Older Americans Act: Programs, Funding, and 2006 Reauthorization (P.L. 109-365)

The Older Americans Act:
Programs, Funding, and 2006 Reauthorization
(P.L. 109-365)
Updated December 18, 2006
Carol O’Shaughnessy
Specialist in Social Legislation
Domestic Social Policy Division
Angela Napili
Information Research Specialist
Knowledge Services Group



The Older Americans Act: Programs, Funding, and

2006 Reauthorization (P.L. 109-365)


Summary
The Older Americans Act (OAA) is the major vehicle for the delivery of social
and nutrition services for older persons. Originally enacted in 1965, the act supports
a wide range of social services and programs for older persons. Authorization of
appropriations expired at the end of FY2005. The Older Americans Act Amendments
of 2006 (P.L. 109-365) reauthorized all programs under the act through FY2011.
The major program under the act, Title III — Grants for State and Community
Programs on Aging — authorizes grants to 56 state and 655 area agencies on aging
to act as advocates on behalf of, and to coordinate programs for, older persons. Title
III accounted for 70% of the act’s total FY2006 appropriations ($1.24 billion out of
$1.78 billion). States receive separate allotments of funds for supportive services and
centers, family caregiver support, congregate and home-delivered nutrition services,
the nutrition services incentive grant program, and disease prevention and health
promotion services. Title V — Community Service Senior Opportunities Act — is
the only federally subsidized employment program for low-income older persons. It
represented almost one-quarter of the act’s total funding in FY2006 ($432.3 million).
P.L. 109-365 added requirements that state and area agencies on aging focus
programs and services on specific groups of older people, including those at risk for
institutional care and those with limited English proficiency. The law also added
requirements that the Administration on Aging (AoA) and state and area agencies
focus efforts on the promotion of home and community-based long-term care
services for older people to prevent or delay the need for institutional care. The law
also revised the formula for distribution of Title III grants to require that states
receive at least as much as they received in FY2006 (a 2006 “hold harmless” level),
and to gradually eliminate a “guaranteed growth” provision.
The new law added responsibility for AoA to develop and implement systems
for elder justice and to conduct an elder abuse national incidence study. It also added
authority for competitive grants to states for elder justice activities under Title VII.
In addition, the law authorized the Assistant Secretary on Aging to conduct several
new research and demonstration programs, including model projects to assist older
people “age in place”(including in Naturally Occurring Retirement Communities, or
NORCs); and to develop systems for mental health screening and treatment for older
people. P.L. 109-365 maintained the Title V program focus on employing older
people in community service jobs, but it also revised the program to place more
emphasis on training eligible older individuals. The new law required the Secretary
of Labor to conduct a national competition for Title V funds every four years.
For FY2006, the act’s programs received $1.78 billion, a 2% decrease from the
FY2005 level. Figure 1 shows the distribution of FY2006 funding by program.
Table 3 shows the appropriations history for OAA programs for FY1999-FY2006.
For appropriations amounts for FY1966-FY2004, see CRS Report RL32437. For
FY2007 appropriations and the FY2008 budget request, see CRS Report RL33880.
This report will not be updated.



Contents
In troduction ......................................................1
P.L. 109-365 in Brief...............................................2
Older Americans Act Programs and 109th Congress Legislation..............3
Title I. Declaration of Objectives.................................3
P.L. 109-365 Amendments to Title I...............................3
Title II. Administration on Aging.................................3
P.L. 109-365 Amendments to Title II..............................4
Elder Justice Activities.....................................4
Promotion of Home and Community-based Long-term
Care Services.........................................4
Mental Health Services.....................................5
National Center on Senior Benefits Outreach and Enrollment.......5
Private Pay Agreements with Profitmaking Organizations..........6
Title III. Grants for State and Community Programs on Aging...........7
Supportive Services and Centers..............................8
Nutrition Services.........................................8
National Family Caregiver Support Program...................10
P.L. 109-365 Amendments to Title III ............................11
Targeting Services to Specific Groups of Older People...........11
Home and Community-based Long-term Care Services...........12
State and Area Agency on Aging Planning for the Baby Boom
Population ..........................................12
Nutrition Services........................................13
National Family Caregiver Support Program...................14
Emergency Preparedness...................................15
Voluntary Contributions for Title III Services...................15
Title III Formula Allotments to States.........................16
Title IV. Activities for Health, Independence, and Longevity...........17
P.L. 109-365 Amendments to Title IV............................18
Model Projects for Aging in Place............................18
Demonstration Efforts to Address Mental Illness in Older People...19
Other Research and Demonstration Activities...................19
Title V. Community Service Senior Opportunities Act ...............20
P.L. 109-365 Amendments to Title V .............................24
Program Purpose.........................................24
Eligibility ...............................................24
Time Limit on Participant Enrollment.........................26
Competition and Grantee Performance Indicators................27
Enrollee Placement in Unsubsidized Employment...............30
Title VI. Grants for Services for Native Americans..................30
P.L. 109-365 Amendments to Title VI............................30
Title VII. Vulnerable Elder Rights Protection Activities...............31
P.L. 109-365 Amendments to Title VII............................32
Elder Justice Grants.......................................32



Older Americans Act Appropriations .................................33
Appendix. The Older Americans Act: Historical Development............38
Major Amendments to the Older Americans Act....................39
List of Figures
Figure 1. Older Americans Act, FY2006 Funding ($1.8 billion)............34
List of Tables
Table 1. Title V of the Older Americans Act:
PY2005 and PY2006 Funding and Participant Positions
for National Organizations and State Sponsors......................22
Table 2. Authorization of Appropriations for
Older Americans Act Programs in P.L. 109-365.....................32
Table 3. The Older Americans Act, Alzheimer’s Demonstration Grants,
and White House Conference on Aging Funding, FY1999-FY2006......35



The Older Americans Act: Programs,
Funding, and 2006 Reauthorization
(P.L. 109-365)
Introduction
The Older Americans Act (OAA) is the major vehicle for the delivery of social
and nutrition services for older persons. Originally enacted in 1965, the act supports
a wide range of social services and programs for older persons. These include
supportive services, congregate and home-delivered nutrition services, community
service employment, the long-term care ombudsman program, and services to prevent
the abuse, neglect, and exploitation of older persons. The act also supports grants to
Native Americans and research, training, and demonstration activities.
P.L. 109-365 (H.R. 6197), the Older Americans Act Amendments of 2006, was
signed by the President on October 17, 2006.1 P.L. 109-365 reauthorized all
programs under the act through FY2011. H.R. 5293, the Senior Independence Act
of 2006, was reported by the House Committee on Education and the Workforce2 and
passed by the House on June 21, 2006. S. 3570, the Older Americans Act
Amendments of 2006, was reported by the Senate Committee on Health, Education,
Labor, and Pensions on September 19, 2006. (For a side-by-side comparison of H.R.

5293 and S. 3570, see CRS Report RL33660, Older Americans Act Reauthorization:


Side-by-Side Comparison of Current Law, H.R. 5293, and S. 3570.) H.R. 6197, the
House and Senate compromise bill, was passed by the House on September 28, 2006,
and by the Senate on September 30, 2006.
This report provides a brief summary of changes to the act made by P.L. 109-
365; background on all titles of the act, followed by a discussion of selected major
provisions made in each title by P.L. 109-365; and a discussion of recent funding for
the act’s programs. Table 2 shows the authorization of appropriations contained in
P.L. 109-365 for each program under the act. Table 3 shows the appropriations
history for the act’s programs for FY1999-FY2006. Appropriations amounts for
previous years are available in CRS Report RL32437, Older Americans Act: History
of Appropriations, FY1966-FY2004, by Carol O’Shaughnessy. For information on
FY2007 appropriations, see CRS Report RL33880, Older Americans Act: FY2006
Funding, FY2007 Proposals, and FY2008 Budget Request, by Carol O’Shaughnessy
and Angela Napili. The Appendix at the end of the report summarizes major
amendments to the act beginning in 1967.


1 Authorization of appropriations had expired at the end of FY2005.
2 Committee on Education and the Workforce, U.S. House of Representatives, H.Rept. 109-

493, Senior Independence Act of 2006, 109th Cong., 2nd sess., June 8, 2006.



P.L. 109-365 in Brief
P.L. 109-365 focused attention on a number of specific groups of older people.
The OAA previously required state and area agencies on aging to target services and
programs on specific groups of older people, including those with the greatest social
or economic need, especially low-income older people and those residing in rural
areas. P.L. 109-365 added requirements that state and area agencies, and Title III
aging service providers, focus services and programs toward additional groups,
including older people at risk for institutional care, and older people with limited
English proficiency. The law added several new provisions to focus attention on
older people with mental illness, including authorizing the Assistant Secretary on
Aging to designate an individual in AoA to be responsible for mental health services
authorized by the act.
P.L. 109-365 included several provisions related to elder justice activities. Elder
justice is defined in the law as efforts to prevent, detect, treat, intervene in, and
respond to elder abuse, neglect, and exploitation and to protect elders with
diminished capacity while maximizing their autonomy. The law authorized the
Assistant Secretary to designate within AoA an individual responsible for
administering activities related to elder abuse prevention programs, and required a
national study on the incidence and prevalence of elder abuse, neglect and
exploitation in all settings where older people live. In addition, the law added a
requirement that the Assistant Secretary award funds for competitive grants to states
for development and implementation of elder justice activities.
P.L. 109-365 expanded the role of AoA and state and area agencies on aging in
promoting home and community-based long-term care services to help older people
avoid institutionalization. The Assistant Secretary is required to, among other things,
conduct research and demonstration projects to identify innovative, cost-effective
strategies for modifying state systems of long-term care. The law also required state
and area agencies on aging to develop and implement comprehensive, coordinated
systems, at their respective levels, for home and community-based services.
Recognizing that growing numbers of people turning age 65 in the coming
decades will place increasing burdens on aging service providers supported by the
act, P.L. 109-365 authorized state and area agencies to include in their respective
plans on aging an assessment of how prepared the state and local communities are
for demographic and other changes in the elderly population.
P.L. 109-365 revised the formula for distribution of Title III grant allotments to
states for supportive services, congregate and home-delivered nutrition services, and
disease prevention and health promotion services. It did so by requiring that states
receive, for these service programs, at least the same amount they received in
FY2006, and by gradually phasing out a “guaranteed growth” factor over a four-year
period.
The law added requirements that the Assistant Secretary conduct several new
demonstration programs under Title IV. Among these are demonstration model
projects to help older people “age in place,” including in Naturally Occurring



Retirement Communities (NORCs); and to develop systems for the delivery of
mental health screening and treatment services for older people who lack access to
such services.
P.L. 109-365 revised the Title V community service employment program to
place more emphasis on training eligible older individuals; however, it maintained
the program focus on employing older people in community service jobs. The law
clarified the definition of income when determining an individual’s eligibility, placed
a time limit on enrollee participation, and placed more emphasis on transitioning
participants to unsubsidized employment. The law also required the Secretary of
Labor to conduct a national competition for Title V funds every four years.
Older Americans Act Programs and
109th Congress Legislation
The following provides a brief description of the act’s titles and highlights
selected amendments made by P.L. 109-365 in each title.
Title I. Declaration of Objectives
Title I of the act 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.
P.L. 109-365 Amendments to Title I
P.L. 109-365 added definitions for various terms used in the act.3
Title II. Administration on Aging
Title II establishes AoA within the Department of Health and Human Services
(HHS) as the chief federal agency advocate 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.
Among other things, Title II requires AoA to establish the National Eldercare Locator
Service to provide nationwide information through a toll-free telephone number to
identify community resources for older persons. It also requires AoA to establish the
National Long-Term Care Ombudsman Resource Center, the National Center on


3 Definitions for the following terms were added or amended: assistive device, technology,
technology service; evidence-based health promotion programs; exploitation; information
and assistance; long-term care facility; neglect; Aging and Disability Resource Center; at
risk for institutional placement; civic engagement; elder justice; fiduciary; Hispanic-serving
institution; long-term care; self-directed care; self-neglect; state system of long-term care
and integrated long-term care.

