Older Americans Act Orientation

1. Older Americans Act Orientation JEAN LLOYD, MS, RD US Administration on Aging 4th State Units on Aging Nutritionists/Administrator Conference August, 2006

2. Overview • Aging Statistics • Older Americans Act • Nutrition Program • Resources • Choices for Independence

3. Aging Statistics

4. Number of Persons 65+ & 85+ 1900–2050 [Numbers in Millions]

5. % of Americans AGE 65 Expected to Live to AGE 90

6. Number of Older Adults • 60+ 48.6 M • 65+ 35.9 M • 85+ 4.6 M 65+ • Community 33.4 M (93.5%) • Nursing Homes 1.5 M (4.5%) • Assisted Living 1 M ( 2%)

7. The New Aging Reality OLDER AMERICANS LIVE • Longer • Healthier • More independently • More functionally fit • And in the community.

8. Long Term Care Definition • Range of medical, social & personal care services to meet health & personal needs of functionally impaired people.

9. Older Americans Act

10. Older Americans Act Programs and Services • Established in 1965 • Does not have any income requirements, forbids means-testing • Means-testing is the determination of eligibility for services based on a specific level of income • For persons 60+, targeting services to persons in greatest economic and social need, with particular attention to low income minorities and individuals residing in rural areas

11. Mission To help older people retain their dignity and independence and remain in their own homes and communities for as long as possible.

12. Older Americans Act, as amended in 2000 – Overviewhttp://www.aoa.gov/about/legbudg/oaa/legbudg_oaa.asp • Title I – Declaration of Objectives; Definitions • Title II – Administration on Aging • Title III – Grants for State and Community Programs on Aging • Title IV – Training, Research and Discretionary Projects and Programs • Title V – Community Service Employment Program for Older Americans • Title VI – Grants for Native Americans • Title VII – Vulnerable Elder Rights Protection Activities

13. Title I – Objectives • Prevention To inform, empower and assist older persons and their families to make choices that improve the quality of life • Independence Opportunities for older people to remain at home and avoid institutional placements • Protection To safeguard older consumers’ physical, mental, emotional and financial well-being

14. Administration on Aging (AoA) Assistant Secretary for Aging National Aging Services Network Tribal Organizations (243) State Units on Aging (56) Area Agencies on Aging (645) Local Service Provider Agencies (29,000) Nutrition Service Providers (4,400) Senior Centers (6,045) that receive support under the OAA Title II - Administration on Aging

15. Part A – General Purpose Part B – Supportive Services and Senior Centers Part C – Nutrition Services Part D – Disease Prevention and Health Promotion Part E – National Family Caregivers Support Program Title III – Grants for State and Community Programs on Aging

16. Part A – General Purpose Sec 301 – Purpose & Administration It is the purpose of this title to encourage and assist State agencies and area agencies on aging to…foster the development and implementation of comprehensive and coordinated systems …” Sec 302 – Definitions The term “comprehensive and coordinated system” means a system for providing all necessary supportive services, including nutrition services…” Title III – Grants for State and Community Programs on Aging

17. Part A – General Purpose Sec 303 – Authorization of Appropriations, Uses of Funds Sec 304 – Allotment; Federal Share Sec 305 – Organization – State Agencies on Aging, designation/de-designation of planning and service areas, single planning and service areas, area plan, funding formula Title III – Grants for State and Community Programs on Aging

18. Part A – General Purpose Sec 306 – Area Plans Sec 307 – State Plans Sec 308 – Planning, Coordination, Evaluation & Administration of State Plans – State administration costs, transfers, waivers for transfers Sec 309 – Payments Section 310 – Disaster Relief Reimbursements Title III – Grants for State and Community Programs on Aging

19. Part A – General Purpose Sec 311 – Nutrition Services Incentive Program Sec 312 – Multipurpose Senior Centers; Recapture of Payments Sec 313 - Audit Sec 314 – Rights relating to In-Home Services for Frail Older Individuals Sec 315 - Consumer Contributions- Cost Sharing and Voluntary Contributions Sec 316 - Waivers Title III – Grants for State and Community Programs on Aging

20. Information & Assistance Case Management Transportation Homemaker/Chore Personal Care Senior Centers Health and Nutrition Education “Any other services necessary for the general welfare of older individuals” Title III-BSupportive Services &Senior Centers

21. Congregate Nutrition Services (C-1) 5 or more days a week Congregate setting, including Adult Day Care Nutrition Education & Counseling, including caregivers Home-Delivered Nutrition Services –Homebound (C-2) Hot, cold, frozen, dried, canned or supplemental meals Nutrition Education & Counseling, including caregivers Title III-CElderly Nutrition Program

22. Information at Senior Centers, Meal Sites & Home-Delivered Meals Programs Health Screening & Risk Assessments Hypertension -- Cholesterol Glaucoma -- Vision Hearing -- Diabetes Physical Fitness Prevention & Reduction of Alcohol, Substance Abuse, Smoking Cessation Medication Management Nutrition Counseling, including caregivers Title III-DDisease Prevention/Health Promotion

23. Title III-ENational Family CaregiverSupport Program Focus on Caregiver vs. Care Recipient • Service Categories • Information about Services • Assistance with Access to Services • Individual Counseling, Support Groups, Caregiver Training • Respite Care • Supplemental Services, on a Limited Basis

