the capacity of the aging services network: top 10 things ... · states and area agencies on aging...

The Capacity of the Aging Services Network:

Top 10 Things to Know for Reauthorization

1965

OAA, Medicare,

Medicaid

1972

SSI, Congregate Meals

1973

AAAs enacted

1975

SSBG

1981

Medicaid Waiver

1987

LTC Ombudsman

1990

Americans with

Disabilities Act

1999

Olmstead Decision

1992

Elder Rights title

added

2000

Family Caregiver

2006

First Boomers Turn 60

2006

ADRC, Health

Promotion, Nursing

Home Diversion

A Joint Proposal of NASUA and n4a 4

OAA

=0.066%

Total

Spending

$2.73

Trillion

AoA

State Units

on Aging

Area Agencies on

Aging

Title VI Native American

Aging Programs

Service Providers

Volunteers

56

244

0ver 30,000

Over 500,000

629

•The age wave has begun.

Source of charts: U.S. Census Bureau, “65+ in the United States: 2005,” December 2005.

2000 2020

0

10

20

30

40

50

60

70

80

nu

mb

ers

in

milli

on

s

1900-2030

05

101520253035404550

65-74

75-84

85 and older

The characteristics of the population served by the Aging Services Network continue to diversify, with nearly two-thirds of states and AAAs serving both the elderly and physically disabled younger adult populations regardless of age.

14%

64%

22% 60 years of age and older population only

60 years of age and older population and disabled population regardless of age

0%

10%

20%

30%

40%

50%

60%

70%

80%

Perc

en

t o

f S

tate

s

34.8

77.1

18.5

49.4

35.739.2

82.4

25.4

63.4

48.2

0

10

20

30

40

50

60

70

80

90

All age groups Older Adults 60+ Children 0-17 Adults ages 18-59 Private pay clients

Figure 7. Proportion of AAAs who are the Single Point of Entry for at least some services, by target population and year

2007

2008

Federal funding continues to decline despite growth in the number of eligible Americans.

2%

20%

22%56%

Less than $1 million

Between $1 and $25 million

Between $26 and $50 million

More than $50 million

Average of 30% of SUA budget is OAA funding

Average Budget: $ 7.5 millionLowest Quartile: $ 2.0 million

Second Quartile: $ 3.8 million

Third Quartile: $ 8.7 million

Average Percent of Budget from OAA: 40.4Lowest Quartile: 21.5

Second Quartile: 36.0

Third Quartile: 56.0

Although funding from the Administration on Aging has not kept pace with the numbers of individuals 60 plus, states, the Area Agencies on Aging and the other network partners have successfully leveraged federal funding

AoA

provides

seed

funding and

oversight

States add

states’ share of

federal funds,

provide

additional

state-only

support and

distribute

funds

AAAs may add

local funding

and support and

purchase

services

Providers add

additional

support and in-

kind

contributions

and deliver

services

Volunteers lend

time and

support

For every $1 in federal funding, state and local agencies on aging acquire more than $2 in other funding

Aging

Services

Network

OAA

Medicaid

State-

Only

Funding

Targeted

Tax/

Lottery

Private

Funding

Other

Federal

Funding

Local

Govt

Funding

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Older Americans Act

Medicaid

State appropriation

Local (i.e., county or city) funding

Targeted tax

State lottery

Foundation/private grants

Percent of States

Figure 1: Proportion of agencies with funds from various sources

(in addition to OAA funding)

71.7 70.361.7

56.8 54.2 53.8 53.2 51.1

35.8 34.628.3

17.710.2 9.0 7.3

0.60

10

20

30

40

50

60

70

80

Stat

e gen

eral

reve

nue

Local f

undin

g

SHIP

*

Med

icai

d wai

ver

Oth

er st

ate fu

nding

Gra

nt fun

ds

Con

sum

er co-p

ay/co

st shar

e

Oth

er char

itable

don

atio

ns

Fundra

isin

g

Tra

nspor

tatio

n fundin

g

Med

icai

d

Privat

e pay

con

sum

ers

HU

D**

Faith

-bas

ed o

rgan

izat

ions

Med

icar

e

India

n Hea

lth S

ervi

ce

The Aging Services Network continues to develop a comprehensive strategy of services for long-term services and supports for all Americans of all ages and abilities that may help bend the cost curve on entitlements.

