a child, an older relative caregiver is the grandparent, step-grandparent,
or other relative (other than the parent) by blood, marriage, or adoption, of the child; is the
primary caregiver of the child because the biological or adoptive parents are unable or unwilling
to serve as the primary caregivers of the child; and has a legal relationship to the child, such as
legal custody, adoption, or guardianship, or is raising the child informally. In the case of a
caregiver for an individual with a disability, an older relative caregiver is the parent, grandparent,
or other relative by blood, marriage, or adoption, of the individual with a disability.
Section 5. Activities for Health, Independence, and Longevity
Under OAA Title IV, the bill would authorize the Assistant Secretary to make grants and enter
into contracts providing continuing support for Medicare program integrity initiatives that train
senior volunteers to prevent and identify health care fraud and abuse. It would authorize the
appropriation of such sums as may be necessary for each of FY2016 through FY2018 to carry out
training, research, and discretionary projects relating to older Americans. It would further amend
Congressional Research Service
16
c11173008
.
Older Americans Act: Background and Overview
requirements for training grants under Native American Programs to provide annually for
“national trainings” for directors of programs under Title IV of the act instead of (as currently) an
annual national training meeting.
Also under OAA Title IV, it would also amend requirements for legal assistance demonstration
and support projects for older individuals to require that the Assistant Secretary make grants or
enter into contracts with “nonprofit organizations” experienced in providing support and technical
assistance on a nationwide basis to certain specified entities and other organizations interested in
the legal rights of older individuals instead of (as currently) “national nonprofit organizations”
with such experience. The bill would repeal certain grant programs under Title IV of the act.
Specifically, it would repeal grants for Section 415 (Computer Training), Section 419
(Multidisciplinary Centers and Multidisciplinary Systems), and Section 421 (Ombudsman and
Advocacy Demonstration Projects).
Section 6. Community Service Senior Opportunities
The bill would authorize the appropriation of such sums as necessary for each of FY2016 through
FY2018 for the Community Service Employment for Older Americans Program under Title V of
the act.
Section 7. Grants for Native Americans
The bill would authorize the appropriation of such sums as necessary for each of FY2016 through
FY2018 for the Native American Caregiver Support Program under Title VI of the act.
Section 8. Vulnerable Elder Rights Protection Activities
Ombudsman Definitions
The bill would amend the definition of the term resident to mean “an individual” who resides in a
long-term care facility instead of (as currently) “older individual.”
Ombudsman Programs
The bill would require the state long-term care (LTC) Ombudsman to be responsible for the
management, including the fiscal management, of the Office of the State LTC Ombudsman
(hereinafter referred to as the “Office”). It would amend the functions of the Ombudsman to add
language stating that the Ombudsman’s functions include identifying, investigating, and resolving
complaints that are made by, or on behalf of, residents with limited or no decision-making
capacity and who have no known legal representative. It would further specify that if such a
resident is unable to communicate consent for an Ombudsman to work on a complaint involving
the resident, the Ombudsman would be required to seek evidence to indicate what outcome the
resident would have communicated and work to accomplish that outcome. It would also amend
the duties of designated local ombudsman entities and representatives to identify, investigate, and
resolve complaints made by or on behalf of residents with limited decision-making capacity in
similar circumstances.
Congressional Research Service
17
c11173008
.
Older Americans Act: Background and Overview
In addition to residents having regular and timely access to the Ombudsman’s services, the bill
would require that the Ombudsman ensure residents have private and unimpeded access to such
services. In providing technical support for the development of resident and family councils, the
bill would require the Ombudsman to actively encourage and assist the development of such
councils. Similarly, it would amend the duties of designated local ombudsman entities and
representatives to actively encourage and assist in the development of such councils. It would
further add that the Ombudsman, when feasible, continue to carry out specified functions on
behalf of residents transitioning from a LTC facility to a home care setting.
Procedures for Access
It would amend the requirement that a state ensure representatives of the Office have “access” to
LTC facilities and residents to specify that representatives have “private and unimpeded access.”
