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