Growing%20Needs,%20Shrinking%20Resources:%20%20an%20update%20from%20the%20field

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Quality Future Older Americans Act
Reauthorization and Other Opportunities to
support older persons family caregivers Amy
Wiatr-Rodriguez Aging Services Program
Specialist U. S. Administration on Aging -
Chicago, IL

Minnesota Age Disabilities Odyssey Rochester,
MN June 21, 2011
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Outline

• AoA Overview
• Selected AoA Key Opportunities
• OAA Overview
• OAA Reauthorization

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AoA Overview
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AoA Federal Leader of the Aging Network

• The Aging Network is comprised of
• 56 State Units on Aging (SUAs),
• 246 Tribal organizations,
• 630 regional Area Agencies on Aging (AAAs), and
• more than 29,000 State, local, and
  community-based services organizations that reach
  into every community in the Nation.
• Local organizations provide direct services to
  more than 10 million older adults almost 1
  million family caregivers each year.
• The Aging Network was created out of and pursuant
  to the Older Americans Act. In addition to
  setting up the SUA and AAA structures, the Act
  also provides 1.5 billion annually for local
  provision of services.

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AoA Strategic Goals for 2007 2012,which are
mirrored in the current MN State Plan on Aging
Goals

• 1 - Empower older people, their families, and
  other consumers to make informed decisions about,
  and be able to easily access, existing health and
  long-term care options
• 2 - Enable seniors to remain in their own homes
  with high quality of life for as long as possible
  through the provision of home and community-based
  services, including supports for family
  caregivers
• 3 - Empower older people to stay active and
  healthy through OAA services and newer prevention
  benefits under Medicare
• 4 - Ensure the rights of older people and prevent
  their abuse, neglect and exploitation
• 5 - Maintain effective and responsive management

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Selected AoA Key Opportunities
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Copy of a slide from presentation by Dr. Mark
Williams and Tina Budnitz atCMS Care Transitions
conference, December 3, 2010, available at
http//www.cms.gov/DemoProjectsEvalRpts/MD/itemdet
ail.asp?itemIDCMS1239313
Key Initiative Care Transitions
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Copy of a slide from presentation by Dr. Mark
Williams and Tina Budnitz at CMS Care Transitions
conference, December 3, 2010, available at
http//www.cms.gov/DemoProjectsEvalRpts/MD/itemdet
ail.asp?itemIDCMS1239313
Key Initiative Care Transitions
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Key Initiative Care Transitions
Care Transitions The process of engaging
consumers and their informal caregivers in the
discharge planning process to ensure they have
the post-discharge care instructions and
resources they need to avoid unnecessary
hospitalization or institutionalization.
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Key Initiative Care Transitions

• Opportunity - CMS Funding 500 Million
• Program Goals include
• Improve transitions from inpatient hospital
  setting to other care settings
• Improve quality of care
• Reduce readmissions for high risk beneficiaries
  and
• Document measurable Medicare savings
• Eligible entities include Acute Care Hospitals
  with high readmission rates community-based
  organizations (CBOs) that provide care
  transitions services
• Partnership between hospital CBO

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Key Initiative Care Transitions

• Applications will be due on rolling-basis
• Preferences must be given to applications that
• Include participation in a program administered
  by AoA
• Provide services to medically-underserved
  populations, small communities and rural areas
• Physician group practices

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Key Initiative Care Transitions

• AoA has provided a multi-part series of Webinar
  trainings, including
• Providing an overview of Care Transition models
• Assessing your agencys readiness to lead or
  participate
• Gathering data and support
• Building the necessary partnerships and
• Assessing your financial systems, payments and
  billing.
• http//www.aoa.gov/AoARoot/Aging_Statistics/Health
  _care_reform.aspx

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Key Initiative Care Transitions

• For more information about the Partnership for
  Patients, visit http//www.HealthCare.gov/center/p
  rograms/partnership.
• For more information about the Community-based
  Care Transitions Program funding opportunity,
  visit http//www.cms.gov/DemoProjectsEvalRpts/MD/i
  temdetail.asp?itemIDCMS1239313.
• For more information about AoAs Aging
  Disability Resource Centers Evidence-Based Care
  Transitions Program, visit http//www.aoa.gov/AoA
  Root/AoA_Programs/HCLTC/ADRC_caretransitions/index
  .aspx