Elder Abuse, the National Aging Information Center, and the Pension Counseling
and Information Program.
P.L. 109-365 Amendments to Title II
Elder Justice Activities. As average lifespans continue to rise,4 increasing
the likelihood of age-related disability, older people who rely on family, friends, or
professionals for care could become vulnerable to abuse, neglect, and exploitation.
In response to these demographic trends, recent Congresses have considered
legislation that would support a coordinated federal effort to address abuse, neglect,
and exploitation of the elderly.5 A number of bills have taken a multidisciplinary
approach that would involve law enforcement, public health, and social services
personnel to address these issues.
In addition to these proposals, Congress included several provisions related to
elder justice activities in the OAA reauthorization legislation. P.L. 109-365 defines
elder justice as efforts “to prevent, detect, treat, intervene in, and respond to elder
abuse, neglect, and exploitation and to protect elders with diminished capacity while
maximizing their autonomy.”6 The law added various elder justice activities to be
carried out by the Assistant Secretary. (The law also authorized a new grant program
as part of Title VII of the act, discussed below.) These include authorizing the
Assistant Secretary to designate within AoA an individual responsible for
administering activities related to elder abuse prevention programs. Among this
person’s responsibilities are “to develop objectives, priorities, policy and a long-term
plan for facilitating the development, implementation, and improvement of a
coordinated, multidisciplinary elder justice system.” In addition, the law requires the
conduct of a national incidence and prevalence study of elder abuse, neglect and
exploitation in all settings where older persons live.
Promotion of Home and Community-based Long-term Care
Services. In recent years, Congress and the Administration have devoted expanded
resources to the development of home and community-based long-term care services.
AoA and the Centers for Medicare and Medicaid Services (CMS) have awarded
funds to states to expand these services as one means to prevent older people with
chronic illnesses or impairments from unnecessarily entering an institution and to7
respond to their desire to receive needed assistance in their own homes. These


4 See CRS Report RL32792, Life Expectancy in the United States, by Laura B. Shrestha.
5 The Elder Justice Act of 2002 (S. 2933) was first introduced in the 107th Congress. A
similar measure (S. 333) was introduced in the 108th Congress; the bill was approved by the
Senate Finance Committee but never taken up on the Senate floor. On November 15, 2005,
S. 2010, the Elder Justice Act, was introduced; the bill was ordered reported by the Senate
Finance Committee on August 3, 2006. Other proposals have been introduced in the House,thth
H.R. 4993, in the 109 Congress, and H.R. 2490, in the 108 Congress.
6 P.L. 109-365, Section 101.
7 These initiatives have included, for example, grants for Real Choice Systems Change,
Money Follows the Person, and Aging and Disability Resource Centers, among others. See
(continued...)

initiatives have been in partial response to the Supreme Court’s decision in Olmstead
v. L.C., which held that unjustified isolation of persons with disabilities in
institutions is regarded as discriminatory under specified circumstances.8
In light of these developments, Congress in P.L. 109-365 explicitly expanded
AoA’s role in promoting home and community-based long-term care services. In
doing so, the Assistant Secretary is required to, among other things, conduct research
and demonstration projects to identify innovative, cost-effective strategies for
modifying state systems of long-term care; and target services to individuals at risk
for institutional placement in order to permit them to remain in home and
community-based care settings.
In addition, the Assistant Secretary is to implement in all states Aging and
Disability Resource Centers (ADRCs) “to serve as visible and trusted sources of
information on the full range of long-term care options,” and “to provide
personalized and consumer-friendly assistance to empower individuals to make
informed decisions about their care options.” In recent years, AoA has used its Title
IV research and demonstration authority to help fund ADRCs in 43 states. The
ADRC grant program is a cooperative effort between AoA and CMS and was
developed to help states enhance individuals’ choice of services, support informed
decision-making, and create a single, coordinated system of information and access
for all persons seeking help in accessing long-term care services. P.L. 109-365
allows AoA to continue and expand this initiative.
Mental Health Services. The law authorized the Assistant Secretary to
designate an officer or employee to be responsible for administering mental health
services authorized under the act. The officer is to “develop objectives, priorities and
a long-term plan to support state and local efforts regarding education about and
prevention, detection and treatment of mental disorders.” This includes age-related
dementia, depression, and Alzheimer’s disease and related neurological disorders.
National Center on Senior Benefits Outreach and Enrollment.
Research has shown that many older people do not participate in federal and state


7 (...continued)
[http://www.cms.hhs.gov/NewFreedomInitiative/02_WhatsNew.asp#] and [http://www.cms.
hhs.gov/NewFreedomInitiative], visited Dec. 7, 2006.
8 The Court ruled that “unjustified isolation...is properly regarded as discrimination based
on disability.” It also noted several limitations: a state treatment professional must determine
the appropriateness of the environment; community placement is not opposed by the
individual with a disability; and the placement can be easily accommodated. While the case
dealt specifically with the rights of certain people with mental disabilities, subsequent
Health Care Financing Administration (now the Centers for Medicare and Medicaid
Services) guidance stated that the case was applicable to all people with disabilities. See
CRS Report RS20588, Olmstead vs. L.C. Implications and Subsequent Judicial,
Administrative and Legislative Actions, by Melinda De Atley and Nancy Lee Jones.
Available at [http://www.congress.gov/erp/rs/pdf/RS20588.pdf].

programs for which they may be eligible, such as food stamps9 and supplemental
security income.10 Recognizing the difficulties in enrolling eligible older people,
Congress in P.L. 109-365 authorized the Assistant Secretary to establish a new
National Center on Senior Benefits Outreach and Enrollment, whose purpose is to
maintain and update web-based decision support and enrollment tools as well as
other systems to inform older people about federal and state benefit programs.
Among other tasks, the Center is also to develop and maintain an information
clearinghouse on best practices and cost-effective methods to find and enroll older
people who have the greatest economic need for program participation.
Private Pay Agreements with Profitmaking Organizations. Under
prior law, area agencies on aging or tribal organizations, could enter into agreements
with private profitmaking organizations to provide services to older people. Since
area agencies staff have expertise on a wide range of issues that affect all older
people in their planning and service areas, they are frequently called upon by many
organizations to provide information and services to many organizations, including
profitmaking organizations. For example, there have been instances where area
agencies on aging have entered into agreements with profitmaking organizations to
conduct activities to benefit employees of these organizations, such as conducting
seminars on caregiving issues employees faced with caregiving responsibilities in
their own families.
The Administration proposed clarification and expansion of these provisions
by specifying the circumstances under which such agreements could take place and
specifically that area agencies and other grantees under the act could be reimbursed
by the private profitmaking sector for carrying out these services. The House
Education and Workforce and the Senate HELP Committees generally agreed with
the proposal, but added stipulations that these agreements could take place only if
certain safeguards, including provisions regarding reimbursement of costs incurred
by area agencies of providing services to the private sector, were added to the
provision. In addition, other provisions regarding AoA’s responsibilities for
reporting to Congress on the implementation of this new provision were added.
Under the provision in P.L. 109-365, state and area agency on aging or tribal
organization may enter into agreements with profitmaking organizations to provide
services to older people, if (1) all costs of providing the services, including
administrative costs, will be reimbursed to the agency or tribal organization; (2) the
organization reimburses the agency or tribal organization for the cost incurred at the
fair market rate; and (3) the reimbursement rates are consistent with the prevailing
market rate in the geographic area where the services are provided. Any revenue
generated through these agreements must be used to provide or support services to
older people that are consistent with the act. The law further stipulated that activities


9 See, for example, Food Stamp Participation by Eligible Older Americans Remains Low,
FoodReview, by Parke Wilde and Elizabeth Dagata, Economic Research Service, U.S.
Department of Agriculture, FoodReview. Summer-Fall 2002.
10 See, for example, The Incredible Shrinking Program: Trends in SSI Participation of the
Aged, by Todd E. Elder and Elizabeth T. Powers. Research on Aging, Vol. 28, No. 3, pp.

341-358, May 2006.



to be carried out under these agreements may not result in the displacement of
services otherwise available to older individual with greatest social need, greatest
economic need, or an older individual at risk for institutional placement. In addition,
the activities may not in any other way compromise, undermine, or be inconsistent
with the objective of serving the needs of older people.
In addition, the Assistant Secretary is required to develop and implement
monitoring procedures and reporting requirements for these agreements. Reporting
requirements are to include information on the number of agreements with
profitmaking organizations in each state; summaries of all agreements made; the
types of organizations participating and services provided; the net proceeds gained
under the agreements; and documentation of funds spent and reimbursed under the
agreements.
Title III. Grants for State and Community Programs on Aging
Title III authorizes grants to state and area agencies on aging to act as advocates
on behalf of, and to coordinate programs for, older persons. It accounted for 70% of
total OAA funds in FY2006 ($1.24 billion out of $1.78 billion). The program, which
supports 56 state agencies on aging, 655 area agencies on aging, and more than
29,000 service providers, authorizes six separate service programs. States receive
separate allotments of funds for supportive services and centers, family caregiver
support, congregate nutrition services, home-delivered nutrition services, nutrition
services incentive grants, and disease prevention and health promotion services.
Title III services are available to all persons aged 60 and over, but are targeted
to those with the greatest economic or social need, particularly low-income and
minority persons 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 fee scale basis, but older persons must not be denied services
due to failure to make cost-sharing payments.
AoA allots funds for supportive services, congregate and home-delivered
nutrition services, and disease prevention and health promotion services to states
based on each state’s relative share of the total population aged 60 years and over.
Funds for nutrition services incentive grants are allotted to states based on a formula
that takes into account the number of meals served by each state’s nutrition program
the prior year. Funds for the family caregiver program are allotted to states based on
each state’s relative share of the total population aged 70 years and over (although
persons under age 70 are eligible to receive caregiver services).
In FY2004, Title III programs served 8.1 million older persons, who received
a range of services including transportation, home care, adult day care, information
and assistance, and legal assistance. Of all persons served, 28% had income below
the poverty level, and 22% were minority older persons.11


11 Administration on Aging, The Aging Network: 2004 State Program Reports, at
(continued...)

Supportive Services and Centers. The supportive services and senior
centers program provides funds to states for a wide array of social services, as well12
as the activities of more than 6,000 senior centers. Funded at $350.4 million in
FY2006, it represents 28% of Title III funds ($1.24 billion). Supportive services
allow older persons to reside in their homes and communities and remain as
independent as possible. In FY2004, the program provided more than 36 million
rides to a variety of community services, such as doctors’ offices, grocery stores, and
senior centers; more than 20 million hours of personal care, homemaker, and chore13
services; and more than 8 million hours of services in adult day care.
An AoA 2004 survey of Title III service recipients found that services are
targeted on particularly vulnerable populations. For example, four-fifths of
transportation services recipients said they either could not drive or had no vehicle
available; and two-thirds reported that they rely on OAA transportation services for
at least half of their local transportation needs. Over two-thirds of these recipients
reported living alone, and almost three-quarters were age 75 or older.14
Over 75% of homemaker services recipients reported needing assistance with
one or more Instrumental Activities of Daily Living (IADLs, such as preparing meals
and doing light or heavy housework) and 43% reported needing assistance with one
or more Activities of Daily Living (ADLs include bathing, dressing, toileting,
transferring from a bed or a chair, eating, and getting around inside the home).
Almost three-quarters of homemaker services recipients reported living alone, and