It would also amend language that representatives have appropriate access to review the medical
and social records of a resident, subject to certain conditions, to state that representatives have
appropriate access to “all files, records, and other information” concerning a resident rather than
(as currently) “files.” It would amend language clarifying that representatives have appropriate
access to review such information when a resident is “unable to communicate consent” to the
review and has no legal representative, rather than (as currently) “unable to consent.” Similarly, it
would amend language that representatives have access to the “records” as is necessary to
investigate a complaint, to specify that representatives have access to the “files, records, and
information” necessary.
It would add that the Ombudsman and representatives of the Office would be considered a
“health oversight agency” for purposes of Section 246(c) of the Health Insurance Portability and
Accountability Act of 1996 (HIPAA, including regulations issued under that section). Thus, the
release of residents’ individually identifiable health information to the Ombudsman could not be
prevented from occurring under certain specified circumstances.
Disclosure
The act requires the state agency to establish procedures for the disclosure of files maintained by
the program by the Ombudsman or other ombudsman entities. The bill would strike the language
“files and records” and replace with “files, records, and other information” each place the term
appears under disclosure requirements. It would amend disclosure requirements pertaining to the
identity of the complainant or resident to ensure that the Ombudsman may disclose information as
needed in order to best serve residents with limited or no decision-making capacity who have no
known legal representative and are unable to communicate consent, in order for the Ombudsman
to carry out functions and duties as described.
Conflict of Interest
The bill would replace the subsection on conflict of interest with a new subsection that separately
describes individual and organizational conflict of interest.
Congressional Research Service
18
c11173008
.
Older Americans Act: Background and Overview
Individual Conflict of Interest
The bill would require the state agency to ensure that no individual, or member of an immediate
family of an individual, involved in the designation of the Ombudsman, or the designation of a
local ombudsman entity or representative, is subject to a conflict of interest. Furthermore, the
state agency would be required to ensure that no officer or employee of the Office, representative
of a local Ombudsman entity, or member of the immediate family of the office, employee, or
representative, be subject to a conflict of interest. The bill would also require the state agency to
ensure that the Ombudsman
• does not have direct involvement in the licensing or certification of a LTC facility
or provider of a LTC service;
• does not have an ownership or investment interest in a LTC facility or service;
• is not employed by, or participating in the management of, a LTC facility or a
related organization, and has not been employed by such a facility or
organization within one year before the date of the determination involved;
• does not receive, or have the right to receive, directly or indirectly, remuneration
under a compensation arrangement with an owner or operator of a LTC facility;
• does not have management responsibility for, or operate under the supervision of
an individual with management responsibility for adult protective services
(APS); and
• does not serve as a guardian or in another fiduciary capacity for residents of LTC
facilities in an official capacity.
Organizational Conflict of Interest
The bill would require the state agency to comply with specified requirements in a case where the
Office poses an organizational conflict of interest, including a situation in which the Office is
placed in an organization that is responsible for licensing, certifying, or surveying LTC services in
the state; is an association of LTC facilities or any other residential facilities for older individuals;
provides LTC services including those carried out under certain Medicaid waiver and other
authorities; provides LTC case management; sets rates for LTC services; provides APS; is
responsible for Medicaid eligibility determinations; conducts preadmission screenings for
placement in LTC facilities; or makes decisions regarding admission or discharge of individuals
to or from such facilities.
The state agency would not be authorized to operate the Office or carry out the program, directly,
or by contract or other arrangement, in a case in which there is an organizational conflict of
interest unless such conflict of interest has been identified by the state agency, disclosed by the
state agency to the Assistant Secretary in writing, and remedied in accordance with certain
requirements. In a case where potential or actual organizational conflict of interest involving the
Office is disclosed or reported to the Assistant Secretary by any person or entity, the Assistant
Secretary would require the state agency to remove the conflict or submit and obtain the approval
of the Assistant Secretary for an adequate remedial plan that indicates how the Ombudsman will
be unencumbered in fulfilling specified functions.
Congressional Research Service
19
c11173008
.
Older Americans Act: Background and Overview
With respect to the state agency requiring the Office to provide such information as it determines
necessary to public and private agencies and other entities regarding the problems and concerns
of those residing in LTC facilities, it would specify that such information could be provided for
all “individuals” in LTC facilities, regardless of age, rather than (as currently) “older individuals.”