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Key Initiative Evidence-Based Health Promotion

• Important?
• If we can prevent chronic illness, we can improve
  lives and save health care dollars.
• 85 of health care spending is for care and
  treatment of people with chronic conditions
• 2/3 of Medicare dollars is spent on beneficiaries
  with 5 chronic conditions

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Key Initiative Evidence-Based Health Promotion

• Programs provide seniors with the tools to
  maintain their health, reduce their risk of
  developing chronic diseases, and manage their
  health to live as independently as possible.
• Centerpiece is the Evidence-Based Disease and
  Disability Prevention Program. It provides
  discretionary grants to states to support
  collaborations between aging and public health
  networks to implement evidence-based prevention
  programs. These programs help seniors to improve
  and/or maintain their physical and mental health,
  reduce their risk of falling, and better manage
  their chronic diseases.
• AoA also supports a Diabetes Self-Management
  Training Initiative, the Hispanic Elders Project,
  and leads the aging component of HHSs Healthy
  People 2020.

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Key Initiative Evidence-Based Health Promotion

• What is an Evidence-Based Disease and Disability
  Prevention (EBDDP) Program? A community-based
  program for older adults that has been shown to
  be effective in helping individuals with chronic
  conditions and has been
• tested through randomized controlled trials and
  proven effective at improving /or maintaining
  the health status of older people
• provided successfully by community-based human
  services organizations, using non-clinical
  workers and/or volunteers
• published in a peer-reviewed scientific journal
  and
• translated into practice and ready for broad
  national distribution through community-based
  human services organizations.

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Key Initiative Evidence-Based Health Promotion

• Opportunity - AoA, with CDC, is providing 27
  million over 2 years to support state-led
  partnerships involving aging and public health
  networks to implement chronic disease self
  management programs at the community level
  (awards announced in 2010).
• 50,000 older adults will participate in chronic
  disease self management programs and experience
  improved health and well-being as a result.
• States will implement and expand an
  infrastructure and statewide distribution system
  for delivery of CDSMP and other evidence-based
  prevention programs for older adults
• States and communities will embed these
  structures in their statewide systems that
  provide community-based services and supports for
  older adults.

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Key Initiative Evidence-Based Health Promotion

• Go to the AoA-funded Resource Center at
  http//www.healthyagingprograms.org/
• The 6/10/11 CDSMP Weekly Update email notes the
  availability of approximately 40 million via CDC
  to strengthen and better coordinate activities
  within state and territorial health departments
  aimed at preventing chronic diseases and
  promoting health. State and territorial health
  departments interested in submitting proposals
  can find more information at www.grants.gov.
• Sign up to receive AoA eNews at
  http//www.aoa.gov/AoARoot/Press_Room/Enews/Curren
  tNewsLetter.pdf
• The June issue has information on 100 million in
  funding from HHS for up to 75 Community
  Transformation Grants. The article states,
  Created by the Affordable Care Act (ACA), these
  grants are aimed at helping communities implement
  projects proven to reduce chronic diseases, such
  as diabetes and heart disease.

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OAA Overview
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Current Older Americans Act

• Title I Declaration of Objectives Definitions
• Title II Administration on Aging
• Title III Grants for State and Community
  Programs on Aging
• Title IV Activities for Health, Independence
  and Longevity
• Title V Community Service Senior Opportunities
  Act
• Title VI Grants for Native Americans
• Title VII Allotments for Vulnerable Elder
  Rights Protection Activities

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Older Americans Act Services

• Title III Subtitles
• Social Services (Title III-B) Personal Care,
  Homemaker, Chore, Adult Day Care/Health,
  Information and Assistance, Transportation, Case
  Management, Outreach, Senior Opportunities and
  Services, Legal Assistance, Senior Centers,
  Respite, Home Repair, Housing Assistance,
  Ombudsman, etc.
• Nutrition (Title III-C) Congregate
  Home-delivered Meals, Nutrition Education,
  Nutrition Counseling, etc.
• Health Promotion/Disease Prevention (Title
  III-D) Education Screening, Medication
  Monitoring/Management, Programs related to
  chronic disabling conditions, etc.
• Family Caregiver Support Program (Title III-E)
  Information, Support Groups/Training/Education,
  Case Management, Respite and Supplemental
  Services (e.g., Gap Filling Services).

