Relevance to Centers for Independent Living (CILs)
The aging network of organizations is responsible for establishing programs for older Americans at risk of losing their independence. Their focus is mainly on those that are frail, disabled, of low income status and living alone. In this section, CILs will learn about the aging network's organizational structure and the funding allocation process. This knowledge will help CILs figure out how they may be able to access some of the monies being allocated for programs on the state and local levels.
The Area Agencies on Aging (local level) and the State Units on Aging (state level) evaluate and determine the needs of the older citizens they serve in their region. They work together to develop and design programs that best meet the priorities established by the Administration on Aging (AoA) and the needs of their older citizens.
CILs are in an excellent position to provide services under contract with Area Agencies on Aging. Collaborative partnerships can develop to meet the increased demand of services needed by older adults.
The Aging Network is a group of organizations that interact on national, regional, state, and local levels. This network provides opportunities for research and sharing of information, collaborative efforts, ease of making referrals when working with long-distance caregivers and the ability to launch national initiatives under the direction of the Administration on Aging (AoA).
To access the Aging Network in the United States, call the ElderCare Locator at 1-800-677-1116. A consumer can speak to an Information Specialist who has access to a database of services. Established in 1991, this national toll-free service helps older adults and their caregivers find available community services. This information is also available on-line and can link consumers to information and referral services offered by state and area agencies on aging. The consumer enters their state and zip code to have access to the services in their community. The website is: www.eldercare.gov.
The organizational chart below indicates the "chain of command" of this network from the President of the United States to local service providers. The aging network's goal is to help elderly consumers, primarily those who are most needy, at risk of losing their independence, of low socioeconomic status, and minority. CILs could become a vital part of this organization and be listed in the chart as a local service provider below the Area Agencies on Aging.
Organizational chart available from: http://www.aoa.gov
The Administration on Aging (AoA) | National Association of State Units on Aging (NASUA) | The National Association of Area Agencies on Aging (NAAAA) | The National Council on Aging (NCOA)
At the federal level, the Administration on Aging (AoA) serves as an advocate agency for the needs of the elderly population. Established in 1965 by the Older Americans Act, the AoA is a part of the U. S. Department of Health and Human Services (HHS). As part of it's mission, the AoA works diligently to increase the awareness between other federal agencies, organizations, groups and the public about the contributions made by older people and the needs of older people at risk. At the community level, AoA seeks to educate older people and their caregivers about available services and their benefits through information, referral and outreach efforts.
To coordinate and develop community-level systems of services that meet the unique needs of older persons and their caregivers, AoA works closely with its nationwide network, which includes:
• ten regional administrative offices,
• 57 State Units on Aging (commonly known as State Agencies on Aging),
• 670 Area Agencies on Aging and 236 Tribal and Native organizations,
• two organizations that serve Native Hawaiians,
• and 29,000 service providers nationwide.
Mandated under various titles of the Older Americans Act, the AoA oversees important programs at the federal level. By providing supportive services, these programs help vulnerable, older Americans remain in their homes. AoA employment and volunteer programs offer opportunities for older persons to improve their health and become active contributors in society.
Grants and cooperative agreements are the vehicles by which AoA transfers its appropriated funding resources to the Aging Network. Grants are used when AoA has no substantial involvement in the administration of the project and there is no direct benefit to the AoA. If AoA expects to have substantial involvement in the direction and implementation of a project, then AoA often uses cooperative agreements.
There are two basic types of federal grants:
1) Formula or (Mandatory), and
2) Discretionary
The AoA's Title VI program uses a hybrid grant which features elements of both Formula and Discretionary grants and is therefore listed separately.
Title III and Title VII of the OAA makes funds available to grantees through Formula grants which are on-going programs administered by state agencies for which no application or competition is required. Using a population-based formula, funds are divided among individual states and U.S. territories. Grantees are required to match a percentage of the federal funds received with state-appropriated funds and to administer the total of state and federal program funds in accordance with an AoA approved State Plan.
