AREA AGENCIES ON AGING

In 1965, when the Older Americans Act (OAA) was passed, all aging program allocations went from the State Unit on Aging (SUA) in each state directly to service providers. During the late 1960s and early 1970s, social movements precipitated a move towards community-based planning for government-funded programs. The result of this shift was that local decision-making occurred at the regional, rather than state or national, level. Thus, in 1973, the OAA was reauthorized, creating the Area Agencies on Aging (AAA). An Area Agency on Aging is a public or private agency designated by a state to address the needs and concerns of all older Americans at the local level. This regional approach provides everyone with an opportunity to participate in the planning of services for older adults in their community.

The OAA also established the Native American Aging Programs, known as Title VI. Through these programs, funds are provided to a tribal organization, which serves the same function for the American Indians, Aleuts, Eskimos, and Hawaiians as the AAA provides to the states.

Creating an AAA

The OAA gives the SUAs the authority to divide a state into planning and service areas. Since 1973, these areas have been synonymous with AAAs. In creating a planning service area and designating an AAA, the OAA mandates that the states must consider, ". . .the geographical distributions of older individuals in the state, the incidence of need for supportive services, nutrition services, multipurpose senior centers, and legal assistance, the distribution of older individuals who have the greatest economic need (with particular attention to low-income minority individuals) residing in such areas, the distribution of older individuals who are Indians residing in such areas, the distribution of resources available to provide such services or centers, the boundaries of existing areas within the state which were drawn for the planning or administration of supportive service programs, the location of units of general purpose local government within the state, and other relevant factors" (Older Americans Act, Section 3025).

At the national and regional level, the aging network includes:

• The Administration on Aging and its ten regional offices, which are part of the Department of Health and Human Services
• Fifty-seven state offices on aging at the state and territorial level
• 655 Area Agencies on Aging
• 230 Native American Title VI aging programs.

An integral part of every AAA is its advisory board. The purpose of the advisory board is to provide input into the development and implementation of the planning document for the AAA. This advisory board also functions as the eyes and ears of the community, ensuring constant feedback to the AAA on its initiatives.

An AAA can be either a public or a nonprofit agency designated by the SUA to address the needs and concerns of all older adults at a designated local level. If the AAA is a public agency, it is usually located within an umbrella organization, such as a county or city government or a regional planning council. The name Area Agency on Aging is a generic name; specific names may vary by location. Regardless of what name is utilized, every AAA must be listed in the yellow pages of phone books under the title Area Agency on Aging, thus ensuring that anyone in the country can easily access their local AAA.

Function and responsibility of an AAA

The main function of an AAA is to be the community focal point in administering OAA program objectives. The main objective for an AAA is to create aging programs in the local community that will foster, assist, and encourage independence in older adults. To meet these objectives, agencies assume the following responsibilities:

• Assessing the needs of older persons in the community
• Identifying service gaps in the community, and finding solutions to meet the needs of the community and fill the service gaps
• Developing a comprehensive and coordinated service plan, called an Area Plan, which is submitted to the State Unit on Aging for approval
• Funding services with available resources, based on need
• Monitoring service providers and evaluating the effectiveness of service
• Serving as a visible and effective advocate for all older adults in the planning service area

Not all AAAs perform the same function in every community, but they all serve as a conduit to services for older adults. Nationally, all AAAs are responsible for administering OAA funds. In addition, many states designate the AAA to administer other funds, including Medicaid Waiver funds, state general fund revenues for older adult programs, Title XX funds, and even some local tax-generated service dollars. Area Agencies on Aging administer these funds largely through contracts with local service providers. Technically, AAAs may only provide information, referral, outreach, and case management services; a waiver from the state is required to provide other direct services. In order to provide other services, an AAA must demonstrate that no other provider is available, or that an adequate supply of services for older adults does not exist.

The planning process

Part of the responsibility of each AAA is the development a four-year Area Plan, which is a strategic plan on aging. The SUA then incorporates these plans into its master plan, which in turn is submitted to the Administration on Aging (AoA). The planning process for the Area Plan is carefully orchestrated. It must include input from the community, older adults, service providers, and any other interested parties. This ensures that the local community is both informed about aging issues and has an opportunity to shape the services provided. In addition, the community has an opportunity to be educated about trends in the aging population, limitations in funding, needs, gaps, and funding shortfalls. Using all the information captured in the public forum process, the AAA creates a draft, which is open for public comment. After community input is gathered, the advisory council and staff make the necessary adjustments to the Area Plan, and it is submitted to the SUA for approval.