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Older Americans Act Services

• Title VII Chapters
• Chapter 1 General State Provisions
• Chapter 2 Ombudsman Programs
• Chapter 3 Programs for Prevention of Elder
  Abuse, Neglect and Exploitation
• Chapter 4 State Legal Assistance Development
  Program

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OAA Reauthorization
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Historical Evolution of the Older Americans Act

• 1965 Older Americans Act signed into law on July
  14, 1965. It established the Administration on
  Aging within the Department of Health, Education
  and Welfare, and called for the creation of State
  Units on Aging.
• Also in 1965, Medicare, Title XVIII, a health
  insurance program for the elderly and Medicaid,
  Title XIX, a health insurance program for
  low-income persons were established as part of
  the Social Security Act.

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Historical Evolution of the Older Americans Act

• 1960's, cont.
• 1967 OAA extended for two years, and provisions
  made for the AoA to study the personnel needs in
  the aging field. AoA moved from the Office of
  the Secretary of HEW and placed in the newly
  created Social and Rehabilitative Service Agency
  within the Department.   
• 1969 OAA Amendments provided grants for model
  demonstration projects, Foster Grandparents, and
  Retired Senior Volunteer Programs.  
• 1970's 
• 1971 Second White House Conference on Aging held
  in Washington, D.C.  
• 1972 A new Title VII is created under the Older
  Americans Act authorizing funds for a national
  nutrition program for the elderly.   
• 1973 OAA Comprehensive Services Amendments
  established AAAs. The amendments added a new
  Title V, which authorized grants to local
  community agencies for multi-purpose senior
  centers created the Community Service
  Employment grant program for low-income persons
  age 55, administered by DOL.

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Historical Evolution of the Older Americans Act

• 1970's, cont.
• 1974 Older Americans Act amendments added
  transportation under Title III model projects.
• 1975 Older Americans Act Amendments authorized
  grants under Title III to Indian tribal
  organizations. Transportation, home care, legal
  services, and home renovation/repair were
  mandated as priority services. 

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Historical Evolution of the Older Americans Act

• 1970's, cont.
• 1977 OAA Amendments required changes in Title VII
  nutrition program, primarily related to the
  availability of surplus commodities through the
  Dept. of Agriculture.  
• 1978 OAA Amendments consolidated the Title III
  Area Agency on Aging administration and social
  services, the Title VII nutrition services, and
  the Title V multi-purpose senior centers, into a
  new Title III and added a new Title VI for grants
  to Indian Tribal Organizations. The old Title V
  became the Community Service Employment grant
  program for low-income persons, age 55 and older
  (created under the 1978 amendments as Title IX).
  
• OAA amendments also required each state to
  establish a long-term care ombudsman program to
  cover nursing homes   
• 1980's 
• 1981 Third White House Conference on Aging held
  in Washington, D.C.Older Americans Act
  reauthorized emphasized supportive services to
  help older persons remain independent in the
  community. The OAA also expanded ombudsman
  coverage to board and care homes.

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Historical Evolution of the Older Americans Act

• 1980s, cont.
• 1984 Reauthorization of the OAA clarified and
  reaffirmed the roles of State and Area Agencies
  on Aging in coordinating community-based
  services, and in maintaining accountability for
  the funding of national priority services (legal,
  access, in-home).
• 1987 Reauthorization of the OAA added 6
  additional distinct authorizations of
  appropriations for services in-home services for
  frail elderly LTCO assistance for special
  needs health education and promotion prevention
  of elder abuse, neglect, and exploitation and
  outreach activities for persons who may be
  eligible for benefits under SSI, Medicaid, and
  food stamps. Emphasis given to serving those in
  the greatest economic social need, including
  low-income minorities.The Nursing Home Reform
  Act (Omnibus Budget Reconciliation Act) mandated
  that nursing facility residents have "direct and
  immediate access to ombudspersons when protection
  and advocacy services become necessary."
  Simultaneously, the OAA reauthorization charged
  states to guarantee ombudsman access to
  facilities and patient records, provided
  important legal protections, authorized state
  ombudsmen to designate local ombudsman programs
  and required that ombudsman programs have
  adequate legal counsel.