The AoA funds projects under Title IV of the Older Americans Act to encourage projects that develop, test and disseminate best practices to be used by organizations in the Aging Network. Competitive grants allow AoA to exercise discretion in selecting the projects to be funded and in determining the amount to be awarded. Because of the nature of these projects, substantial involvement on the part of the Agency is often necessary. As a result, discretionary grants are increasingly being administered as cooperative agreements. In addition, funds that Congress has set aside for specific legislatively defined purposes are administered with Title IV projects.
Title VI grants to Native American tribes and Hawaiian Americans must submit an application if they wish to be eligible for the allocation of funds. But like formula grants, a population-based formula is used to estimate the distribution of funds that will be made available to grantees under this title.
Each year, Congress appropriates funds for use by AoA and the other federal agencies in carrying out their mission. The AoA provides grant funding to states and territories, including faith-based and academic institutions. Individuals are not eligible to apply for AoA funding. Information about AoA's funding can be found at their website under AoA Grant Programs, Application Instructions, Funding Opportunities, and Resources. To read the AoA's Strategic Action Plan for FY 2003-2008 go to: http://www.aoa.gov. Click on the "About AoA" icon and then click on Strategic Action Plan icon.
Chart available at: http://www.mfaaa.org/aging_chart.html
NASUA was founded in 1964 as a national nonprofit membership organization comprised of the 57 state and territorial government agencies on aging. It represents the interests of the State Units on Aging (also known as State Agencies on Aging) across the country by promoting social policy in the public and private sectors. It is designated by the governor and state legislatures as the focal point for issues related to older persons.
• to advance health, social and economic policies responsive to the needs of the aging population
• to improve the capacity of its membership
• to promote the rights, dignity and independence of, and expand opportunities and resources for older persons, adults with disabilities and their families
• Inform policymakers on the current and future needs and preferences of older persons, adults with disabilities and their families and on the status and operations of federal and state programs that serve them,
• Serve as the vehicle for the membership to collectively develop and promote policy recommendations with the public and private sector,
• Work efficiently with other national organizations,
• Analyze federal legislative, regulatory and administrative activities that affect state policies and programs,
• Facilitate the exchange of information, ideas and experience on effective and efficient state and local policy options, program models, service delivery strategies and management practices,
• Provide general and specialized information, consultation, training, technical assistance and professional development support on the full range of policy, program and management issues of concern to the membership,
• Create mutually beneficial relationships with the business community, private foundations and philanthropic individuals, and
• Seek and manage funds from various sources to further the mission and objectives of the membership of the Association.
NASUA supports its members through activities that are carried out in four key organizational areas:
its areas of expertise include income and health care entitlement programs (Social Security, Medicare, Medicaid) and discretionary human service programs (OAA, housing, employment and training, health promotion, nutrition and transportation).
NASUA is involved in a number of national coalitions: Leadership Council of Aging Organizations, the Long Term Care Campaign, the Disability and Aging Coalition, the Mental Health and Aging Coalition, the Title XX Coalition, the Campaign for Quality Care, the Consumer Consortium on Assisted Living and the National Medicare Education Campaign.
Its members are kept informed through policy memorandums that summarize the Association's current activities and analyze various policy initiatives under consideration. Policy briefings are given by NASUA staff at semi-annual membership meetings and during other national conferences.
The Center for the Advancement of State Community Service Programs works to increase the development of state programs for older persons and other adults with disabilities that are designed to provide home- and community-based service options as an alternative to institutional care.
The Center has extensive knowledge and expertise in Medicare, Medicaid, managed care, case management, consumer direction, housing options, health and long term care insurance, and long term care quality assurance.
The Center for State Action on Elder Rights works to advance the state aging network's advocacy to protect the rights of vulnerable elders so that they have opportunities to make choices and maintain control over their lives.
The Center provides technical assistance and training to four elder rights programs administered by state agencies on aging: 1) adult protection service/elder abuse prevention, 2) ombudsman, 3) legal assistance, and 4) health insurance counseling.
The Center for State Promotion of Productive Aging works to increase the development of state programs that support independent living and improve the quality of life for the older population.
By strengthening the capability of the aging service system, the onset of disabilities and the use of the long-term care system can be delayed or alleviated. The aging service system must be able to respond to the needs of older persons and their caregivers for information, access to services, good health practices, and employment.