69% were aged 75 or older; 55% of recipients reported income of $10,000 or less.15


Nutrition Services. The Title III nutrition program, funded at $714.6 million
in FY2006, represents 58% of Title III funds, and 40% of the act’s total funding.
Data for FY2004 (latest available) show that of the 249 million meals served, 57%
were provided to frail older persons (and their caregivers) at home, and 43% were
provided in congregate settings, such as senior centers and schools.16


11 (...continued)
[http://www.aoa.gov/prof/agingnet/NAPIS/SPR/2004SPR/tables/2004tables.asp], visited
Dec. 7, 2006.
12 Administration on Aging, The Aging Network: 2004 State Program Reports: Table 10.
Focal Points and Senior Centers. At [http://www.aoa.gov/prof/agingnet/NAPIS/
SPR/2004SPR/tables/2004tables.asp], visited Dec. 7, 2006.
13 U.S. Department of Health and Human Services, Fiscal Year 2007: Administration on
Aging: Justification of Estimates for Appropriations Committees, pp. 28-29.
14 Administration on Aging, Highlights from the Pilot Study: Second National Survey of
Older Americans Act Title III Service Recipients. At [http://aoa.gov/about/results/
Final-Highlights-2nd-natioinal-survey.pdf] [sic], visited Dec. 7, 2006.
15 Ibid. Administration on Aging, Highlights from the Pilot Study: Second National Survey
of Older Americans Act Title III Service Recipients.
16 U.S. Department of Health and Human Services, Fiscal Year 2007: Administration on
Aging: Justification of Estimates for Appropriations Committees, pp. 28-29.

Persons who are age 60 or older, and their spouses of any age, may participate
in the nutrition program. The law also allows the following groups to receive meals:
persons under age 60 with disabilities who reside in housing facilities occupied
primarily by the elderly where congregate meals are served; persons with disabilities
who reside at home with, and accompany, older individuals; and volunteers who
provide services during the meal hours.
Meals provided must comply with the Dietary Guidelines for Americans
published by the Secretary of HHS and the Secretary of Agriculture. Projects must
provide meals that meet certain dietary requirements based on the number of meals
served by the project each day. That is, projects that serve one meal per day must
provide to each participant a minimum of one-third of the daily recommended dietary
reference intakes as established by the Food and Nutrition Board of the Institute of
Medicine. Projects that serve two meals per day must provide a minimum of two-
thirds of the dietary reference intakes, and projects that serve three meals per day
must provide 100% of the dietary reference intakes.
Congregate and home-delivered17 nutrition services providers are required to
offer older persons at least one meal per day five or more days per week. The law
provides an exception in rural areas if the five-day weekly frequency is not feasible
and a lesser frequency has been approved by the state agency on aging. Congregate
nutrition providers are required to provide at least one “hot or other appropriate
meal” per day; home-delivered nutrition providers are to provide at least “one hot,
cold, frozen, dried, canned, fresh, or supplemental foods” meal per day.
The last major national evaluation of the nutrition program was completed in
1996. It showed that, compared to the total elderly population, nutrition program
participants were older and more likely to be poor, to live alone, and to be members
of minority groups. Almost half of home-delivered meal recipients and more than
one-third of congregate meal recipients had income below the federal poverty level,
compared to about 15% of the total U.S. population aged 60 and over (at the time of
the evaluation). Recipients were also more likely to have health and functional
limitations that place them at nutritional risk. The report found the program plays an
important role in participants’ overall nutrition and that meals consumed by
participants are their primary source of daily nutrients. The evaluation also found
that the program leverages a fairly significant amount of non-federal dollars: for
every federal dollar spent, the program leveraged (at that time) on average $1.70 for
congregate meals, and $3.35 for home-delivered meals from a variety of sources,
including state, local, and private funds as well as participant contributions toward
the cost of meals.18 (The law requires a 15% nonfederal match.)


17 Title III home-delivered nutrition services are sometimes informally referred to as “Meals
on Wheels.” We avoid this phrase to prevent confusion. Some organizations funded under
Title III do not have “Meals on Wheels” in their names, and some organizations with “Meals
on Wheels” in their names do not receive Title III funds.
18 U.S. Department of Health and Human Services, Office of the Assistant Secretary for
Aging, Serving Elders at Risk: The Older Americans Act Nutrition Programs, National
Evaluation of the Elderly Nutrition Program, 1993-1995, June 1996. Available at
(continued...)

More recent AoA survey data showed recipient characteristics similar to the
1996 national evaluation. In 2004, 62% of congregate nutrition survey respondents
were age 75 and older; 52% lived alone. Over one-quarter had annual income of
$10,000 or less; 56% reported that the congregate meals program provided one-half
or more of their daily food intake. Furthermore, many congregate nutrition recipients
said they participated in other activities at the meal site: 52% said they took part in
physical fitness activities when available; 59% used health screening services at the
nutrition sites; and 57% said that their social activities increased since they started
receiving congregate meals.19
This 2004 survey found that almost three-quarters of home-delivered
respondents were age 75 and over; 61% lived alone; 46% had annual income of
$10,000 or less; 66% said that the home-delivered meals program provided at least
half their daily food intake. According to the AoA survey, home-delivered meals
recipients are particularly impaired and are at risk for institutionalization. Almost
40% of recipients reported needing assistance with one or more ADLs compared with
only 6% in the total U.S. population aged 60 and over. Almost 30% needed
assistance with three or more ADLs. In addition, 69% reported needing assistance
with one or more IADLs.20
AoA data show that for FY2004, the U.S. average cost of congregate meals was
$5.81, ranging from $14.70 in Alaska to $1.60 in Puerto Rico. The average cost of
home-delivered meals was $4.68, ranging from $11.28 in Minnesota to $1.32 in
Puerto Rico.21
National Family Caregiver Support Program. The National Family
Caregiver Support Program (NFCSP) was added to Title III by the 2000 amendments
(P.L. 106-501). Funded at $156.1 million in FY2006, it represents 13% of Title III
funds and 8.8% of the act’s total funding. The legislation authorizes the following
services: information and assistance to caregivers about available services; individual
counseling; organization of support groups and caregiver training; respite services
to provide families temporary relief from caregiving responsibilities; and
supplemental services (such as adult day care or home care services, for example),
on a limited basis, that would complement care provided by family and other
informal caregivers.


18 (...continued)
[http://www.aoa.dhhs.gov/prof/aoaprog/nutrition/program_eval/eval_report.asp], visited
Dec. 7, 2006.
19 Administration on Aging, Highlights from the Pilot Study: Second National Survey of
Older Americans Act Title III Service Recipients (Additional Information site), at
[http://aoa.gov/about/results/Final-Highlights-2nd-natioinal-survey.pdf][sic], visited Dec.

7, 2006.


20 Ibid., Administration on Aging, Highlights from the Pilot Study: Second National Survey
of Older Americans Act Title III Service Recipients. The survey cites the Survey of Income
and Program Participation for its IADL figures on the U.S. population over age 60.
21 Administration on Aging. Unpublished data via personal communication. October 24,

2006.



Caregivers may receive information and assistance, and individual counseling,
access to support groups, and training. Services that tend to be more individualized,
such as respite, home care, and adult day care, are to be directed to persons who have
specific care needs. These are defined in the law as persons who are unable to
perform at least two ADLs without substantial human assistance, including verbal
reminding, or supervision; or due to a cognitive or other mental impairment, require
substantial supervision because of behavior that poses a serious health or safety
hazard to the individual or other individuals. In FY2004, almost half of caregiver
funding was spent on respite services, with the remainder spent on caregiver
information and assistance services.22 The law allows states to establish cost-sharing
policies for individuals who receive respite and supplemental services provided under
the program.
Priority is to be given to older persons and their families who have the greatest
social and economic need, with particular attention to low-income individuals, and
to older persons. In addition, under certain circumstances, grandparents and certain
other caregivers of children may receive services.
The federal matching share for caregiver services is 75%, with the remainder to
be paid by states. This is a lower federal matching rate than is applied to other Title
III services (such as congregate and home-delivered nutrition services, and other
supportive services) where the federal matching rate is 85%.
According to AoA, in FY2004, states and territories conducted outreach efforts
to provide information about caregiver programs to more than 9 million persons;
provided access assistance to 525,000 caregivers; and conducted counseling and
training services for over 322,000 caregivers. The program also supported respite
care services for over 190,000 caregivers.23 In a 2004 survey of NFCSP caregivers,
over three-quarters said they had been providing care for three years or longer, and
almost two-thirds were aged 60 and over themselves. Almost three-quarters of
caregivers said that they helped with dressing and bathing; 91% said that they helped
with preparing meals and laundry; and 83% said they helped with medicine and
bandages. Over 77% of care recipients were age 75 and older (with over one-third
age 85 or older).24
P.L. 109-365 Amendments to Title III
Targeting Services to Specific Groups of Older People. Title III
contains numerous requirements that state and area agencies on aging target services
to older people who fall into various groups with special needs. Specifically, the law


22 Administration on Aging, “‘FY 2004 Title III-E - National Family Caregiver Support
Program,” [http://www.aoa.gov/about/results/III-E%202004.xls], visited Dec. 7, 2006.
23 U.S. Department of Health and Human Services, Fiscal Year 2007: Administration on
Aging: Justification of Estimates for Appropriations Committees, p. 29.
24 Ibid., Administration on Aging, Highlights from the Pilot Study: Second National Survey
of Older Americans Act Title III Service Recipients, at [http://aoa.gov/about/results/Final-
Highlights-2nd-natioinal-survey.pdf][sic], visited Dec. 7, 2006.