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Historical Evolution of the Older Americans Act

• 1990's 
• 1992 Reauthorization of the Older Americans Act
  places increased focus on caregivers,
  intergenerational programs, protection of elder
  rights.
• OAA amendments added a new Title VII "Vulnerable
  Elder Rights Activities" which included the
  long-term care ombudsman prevention of elder
  abuse, neglect and exploitation elder rights and
  legal assistance development and benefits
  outreach, counseling and assistance programs. The
  legislation emphasized the value of the four
  programs coordinating their efforts. The
  amendments highlighted the role of local
  ombudsman programs and the state ombudsman's role
  as leader of the statewide program and advocate
  and agent for system-wide change.
• 1995 White House Conference on Aging convened May
  2 - 5, 1995 in Washington, D.C.30th
  Anniversaries of Older Americans Act, Medicare,
  Medicaid the Foster Grandparent Program. 60th
  Anniversary of Social Security. Operation
  Restore Trust Initiated.

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Historical Evolution of the Older Americans Act

• 2000's 
• 2000 Older Americans Act Amendments of 2000
  signed into law (P.L. 106-501), establishing the
  new National Family Caregiver Support Program,
  and reauthorizing the OAA for 5 years on November
  13, 2000.  
• 2001 HHS Secretary Tommy G. Thompson released
  113 million for first National Family Caregiver
  Support Programs grants to states on February 15,
  2001.
• 2002 Kick off of 30th Anniversary of the Older
  Americans Act Nutrition Program in March.  
• 2005 5th White House Conference on Aging held.
• 2006 Older Americans Act Amendments of 2006
  signed into law (P.L. 109-365), embedding the
  principles of consumer information for long-term
  care planning, evidence based prevention
  programs, and self-directed community based
  services to older individuals at risk of
  institutionalization. OAA was reauthorized for 5
  years on October 17, 2006.

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Historical Evolution of the Older Americans Act

• Older Americans Act Amendments of 1969
• Nutrition Program for the Elderly Act (1972)
• Older Americans Act Amendments of 1972 (vetoed)
• Older Americans Act Amendments of 1973
• Older Americans Act Amendments of 1975
• Older Americans Act Amendments of 1978
• Older Americans Act Amendments of 1984
• Older Americans Act Amendments of 1987
• Older Americans Act Amendments of 1992
• Older Americans Act Amendments of 2000
• Older Americans Act Amendments of 2006

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OAA Reauthorization as of 2011

• Three AoA listening sessions held early in 2010,
  also listening webinar with DOL on Title V
• National organizations events activities
• Including NASUAD, n4a, NCOA
• Can still submit comments see webpage
• In progress in DHHS
• Congressional meetings ongoing

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OAA Reauthorization Themes

• Reoccuring themes out of listening sessions
• Advocacy role of the Assistant Secretary
  particularly with federal agencies
• Advocacy role of entire aging network
• HCBS
• Info. assistance consolidated access (SPE
  ADRC)
• flexibility in programming to respond to local
  and area needs (e.g. consolidating C1 and C2)

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OAA Reauthorization Themes

• Broader range of EB interventions as part of
  health promotion, disease prevention
• More respite
• Innovation, research, demonstration, training
• Restore more of a sense of community service
  back into Senior Community Service Employment
  Program distinguish from other workforce/job
  placement programs
• Tribal sovereignty consolidating programming
  from other parts of Act into Title VI
• Elder Rights/Justice building infrastructure
  (coord. with domestic violence APS, ombudsman,
  consumer protection)

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FFY 2012 Budget

• FY 2012 Presidents Budget Request for AoA
  2.251 billion
• Proposes to transfer SHIP SCSEP to AoA
• Includes 21.5m for elder rights elder justice
  (16.5m for APS 5m for Ombudsman)
• Includes 40m for Caregiver Program
• Includes 48m for Home and Community-Based
  Services
• Includes 7.5m for Lifespan Respite
• Includes CLASS Program Administration

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Copies of the complete AoA Strategic Action Plan
available at www.aoa.gov, click About AoA, then
click Strategic Plan

• Amy Wiatr-Rodriguez, MSW
• Aging Services Program Specialist
• U. S. Administration on Aging
• Chicago Regional Support Center
• 233 N. Michigan Ave., Suite 790
• Chicago, IL  60601
• Phone [phone]
• Fax [phone]
• Email amy.wiatr_at_aoa.hhs.gov