The State Units on Aging (SUA) are also known as the State Agencies on Aging. They are state and territorial government agencies selected by governors and state legislatures. Their function is to administer and manage, design and advocate for benefits programs and services for the elderly and their families and for adults with disabilities. They have administered the Older Americans Act (OAA) in their respective states since 1965. They are linked to regional administrative offices, which report directly to the Administration on Aging (AoA).
These agencies share a universal agenda to provide opportunity and support for older people to remain in their homes and communities. They play an active role in assisting other agencies and organizations to collaborate in bringing optimum care to older persons who are most vulnerable.
A key component of the programs and services they provide or manage is the provision of accessible and credible information, thus empowering older persons and their families to make informed decisions and choices. Each state has a comprehensive information, counseling, education and assistance system linking consumers to the resources and services they need to remain independent in their homes and communities.
Working in partnership with Area Agencies on Aging (AAA), the SUAs serve as effective and visible advocates for older persons within their perspective states. The SUAs have policy, planning and advocacy roles in leveraging other federal, state and local public and private funds to support programs on aging. They manage state funded home and community-based programs for older persons and the Medicaid Home and Community-Based Services Waiver programs for elderly (in 28 states) and/or programs for younger adults with physical disabilities (in 21 states).
The goal of these programs is the development of a comprehensive service system that helps people remain independent in their homes and communities and avoid unnecessary institutionalization. Nationally, about one-third of their funding for home and community services comes from the federal Older Americans Act. The rest comes from state and other federal sources.
SUA's mission it to assure that individual older persons have:
• civil rights, autonomy and dignity protected,
• claims to entitlements honored, and
• contracts and covenants for care and benefits fulfilled.
This mission is addressed through a number of elder rights programs:
• Long Term Care Ombudsman Program
• Legal Services Program
• Adult Protective Service/Elder Abuse Program
• State Health Insurance Program
SUAs' functions can be broken down into the following four major areas:
1) Management and Administration
2) Service Systems Development
3) Services Development
4) Advocacy
The State Units on Aging are to assure the proper and efficient administration of state and local activities related to the purposes of the Older Americans Act. The state plan is one of the most important documents that a SUA produces because it encompasses all the specific programmatic and financial commitments that it will administer, coordinate, or supervise over a multi-year period.
The state plan:
A) provides a direction of what the state expects to accomplish during the period of the plan and
B) must be based on the area plans developed by the Area Agencies
on Aging within the state so as to reflect the priorities and conditions of
local communities.
The SUA divides the state into distinct planning and service areas (PSAs) in accordance with guidelines issued by AoA. Then the SUA designates each area a public or private agency or organization to serve as the Area Agency on Aging for the purpose of developing area wide social service delivery systems for older persons.
SUAs are responsible for developing and using intrastate funding formulas. These formulas assure that a minimum base of Title III funding support will be dispensed to each Area Agency on Aging and for programs within the planning and service areas. The funding formula must take into account the geographical distribution of persons age 60 years and older. The OAA requires states to publish a detailed disclosure statement on the formula for public review and comment.
As a condition for receiving Title III funding, the Older Americans Act stipulates that each state designate a state agency as the sole state agency to:
a) develop and administer the state plan,
b) be primarily responsible for the planning, policy development, administration, coordination, priority setting, and evaluation of all activities in the state related to the purposes of the Older Americans Act,
c) serve as an effective and visible advocate for the elderly by reviewing and commenting upon all state plans, budgets, and policies which affect the elderly, and providing technical assistance as needed,
d) divide the state into distinct planning and service areas, taking into account the geographical distribution of individuals aged 60 years and older in the state, the incidence of the need for supportive services, the distribution of low-income elderly residing in such areas, and other factors,
e) set specific objectives, in consultation with area agencies on aging, for each planning and service area for providing funded services; provide an assurance that the state agency will undertake specific program development, advocacy, and outreach efforts focused on the needs of low-income minority older individuals and other older individuals residing in rural areas; and provide a description of the efforts that will be undertaken by the state agency,
f) consult with area agencies, develop and publish a formula for
distribution within the state of funds received through the OAA.
The State Units on Aging focus their monitoring efforts on how well area plans are being administered while the Area Agency on Aging focuses on monitoring and evaluating the work of local service providers.
