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Institute of Medicine (US) Committee to Evaluate the State Long-Term Care Ombudsman Programs; Harris-Wehling J, Feasley JC, Estes CL, editors. Real People Real Problems: An Evaluation of the Long-Term Care Ombudsman Programs of the Older Americans Act. Washington (DC): National Academies Press (US); 1995.

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Real People Real Problems: An Evaluation of the Long-Term Care Ombudsman Programs of the Older Americans Act.

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AOlder Americans Act: A Staff Summary (A Publication of the Select Committee on Aging)*


In response to concern about a lack of community social services for older persons and the desire by policymakers to improve the status of older Americans, in 1965 Congress created the Older Americans Act, a federal program specifically designed to meet the social services needs of older persons. The original legislation established authority for grants to states for community planning and social services, research and development projects, and personnel training in the field of aging. The law also established the Administration on Aging within the then Department of Health, Education, and Welfare (DHEW) to administer the newly created grant programs and to serve as the federal focal point on matters concerning older persons. Although older persons may receive services under many other federal programs, today the Act is considered to be the major vehicle for the organization and delivery of social, nutritional, and other services to this group. The Act authorizes a wide array of service programs through a nationwide network of 57 state agencies on aging and 665 area agencies on aging, supports the sole federal job creation program benefiting low-income older workers, and is a major source of federal funding for an extensive grant program for training, research, and demonstration activities in the field of aging. The Act has been amended 13 times since the original legislation was enacted.

This appendix contains excerpts from Older Americans Act: A Staff Summary, Subcommittee on Human Services of the Select Committee on Aging, House of Representatives. Committee Publication No. 102–911, December, 1992. U.S. Government Printing Office: Washington, D.C.


Development of the State and Area Agency on Aging Structure: General Background

Since original passage of the Act in 1965, the Title III program has evolved from simply a funding source for social service programs to a planning vehicle for development of a comprehensive and coordinated service system for older persons with funding authority for abroad range of supportive services, and for congregate and home-delivered nutrition services. Significant amendments in 1969, 1973, and 1978 broadened the scope of operations and established the basis for a “network” on aging under the Title III program umbrella. Over the course of the various amendments to Title III, Congress has directed that state and area agencies on aging be the major focus for planning, coordination, and advocacy for programs and services on behalf of older persons.

The 1965 amendments authorized federal Title III grants to state agencies on aging to directly fund social service programs serving the elderly. State agencies acted as dispensers of federal funds rather than service planners. The 1967 amendments increased the funding allowable for statewide administration of the program. A major step was taken in 1969 when Congress revised the program to give state agencies responsibility and funding for statewide planning, coordination and evaluation of programs to serve the elderly and to foster state leadership toward achieving cooperation of all agencies and organizations concerned with their needs. Congress continued the authorization of funds for social service programs in these amendments, but also provided a distinct authorization of funds for state agency administration for the first time.

The 1973 amendments significantly restructured the Title III program in order to improve the planning and organization of services for older persons at the state and local levels. State agencies on aging were required to divide the state into geographic areas, or planning and service areas, and to establish area agencies on aging at the community level for the purpose of developing areawide social service delivery systems for older persons. These amendments emphasized the need for more effective planning and coordination of existing service programs on both the state and local levels, and continued the authorization of funds for the development of social services by area agencies.

These 1973 changes were made, in part, as a result of congressional hearings that showed: (1) federal funds were fragmented over too many activities at the community level; (2) duplication of effort on the local level was prevalent; (3) state and local financial participation had not provided sufficient funds to maintain programs at necessary operating levels; (4) federal funds had not been sufficient for states to develop and maintain effective programs for the elderly; (5) state agencies on aging had not always been established as single state units as envisioned by Congress, but rather as subunits of other state agencies; and (6) social services funds had not been used for older persons most in need, such as low-income and minority persons. With these amendments, Congress intended for state and area agencies to work together in planning for the development of a comprehensive social service system throughout the state and also intended to give localities a more active role in meeting older persons' social service needs.