It would also specify that the state agency require the Office, no later than one year after the date
of enactment, “strengthen and update” procedures for the training of the representatives of the
Office, rather than (as currently) “establish” such procedures. It would add a provision that the
state agency require the Office to ensure the Ombudsman, or a designee, participate in training
provided by the National Ombudsman Resource Center.
Prevention of Elder Abuse, Neglect, and Exploitation
Under current law, the state agency is required to use its elder abuse program allotment to carry
out specified activities to develop programs for the prevention, detection, treatment, and response
to elder abuse, neglect, and exploitation. The bill would include as a new activity promoting the
submission of data on elder abuse, neglect, and exploitation for the appropriate database among
the list of existing activities the state agency may engage in to carry out such programs.
It would also add new language under an existing activity promoting the development of an elder
abuse, neglect, and exploitation system that includes, in connection with enforcement of elder
abuse laws and reporting of suspected elder abuse, language that would specify “forensic
specialists” in the use of such personnel trained in special problems of elder abuse. It would
further add language to this activity with respect to multidisciplinary programs and services to
ensure the state will deal effectively with elder abuse programs and arrangements that protect
against financial exploitation.
It would add new language under an existing activity supporting multidisciplinary elder justice
activities to include “supporting and studying innovative practices in communities to develop
partnerships across disciplines for the prevention, investigation, and prosecution of abuse,
neglect, and exploitation” to the list of example activities.
Section 9. Behavioral Health
The bill would amend certain sections of the act (§102, Definitions; §201, Establishment of AOA;
§202, Functions of the Assistant Secretary; and §321, Supportive Services and Senior Centers) to
include the term “behavioral” to specified provisions that address mental health to read “mental
and behavioral” health.
Section 10. Guidance on Serving Holocaust Survivors
The bill would require the Assistant Secretary to issue guidance to states, AAAs, and providers of
services for older individuals with respect to serving Holocaust survivors, including promising
practices for conducting outreach. It would require the Assistant Secretary to consult with experts
and organizations serving Holocaust survivors and take into account the possibility that the needs
of Holocaust survivors may vary based on geography. The proposed guidance must include how
certain providers, such as nutrition services providers, transportation service providers, LTC
ombudsman, and supportive services providers may address the specified needs of Holocaust
survivors under the act.
Congressional Research Service
20
c11173008
.
Table A-1. Comparison of Changes to Definitions in Title I of the Older Americans Act: Current Law and Older Americans
Act Reauthorization Act of 2015 (S. 192)
(Proposed changes to current law under S. 192 indicated in italics)
Term
Current Law
Senate Bill (S. 192), as Reported to Senate
Abuse
The term ‘‘abuse’’ means the willful—
The term “abuse” means the knowing infliction of physical or psychological harm
or the knowing deprivation of goods or services that are necessary to meet
(A) infliction of injury, unreasonable confinement, intimidation, or cruel
essential needs or to avoid physical or psychological harm.
punishment with resulting physical harm, pain, or mental anguish; or
(B) deprivation by a person, including a caregiver, of goods or services that
are necessary to avoid physical harm, mental anguish, or mental illness.
Adult
Not defined.
The term “adult protective services” means such services provided to adults as the
Protective
Secretary may specify and includes services such as—
Services
(A) receiving reports of adult abuse, neglect, or exploitation;
(B) investigating the reports described in subparagraph (A);
(C) case planning, monitoring, evaluation, and other casework and services; and
(D) providing, arranging for, or facilitating the provision of medical, social service,
economic, legal, housing, law enforcement, or other protective, emergency, or
support services.
c11173008
.