The State Units on Aging's primary function is to develop a comprehensive and coordinated system of social and health-related services for older persons. The services include: access services, nutrition services, in-home services, legal services, etc.
State priorities are adaptable local needs. Statewide systems building efforts contribute to the growth of local aging services.
The SUA works in partnership with the Area Agencies on Aging (AAAs) to develop and implement service delivery systems at the local level. The SUA works to improve existing relationships in the human services network and to establish new links among federal, state and local agencies and private organizations sharing a common commitment to older persons. The SUA's service coordination activities are normally focused on maximizing program continuity and improving the quality of services provided.
Together, the State Units on Aging and the Area Agencies on Aging have played a major role in identifying the service needs of the older population. The SUA evaluates the need for supportive services and nutrition services within the state and determines what the statewide priorities should be. The AAA's responsibility is the development of service plans. Each Area Agency on Aging must provide assurances that an adequate proportion of their allotment under Title III-B services will be spent for the delivery of each of the following categories of services:
a) access to services,
b) in-home services, and
c) legal assistance.
The State Units on Aging's advocacy responsibility is critical for assuring that older persons' interests and views are effectively represented in the state.
The SUAs used a combination of direct and indirect strategies:
a) Direct: State Units on Aging represent older persons' interests by reviewing and commenting on all state plans, budgets, and policies that affect older persons, coordinating statewide planning and development efforts, and collaborating with other public and private entities to expand aging services.
b) Indirect: State Units on Aging advocate by assisting others through funding special advocacy services, training on advocacy skills, sharing information on important policy issues, and by providing technical assistance to other entities or individuals representing older persons as needed.
The National Association of Area Agencies on Aging (NAAAA) is a private, nonprofit organization representing the interests of Area Agencies on Aging across the country. Incorporated in 1975, the NAAAA provides advocacy, information, and training related to Area Agencies on Aging and programs for older adults. NAAAA provides technical assistance and consulting services to employers and organizations in the development and implementation of elder care information and referral services and establishes linkages to case managed community-based systems of long-term care.
The Association's priority activities are:
• Improving the visibility of the nation's aging network with an emphasis on accessibility to the network's information and referral services
• Advocating for adequate resources for supportive services for those older adults in need at the state and local level
• Brokering community-based long-term care services and access to such services through information, referral, and case management
• Developing linkages with the private sector to enhance its responsiveness to older adults and support for their caregivers
• Providing information to older adults and their caregivers that assist their efforts at responsible advocacy and empowerment in choosing and creating community-based services that are adequate, acceptable, and affordable
• Developing improved planning and management practices
for Area Agencies on Aging and their service providers
An Area Agency on Aging is a public or private nonprofit agency designated by the state to administer the Older Americans Act at a regional level to respond to the needs of Americans aged 60 and over. Having regional oversight of the programs and funding allows the state to be more responsive and to be better able to assess local needs and concerns. These local AAAs are linked to state units of aging, which serve as liaisons to the state government and provide administrative oversight, training, advocacy and other services to the AAAs. There are 670 Area Agencies on Aging nationwide. All the counties in each state are covered by a designated Area Agency on Aging (AAA).
The AAAs study the needs of the older population in their regions and develop programs that fill unmet needs in the community, often forming partnerships with other local social service providers. They create multi-year plans that are implemented with the Older Americans Act and other applicable funds that the AAA administers. Their purpose is to help older adults live in their communities in the least restrictive environment with maximum dignity and independence. They perform this service through a variety of means, such as:
• Entering into grant agreements with each county to provide aging services
• Serving in an advisory capacity to older individuals at risk of losing independence
• Providing feedback to the state on aging issues and service delivery
• Strategic planning that addresses issues and needs of the older population
• Technical assistance to local aging services providers
• Technical assistance to counties
• Education
• Training
• Performance assessment (management, fiscal, service)
• Quality assurance
• Advocacy (federal, state, local)
• Program administration (federal, state and local dollars)
• Facilitation of cooperative relationships
• Information gathering and dissemination
• Referrals
• Problem resolution
• Creative solutions
While services are funded primarily by AoA from the federal OAA and State Block Grant funds through the State Units on Aging, the Area Agency on Aging must match and expand through local government, foundations, private sector, voluntary contributions and fund raising activities. The services provided with these funds enable an older person to continue living in their home independently or with some assistance, rather than face premature institutionalization.