Pursuant to the 1973 law, area agencies on aging generally were not to provide services directly, but were to promote leadership in identifying gaps and weaknesses in the existing service system and use their limited funds to foster expansion of services in cooperation with other providers.

A multiplicity of social services could be provided under the auspices of state agencies, and with the implementation of the 1973 amendments through area agencies on aging. But the major service component of the Older Americans Act, the national nutrition program for the elderly, was enacted by Congress in 1972 as Title VII of the Act and it first received funding in 1973. It evolved from nutrition demonstration projects first funded under the Older Americans Act in 1968 with the purpose of developing techniques for improving diets, fostering social interaction among older persons, and facilitating the delivery or social services. Aspects of these demonstration projects were incorporated into the law.

The 1973 amendments that established the area agency program under Title III provided that state administrative costs for the nutrition program would be covered by the Title III program. This action was the first step toward integration of the nutrition and social services programs which evolved further with the 1978 amendments to the Act.

The 1978 amendments represented a major change in the structure of the aging network programs at the state and local levels when the separately authorized social services, nutrition services, and multipurpose senior center programs were folded into one title under the Title III administrative structure. Title III social services were funded through area agencies, Title VII nutrition services were funded through area agencies on aging or directly by state agencies on aging, and Title V senior center grants were awarded directly from the Commissioner on Aging. The consolidation of these separate titles into one title was intended to foster greater coordination among the Older Americans Act programs with area agencies on aging responsible for managing funds for social, nutrition, and senior center programs within their respective communities. It was also assumed that consolidation of the service programs would increase the visibility, political strength, and significance of area agencies' scope of operations, as well as improve coordination among the service components under the Act. Another major change made by the 1978 amendments was the addition of a separate authorization of appropriations for home-delivered nutrition services, which were previously allowable under the separate Title VII program. Although the 1978 amendments consolidated the various service programs under one program umbrella, Congress maintained separate authorization of appropriations for supportive services and nutrition services.

Although the 1987 amendments made no structural change in the organization of the Title III services program, they significantly expanded certain service components of the state and area agency on aging program to address the special needs of certain populations of the elderly, including the frail elderly living at home, residents of long-term care facilities, and persons at risk of abuse, neglect, or exploitation. The 1987 law added 6 additional distinct authorizations of appropriations for services under Title III, as follows: in-home services for frail older individuals; long-term care ombudsman services; assistance to older persons with special needs; health education and promotion services; services to prevent abuse, neglect, and exploitation of older individuals; and outreach activities for persons who may be eligible for benefits under the Supplemental Security Income (SSI), medicaid, and food stamp programs. Although state and area agencies on aging had some responsibilities to address these service areas, there was no separate authorization of funds under Title III to carry out these responsibilities prior to the 1987 amendments.

The 1992 amendments modified the structure of the Title III program through a series of changes designed to promote services that protect the rights, autonomy, and independence of older persons. These amendments shifted some of the separate Title III service components to a newly authorized Title VII, Vulnerable Elder Rights Protection Activities. Programs shifted from Title III to the new Title VII included the long-term care ombudsman program; services to prevent abuse, neglect, or exploitation; and state legal assistance development services. Another Title III program, authorized by the 1987 amendments, was also shifted and then expanded under the new Title VII. This program is designed to assist older persons to secure certain rights to which they may be entitled under other public programs and to obtain assistance under private programs.

In addition to creation of a new elder rights title, the 1992 amendments added two new service components to Title III: school-based meals for volunteer older individuals and multigenerational programs; and supportive activities for caretakers who provide in-home services to frail older individuals.

Overview of State and Area Agency on Aging Responsibilities


Overall, the Title III organizational structure is intended to form a “network on aging” linking AoA, state and area agencies on aging, other public and private agencies, and social and nutrition services providers in efforts to expand and improve programs for older persons. Major functions of state and area agencies on aging include planning and coordinating services on behalf of the elderly and acting as their advocates. The goal of the program as set forth in the legislation is to develop a comprehensive service system designed to assist older individuals maintain maximum independence, to remove barriers to economic and personal independence, and to provide a continuum of care for the vulnerable elderly.

