Advocates assisting Medicare beneficiaries, including those who are dually eligible for Medicare and Medicaid, should review the supportive services available under the Older Americans Act (OAA) for individuals in their homes or communities. The OAA includes a wide variety of services that may assist those receiving home health care under Medicare or Medicaid. In passing the OAA in 1965, Congress sought to provide assistance to older Americans through supportive social services while maintaining the participants' "maximum independence and dignity in a home environment." The OAA is administered nationally by the Assistant Secretary for Aging of the Department of Health and Human Services. The Assistant Secretary for Aging heads the office of the United States Administration on Aging. A major function of the Administration on Aging is to provide funds to designated State Units on Aging which in turn distribute funds to Area Agencies on Aging (AAAs). Together, State and Area Agencies on Aging develop and implement systems for the delivery of services. Each state is responsible for the creation of social services programs suited to its residents' needs. Because each state receives funding proportional to its population of older individuals, programs and services differ from state to state.
To be eligible for services funded by the Older Americans Act, program participants must be 60 years old or older and must be in greatest social or economic need. These eligibility factors have been a source of confusion to programs. To address this confusion, Congress has clarified that while serving the general population of persons 60 years of age and older, OAA-funded programs have a mandate to identify and target low-income minority individuals suffering from physical and mental disabilities, language barriers, or those who are racially, ethnically, culturally, or geographically isolated.
Congress has clarified that the economic need aspect of eligibility is not defined by "means-testing." Rather, program participants may be encouraged to make voluntary contributions toward services and providers have the flexibility to suggest a non-prohibitive contribution amount. The Older Americans Act also does not use Social Security quarters of coverage requirements as an eligibility factor. OAA programs therefore have the potential to reach a segment of the population 60 and older that does not qualify for Medicare or Medicaid services. Moreover, because eligibility does not depend on work experience, seniors with little to no work experience are still eligible to receive the benefits.
Notably, immigrants otherwise made ineligible for federal and state public benefits by the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) are also eligible for in-home care, nutrition services, and other community programs under the Older Americans Act.
Programs Funded under Title III of the OAA
Title III Programs are divided into four programs: Supportive Services, Nutrition and Meals Services, Disease Prevention and Health Promotion, and the National Family Caregiver Support Program.
A. Supportive Services (Title III-B) Certain services deemed "priority" services under the Act must be funded annually. These include:
- Legal assistance;
- Access to services (transportation, outreach, information and assistance, and case management services); and
- In-home services (homemaker and home health aides, visiting and telephone reassurance, chore maintenance).
Consequently, these services are most prevalent. Other optional programs may be offered, including such services as health screening, education and training; transportation services; and minor residential repair and renovation projects designed to adapt homes to the needs of older individuals. Additionally, states may have programs providing advice on financial planning for retirement, programs designed to prevent institutionalization, and investigations into nursing home abuse.
Title III-B Supportive services also include special provisions for "Frail Older Americans" and their caregivers. These programs are designed to assist individuals who are unable to perform at least two activities of daily living (ADLs) without substantial human assistance Services may include chore maintenance and the assistance of homemakers or home health aides. Notably, older Americans with Alzheimer's disease and related neurological disorders are specifically mentioned as intended beneficiaries.
B. Nutrition and Meals Services (Title III-C)
State and local programs also receive funding under Title III-C to provide older Americans with Nutrition and Meals services. Title III-C requires that programs be established to deliver meals to adult day care centers and also to seniors residing at home. All state and local programs receiving funding are generally required to deliver at least one meal per day, five days a week to program participants.
The Nutrition programs are a valuable resource for several reasons. The programs reach a variety of people, many of whom may not be Medicare and/or Medicaid beneficiaries, thus widening the scope of people eligible to participate. Because states are permitted to arrange for the delivery of meals to "multigenerational meal sites," disabled individuals under 65 residing in housing primarily serving the elderly are eligible to participate in the meals programs. In addition, spouses of older Americans already participating in meals programs are themselves eligible to participate and receive home-delivered meals regardless of their age or condition. Finally, the meals programs ensure good nutrition. Title III requires that the meals meet federal dietary guidelines. Providers are encouraged to serve modified meals (low fat, low sodium, or low calorie) upon request to meet the needs of program participants, and many state and local programs offer nutritional education services or counseling.
C. Disease Prevention and Health Promotion (Title III-D)
The Older Americans Act also provides states with money to be used for disease prevention and health promotion. Specifically, state agencies and local organizations may use money from Title III-D grants for health screening, education and training, and individual health counseling. States are directed to provide these services at senior centers, in connection with meal delivery programs at congregate meal sites, or through the home delivery meal program. Because states must give first priority for such programs to areas that are medically underserved, these services may provide important health screening tools to older Americans who other wise lack access to services.
D. National Family Caregiver Support Program (Title III-E)
Title III-E of the OAA provides funding to state and local programs to assist caregivers of older Americans in many ways. Relatives of older Americans providing in-home care qualify for supportive services. State and local agencies may provide caregivers with information and assistance about available services for older Americans; individual counseling and training to assist caregivers in decision making; "respite care" to provide temporary relief to caregivers of their responsibilities; and supplemental services to supplement the caregiver's activities.
The programs funded under the Older Americans Act represent an array of services that may fill unmet needs. Medicare participants may benefit from the additional services provided by Title III, and individuals ineligible for Medicare or Medicaid may find the programs especially useful. Information about local services can be found by contacting a local Area Agency on Aging or the State Office on Aging. Additional information about the OAA and its services and programs is available through the Administration on Aging, at http://www.aoa.gov/. The national elder care locator, 1-800-677-1116, is an important resource for identifying and accessing local Title III supportive services.