Introduction
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."[1]
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.[2]
Because each state receives funding proportional to its
population of older individuals,[3]
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[4]
and must be in greatest social or economic need.[5] 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.[6]
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.[7]
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).[8]
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.[9] 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[10]
Services may include chore maintenance and the assistance of
homemakers or home health aides.[11] 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.[12] 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.[13]
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.[14] 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.[15] 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,[16] and
many state and local programs offer nutritional education services
or counseling.[17]
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.[18] Because
states must give first priority for such programs to areas that are
medically underserved,[19]
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.[20] 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.[21]
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.dhhs.gov/. The national elder care locator,
1-800-677-1116, is an important resource for identifying and
accessing local Title III supportive services.
[1] Older Americans Act of 1965, Pub. L. No. 89-73, at
3021(a)(1)(A), (codified as 42 U.S.C. § 3001-3057(n)).
[2] See 42 U.S.C. § 3025(a).
[4] Title III programs were intended to benefit "older
individuals," originally defined as individuals over age
60. 42 U.S.C. § 3022(9).
[5] See 42 U.S.C. 3025(a(2)(E).
[7] Provisions of PRWORA bar the delivery of specific
types of public benefits to certain aliens residing in the
United States. See 8 U.S.C. §§ 1611; 1621 (2000). As a
result, non-qualified aliens and non-immigrants are
generally barred from securing public benefits falling
within PRWORA's statutory definitions. However, certain
types of public benefits are not contemplated by PRWORA. Additionally,
exceptions within the Act itself and guidance from the
United States Secretary of Health and Human Services
indicate that PRWORA does not, and should not be interpreted
as applying to all public benefits. See 8 U.S.C. § 1621; HHS
Release, 63 Fed. Reg. 41658 (August 4, 1998). The programs
funded by the Older Americans Act do not fall within
PRWORA's exclusion and immigrants may therefore still
benefit from OAA services. See Fed. Reg. 45256 (Aug. 26,
1997).
[8] 42 U.S.C. § 3027(a).
[9] See 42U.S.C. § 3030d(a).
[10] 42 U.S.C. § 3002(26).
[11] See 42 U.S.C. §3030(d)(a)(5)(B); 3030(d)(a)(22).
[12] See 42 U.S.C. §§ 3030e-f.
[13] See id.
[14] See 42 U.S.C. § 3030g-21(A)(2)(I); see also §
3030e(2).
[15] 42 U.S.C. § 3030g-21(A)(2)(I).
[16] See id. at § 3030g-(21).
[17] See id. at § 3030g-21(A)(2)(J).
[18] See 42 U.S.C. § 3030m.
[19] 42 U.S.C. 3030n.
[20] See 42 U.S.C. 3030s; 3030s-1.
[21] 42 U.S.C. 3030s-1.
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