A Guide to Long-Term Care for State Policy Makers:
A Guide to the Older Americans Act
“The new Older Americans Act helps empower individuals and supports better planning, improved home and community-based long-term care options, and more flexible and consumer-friendly systems that allow Americans to remain vibrant and independent.”
Josefina G. Carbonell, Assistant Secretary for Aging U.S. Health and Human Services
On October 17, 2006, President Bush signed into law the Older Americans Act (OAA) Amendments of 2006, which positions the U.S. Administration on Aging (AoA) and its Aging Services Network throughout the country to expand efforts to redirect the nation’s long-term care (LTC) system toward increased options for home and community services and supports. The legislation provides state policymakers with new and strengthened resources to:
- Improve consumer access to publicly funded LTC services,
- Strengthen consumer direction and control of those services, and
- Encourage consumers to assume personal responsibility for their own LTC planning.
The reauthorized act buttresses AoA’s Choices for Independence Initiative to improve the quality of life for older Americans and people with disabilities and their family caregivers within a cost-effective system of care. The secretary of the U.S. Department of Health and Human Services called it “a fundamental transformation in the way we deliver long-term care.” The OAA Amendments expand the aging networks’ ability to serve diverse populations of older people and younger adults with disabilities, and provides grant incentives to stimulate innovative programs at the state and local levels.
As AoA Deputy Assistant Secretary Frank Burns told a conference in 2007: “Choices is about putting a different structure and efficient system of distribution” over core Older Americans Act programs, and “expanding the use of those services.” He said the three key integrated set of strategies of Choices for Independence empower the Aging Services Network to:
- Develop Aging and Disability Resource Centers as “one-stop shopping” in the community for consumers to learn about and access LTC services and supports;
- Use flexible service models, including consumer-directed models of care for high-risk individuals and other senior citizens who need services and supports in the community; and
- Make it easier for seniors to learn about and take advantage of low-cost, evidence-based prevention programs that can help older Americans better manage their chronic conditions and physical and mental health.
The Older Americans Act Amendments contain numerous provisions that provide the Aging Services Network (state agencies on aging, area agencies on aging [AAAs], tribal organizations, community service providers and caregivers) with increased flexibility and creativity in implementing provisions under the act. The provisions include the following:
- Authorizes creation of Aging and Disability Resource Centers that provide:
- Comprehensive information about available public and private LTC programs, options and resources within a community;
- Personal counseling to help individuals assess their LTC needs and develop and implement a plan for LTC; and
- Access to publicly supported LTC programs for those eligible.
- Encourages the Aging Network to promote the use of consumer-directed models of care for individuals who need community services and supports.
- Authorizes AoA to establish criteria for state and communities to use in implementing evidence-based disease prevention programs.
- Expands the National Family Caregiver Support Program to include grandparents or relative caregivers age 55 and older (lowered from age 60) who are caring for children of any age with a disability and family members who are caring for a person with Alzheimer’s Disease.
- Improves access to programs and services under the act by addressing the needs of older people with limited English proficiency.
- Develops a long-term plan to support state and local efforts in the provision of mental health services.
- Authorizes AoA to fund the development of innovative models to support aging in place (such as naturally occurring retirement communities) through transportation, health programs and social work services.
Issues for State Policymakers
The reauthorized Older Americans Act gives state policymakers enhanced opportunities to provide and expand LTC services in home and community-based settings. It also provides support for state and community planning to address LTC needs of current seniors and the baby boomer generation. The OAA requires state and area aging agencies to develop and implement a “comprehensive, coordinated” LTC system that enables older people to receive LTC in home and community-based settings and that is responsive to their needs and preferences.
Modernizing community-based LTC systems to empower people to make informed decisions about their care options and to assume greater control over the services they receive requires careful state planning. State policymakers will want to seek answers to the following questions:
- What major system reform initiatives are needed to ensure that the state is making progress toward a more balanced LTC system that offers consumers choice, control and independence?
- How much progress has the state made on the three Choices for Independence strategies: making it easier for consumers to learn about and access existing LTC services in their communities: adopting flexible service models such as consumer-directed care; and providing low-cost, evidence-based disease prevention programs? What additional tools or resources might the state aging agency and local AAAs need to accomplish these strategies?
- Is the state’s aging agency in the best position to take advantage of the additional LTC responsibilities that the Older Americans Act provides and can it mount healthy aging programs? Is it also administering the Medicaid HCBS waiver programs and thus able to provide services and supports to both Medicaid-eligible and non-Medicaid eligible older people?
- Has the state taken full advantage of the federal and other grant opportunities to develop Aging and Disability Resource Centers, implement consumer direction models in all HCBS programs, and help people move out of nursing homes?
- What steps have the state’s aging agency and the Aging Network taken to ensure coordination and collaboration with other state agencies and community partners to implement a seamless system for consumers who seek LTC services?
- Federal funding increases in recent years have not kept pace with inflation or the growing number of people who may need LTC services and supports. Does the state Aging Network have the necessary resources for its expanded role; if not, what are other possible sources for additional funds?
Resources
Administration on Aging website. http://www.aoa.gov/OAA2006/Main_Site/index.aspx
Choices for Independence Working Together to Build the Future of Long-Term Care Summit: http://www.kaisernetwork.org/health_cast/hcast_index.cmf?display=detail&HC=1988
Contact for more information
Donna Folkemer
Group Director, Forum for State Health Policy Leadership
National Conference of State Legislatures
(202) 624-8171
donna.folkemer@ncsl.org
Funding for this project was made possible through funding from the U.S. Administration on Aging. The views expressed in written materials or publications do not necessarily reflect the official policies of the Department of Health and Human Services nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
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