The program supports 57 state agencies on aging and 665 area agencies on aging. State and area agencies on aging administer Title III service funds in addition to substantial funding from other federal, state, and local sources.

Designation of State and Area Agencies on Aging and Planning and Service Areas

In order to be eligible for funds under Title III, each state is required to designate a state agency on aging to be responsible for developing a state plan on aging to be administered within the state. State agencies on aging may be either independent agencies within state government reporting directly to the governor, or units located within larger state human resources agencies. A little more than half of state agencies on aging are independent, single-purpose agencies, and the balance are located within a multipurpose agency.

As part of its responsibilities, the state agency is required to divide the state into planning and service areas and to designate area agencies on aging that, in turn, are to be responsible for community planning, coordination of services, and development of supportive and nutrition services within their respective areas. In designating planning and service areas within the state, the state agency must consider the following factors: the geographic distribution of persons 60 years and over; the areawide need for supportive and nutrition services, multipurpose service centers and legal assistance; the distribution of older persons with greatest economic and social need (with particular attention to low-income minority older persons), and of older Native American Indians; existing boundaries designated for the planning and administration of other supportive services programs; and the location of units of general purpose local government within the state. A state may designate as a planning and service area any unit of general purpose local government representing a population of 100,000 or more. Upon approval of the Commissioner on Aging, planning and service areas may cross state boundaries, including instances in which an Indian reservation is located across state boundaries. Indian reservations and, in certain limited circumstances, entire states, may constitute a single planning and service area. In FY 1992, there were 665 planning and service areas, including 11 single planning and service areas covering whole states or territories.

In designating an area agency, the state agency must give preference to an established office on aging unless said agency does not have the capacity to carry out the area plan. Other entities specified by law for designation as area agencies include: an office of general purpose local government or any combination of units of general purpose local government designated by local officials, and any other public or nonprofit agency that can conduct planning activities and provide services supported by Title III. When an area agency is part of another organization, the designated unit must function only as the area agency and be an identifiable unit within the organization. When designating any new area agencies after October 9, 1984, state agencies are required to give the right of first refusal to units of general purpose local government if these units otherwise meet the requirements of the law, and if the boundaries of the unit and the planning and services area are reasonably contiguous.

About 40 percent of the 665 area agencies are private, nonprofit organizations. About a quarter are located in councils of government, slightly more than a quarter are public agencies, and the remainder are other entities.

State and Area Agency on Aging Responsibilities

State and area agencies are required to develop plans on aging on a 2-, 3-, or 4-year basis as determined by the state agency. The plans must comply with requirements set forth by federal law and regulation. The Commissioner on Aging approves state plans, and state agencies approve plans developed by area agencies. In general, plans are to set forth goals and objectives as to how state and area agencies will implement the Title III program and coordinate service programs on behalf of the elderly.

Among other things, state agencies are required by law to:1

  • be primarily responsible for the planning, policy development, administration, coordination, priority setting, and evaluation of all state activities related to the objectives of the Act;
  • serve as an effective and visible advocate for the elderly by reviewing and commenting upon all state plans, budgets, and policies affecting the elderly;
  • evaluate the need for services within the state and determine the extent to which existing public or private programs meet identified needs;
  • set a minimum percentage of supportive services funds to be spent by each area agency on three priority services: access services (transportation, outreach, information and assistance, and case management services); in-home services (homemaker, home health aide, visiting and telephone reassurance, chore maintenance, and supportive services for families of elderly victims of Alzheimer's disease and other neurological and organic brain disorders of the Alzheimer's type); and legal assistance; and
  • assure that individuals involved in the designation of state or area agencies, or the heads of any subdivision of state or area agencies, or officers, employees or other representatives of state or area agencies, are not subject to conflicts of interest and that mechanisms are in place to identify and remove conflicts of interest.

Area agencies on aging are responsible for the administration of Title III funds and for coordinating all services and programs for the elderly within their respective planning and service areas. In developing area plans, area agencies are required to determine the extent of need for supportive and nutrition services and multipurpose senior centers, and to evaluate the effectiveness of existing resources to meet those needs.