targets older people who are in greatest social and economic need, with particular
attention on low-income minority older persons and those residing in rural areas.
The law requires that states, in developing their intrastate funding formulas, take into
account the distribution of people with those characteristics. It also requires that the
agencies set specific objectives for serving low-income minority older persons and
that program development, advocacy, and outreach efforts be focused on these
groups. Service providers are required to meet specific objectives set by area
agencies for providing services to low-income minority older persons, and area
agencies are required to describe in their area plans how they have met these
objectives.
P.L. 109-365 added a number of additional groups of older people to receive the
attention of state and area agencies and Title III aging service providers. The law
added requirements that states and area agencies target services and programs on
older people at risk for institutional care and older people with limited English
proficiency.
Home and Community-based Long-term Care Services. Title III
supports a wide range of home and community-based long-term care services,
including personal care, homemaker and chore services, home-delivered nutrition
services, and assisted transportation. Beyond these Title III-funded services, many
state and area agencies administer home and community-based long-term care
services not funded by Title III. These include those funded by the Medicaid Section
1915(c) home and community-based services waiver program and the Social Services
Block Grant program (Title XX of the Social Security Act). Many state and area
agencies on aging are responsible for administering and managing case management
and assessment of the long-term care needs of older persons; many have expanded
and coordinated a variety of services to help older persons remain at home and avoid
entry into institutions.
P.L. 109-365 defines the responsibilities of state and area agencies on aging
with respect to home and community-based services, thus codifying what many are
already doing. Specifically, the law requires state and area agencies on aging to
develop and implement comprehensive, coordinated systems, at their respective
levels, for home and community-based services. They would accomplish this by,
among other things, collaborating, coordinating and consulting with other agencies
responsible for formulating, implementing and administering long-term care
programs; and making recommendations regarding strategies to modify the state’s
long-term care system in order to respond to the needs and preferences of older
individuals and family caregivers.
State and Area Agency on Aging Planning for the Baby Boom
Population. The increasing numbers of people turning age 65 in the coming
decades will place increasing burdens on aging service providers supported by the
Older Americans Act (the first wave of the baby boom population are turning age 60
in 2006 and will turn age 65 in 2011). Groups representing aging service providers,
such as the National Association of State Units on Aging, and the National
Association of Area Agencies on Aging, proposed new Older Americans Act
initiatives to help state and area agencies plan and prepare for the growing elderly



population across the nation. While state and area agencies are already responsible
for assessing the needs of the current older population in their states and areas, the
baby boom population is expected to increase the need for resources as well as
planning efforts.
P.L. 109-365 requires each state agency on aging, at the election of the state, to
include in state plans on aging an assessment of how prepared the state is for changes
in the elderly population over a 10-year period. The assessment may include:
!an analysis of how demographic changes may affect older
individuals, including those with low incomes, those with greatest
economic need, minority older individuals, those residing in rural
areas, and those with limited English proficiency;
!an analysis of how the programs, policies, and services provided by
states and area agencies can be improved, and how resource levels
can be adjusted to meet the needs of the changing population of
older individuals in the state; and
!an analysis of how the change in the number of persons age 85 years
and older is expected to affect the need for supportive services.
The law also authorizes area agencies on aging to conduct similar activities and
to make recommendations to government officials on actions to build their capacity
to respond to the needs of the growing aging population, including health and human
services, land use, housing, transportation, public safety, workforce and economic
development, and emergency preparedness, among others.
Nutrition Services.
Purpose of Nutrition Service Program and Sense of the Congress
Regarding Malnourishment in Older People and Use of Multivitamin-
Mineral Supplements. The law added a new purpose statement emphasizing the
importance of both the nutritional and the socialization aspects of the program as
well as its importance in promoting the health of older people. The purposes of the
program as stipulated in the law are:
!to reduce hunger and food insecurity and promote
socialization of older individuals; and
!to promote the health and well-being of older individuals by
assisting them to access nutrition and other disease prevention
and health promotion services to delay the onset of adverse
health conditions resulting from poor nutritional health or
sedentary behavior.
The law inserted several congressional findings noting malnourishment of older
adults living in the community and in nursing homes, and the susceptibility of older
adults to nutrition deficiencies. The law also noted that while diet is the preferred
source of nutrition, evidence suggests that the use of a single daily multivitamin-
mineral supplement may be an effective way to address poor nutrition among older
people. Also, it noted that Title III nutrition service providers should consider
whether congregate and home-delivered participants would benefit from a



multivitamin-mineral supplement that is in compliance with government quality
standards and that provides at least two-thirds of essential vitamins and minerals at

100% of daily value levels as determined by the Commissioner of Food and Drugs.


Nutrition Service Evaluation. P.L. 109-365 requires the Assistant Secretary
to use funds set aside for evaluation under Title II to conduct an evidence-based
evaluation of the nutrition program. The evaluation is to be conducted by the Food
and Nutrition Board of the Institute of Medicine and is to include:
!an evaluation of the effect of nutrition projects on the health and
nutrition status of participants, prevention of hunger and food
insecurity, and ability of participants to remain living independently;
!a cost-benefit analysis of nutrition projects, including their potential
to affect Medicaid costs; and
!recommendations on how nutrition projects may be modified to
improve outcomes, and the nutritional quality of meals.
Additional Nutrition Services. The law adds new services designed to
enhance the scope of the services currently available. It adds nutrition assessment
and counseling as services that may be available to participants.
National Family Caregiver Support Program.
Priority for Caregiver Services. P.L. 109-365, as in prior law, continues
to require state agencies, in providing caregiver services, to give priority to caregivers
who are older individuals (i.e., those age 60 and older) with greatest economic or
social need, with particular attention to low-income older individuals. But the law
also clarified that priority is to be given to older individuals who are providing care
to individuals with severe disabilities (including children with severe disabilities).
In addition, when providing services to family caregivers of persons with
Alzheimer’s disease and related disorders with neurological and organic brain
dysfunctions, P.L. 109-365 required the state to give priority to those caregivers
providing assistance to persons age 60 and over with such diseases. Also, when
providing services to grandparents or older relative caregivers of children, the state
is required to give priority to those providing care to children with severe disabilities.
Grandparents and Older Relative Caregivers of Adopted Children.
Grandparents or older relative caregivers who provide care to children may receive
caregiver services under the program. Under prior law, children were defined as
those who were related to the caregiver by blood or marriage. P.L. 109-365 clarified
that caregivers of children who are adopted may receive services under the program.
Eligibility Age for Grandparents and Relative Caregivers. The law
changed the age of eligibility for grandparents and older relative caregivers who are
caring for children from age 60 to age 55. Under prior law, grandparents or other
older individuals who are relative caregivers of children (under the age of 18) could
receive caregiver support services only if they were age 60 and older.



Services for Adults Caring for Children with Disabilities. P.L. 109-
365 clarified that caregiver services may be provided to older individuals who are
caring for a child with disabilities regardless of age of the child. Under AoA
guidance prior to passage of the law, parents of children with disabilities could
receive caregiver services only if their children were age 18 or younger; parents of
children with disabilities who were age 19-59 were not eligible for the act’s caregiver
services.
Emergency Preparedness. The devastation caused by Hurricanes Katrina
and Rita had significant negative effects on older people, especially those with
physical and mental disabilities, and those who were socially isolated and dependent
upon informal caregivers and/or social service programs. Disaster-related
environmental factors, such as dehydration and exposure to infectious diseases,
seriously affect frail older people with chronic conditions.
In the event of a federally declared disaster, the Older Americans Act authorizes
the Assistant Secretary of AoA to allocate funds to state agencies on aging and to
tribal organizations receiving a Title VI grant to provide social services and related
supplies for older persons in affected states.25 Funding is allocated from Title III.26
State agencies on aging pass these funds through to area agencies on aging. Title III
funds are in addition to any funds that may be available to support older persons
through the Federal Emergency Management Agency (FEMA).
State and area agencies have been instrumental in actions to assist older people
in disaster-affected states. In order to assure that all agencies prepare for any future
emergency situations, P.L. 109-365 added new requirements for state and area
agencies’ disaster and emergency planning. The law requires state and area agencies
to include in their respective plans, information on how they will coordinate activities
and develop long-term emergency preparedness plans with state and local emergency
response agencies, relief organizations, state and local governments, and other
organizations responsible for emergency preparedness and response. In addition,
state agencies on aging are to include in their aging plans, information describing
their involvement in the development, revision, and implementation of emergency
preparedness plans, including the State Public Health Emergency Preparedness and
Response Plan.27
Voluntary Contributions for Title III Services. The Older Americans Act
provides that each recipient of services should have an opportunity to voluntarily
contribute toward the cost of all services. It stipulates that voluntary contributions
must be allowed, and may be solicited, for all services provided under the act, as long


25 AoA has recently issued an emergency assistance guide for state and area agencies on
aging: Administration on Aging, Emergency Assistance Guide 2006. See
[http://www.aoa.gov/PRESS/preparedness/pdf/Attachment_1356.pdf]; [http://www.aoa.gov/
PRESS/preparedness/pdf/Attachment_1357.pdf], visited December 7, 2006.
26 The amount available may not exceed 2% of funds appropriated under Title IV of the act.
27 For further information, see CRS Report RL33579, The Public Health and Medical
Response to Disasters: Federal Authority and Funding, by Sarah A. Lister.

as the method of solicitation is non-coercive. Among other things, older people may
not be denied services if they do not contribute toward the costs of services. (The
issue of allowing cost-sharing was an issue in previous Congresses; for further
information, see CRS Report RL30055, Older Americans Act: 2000 Reauthorization
Legislation, by Carol O’Shaughnessy.)
The law also makes a distinction between cost-sharing for certain services and
voluntary contributions by older persons. Certain stipulations apply to cost-sharing,
which is allowed for certain services. These include prohibiting states from applying
cost-sharing for services to people who have low income (defined as income at or
below the federal poverty level).28,29
P.L. 109-365 added an amendment to the voluntary contributions provision in
the act. (No changes were made the provisions regarding cost-sharing.) The law
stipulates that voluntary contributions shall be encouraged from individuals whose
self-declared income is at or above 185% of the federal poverty level at contributions
levels based on the cost of services. (However, the law did not change the provision
that all older persons, regardless of income, are to be encouraged to make a voluntary
contribution, but may not be denied a service for failure to contribute.) The
amendment was intended to respond to concerns from aging service providers about
the rising cost of services, especially nutrition services, without any substantial
increase in federal or state funds, and that those who can afford to make a voluntary
contribution should be encouraged to do so.
Title III Formula Allotments to States. P.L. 109-365 revised the formula
for distribution of Title III allotments to states for supportive services, congregate and
home-delivered nutrition services, and disease prevention and health promotion


28 Other stipulations include (1) cost-sharing is not permitted for information and assistance,
outreach, benefits counseling, case management, ombudsman, elder abuse prevention, legal
assistance, consumer protection services, congregate and home-delivered nutrition services,
and services delivered through tribal organizations; (2) cost-sharing must be applied on a
sliding scale, based on income, and the cost of services. Income is to be established by
individuals on a confidential self-declaration basis, with no requirement for verification.
Service providers and area agencies on aging are prohibited from denying services to older
individuals due to their income or failure to make cost-sharing payments; (3) states may not
consider assets, savings, or other property owned by individuals when creating a sliding
scale for cost sharing, or when seeking contributions. In addition, states may exclude from
their cost-sharing policies other low-income persons who have income above the poverty
level.
29 States’ implementation of the cost-sharing provisions added by the 2000 reauthorization
legislation has been the subject of a Department of Health and Human Services/Office of
the Inspector General (DHHS/OIG) review. Among other things, the review found that
relatively few states (12) have implemented cost sharing; some of those states do not always
follow the law’s requirements that cost-sharing practices protect low-income individuals’
access to services; and AoA has provided limited guidance to states on cost-sharing policy.
The review recommended that AoA ensure that state practices adhere to the law’s
requirements and provide additional guidance to states, among other things. For further
information, see Cost Sharing for Older Americans Act Services, OIG-02-04-00290,
September 2006.

services.30 The formula for allotment of Title III funds to states contains several
factors: first, a state’s relative share of the total U.S. population age 60 and over as
compared to all states; second, a minimum grant amount for all states, defined as
one-half of 1% of the total appropriation. P.L. 109-365 did not change these two
parts of the formula.
Another provision contained in prior law was a requirement that no state
receive less than it received in FY2000 (referred to as the FY2000 “hold harmless”
amount), plus at least 20% of the percentage increase in appropriations for the
respective programs above their FY2000 appropriations levels (referred to as the
“guaranteed growth” factor). P.L. 109-365 revised this provision by (1) updating the
hold harmless amount to FY2006, and (2) gradually eliminating the guaranteed
growth factor over four years.
Thus, the law now requires that states (1) receive funds based on their relative
share of the U.S. population age 60 and over; (2) receive no less than one-half of 1%
of the total appropriation; and (3) receive no less than the amount they received for
FY2006 (the FY2006 “hold harmless”) plus a phased-out guaranteed growth factor
— that is, for FY2007, 20% of the percentage increase in appropriation amounts for
the respective programs over the FY2006 amounts; for FY2008, 15%; for FY2009,
10%, and for FY2010, 5%. By FY2011, the formula allocation to states will be based
on only the population factor and the minimum grant provisions.
Title IV. Activities for Health, Independence, and Longevity31
Title IV of the act authorizes the Assistant Secretary for Aging to award funds
for training, research, and demonstration projects in the field of aging. Funds are to
be used to expand knowledge about aging and the aging process and to test
innovative ideas about services and programs for older persons. Over the years Title
IV has supported a wide range of research and demonstration projects, including
those related to income, health, housing, retirement, long-term care, as well as
projects on career preparation and continuing education for personnel in the field of
aging.