•National Family Caregiver

•Lifespan Respite Care

•Alzheimer’s Disease

•Native American Caregiving Support Program

Supporting Family

Caregivers

•Information and Referral, Case Management

•Home Delivered, Congregate, and Native American Nutrition

•Personal Care, Homemaker Assistance, Adult Day Care

•Transportation

Maintaining Health and

Independence

•Long-Term Care Ombudsman

•Prevention of Elder Abuse and Neglect

Protecting Vulnerable

Older Americans

•Aging and Disability Resource Centers, Evidence Based

Disease Prevention, Community Living Incentives

•Program Innovations

•Aging Network Support

Supporting the National

Aging Network Services

•Seniors Community Service Employment for Older

Americans Program

Employing Senior

Workers

Long-Term Care Planning by AAAs

15.6

33.4

65.2

69.4

69.6

84.2

89.9

94.1

0 10 20 30 40 50 60 70 80 90 100

Participation in AoA "Own Your Future" campaign

Options counseling through an ADRC

Information about long-term care insurance

Elder rights education

Options counseling through other

services such as case management

Information about establishing legal

directives such as living wills

Outreach and educational presentations

Information about and referral to

long-term care services

The Aging Services Network is evolving towards more consumer-driven activities.

0 5 10 15 20 25 30

In OAA programs

Medicaid HCBS

State funded HCBS

Number of States

Percentage of AAAs who provide consumer-directed options in the following services.

Respite Care 26.0

Personal Care 25.3

Homemaker 23.5

Family Caregiver Support Program 22.6

The Aging Services Network is providing evidence-based health promotion and disease prevention programs that allow older adults and individuals with disabilities to remain in their homes and communities.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

A M

atter

of

Bala

nce

Chro

nic

Dis

ease S

elf-M

anagem

ent

EnhanceF

itness

EnhanceW

elln

ess

Healthy

IDE

AS

or

PE

AR

LS

Medic

aid

Managem

ent

Impro

vem

ent

Syste

m

Perc

en

t o

f S

tate

s

Over half (55.6%) of AAAs are involved in providing evidence-based programs to prevent/manage chronic disease or disability.

Most common-

•Chronic Disease Self-Management Program

•A Matter of Balance

•EnhanceFitness

•EnhanceWellness

States and Area Agencies on Aging are encouraging the development of livable communities for all ages--the development of services and infrastructure to assist people across their lifespan--through the use of various grant initiatives and state-funded-only programs.

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Quality for institutional services

Regulation of home and community based providers

Financing

Eligibility determination

Quality for home and community based services

Planning and development of policy

Percent of States

46%

14%

40%

Yes

No

My state is in the process of making changes to achieve this goal.

Figure 2: Most Common AAA Partnerships

75.3

75.5

76.9

77.3

78.3

79.3

80.1

80.9

85.9

86.5

87.8

0 20 40 60 80 100

Other social service organizations

Charitable Organizations

Public housing authority

Health care providers

Long-Term Care Facilities

Medicaid

Federal programs

Emergency Preparedness Agencies

Advocacy Organizations

Adult Protective Services

Transportation Agencies

Figure 5: Enhanced Nursing Home Diversion

(Proportion of AAAs who are involved in efforts consistent

with nursing home diversion)

89.5 90.5

13.7

21.0

60.5

0

10

20

30

40

50

60

70

80

90

100

Consumers with greatest

impairment get priority for

services in at least some

programs

Consumers most at risk

for nursing home

placement get priority for

services in at least some

programs

Currently paritipate in an

AoA NH Diversion

Modernization grant

Organization has a formal

nursing home diversion

program other than NH

Diversion grant

Facilitates the transition

of consumers from

institutional placements

into the community

States and communities continue to face extraordinary pressure due to the economic decline.

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

No Increase

Disease prevention or wellness programs

Senior centers

Medicaid HCBS disabled

Chore

Adult day care

State Pharmaceutical Drug Assistance Programs

State Health Insurance Assistance Programs

Long Term Care Ombudsman Programs

Congregate meals

Low Income Home Energy Assistance Program

Homemaker

Food stamps

Senior employment and community service

Respite

Medicaid HCBS elderly

Housing assistance/foreclosure counseling

Adult Protective Services

Personal care

Transportation

Information and Referral

General Information Requests

Home delivered meals

% of States

Strengthen core OAA functions and infrastructure to build on proven best practices to create a system that empowers and facilitates consumer choice, from private pay to Medicaid, while building on and complementing the energy of a growing aging service industry.

1. Move from an agency-based system to a consumer-

driven system that builds on emerging markets

2. Recognize and strengthen the critical role of SUAs, AAAs & Title VI entities in long-term services & supports

3. Strengthen the states’, AAAs’ & Title VI entities’ community planning role in the development of Livable Communities for All Ages

05

101520253035404550

Nu

mb

er

of

Sta

tes

Irene Collins, President c/o Martha Roherty

Executive Director

NASUA

1201 15th Street, NW

Suite 350

Washington, DC 20005

202-898-2578

www.nasua.org

mroherty@nasua.org

Lynn Kellogg, President

c/o Sandy Markwood

CEO

n4a

1730 Rhode Island Avenue, NW

Suite 1200

Washington, DC 20036

202-872-0888

www.n4a.org

smarkwood@n4a.org