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Aging Agency Prepares for Older American Act
Reauthorization
Proposing technical changes and new 'Choices for
Independence'
 March 19, 2006 – Representatives from the
Administration on Aging will be meeting today at the 2006 Joint
Conference of the National Council on Aging and the American Society of
Aging to discuss changes they are proposing in the reauthorization of
the Older Americans Act, including a proposal called "Choices for
Independence," which is a $28 million demonstration project. AoA says it
builds on the mission and success of the Act and aims to strengthen and
modernize its role in promoting consumer choice, control, and
independence in long-term care.
Choices aims to strengthen the nation’s capacity to
promote the dignity and independence of older people and meet the
challenges associated with the aging of the baby boom generation,
according to AoA.
"It also aims to supplement the President’s New
Freedom Initiative and the Administration’s policy for modernizing
Medicare and Medicaid by strengthening the Act’s role in promoting
consumer choice, control, and independence in long-term care," the
agency says.
The Older Americans Act supports a Federal, state,
tribal and local partnership known as the national aging services
network, which includes 56 state units on aging, 655 area agencies on
aging, 243 tribal organizations, 29,000 community-based organizations,
and over 500,000 volunteers.
The network uses $1.4 billion in federal funds each
year to leverage an additional $4 billion from other public and private
sources to provide home and community-based services to over 8 million
elderly individuals. Services include home-delivered meals, nutrition
services in congregate settings, transportation, adult day care, health
promotion, and support for family caregivers.
The reauthorization package also includes technical
amendments which clarify some of the issues that were raised in earlier
listening sessions conducted by Assistant Secretary
Josefina G. Carbonell.
The proposed Choices for Independence Proposal, and
the technical clarifying proposals are below.
Technical
Clarifying Amendments
1. SEQ CHAPTER \h \r 1Clarification
of State Portion of Non-Federal Share
SEQ CHAPTER \h \r 1This
provision would clarify the State-only portion (as opposed to the
State/local portion) of the non-Federal share of the cost of supportive
services, senior centers, and nutrition services provided under title
III.
2. SEQ CHAPTER \h \r 1Consumer
Contributions
SEQ CHAPTER \h \r 1This
provision would clarify current cost-sharing authority to permit States
to establish a fee-for-service system, on a sliding fee scale, for
receipt of services funded under the Act. Fee revenues (and voluntary
contributions) could be used only to provide Act services. Individuals
with self-declared incomes at or below the Federal poverty level would
be exempt from fees, and fees would not be permitted with respect to
information and assistance services or any services provided under title
VI (grants for Native Americans) or title VII (allotments for vulnerable
elder rights protection activities).
3. SEQ CHAPTER \h \r 1Designation
of a Single Statewide Planning and Service Area
SEQ CHAPTER \h \r 1This
provision would clarify that States are permitted under the Act to
consolidate a system of multiple planning and service areas (PSAs) into
one statewide PSA. The existing due process provisions of the Act
associated with a State making such change remain in force.
4. Funding for Program Evaluation
SEQ CHAPTER \h \r 1This
provision would provide a new mechanism for funding the evaluation of
Older Americans Act programs. The proposed legislation would replace
the current funding authority (under which no more than a specified
dollar amount may be taken from title III and IV funds, respectively)
with new authority permitting the use, for evaluation purposes, of up to
0.5 percent.
5. SEQ CHAPTER \h \r 1Nutrition
Services Incentive Program
This provision would streamline the administration of the NSIP
program by providing States with their allotments in the form of cash.
Flexibility is provided for local nutrition programs that desire to
access commodities to use part or all of their cash allotment to obtain
them from local school food authorities. In addition, the proposal
provides for the dissemination of information regarding school food
authorities to local nutrition grantees.
6. SEQ CHAPTER \h \r 1Self-Directed
Care Under Older Americans Act Programs
SEQ CHAPTER \h \r 1This
provision recognizes the importance of the Act’s historical emphasis on
the use of consumer-directed models of care. It provides, to the
greatest extent feasible, that Act services to assist individuals with
activities of daily living be furnished in a manner that offers such
individuals the maximum choice and control over the provision of such
services.