30 This discussion does not pertain to allotment of funds for family caregiver services or to
nutrition services incentive funds. These programs receive funds under different formulas.
Family caregiver funds are allocated to states based on a state’s relative share of the U.S.
population aged 70 and over with a requirement that no state will receive less than one-half
of one percent of the total appropriation. Funds for nutrition services incentive grants are
allotted to states based on a formula that takes into account the number of meals served by
each state’s nutrition program the prior year.
For further information, see CRS Report RS22549, Older Americans Act: Funding
Formulas, by Kirsten J. Colello.
31 P.L. 109-365 changed the name of Title IV; it was formerly Training, Research, and
Discretionary Projects and Programs.

In recent years, AoA has funded a number of national efforts that support the
work of state and area agencies on aging, including the National Long-Term Care
Ombudsman Resource Center, the National Center on Elder Abuse, and other
national resource centers that focus on legal assistance, retirement needs of minority
populations, and the vulnerable elderly.
Other recent projects have included funding for Aging and Disability Resource
Centers (ADRCs), and outreach activities to help Medicare beneficiaries understand
their benefits under the Medicare Modernization Act (MMA) (both activities
conducted in cooperation with CMS.) Other initiatives have included a nutrition and
physical activity campaign (You Can! Steps to Healthier Aging); evidence-based
health care interventions; and intergenerational opportunities that link older
volunteers with children with disabilities whose support system is fragile.
P.L. 109-365 Amendments to Title IV
P.L. 109-365 added authority for the Assistant Secretary on Aging to conduct
several new demonstration programs under Title IV. Among these are
demonstrations for model projects to assist older people to age in place, including in
Naturally Occurring Retirement Communities (NORCs); and for mental health
services for older people.
Model Projects for Aging in Place. Many communities around the country
are experimenting with ways to assist older people who have “aged in place,” that is
who have resided in their own homes independently for many years, and now may
need a variety of supportive services to assist them to continue to do so. In recent
years, House and Senate appropriations legislation has included earmarks for a
number of projects to provide support for organizations that assist these “Naturally
Occurring Retirement Communities” (NORCs). For example, for FY2007, the
House and Senate Appropriations Committees earmarked funds for, respectively, 15
and 5 NORC projects as part of the AoA Title IV research and demonstration32
program.
P.L. 109-365 added a requirement that the Assistant Secretary award Title IV
funds to carry out model aging in place projects, including NORCs. The aim of these
projects is to help sustain the independence of older individuals in communities
where they have established personal, family, and professional supportive networks.
The bill defines a “Naturally Occurring Retirement Community” as a residential
building, a housing complex, an area (including a rural area) of single family
residences, or a neighborhood composed of age-integrated housing where 40% of the
heads of households are older people; or where a critical mass of older people lives
which would allow a service provider to achieve efficiencies in providing health and
social services to the group. Institutional care or assisted living settings are excluded
from the definition.


32 House Committee on Appropriations, Departments of Labor, Health and Human Services,
and Education, and Related Agencies, H.Rept. 109-515, 109th Cong., 2nd sess., p. 161ff;
Senate Committee on Appropriations, Departments of Labor, Health and Human Services,thnd
and Education and Related Agencies, S.Rept. 109-287, 109 Cong., 2 sess., p. 212.

Entities to receive funds under this demonstration are required to provide
comprehensive and coordinated health and social services, including the following
services: case management, case assistance, and social work services; health care
management and health care assistance; education, socialization, and recreational
activities; volunteer opportunities for project participants; outreach, and coordination
of the Title III services for eligible older individuals served by the project.
Demonstration Efforts to Address Mental Illness in Older People.
The law added a provision requiring the Assistant Secretary to make competitive
grants to states to develop systems for the delivery of mental health screening and
treatment services for older individuals who lack access to such services and
programs. The purpose of the grants would be to
!increase public awareness regarding the benefits of prevention and
treatment of mental disorders in older individuals;
!reduce the stigma associated with mental disorders in older
individuals and other barriers to the diagnosis and treatment of the
disorders; and
!reduce age-related prejudice and discrimination regarding mental
disorders in older individuals.
Other Research and Demonstration Activities. P.L. 109-365 authorized
the Assistant Secretary on Aging to award Title IV funds for a number of other
demonstration projects. Among others, these include
!planning activities to prepare communities for the aging of the
population;
!development, implementation and assessment of technology-based
service models to support health monitoring, communication
devices, assistive technologies, and other technology to remotely
connect family and professional caregivers to frail older individuals;
!activities to promote improved support to family and other informal
caregivers of older people;
!efforts to build awareness of cognitive impairments affecting older
people;
!efforts to promote civic engagement activities by older people; and
!innovative approaches to improve transportation services for older
people, such as volunteer driver programs, economically sustainable
transportation programs, and programs to allow older people to
transfer their cars to transportation providers in exchange for
transportation services.



Title V. Community Service Senior Opportunities Act33
The community service employment program for older Americans has as its
purpose the promotion of useful part-time opportunities in community service
activities for unemployed low-income persons who are 55 years or older and who
have poor employment prospects. The program is the primary job creation program
for adults since the elimination of public service employment under the
Comprehensive Employment and Training Act (CETA).34 Modeled after a pilot
program called Operation Mainstream, it was first funded in 1965. Operation
Mainstream was designed to employ poor, chronically unemployed adults and
operated primarily in rural areas. In 1967, administrative responsibility for Operation
Mainstream was transferred from the Office of Economic Opportunity to the
Department of Labor (DOL), but funding authority continued under the Economic
Opportunity Act. In 1973, the program was given a statutory basis under Title IX of
the Older American Comprehensive Services Amendments. The 1975 amendments
to the Older Americans Act incorporated the program as Title IX of the act, and the
1978 amendments redesignated the program as Title V. The program continues to
be administered by DOL.
For FY2006, the community service employment program represented almost
one-quarter of OAA funds ($432 million out of $1.78 billion). The program not only
provides opportunities for part-time employment and income for older persons, but
also contributes to the general welfare of communities by providing a source of labor
for various community service activities. Enrollees work part-time in a variety of
community service activities. The program provides for 61,050 jobs, serving about

92,300 persons in FY2006. The annual cost per slot in FY2006 was $7,081.


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 physical
examinations, personal and job-related counseling, and transportation for
employment purposes, under certain circumstances. Participants also may receive
on-the-job training. Enrollees are paid at the established rate of pay when
participating in training.
Persons eligible to participate in the program are those who are 55 years of age
or older, whose income does not exceed 125% of the DHHS poverty level guidelines
($12,250 for a one-person household in 2006 in the contiguous United States; higher
amounts in Alaska and Hawaii). (For further information on eligibility, see the
section below on changes made by P.L. 109-365.)


33 P.L. 109-365 changed the name of Title V; it was formerly the Older American
Community Service Employment Program.
34 The Rehabilitation Act authorizes a community service employment program for persons
with disabilities. It has never been funded. Another program, the Senior Environmental
Employment (SEE) Program, provides an opportunity for retired and unemployed older
Americans age 55 and over to work in jobs for grantees of the Environmental Protection
Agency (EPA). See [http://www.epa.gov/ohr/see/brochure/], visited Dec. 7, 2006.

Current DOL regulations35 give first priority to veterans and qualified veteran
spouses at least 60 years old; second priority to other persons at least 60 years old;
third priority to veterans and qualified veteran spouses aged 55-59; and fourth
priority to other persons aged 55-59. The regulations also state that “special
consideration” should be given to persons with incomes below the poverty level,
persons with poor employment prospects, persons with the greatest social and/or
economic need, eligible minorities, limited English speakers, and Indians.
Regulations forbid an upper age limit, and they require annual recertification of
income.
Title V wages are exempted in determining eligibility and level of benefits for
the food stamp program and for federal housing programs. Enrollee wages are
subject to federal, state, and local taxes, and participants contribute to social security.
Wages received under Title V are counted when determining eligibility for certain
income-tested programs, such as the supplemental security income (SSI) program.
Funds under the program are distributed to states and to national organizations
according to a set of requirements that include a FY2000 hold harmless amount
(funds are distributed to state agencies and national organizations at their FY2000
level of activities) in addition to relative state population aged 55 and over and the
relative state per capita income.
In 2002 and again in 2006, DOL initiated a competitive grant award process for
distribution of funds to national organizations. The process was effective with the
release of funds for FY2003 (for use during program year (PY) 2003-2004 — July
1, 2003-June 30, 2004). Prior to that time, funds allocated for national organizations
had been awarded on a non-competitive basis to nine public or nonprofit private
organizations and one public agency, the U.S. Forest Service in the U.S. Department
of Agriculture (USDA). The initiation of the competitive grant process has resulted
in distribution of funds to more organizations; some organizations that received funds
prior to the competitive process either received some reduction in funds or did not
receive funds after competition.
Table 1 shows the distribution of funds to national organizations and states for
program years (PY) 2005 and 2006 (that is, for July 1, 2005-June 30, 2006, and for
July 1, 2006-June 30, 2007, respectively). In PY2005, 13 organizations received
funds, in addition to state agencies. In PY 2006, 18 organizations received funds, in
addition to state agencies.


35 U.S. Department of Labor, Employment and Training Administration. 20 CFR Part 641,
April 1, 2006.

CRS-22
Table 1. Title V of the Older Americans Act:
PY2005 and PY2006 Funding and Participant Positions for National Organizations and State Sponsors
PY2005% of total PY2005PY2006% of PY2006
amountamountparticipantamounttotal participant
Sponsor (millions)a positions (millions)a amount positions
AARP Foundation Programs$73.516.8%10,269$69.716.1%9,751
Asociación Nacional Pro Personas$7.71.8%1,074$8.11.9%1,133
Mayores
iki/CRS-RL31336Easter Seals, Inc. $16.13.7%2,248$16.03.7%2,236
g/wExperience Worksb85.819.6%11,995$83.419.3%11,657
s.or
leakGoodwill Industries International,Not funded — — $10.42.4%1,460
Inc.
://wikiInstitute for Indian Development,Not funded — — $1.50.3%205
httpIn c .
Mature Services, Inc. $5.41.2%771$5.01.2%695
National ABLE Network$5.41.2%760$5.61.3%777
National Asian Pacific Center on$6.01.4%836$6.01.4%835
Aging
National Caucus and Center on the$15.23.5%2,129$13.03.0%1,821
Black Aged, Inc.
National Council on the Aging$21.85.9%3,053$24.95.8%3,475



CRS-23
PY2005% of total PY2005PY2006% of PY2006
amountamountparticipantamounttotal participant
Sponsor (millions)a positions (millions)a amount positions
National Indian Council on Aging $6.01.4%842$4.51.0%630
National Urban Leaguenot funded — — $8.72.0%1,222
Quality Career Services, Inc.not funded — — $1.50.3%205
Senior Services America, Inc.c$51.011.0%7,175$50.011.6%6,986
SER-Jobs for Progress National, Inc.$26.25.9%3,658$25.15.8%3,513
iki/CRS-RL31336The Workplace, Inc.not funded — — $2.00.5%273
g/wU.S. Forest Service$20.44.6%2,848 d d d
s.or
leakVermont Associates for Training andnot funded — — $1.80.4%258
Development, Inc.
://wikiNational organization sponsors,$340.578%47,658$337.278%47,133
httptotal
State and territorial sponsors, total$96.2 22%13,439$95.622%13,206
Total $436.7 100% 61,047 $432.8 100% 60,339
Employment & Training Administration, U.S. Department of Labor.
unds are used for the period July 1-June 30. PY2006 funds are an annualized projection; in some cases national organization grantee final will differ due to transition-related delays
between PY2005 to PY2006 grants. Grantees received a portion of their PY2006 amounts to be used for the first quarter of PY23006
erly Green Thumb, Inc.
nds for this organization were previously administered by the National Council of Senior Citizens.
ot receive a full grant for PY2006 but received funds for the first quarter only.