Among other activities, area agencies are required by law to:2

  • serve as an advocate and focal point for the elderly within the community by monitoring, evaluating, and commenting on all policies, programs, hearings, and community actions affecting the elderly;
  • assure that an adequate proportion of Title III supportive service funds will be expended for access, in-home, and legal assistance services;3
  • conduct activities to facilitate coordination of community-based long-term care services designed to include the development of case management services as a component of long-term care services; and area agencies must assure that case management services provided under Title III do not duplicate such services provided through other federal and state programs and are coordinated with such other programs. The law provides that Title III case management services may be provided by public agencies, or private nonprofit agencies that do not provide, or do not have a direct or indirect ownership or controlling interest in, or a direct or indirect affiliation with, an entity that provides services other than case management. If the private, nonprofit agency is located in a rural area, it may obtain a waiver of this prohibition, and
  • as part of their coordinating responsibilities for special populations, coordinate mental health services supported with Title III funds with mental health services provided by community health centers and other agencies; coordinate priority services under the area plan with activities of organizations that assist victims of Alzheimer's disease and their families; and coordinate community-based long-term care services for older persons at home or who are hospitalized and at risk of institutionalization, and older persons residing in nursing homes who could return to their homes with appropriate community-based services.

Service Programs Authorized Under Title III

Title III authorizes funds to state and area agencies for a number of different service programs. The two largest programs funded under Title III are the supportive services program (part B), which supports a broad range of social services, and the nutrition program (part C), which supports congregate and home-delivered nutrition services. These programs represent almost all of FY 1993 Title III funding. In addition to these programs, Title III authorizes funds for in-home services for the frail elderly (part D); assistance for special needs (part E); disease prevention and health promotion (part F); and supportive activities for caretakers who provide in-home services to frail older individuals (part G). Of these programs, in-home services for the frail elderly and disease prevention and health promotion have been funded as of FY 1993.


Title VII, Vulnerable Elder Rights Protection Activities, added by the 1992 amendments to the Act, consolidates and expands certain programs and services that were previously authorized under Title III of the Act. The title was created based on congressional findings that there is a need to strengthen state responsibility for the development, coordination, and management of statewide programs and services to assure that older persons have access to, and assistance in securing and maintaining, benefits available to them, and their rights. Title VII contains four components: the long-term care ombudsman program; the program for the prevention of elder abuse, neglect, and exploitation; the state elder rights and legal assistance development program; and outreach, counseling, and assistance programs. The title also contains a separate authorization of appropriations for a Native Americans elder rights program.

Funds appropriated for Title VII activities are awarded to state agencies on aging based on a formula that takes into account the state's population aged 60 years or over compared to all states. The law requires that states be allotted funds for the long-term care ombudsman and elder abuse prevention programs (previously funded under Title III) in an amount no less than they received in FY 1991. It also requires that certain minimum funding levels be maintained for all Title VII programs.4

State agencies on aging are given discretion as to how they distribute Title VII funds within the state. States may implement the program directly, or through contracts or agreements with public or nonprofit private agencies or organizations, such as other state agencies, area agencies on aging, county governments, institutions of higher education, Indian tribes, or nonprofit service providers or volunteer organizations.



This is a partial list of requirements specified by law or regulation for state agencies or state plans on aging.


This is a partial list of requirements specified by law or regulation for area agencies or area plans on aging.


As noted above under state agency on aging responsibilities, state agencies are responsible for setting a minimum percentage of Title III supportive services funds to be spent by area agencies on access, in-home, and legal assistance services


For all states, the District of Columbia, and Puerto Rico, the minimum funding level is equal to one-half of 1 percent of the total Title VII appropriation; for Guam, the U.S. Virgin Islands, and the Trust Territories of the Pacific, the minimum is equal to one-fourth of 1 percent of the appropriation; and for American Samoa and the Northern Mariana Islands, the minimum level is equal to one-sixteenth of 1 percent of the appropriation.

Copyright 1995 by the National Academy of Sciences. All rights reserved.
Bookshelf ID: NBK231086


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