The AAAs work with leaders of communities within their planning and service areas to designate one or more community focal points for service and delivery. Services funded through OAA, as well as services funded through other public and private sources, are coordinated through these focal points. In communities across the country, senior centers, town halls, churches and other facilities have been established as focal points to provide information and access services for older persons.
Services available through AAA and Title VI agencies fall into five broad categories:
• Information and Referral/Assistance
• Health Insurance Counseling
• Client Assessment
• Care Management
• Transportation
• Caregiver Support
• Retirement Planning and Education
• Employment services
• Senior Centers
• Congregate Meals
• Adult Day Care Services
• Volunteer Opportunities
• Meals-on-Wheels
• Homemakers
• Chore Services
• Telephone Reassurance
• Friendly Visiting
• Energy Assistance and Weatherization
• Emergency Response System
• Home Health Services
• Personal Care Services
• Respite Care
• Senior Housing
• Alternative Community-Based Living Facilities
• Legal Assistance
• Elder Abuse Prevention Programs
• Ombudsmen Services for Complaint Resolution
The reauthorization of the OAA in FY 2000 added the Family Caregiver Program as a new initiative to assist the aging population with more home healthcare programs.
Area Agencies on Aging often serve as portals to care, assessing multiple service needs, determining eligibility, authorizing or purchasing services and monitoring the appropriateness and cost effectiveness of services. AAA provides direct services and contact with local providers to furnish other services within the community. While there is much consistency in the types of essential home and community-based services available, these services are customized to reflect varying local needs and resources. The AAA monitors the services for compliance and provides technical assistance.
In 1950, the National Council on Aging was founded. It is America's first national, private, nonprofit group of people and organizations devoted to promoting the independence, well-being, dignity and contributions of older people. It helps community organizations improve the lives of older people through research, training, leadership and advocacy.
Some of the programs NCOA helped develop for older people are:
• Meals-on-Wheels
• Family Friends
• Foster Grandparents, and
• Benefits CheckUp
Its members include:
• Senior Centers
• Area Agencies on Aging
• Adult Day Services
• Faith Congregations
• Senior Housing
• Health Centers
• Employment Services
• Consumer Organizations
Its role is:
• To lead campaigns to preserve funding for the Older Americans Act and other government programs that benefit older Americans,
• To conduct public awareness studies to help shape the attitudes of millions, such as the myths and realities of aging, and
• To work for and support thousands of American community
organizations that provide services and programs to older consumers and their
families.
Their plan focuses on five main areas:
1) Health care
2) Finance
3) Consumer products and services
4) Telecommunications
5) Technology
The National Enterprise Alliance is a network of community-based organizations that collaborate to accomplish mutually compatible goals that would be difficult to achieve alone. Since 1996, it has grown from 10 Area Agencies on Aging in five states to 54,000 Community Partners nationwide and growing.
NEA's primary mission is to work toward a future that will:
• Enhance the ability of their members to provide responsible services to their clients
• Assist, by generating revenue, in the support of people who need assistance
• Advocate on behalf of their constituency
• Work and collaborate with other community services to achieve optimal independent lifestyles for their consumers, and
• Assure that people have choices in the conduct of their
lives
The goals of the NEA are to:
• Diversify Revenue
• Achieve Cost Savings
• Position Community Partners for Opportunities
• Change Attitudes and Beliefs
• Increase the Prestige of Partners
• Share Management Systems
On March, 2003, the NEA and NCOA formed a partnership in which NCOA's members may be able to reduce their expenses through this collaboration.
In order to benefit from NEA's services, an organization must form a collaborating partnership with NEA. NEA believes that through collaboration, economies can be achieved.
State Units on Aging (SUAs) are agencies of state and territorial governments designated by governors and state legislatures to administer, manage, design and advocate for benefits, programs and services for the elderly and their families and, in many states, for adults with physical disabilities. These state government agencies all share a common agenda of providing the opportunities and supports for older persons to live independent, meaningful, productive, dignified lives and maintain close family and community ties. Your State Unit on Aging will be listed at your state capital's website since the Governor oversees its administration.