P.L. 109-365 Amendments to Title V
Program Purpose. One of the issues under discussion by the 109th Congress
was the future direction of the program. The original House-passed and Senate-
committee approved bills (H.R. 5293 and S. 3570) took different approaches. The
proposals in H.R. 5293 were wider in scope than those in S. 3570, and many of its
proposed changes emanated from the view that the program should place more
emphasis on training of participants for unsubsidized employment than exists under
the current program. While H.R. 5293 would have retained the community service
nature of the jobs in which enrollees are placed, it also would have allowed enrollees
to be placed in private, for-profit employment while serving as Title V enrollees.
Ultimately, P.L. 109-365 maintained the program focus on employing older
people in community service jobs, and did not include the proposal to allow grantees
to place Title V enrollees in private, for-profit employment. The law did allow
grantees to increase their efforts on training of participants for unsubsidized
employment. It did so by allowing grantees to use an increased amount of their funds
on certain activities, such as training, as described below.
The law stipulated that at least 75% of a project’s funds are to be used for
wages, benefits, and other enrollee costs, such as the costs of physical exams, federal
holiday pay and sick leave (that is not part of an accumulated sick leave program).
The law also stipulated that a Title V grantee may make a request to the Secretary to
spend a lesser amount, that is, at least 65% of funds on these costs, and may do so if
approved by the Secretary. In this case, the grantee may use part of the remainder of
funds (up to 10%) for certain other activities, including training (on the job,
classroom, or other training), job placement assistance, and participant supportive3637
services (but not for costs of administration). The law stipulated that participants
in training will receive Title V wages. The remainder of funds, after deducting the
allowable amount for administration, is to be used to pay for the costs of these Title
V activities as well as outreach to, and recruitment, selection, intake, orientation and
assessment of, eligible individuals.
Eligibility. Prior to enactment of P.L. 109-365, DOL policy, but not the law,
specified income sources that were to be considered when determining an
individual’s eligibility for the Title V program, and how income was to be calculated.
P.L. 109-365 now stipulates certain income exclusions and how income is to be
calculated.
Income Sources. In 1995, DOL issued income determination guidelines to be
used in determining an individual’s Title V eligibility. The 1995 guidelines excluded


36 Supportive services are defined in P.L. 109-365 as the cost of transportation, health and
medical services, special job-related or personal counseling, incidentals (such as work shoes,
badges, uniforms, eyeglasses and tools), child and adult care, dependent care, temporary
shelter, housing, needs-related payments, and follow-up services. Note: supportive services
are defined in two sections of the law, Section 502(c)(6)(A)(iv) and Section 518(a)(7).
37 The law requires that a project may use up to 13.5% of its funds for administration; in
certain circumstances, a project may use up to 15% of its funds.

25% of Social Security income, Social Security Disability Insurance (SSDI) income,


unemployment compensation, veterans’ payments, and $3,000 of interest and
dividend income. In 2005, DOL issued revised guidelines and changed some of the
income criteria to be considered when determining eligibility. The 2005 guidelines
stipulated that Title V project sponsors were required to include as income the
following when determining eligibility: all of Social Security income, including SSDI
income (minus Medicare deductions for persons age 65 or older), unemployment
compensation, veterans’ payments, all interest and dividends as well as earnings,
pension income, rents, and alimony, among other things.38
The 2005 guidelines required project sponsors to exclude as income the
following: Supplemental Security Income (SSI), capital gains (or losses) from the
sale of property, withdrawals of bank deposits, money borrowed, tax refunds, gifts,
lump-sum inheritances or insurance payments, public assistance payments, disability
payments (except Social Security Disability Insurance), child support, worker’s
compensation, gambling and lottery earnings, and the first $2,000 of certain per
capita fund distributions to Indians.39
In a 2005 review of the program, the Government Accountability Office (GAO)
found that most national and state grantees surveyed expressed concern with some
of the 2005 revised income criteria, specifically those including SSDI and Social
Security. As an example, one national grantee stated that including SSDI is
“especially onerous because individuals receiving SSDI are among the hardest to
serve. A state grantee stated that SSDI should not be included in determining
program eligibility because other disability benefits were not included in calculating
income eligibility.” Another expressed concern about the inclusion of all of Social
Security income.40
In response to these concerns, Congress specified in P.L. 109-365 certain
income sources to be excluded when determining a person’s income. The law now
excludes as income the following sources (some that the 2005 DOL guidelines had
previously required project sponsors to include): SSI benefits, 25% of benefits


38 U.S. Department of Labor, Training and Employment Guidance Letter No.13-04, Revised
Income Definitions and Income Inclusions and Exclusions for Determining Senior
Community Service Employment Program (SCSEP) Eligibility (January 7, 2005)
[http://wdr.doleta.gov/directives/corr_doc.cfm?DOCN=1672]. The letter supercedes U.S.
Department of Labor, Older Worker Bulletins, nos. 04-5 and 95-5 [http://www.doleta.gov/
Seniors/html_docs/Library.cfm], visited Dec. 7, 2006.
39 U.S. Department of Labor, Training and Employment Guidance Letter No.13-04: Revised
Income Definitions and Income Inclusions and Exclusions for Determining Senior
Community Service Employment Program (SCSEP) Eligibility (January 7, 2005)
[http://wdr.doleta.gov/directives/corr_doc.cfm?DOCN=1672]. The letter supercedes U.S.
Department of Labor, Older Worker Bulletins, nos. 04-5 and 95-5 [http://www.doleta.gov/
Seniors/html_docs/Library.cfm], visited Dec. 7, 2006.
40 U.S. Government Accountability Office (GAO). Senior Community Service Employment
Program: Labor Has Made Progress Implementing Older Americans Act Amendments of
2000, but Challenges Remain, Testimony before the U.S. Senate Special Committee on
Aging. GAO-06-549T, April 6, 2006.

received under Title II of the Social Security Act, unemployment compensation, and
payments made to, or on behalf of, veterans or former members of the Armed Forces
under laws administered by the Secretary of Veterans Affairs (VA).
Calculation of Income. Since 2004, DOL issued two sets of revised guidelines
on how income is to be determined, first in April, 2004, and then again in January
2005.41 Prior to these changes, grantees could determine income using either an
individual’s income for the 12 months or six months prior to application (i.e., a 12-
or six-month look-back period). The April 2004 guidelines stipulated that grantees
were to use a 12-month look-back period prior to application; this requirement was
changed nine months later to require that the look-back period be the annualized
income for the six-month period prior to application.42 DOL indicated that changing
the period for income calculation was intended to simplify the process and obtain the
most recent income.43
GAO found concerns among many national and state grantees about DOL’s
revised guidance. Some noted that annualizing six months of income could distort
income for people who had income only for the last six months, for example,
seasonal farmworkers. The effect could have the unintended consequence of making
these people ineligible for Title V jobs.
As a result of these concerns, Congress stipulated in P.L. 109-365 that income
is to be calculated for the 12-month period ending on the date an eligible individual
submits an application. At its option, a Title V grantee may use an individual’s
annualized income for the six-month period ending on the date of application.
Time Limit on Participant Enrollment. Prior to passage of P.L. 109-365,
there was no time limit on how long an enrollee may spend as a Title V participant.
However, DOL regulations allowed grantees to establish a maximum duration of
enrollment when authorized by DOL. DOL data showed that the average length of
time participants spend in the program is about 27 months.
Duration of enrollment was an issue in both the original House and Senate bills,
which differed in length of time that participants could be enrolled. Ultimately, P.L.
109-365 stipulated that, beginning July 1, 2007, eligible individuals may participate
in the program for a period up to 48 months. The Secretary of DOL is required to
authorize a grantee, upon the grantee’s request, to increase the period of participation


41 U.S. Department of Labor, Older Worker Bulletin No. 04-05, Income Definitions and
Income Exclusions for Determining Senior Community Service Employment Program
9SCSEP) Eligibility. April 12, 2004. Also, Ibid., U.S. Department of Labor, Training and
Employment Guidance Letter No.13-04: Revised Income Definitions and Income Inclusions
and Exclusions for Determining Senior Community Service Employment Program (SCSEP)
Eligibility (January 7, 2005) [http://wdr.doleta.gov/directives/corr_doc.cfm?DOCN=1672],
visited Dec. 7, 2006.
42 Ibid., U.S. Department of Labor, Training and Employment Guidance Letter No.13-04:
Revised Income Definitions and Income Inclusions and Exclusions for Determining Senior
Community Service Employment Program (SCSEP) Eligibility (January 7, 2005).
43 Ibid., GAO, p. 18.

for the following hard-to-serve individuals: those who have a severe disability; are
frail or age 75 or older; meet the age eligibility for Title II of the Social Security Act,
but are not receiving benefits; live in an area with persistent unemployment and are
individuals with severely limited employment prospects; or have limited English
proficiency or low literacy skills.
The law also established an overall average enrollment duration cap for
grantees. It stipulated that grantees are subject to an average participation cap for
enrollment of 27 months. A grantee may request an extended period of enrollment
for a specific area where the grantee operates, up to a period of not more than 36
months. The Secretary may approve the request if the Secretary determines that
extenuating circumstances exist, pertaining to the following factors: high rates of
unemployment, or poverty, or participation by enrollees in Temporary Assistance for
Needy Families (TANF) in the area served by the grantee, relative to other areas of
the state or nation; significant downturns in the economy in the area served by the
grantee or in the national economy; significant numbers or proportions of participants
with more barriers to employment; changes in the federal, state or local minimum
wage; and limited economies of scale for Title V activities in the area served by the
grantee.
Competition and Grantee Performance Indicators. The 2000
reauthorization for the first time added in law a set of performance indicators that
were to be applied to state agency and national organization grantees. At the end of
each program year, the Secretary was directed to determine if each national grantee44
had met national performance measures as set forth in the statute. If a grantee failed
to meet the performance standards for a given year, the grantee had to submit a
corrective action plan. If the grantee failed over a two- or three-year period to meet
the indicators, some (or all) of a grantee’s funds were to be reduced or eliminated and
awarded to other grantees. DOL published final regulations stipulating how
performance standards were to be applied on April 9, 2004.45
Before performance standards were finalized, on November 8, 2002, DOL
announced a national competition for soliciting grant applications for the national
organization grants portion of FY2003 Title V funding.46 As indicated earlier, for