Aging and
The term ‘‘Aging and Disability Resource Center’’ means an entity
The term “Aging and Disability Resource Center” means an entity,
Disability
established by a State as part of the State system of long-term care, to
network, or consortium established by a State as part of the State system
Resource
provide a coordinated system for providing—
of long-term care, to provide a coordinated and integrated system for older
Center
individuals and individuals with disabilities [as defined in Sec. 3 of the
(A) comprehensive information on the full range of available public and
Americans with Disabilities Act of 1990 (42 U.S.C. 12102)], and the
private long-term care programs, options, service providers, and resources
caregivers of older individuals and individuals with disabilities, that
within a community, including information on the availability of integrated
provides—
long-term care;
(A) comprehensive information on the full range of available public and
(B) personal counseling to assist individuals in assessing their existing or
private long-term care programs, options, service providers, and resources
anticipated long-term care needs, and developing and implementing a plan
within a community, including information on the availability of integrated
for long-term care designed to meet their specific needs and circumstances; long-term care services, and Federal or State programs that provide long-term
and
care services and supports through home and community-based service programs;
(C) consumers access to the range of publicly-supported long-term care
(B) person-centered counseling to assist individuals in assessing their existing
programs for which consumers may be eligible, by serving as a convenient
or anticipated long-term care needs and goals, and developing and
point of entry for such programs.
implementing a person-centered plan for long-term care that is consistent with
the desires of such an individual and designed to meet the individual’s specific
needs, goals, and circumstances;
(C) access for individuals to the full range of publicly-supported long-term
care services and supports for which the individuals may be eligible,
including home and community-based service options, by serving as a
convenient point of entry for such programs and supports; and
(D) in cooperation with area agencies on aging, centers for independent
living described in part C of title VII of the Rehabilitation Act of 1973 (29
U.S.C. 796f et seq.), and other community-based entities, information and
referrals regarding available home and community-based services for
individuals who are at risk for residing in, or who reside in, institutional
settings, so that the individuals have the choice to remain in or to return to
the community.
Disease
The term ‘‘disease prevention and health promotion services’’ means—
The term ‘‘disease prevention and health promotion services’’ means—
Prevention
and Health
(A) health risk assessments;
(A) health risk assessments;
Promotion
(B) routine health screening, which may include hypertension, glaucoma,
(B) routine health screening, which may include hypertension, glaucoma,
Services
cholesterol, cancer, vision, hearing, diabetes, bone density, and nutrition
cholesterol, cancer, vision, hearing, diabetes, bone density, oral health, and
screening;
nutrition screening;
...
...
c11173008
.
Eder Justice
The term ‘‘elder justice’’—
The term “elder justice” means—
(A) used with respect to older individuals, col ectively, means efforts to
(A) from a societal perspective, efforts to—(i) prevent, detect, treat,
prevent, detect, treat, intervene in, and respond to elder abuse, neglect,
intervene in, and prosecute elder abuse, neglect, and exploitation; and (ii)
and exploitation and to protect older individuals with diminished capacity
protect older individuals with diminished capacity while maximizing their
while maximizing their autonomy; and
autonomy; and
(B) used with respect to an individual who is an older individual, means the
(B) from an individual perspective, the recognition of an older individual’s rights,
recognition of the individual’s rights, including the right to be free of abuse,
including the right to be free of abuse, neglect, and exploitation.
neglect, and exploitation.
Exploitation
The term ‘‘exploitation’’ means the fraudulent or otherwise illegal,
The term “exploitation and financial exploitation” mean the fraudulent or
and Financial
unauthorized, or improper act or process of an individual, including a
otherwise illegal, unauthorized, or improper act or process of an individual,
Exploitation
caregiver or fiduciary, that uses the resources of an older individual for
including a caregiver or fiduciary, that uses the resources of an older
monetary or personal benefit, profit, or gain, or that results in depriving an
individual for monetary or personal benefit, profit, or gain, or that results in
older individual of rightful access to, or use of, benefits, resources,
depriving an older individual of rightful access to, or use of, benefits,
belongings, or assets.
resources, belongings, or assets.
Source: CRS analysis of Section 102, Definitions, of the Older Americans Act (OAA, P.L. 89-73, as amended) and Section 2, Definitions, of the Older Americans Act
Reauthorization Act of 2015 (S. 192), as reported to Senate, February 3, 2015.
c11173008
.
Older Americans Act: Background and Overview
Author Contact Information
Kirsten J. Colello
Angela Napili
Specialist in Health and Aging Policy
Information Research Specialist
kcolello@crs.loc.gov, 7-7839
anapili@crs.loc.gov, 7-0135
Congressional Research Service
24
c11173008