24. Title IVTraining, Research, and Discretionary Projects and Programs • Education • Training • Demonstrations • Innovations • Funding – 2006 - $24,595,000

25. Title VCommunity Service Employment for Older Americans • Administered by U.S. Department of Labor • Subsidized Employment & Training for Low-Income Seniors 55 Years of Age & Older

26. Title VIGrants for Native Americans • Part A – Indian Program • American Indians • Alaska Natives • Part B – Native Hawaiian Program • Part C – Native American Caregiver Support Program ($5 million included in Title III-E)

27. Title VIIVulnerable Elder Rights Protection • Long-term Care Ombudsman Program • Prevention of Elder Abuse, Neglect & Exploitation • Legal Assistance Development

28. Public Health Service Act – Section 398 • Alzheimer’s Disease Demonstration Grants to States Program – Total Funding – 2006- $11,668,000 • Outreach • Training • Support Groups • Respite Services • Focused on hard-to-reach populations

29. Older Americans Act, 2006http://www.aoa.gov/about/legbudg/current_budg/legbudg_current_budg.asp

30. AoA: 2006 Budget • TOTAL Title III Budget= $1.3 B • NUTRITION = $715 M • NUTRITION = >½ BudgetConsistently NUTRITION SERVICES CG HCBS

31. Older Americans Act Nutrition Program

32. OAA Nutrition Program Purposes • Promote health • Provide nutritious meals • Reduce social isolation • Link to other social & rehabilitative services

33. Purpose of the OAA Nutrition Program • Promote health • Primary prevention: health, wellness & functionality activities • Secondary & tertiary: risk reduction, disease management and treatment, i.e. diabetes self management, diabetes support group, provision of a renal diet • Includes either the provision of or referral to health promotion/disease prevention programs, i.e., physical activity, medication management, etc. • Provide nutritious meals • Meet RDAs and Dietary Guidelines for Americans • Meet special needs: health, racial/ethnic, religious • Meals meet participant preferences, could include choice

34. Purpose of the OAA Nutrition Program • Reduce social isolation • Congregate activities, social, physical, cognitive • Active social engagement, volunteer opportunities • Transition home delivered participants to congregate participation as much as possible • Home delivered, personal interaction, friendly visiting, telephone reassurance • Link to other social, rehabilitative services within HCB LTC • Other food and nutrition assistance services, i.e. the Food Stamp Program, food pantries • HP/DP programs, physical activity, falls prevention, depression screening, medication management, immunization • Other supportive services, i.e., transportation, or in-home services, i.e., personal care

35. Congregate Nutrition Services Congregate settings, including adult day care, intergenerational settings Does not provide for take out meals Home Delivered Nutrition Services Homebound, in home service Meals: 5 or more days per week Nutrition Screening, Education and Counseling Title III-C, OAA Nutrition Program or Elderly Nutrition Program

36. Section 339 Requirements • Program • Partially federally funded, state administered • “A State that establishes and operates a nutrition project under this chapter shall…” • State must solicit advice of a dietitian or individual of comparable expertise in planning nutritional services and ensuring…. • Indicates that meals, other than in-home meals, must be provided in settings close to residences of older individuals

37. Section 339 Requirements • Meals • 1/3 RDA; Dietary Guidelines for Americans, 2005; state & local foodservice law • Design meals to meet special dietary needs (cultural/ethnic preferences, health, religious needs) • Design “appealing” meals, i.e. food/menu choice • OAA provides the authority for program implementation to vary state by state

38. Section 339 Requirements • Other Program Requirements • Some states delegate more responsibility to AAAs and local service providers than others • Local nutrition service providers must implement the program with the expertise of a dietitian or individual of comparable expertiseas well as the input from meal participants, and other knowledgeable individuals • Provide for nutrition screening, education and counseling

39. Meal Service Trends

40. Participant Trends

41. Congregate Expenditures

42. Home Delivered Expenditures

43. Nutrition Program Income as a % of Total Expenditures

44. Average Cost of Meals Based on Total Expenditures

45. Older Americans Act Congressional Action • House Action - Reauthorization • H.R. 5293, Senior Independence Act of 2006, introduced May 2006 • Senate Action - Reauthorization • S. 3570, Older Americans Act Amendments of 2006, introduced June 2006 • Appropriation bills have not been passed in either chamber, continuing resolutions are usual

46. Resources

47. Dietary Guidelines for Americans 2005 HHS Toolkit for Health Professionals • Getting Older. Living Healthier. Feeling Better.Consumer Brochure • Older Adult Health Fact Sheets (8) Specific info re healthy diets & phys activity for health professionals • Nutrition Service Providers GuideAssistance materials for planning meals for older adults in group settings • Available July, 2006 www.healthierus.gov/dietaryguidelines/

48. Resources • National Resource Center on Nutrition, Physical Activity & Aging Florida International Universityhttp://nutritionandaging.fiu.edu • Subscribe: NAN Listserve for BiWeekly Highlights • Older Americans Nutrition Program Toolkit • Creative Solutions • Information on DRIs, Dietary Guidelines • Topics A - Z

49. Resources • US Administration on Agingwww.aoa.gov • Eldercare Locator: access service infowww.eldercare.gov

50. Modernizing the OAA for the 21st Century: Choice for Independence