44 In addition to performance standards, the 2000 amendments added a set of “responsibility
tests” to determine an applicant’s overall ability to administer federal funds. Applicants
determined to be not responsible according to the statutory criteria may not be selected as
national grantees.
45 U.S. Department of Labor, Employment and Training Administration. 20 CFR Part 641,
April 1, 2006.
46 67 Federal Register 68178 (November 8, 2002). DOL gave the following rationale for
opening the application process to competition: “The Department is holding a full and open
competition for SCSEP national grant funds in order to provide better services to SCSEP
participants, host agencies, employers, and the communities that the national grant program
serves. Open competition is not only the preferred vehicle for obtaining new grantees, but
in most cases, it is the required vehicle for obtaining new grantees....The Department favors
full and open competition because it provides the Department with an opportunity to ensure
(continued...)

many years DOL distributed 78% of Title V funds on a noncompetitive basis to 10
entities. According to GAO, the 2002 competition resulted in a “significant
reshuffling of funds and positions among incumbent grantees.”47 Three years later,
on March 2, 2006, DOL again called for a national competition for the national
organization portion of Title V funds.48 During the first national competition in
2002, many national grantees raised issues regarding DOL’s authority to award
funds on a competitive basis. However, the act never explicitly stated whether the
national grants are to be funded on a competitive or a noncompetitive basis.
The DOL competitive awards process and the implementation of the
performance indicators were issues discussed during the 2006 reauthorization
process. Some organizations indicated that the three-year competitive cycle was
difficult to implement — new grantees needed at least one year or more to ramp up
grantee activities, for example, to hire staff, conduct outreach to eligible individuals,
assess their needs, and place them in subsidized jobs. They would then have one or
two years to operate before having to reapply for competitive funds, using the DOL
performance indicators. In addition, some grantees pointed to the time lag in DOL’s
publication of the performance indicators — DOL published the performance
indicators in April 2004, but implemented the national competition in 2002, thereby,
according to grantees, placing them at a disadvantage.
As a result of these concerns, Congress in P.L. 109-365 made a number of
changes to requirements for competition and grantee performance. First, the law
required DOL to hold a national competition for national grantee funds every four
years, rather than every three years (which had been DOL recent practice). After each
year of grantee operation, DOL is to evaluate national organization grantees based
on the performance indicators established by the law (see below). Second, if national
grantees fail to perform they will receive technical assistance from DOL, and are to
take corrective action. Unlike prior law, national grantees will not be subject to
reduction or withdrawal of funds due to failure to meet the performance indicators.
However, if a national organization grantee fails to meet the performance indicators
for four consecutive years, it is prohibited from participating in the next competitive
grant cycle. If a national organization grantee meets the performance standards for
four consecutive years, it may continue to receive funds for an additional year.
The process for competition, technical assistance, and corrective action is
similar for state agency grantees. However, state agency grantees are subject to a
realignment of funds if the Secretary determines that they have failed to meet the
performance indicators for three consecutive years. In this case, the Secretary is
required to have the state conduct a competition to award its funds for the year
following the Secretary’s determination.


46 (...continued)
that the best applicants are awarded grants and the program is administered to its full
potential. It also allows new and different entities, including faith-based and community-
based organizations, to become a part of the grantee community.”
47 Ibid., GAO-06-549T, p. 70.
48 71Federal Register, pp. 10798-10820, March 2, 2006.

Indicators of performance by grantees. Prior to P.L. 109-365, the law
established five indicators of performance; DOL regulations further defined these
indicators.49 The indicators were: number of persons served, with particular
consideration to individuals with greatest economic or social need, or with poor
employment history or prospects, and those over the age of 60; community services
provided; placement and retention in unsubsidized public or private employment;
satisfaction of enrollees, employers, and host agencies with experiences and services
provided; and other indicators determined by the Secretary.
P.L. 109-365 revised the indicators and divided them into core indicators and
additional indicators. Core indicators now include hours (in the aggregate) of
community service and earnings. Similar to prior law, they also include entry and
retention into unsubsidized employment, and the number of eligible individuals
served, including those who are hard-to-serve. Hard-to-serve individuals are defined
as those with a disability, are age 65 or older, are frail, meet the age eligibility under
Title II of the Social Security but do not receive benefits; live in an area with
persistent unemployment; are individuals with severely limited employment
prospects; reside in a rural area; are veterans; have failed to find employment after
using Workforce Investment Act (WIA) services; are homeless or at risk for
homelessness.
Additional indicators are retention in unsubsidized employment for one year;
satisfaction of the participants, employers, and their host agencies with their
experiences and the services provided; and any other indicators determined by the
Secretary.
The Secretary of DOL is required to establish and implement the core and
additional performance indicators by July 1, 2007. The Secretary is prohibited from
holding a grant competition until the later of (1) the date of implementation of
indicators, or (2) January 1, 2010. Also, the Secretary is required to issue definitions
for the performance indicators, after consultation with national and state grantees,
representatives of business and labor organizations, and providers. The Secretary and
grantees are required to agree on expected levels of performance, and the Secretary
is required to make them publicly available. In addition, the Secretary is required to
annually evaluate and publish each grantee’s actual performance levels.


49 U.S. Department of Labor, Employment and Training Administration 20 CFR Part 641.
Senior Community Service Employment Program; Final Rule. Federal Register, April 9,

2004.



Enrollee Placement in Unsubsidized Employment. The 2000
amendments to the act codified in law a DOL regulation regarding placement of
enrollees into unsubsidized employment. These amendments required that grantees
place at least 20% of enrollees into unsubsidized employment. The law defined
“placement into public or private unsubsidized employment” as full- or part-time
employment in the public or private sector by an enrollee for 30 days within a 90-day
period without using a federal or state subsidy program.
P.L. 109-365 made changes to this requirement and stipulated that more
emphasis be placed on unsubsidized employment through the implementation of the
performance indicator on assisting enrollees enter into unsubsidized employment as
described above. The law stipulated that the minimum percentage for the level of
performance related to entry of enrollees into unsubsidized employment is as follows:
for FY2007, grantees are expected to place 21% of enrollees into unsubsidized
employment; for FY2008, 22%; for FY2009, 23%; for FY2010, 24%; and for
FY2011, 25%. Unlike the prior law, P.L. 109-365 did not define entry into
unsubsidized employment. Instead, it stipulated that the Secretary shall issue
regulations to define the indicators of performance.
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 AoA 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 American
elders age 60 or older. In FY2005, grants were awarded to 236 tribal organizations
representing approximately 300 Indian tribes and two organizations serving Native
Hawaiian elders.
The 2000 amendments (P.L. 106-501) added a new part to Title VI authorizing
caregiver support services to Native American elders. Most frequently provided
services under the program are transportation, home-delivered and congregate
nutrition services, and a wide range of home care services.
P.L. 109-365 Amendments to Title VI
P.L. 109-365 allowed tribal organizations who had previously applied for grants
as part of a consortium of tribal organizations to apply for grants even if the tribal
organization submits an application separate from the remaining members of the
consortium, or as one of the remaining members of the consortium. Previously, an
organization that had received funds as part of a consortium could not reapply for
Title VI funds as an independent organization.



Title VII. Vulnerable Elder Rights Protection Activities
Title VII authorizes the long-term care ombudsman program as well as elder
abuse, neglect and exploitation prevention programs.50 Other programs are
authorized, but not funded, that is, legal assistance development and the Native
American elder rights program. (Another new elder justice grant program was
authorized by P.L. 109-365; see below.)
Funding for ombudsman and elder abuse prevention activities is allotted to
states based on a state’s relative share of the total population age 60 and older. State
agencies on aging may award funds for these activities to a variety of organizations
for administration, including other state agencies, area agencies on aging, county
governments, nonprofit service providers, or volunteer organizations.
Most Title VII funding is directed at the long-term care ombudsman program.
Of $20.1 million appropriated for FY2006, almost three-quarters was for
ombudsman activities. The purpose of the program is to investigate and resolve
complaints of residents of nursing facilities, board and care facilities, and other adult
care homes. It is the only Older Americans Act program that focuses solely on the
needs of institutionalized persons. Complaints may relate to action, inaction or
decisions of long-term care providers or their representatives and other actions that
adversely affect the health, safety, welfare or rights of residents. Among their
responsibilities, ombudsmen are required to provide services to assist in protection
of residents, inform them about how to obtain services, and represent their interests
before government agencies.
The ombudsman program leverages funds from a number of sources, other than
the Older Americans Act.51 In FY2005, $78.6 million supported this program from
all sources combined (federal and non-federal). About 58% of the total program
effort came from the Older Americans Act (from both Title VII and Title III funds)
and other federal sources; the remainder came from state and other non-federal
sources. 52
In FY2005, there were 52 and territorial programs and 572 local programs, with
about 1,278 paid staff (full-time equivalents). The program relies heavily on
volunteers to carry out ombudsman responsibilities — more than 13,800 volunteers
assisted paid staff in FY2005. In FY2005, AoA data show that state and local
ombudsman programs opened just over 194,000 new cases of resident complaints


50 For further information, see CRS Report RS21297, Older Americans Act: Long-Term
Care Ombudsman Program, by Kirsten Colello.
51 States receive a separate allotment of funds for ombudsman activities under Title VII; in
addition, they may use Title III funds to support these activities.
52 Administration on Aging, Elder Rights: LTC Ombudsman: National and State Data,
[ h t t p : / / www.a o a . go v/ p r o f / a o a p r o g / e l d e r _ r i g h t s / L T C o mbudsma n/National_and_State_
Data/national_and_state_data.asp], visited Dec. 7, 2006.

and closed more than 187,000 cases in all types of facilities. Most complaints related
to resident care, resident rights, and quality of life issues.53
P.L. 109-365 Amendments to Title VII
Elder Justice Grants. P.L. 109-365 authorized a new state grant program
to promote comprehensive elder justice systems. The law authorized the Assistant
Secretary to award competitive grants to states for elder justice systems which are to
provide for convenient public access to the range of available elder justice
information, programs and services; coordinate the efforts of public health, social
service and law enforcement authorities to identify and diminish duplication and gaps
in the system; and provide a uniform method for standardization, collection,
management, analysis and reporting data on elder justice issues.
States that receive grants are to develop and implement a comprehensive elder
justice system by taking the following steps: establishing a formal working
relationship among public and private elder justice providers and stakeholders in
order to create a unified system across the state; facilitating and supporting the
development of a management information system and standard data elements; and
providing for appropriate education, training and technical assistance.
Older Americans Act
Authorization of Appropriations
Table 2 shows the authorization of appropriations for each title of the act as
stipulated by P.L. 109-365.
Table 2. Authorization of Appropriations
for Older Americans Act Programs in P.L. 109-365
Older Americans Act ProgramsAuthorization of Appropriations
Title II, Administration on Aging
Administration on Aging FY2007-FY2011, such sums as may be necessary.
Eldercare Locator FY2007-FY2011, such sums as may be necessary.
Pension counseling and informationFY2007-FY2011, such sums as may be necessary.
program
Title III, State and Community Programs on Aging
Supportive services and centers FY2007-FY2011, such sums as may be necessary.
Congregate nutrition servicesFY2007-FY2011, such sums as may be necessary.
Home-delivered nutrition servicesFY2007-FY2011, such sums as may be necessary.
Disease prevention and healthFY2007-FY2011, such sums as may be necessary.
promotio n
Family caregiver supportFY2007, $160 million; FY2008, $165.5 million;
FY2009, $173 million; FY2010, $180 million;
FY2011, $187 million.