It should be noted that the OAA has had insufficient funds for programs since its inception. The shortage was especially apparent from 1980 through 2000. During this period, there was little growth in funding, while inflation and the growth of the over-sixty population actually decreased the per capita dollars available to serve older adults. The lack of funding caused many AAAs to seek new sources of financial support. In 2000, however, with the reauthorization of the OAA, Congress supported the largest increase ever for the OAA and funded $125 million for an Adult Caregivers Program.

The other important component of the AAA is coordination. Even though the OAA does not fund all aging programs, AAAs have the responsibility to coordinate other available sources of revenue to avoid duplication, enhance services, and create a comprehensive service network. For example, if a local United Way concentrates its funding on medical transportation, the AAA can then direct its resources to another priority service.

Accessing services

The AAA and Title VI agency in each community provide information and assist individuals in accessing services that fall into five broad categories: information and access services, community-based services, in-home services, housing, and elder rights.

Information and access services consist of the following: Information and referral assistance, which provides assistance with locating services available in the community; health insurance counseling, which helps older adults understand their rights under Medicare, Medicaid, and managed care, and provides information about Medigap and other long-term care insurance policies; client assessment, which consists of a home visit by a trained professional to assess needs and service eligibility; care management, which is a plan of care developed in consultation with the client and family to ensure maximum independence and autonomy for the client; transportation for older adults to medical appointments, shopping, and meal sites; caregiver support, which provides education, counseling, and resources to caregivers while they are providing care to a spouse, older family member, or friend; and retirement planning and education to help older adults nearing retirement to focus on issues such as pension, health concerns, legal issues, and work and leisure options.

Community-based services comprise employment services to assist older adults in finding meaningful employment through the use of skill assessment, job counseling, and job placement; senior centers to provide social, educational, recreational, and physical activities for older adults, as well as a meal site; congregate meals, which are served to older adults in a senior center or group setting for the purpose of providing a nutritious meal in a highly social environment; adult day services, which provide community-based care for functionally impaired older adults, usually during the day hours, providing a respite for care-givers; and volunteer opportunities.

In-home services include home delivered meals, usually a midday or evening nutritious meal delivered to an older adult who is unable to prepare a meal. Meal delivery also provides a social contact for the meal recipient, which may be the homebound older adult's only live contact with the outside world. Homemaker assistance provides help with light housekeeping, laundry, cooking and shopping for the individual who just needs a little help living in the community, while chore services include major housecleaning, pest control, snow removal, and yard work. Telephone reassurance provides a regular daily call to an older adult. This service can reduce the feeling of isolation, and it provides a check on the older person's well-being. Friendly visiting provides a friendly visit to a homebound older adult; and emergency assistance and weatherization provides assistance paying fuel bills. The emergency response system provides older adults with an electronic device that can be activated to call for help. Home health services include visiting nursing, medication dispensing, health monitoring, various therapies, and instruction for individuals and family members, while personal care services provide assistance in bathing, grooming, feeding, mobility and other activities. Respite care provides a needed short-term break for caretakers by providing care for an older person.

Housing services include senior housing, which provides alternatives designed to meet the needs of older adults who wish to remain in an independent living environment, and alternative community-based living facilities, which includes a range of housing options that bridge the gap between independent living and nursing homes. This includes assisted living and adult foster care.

Elder rights provide legal and social help to older adults. Legal assistance provides legal advice and counsel for older persons and families who have legal and financial concerns; elder abuse prevention programs are designed to alleviate situations of abuse, neglect, or self-neglect—these programs include adult protection, guardianship, and conservatorship; and ombudsmen services are available to investigate and resolve complaints that involve older persons living in long-term care facilities.

Having to cope with the failing health of a spouse, family member, or friend can be emotionally draining, and finding the right help can be difficult and frustrating. However, through the AAA system, even relatives who live out of town can access necessary services, as a local AAA can provide information about the agencies in other localities. In this way AAAs serve as gatekeepers of information—they can provide answers about aging services in their community, as well as access to a nationwide network of AAAs. They provide security for the family that must live away from parents, and provide needed support to the older citizen trying to live at home with honor and dignity.

Robert Logan

See also Administration on Aging; Congregate and Home-Delivered Meals; Home Care and Home Services; Housing; Older Americans Act; Senior Centers; Social Services.

INTERNET RESOURCES

Administration on Aging. The AoA website provides information on the Older Americans Act. www.aoa.gov

National Association of Area Agencies on Aging. The N4A website is a good source of information on AAAs. www.n4a.org