Choices for
Independence
Reauthorization of the Older Americans Act includes
a proposal to pilot Choices for Independence, a $28 million
demonstration project to promote consumer-directed and community-based
long term care options. Choices aims to strengthen the nation’s capacity
to promote the dignity and independence of older people and meet the
challenges associated with the aging of the baby boom generation. It
also aims to supplement the President’s New Freedom Initiative and the
Administration’s policy for modernizing Medicare and Medicaid by
strengthening the Act’s role in promoting consumer choice, control, and
independence in long-term care.
The Older Americans Act supports a Federal, state,
tribal and local partnership known as the national aging services
network, which includes 56 state units on aging, 655 area agencies on
aging, 243 tribal organizations, 29,000 community-based organizations,
and over 500,000 volunteers.
The network uses $1.4 billion in federal funds each
year to leverage an additional $4 billion from other public and private
sources to provide home and community-based services to over 8 million
elderly individuals. Services include home-delivered meals, nutrition
services in congregate settings, transportation, adult day care, health
promotion, and support for family caregivers.
Choices for Independence builds on the mission and
success of the Older Americans Act. It also builds on recent HHS
initiatives, including: the Aging and Disability Resource Center
Initiative; the Own Your Future Long Term Care Awareness Campaign; the
Cash & Counseling Demonstration Program; and, the Evidence-Based Disease
Prevention for the Elderly Program.
Choices integrates best practices from these
initiatives into a three-pronged strategy focused on: empowering
individuals to make informed decisions about their long-term support
options; providing more choices for individuals at high-risk of nursing
home placement; and enabling older people to make behavioral changes
that will reduce their risk of disease, disability, and injury.
The Older Americans Act is uniquely positioned to
advance these changes. It has a statutory focus on keeping older people
independent and living in their own homes and communities for as long as
possible, and a successful history of providing low-cost, non-medical
supports through a federal, state and local partnership under a capped
federal appropriation.
Empowering Individuals to Make Informed Choices
Choices aims to empower individuals – both those in
immediate need and those who have the ability to plan ahead for their
long-term care – to make informed decisions about their support
options.
To promote ownership over long-term care planning,
Choices will conduct a public education campaign and provide individual
support through “one stop” resource centers, known as Aging and
Disability Resource Centers.
These resource centers will be “visible and
trusted” sources that people can turn to for information on all
available support options, including private financing options such as
long-term care insurance and home equity instruments. This will reduce
the confusion and frustration consumers and their families often face as
they explore long-term care options. It will also improve government
efficiency by integrating the multiple eligibility forms and procedures
for various public programs that help finance long-term support options.
Providing More Choices for High-Risk
Individuals
Choices will give states and communities greater
flexibility under the Older Americans Act to help moderate and
low-income individuals to remain in their homes and delay their
premature entry into nursing homes.
Choices will provide flexible funding that will be
targeted at individuals, not at service categories as with the current
titles under the Act. This will make it easier for states to respond to
people’s individualized needs and preferences. It also will promote the
use of consumer-directed approaches, including “cash and counseling”
models which give consumers more control over the care they receive.
Building Prevention into Community-Living
Choices will empower older individuals to make
lifestyle changes that will reduce their risk of disease, disability,
and injury. There is a growing body of scientific evidence on the
efficacy of low-cost programs that can empower older individuals,
including functionally impaired individuals, to better maintain their
health. These programs focus on interventions such as chronic disease
self-management, falls prevention, exercise, and nutrition.
Choices will strengthen the role of the Older
Americans Act in translating research into practice by promoting the use
of evidence-based health promotion and disease prevention programs at
the community-level through local aging services provider organizations
such as senior centers, nutrition programs, senior housing projects, and
faith-based groups.
The nation-wide deployment of these programs will
improve quality of life, reduce health care costs, and complement the
increasing focus on prevention in our health care system.
Implementing the Choices Demonstration
Choices will provide competitive matching grants to
states and will entail a rigorous program evaluation. Participating
states will be required to track outcomes based on performance measures
that will be established by AoA.
Such measures may include promotion of consumer
health and well-being, and reductions in the unnecessary use of costly
hospital and nursing home care.
AoA will establish a national technical assistance
program for Choices to support state implementation activities.
Finally, AoA will involve the Centers for Medicare and Medicaid
Services, the Centers for Disease Control and Prevention, the National
Institute on Aging, the Agency for Healthcare Research and Quality, and
other HHS agencies in the implementation of Choices.
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