53 Ibid.

Older Americans Act ProgramsAuthorization of Appropriations
Nutrition services incentive programFY2007-FY2011, such sums as may be necessary.
(formerly the USDA commodity or
cash-in-lieu of commodities program)
Title IV, Activities for Health, Independence, and Longevity
FY2007-FY2011, such sums as may be necessary.
Title V, Community Service Senior Opportunities Act
FY2007-FY2011, such sums as may be necessary.
Title VI, Grants for Native Americans
Indian and Native Hawaiian programsFY2007-FY2011, such sums as may be necessary.
Native American caregiver supportFY2007, $6.5 million; FY2008, $6.8 million;
programFY2009, $7.2 million; FY2010, $7.5 million;
FY2011, $7.9 million.
Title VII, Vulnerable Elder Rights Protection Activities
Subtitle A — State Programs
Long-term care ombudsman program FY2007-FY2011, such sums as may be necessary.
Elder abuse, neglect, and exploitationFY2007-FY2011, such sums as may be necessary.
prevention program
Legal assistance development programFY2007-FY2011, such sums as may be necessary.
Subtitle B — Native American Organization and Elder Justice Provisions
Native American elder rights programFY2007-FY2011, such sums as may be necessary.
Grants for state elder justice systemsNo authorization specified.
Older Americans Act Appropriations
Funding for most Older Americans Act programs is provided through
appropriations legislation for the Departments of Labor, Health and Human Services,
Education and Related Agencies (Labor-HHS-ED). Funds for all AoA programs
(Titles II, III, IV, VI, and VII) are part of the HHS appropriations; Title V is part of
the DoL appropriations. In FY2003, Congress transferred administrative authority
for the nutrition services incentive grant program from the U.S. Department of
Agriculture (USDA), where it had been since its inception, to AoA. The program
retains a separate authorization of appropriations under Title III and its appropriations
are part of the Labor-HHS-ED appropriations legislation.
FY2006 Appropriations. For FY2006, the act was funded at $1.783 billion,
which overall represents a 2% reduction from the FY2005 level. This amount
includes the 1% across-the-board reduction in all federal discretionary programs
required by P.L. 109-148. Although some programs received slight increases, such
as the Title VII long-term care ombudsman and the elder abuse prevention programs
(increases of 6% and less than 1%, respectively), most programs received slight
decreases. A major reduction was made in the Title IV research, training, and
discretionary projects program, which was reduced by 43% from the FY2005 level.
This is because the FY2006 amount does not include earmarked amounts approved
for specific projects required by Congress for FY2005.
Table 3 shows appropriations history for the act’s programs for FY1999-
FY2006. Appropriations amounts for previous years are available in CRS Report



RL32437, Older Americans Act: History of Appropriations, FY1966-FY2004, by
Carol O’Shaughnessy. For information on FY2007 appropriations, see CRS Report
RL33880, Older Americans Act: FY2006 Funding, FY2007 Proposals, and FY2008
Budget Request, by Carol O’Shaughnessy and Angela Napili.
Figure 1 shows the distribution of FY2006 funding by program.
Figure 1. Older Americans Act, FY2006 Funding ($1.8 billion)


Source: Prepared by CRS based on FY2006 appropriations legislation.

CRS-35
Table 3. The Older Americans Act, Alzheimer’s Demonstration Grants, and White House
Conference on Aging Funding, FY1999-FY2006
($ in millions)
s and Alzheimer’s
onstration Grants
FY1999FY2000FY2001 FY2002FY2003 FY2004 FY2005a FY2006b
LE II: Administration on Aging$15.395$16.461$17.232$20.501$20.233$30.618$31.567$30.812
am administration 15.39516.46117.23218.12217.86917.32418.30117.688
iki/CRS-RL31336ork support activities2.379c2.364c13.294d13.266d13.124d
g/w Grants for State and
s.ormmunity Programs on Aging952.339987.6171,151.2851,230.2931,240.8911,243.0591,250.1921,242.378
leak
tive services and centers300.192310.082325.082357.000 355.673 353.889354.136350.354
://wikiegivers 125.000 136.000e 149.025e 152.738e 155.744e 156.060e
http
ease prevention/health promotion16.12316.12321.12321.12321.91921.97021.61621.385
trition services626.261661.412680.080716.170714.274714.462718.696714.579
ongregate meals(374.261)(374.336)(378.412)(390.000)(384.592)(386.353)(387.274)(385.054)
ed meals(112.000)(146.970)(152.000)(176.500)(180.985)(179.917)(182.826)(181.781)
trition services incentive grants(140.000)(140.000)(149.668)f(149.670)(148.697)g(148.192)(148.596)(147.744)
home services for the frail elderly9.7630hhhhhh



CRS-36
s and Alzheimer’s
onstration Grants
FY1999FY2000FY2001 FY2002FY2003 FY2004 FY2005a FY2006b
LE IV: Activities for Health,i
ependence, and Longevity18.00031.162 37.67838.28040.25833.50943.28624.578
Community Service Senior
portunities Act440.200440.200440.200445.100442.306438.650436.678432.311
I: Grants to Native
ericans 18.457 18.457 23.457 31.229 33.704 32.771 32.702 32.353
iki/CRS-RL31336tive and nutrition services25.72927.49526.45326.39826.116
g/wtive American caregivers5.5006.2096.3186.3046.237
s.or
leakLE VII: Vulnerable Elder Rights
on Activities12.18113.18114.18117.68118.55919.44419.28820.142
://wikierm care ombudsman program7.449jjjj14.276)14.16215.000
http
abuse prevention4.7325.1685.1265.142
assistance00000000
tive Americans elder rights program
tal, Older Americans Act Programs$1,456.569$1,507.078$1,684.033$1,783.084$1,771.057$1,798.051$1,813.713$1,782.574
er’s Demonstration Grantsk$5.970$5.970$8.962$11.500$13.412$11.883$11.786$11.660
ite House Cnf. o Agin 00000$2.814l$4.520l0l
Appropriations legislation, various years.



CRS-37
Y2005 amounts reflect the 0.80% across-the-board reduction required by P.L. 108-447, Division J, Section 122. The Administration was given discretion on how to distribute
the reduction among individual accounts and line items.
Y2006 amounts reflect two rescissions: (1) There was an 1% across-the-board reduction required by P.L. 109-148, Division B, Title III, Chapter 8, Section 3801. (2) On June
14, 2006, the HHS Secretary notified the Appropriations Committees that he would transfer funds among HHS programs to finance activities related to the Medicare drug benefit
call center. This transfer was a 0.069% across-the-board reduction and it reduced Administration on Aging funds by $0.9 million. It was authorized by Section 208 of P.L. 109-
149.
ncludes $1.2 million for the Eldercare Locator and $1.2 million for Pension Counseling and Information Program.
ncludes funds for activities previously funded under Title IV: Senior Medicare Patrols; National Long-Term Care Ombudsman Resource Center; and National Center on Elder
Abuse. Also includes funds for the Eldercare Locator and Pension Counseling and Information Program.
nding for Native American family caregiving is shown in Title VI.
ongress originally appropriated $150 million, then rescinded $332,000 (0.22%) pursuant to Section 1(a)(4) of P.L. 106-554.
ongress transferred the program, previously funded by USDA, to AoA in FY2003.
thorized. P.L. 106-501 eliminated separate authority for in-home services for the frail elderly, but such activities may still be funded under the Title III supportive services
iki/CRS-RL31336and centers program.
g/wootnote d. Funds shown are reduced from FY2003 level due to transfer of some funds to Title II.
s.orounts not specified.
leakhe FY1999 Omnibus Consolidated Appropriations Act (P.L. 105-277/H.R. 4328) transferred the administration of the program from the Health Resources and Services
Administration to AoA. The program is authorized under Section 398 of the Public Health Service Act.
://wiki.L. 100-75 required the President to convene the conference no later than Dec. 31, 2005. It was held December 11-14, 2005. See [http://www.whcoa.gov]. FY2006 obligations
httpfor the White House Conference on Aging were funded by carryover balances of prior year appropriations.



Appendix. The Older Americans Act:
Historical Development
Congress created the Older Americans Act in 1965 in response to concern by
policymakers about a lack of community social services for older persons. 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 57 state agencies on aging and
655 area agencies on aging, supports the sole federal job creation program benefitting
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 persons 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 Older Americans Act 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.54
In response to the White House Conference on Aging recommendations,
Representative John Fogarty of Rhode Island and Senator Pat McNamara of
Michigan introduced legislation 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. Because there were objections by the Administration to the
creation of an independent federal agency on aging, the legislation was not enacted.


54 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, Apr. 1961.

Legislation introduced the following year by Representative Fogarty and Senator
McNamara modified the 1962 proposal by creating within DHEW, the
Administration in Aging (AoA) which was to be under the direction of a
Commissioner for Aging, appointed by the President with the approval of the Senate.
However, the 1963 proposal was not enacted.
The Older Americans Act as introduced in 1965 basically 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 wide bipartisan support and was signed into law by President
Johnson on July 14, 1965. 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.”55
Major Amendments to the Older Americans Act
The Older Americans Act has been amended 15 times since the original
legislation was enacted. The first amendments to the act in 1967 extended
authorization for the state grant program and for research, demonstration, and
training programs created in 1965. In 1969, Congress added authority 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.)
Major amendments to the act occurred in 1972 with the creation of the national
nutrition program for the elderly, and in 1973, with the establishment of substate area
agencies on aging. The 1973 amendments represented a major change because for
the first time federal law 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 1975,
Congress extended the Older Americans Act through 1978 and specified certain
services to receive funding priority under the state and area agency on aging program.
The 1978 amendments 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


55 Public Papers of the Presidents of the United States, Lyndon B. Johnson, vol. 2,
Washington, 1965, p. 744.

state and area agencies on aging. 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 Indians.
The 1981 amendments made modifications to give state and area agencies on
aging 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, including adding responsibilities for AoA; adding
provisions designed to target services on low-income minority older persons; giving
more flexibility to states regarding service funds allocations; and giving priority to
the needs of Alzheimer’s victims and their families.
The 1987 amendments expanded certain service components of the state and
area agency program to address the special needs of certain populations. Congress
authorized 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 the Department of Health and Human Services (HHS), and liberalize
eligibility of community service employment participants for other federal programs.
The 1992 amendments 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.
The 2000 amendments were enacted after six years of congressional debate on
reauthorization. P.L. 106-501 extended the act’s programs through FY2005. These
amendments authorized the National Family Caregiver Support Program under Title
III; required the Secretary of the Department of Labor (DOL) 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.
The 2006 amendments extended the act’s programs through FY2011. Among
other things, the law authorized the Assistant Secretary on 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 also authorized the
Assistant Secretary to award competitive grants to states to support the development
of coordinated state systems designed to detect and prevent abuse, neglect and
exploitation.
P.L. 109-365 required AoA and state and area agencies on aging to focus
attention on planning comprehensive and coordinated systems of home and
community-based services to assist older persons with long-term care needs to
remain in their own homes, rather than entering institutions. It also authorized AoA
to award funds for Aging and Disability Resource Centers (ADRCs) to serve as a
visible source of information on the full range of long-term care options to assist frail
older people.
Among other things, P.L. 109-365 revised the formula for the allocation of Title
III funds by updating the “hold harmless” provision to the FY2006 funding level and
phasing out over four years the guaranteed growth provision that had been added by
the 2000 reauthorization legislation. The law 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 on 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 in
Naturally Occurring Retirement Communities (NORCs); and for mental health
services for older people.
It also revised the Title V community service employment program to place
more emphasis on training of older individuals, but also maintains the emphasis on
employing them work in community service activities. The law required the
Secretary of Labor to conduct a national competition for Title V funds every four
years.