Quality Future: Older Americans Act Reauthorization and Other Opportunities

1. 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 1

2. Outline • AoA Overview • Selected AoA Key Opportunities • OAA Overview • OAA Reauthorization

3. AoA Overview

4. 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.

5. 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

6. Selected AoA Key Opportunities

7. Key Initiative: Care Transitions 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/itemdetail.asp?itemID=CMS1239313

8. 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/itemdetail.asp?itemID=CMS1239313 Key Initiative: Care Transitions

9. 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.

10. 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

11. 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

12. Key Initiative: Care Transitions • AoA has provided a multi-part series of Webinar trainings, including: • Providing an overview of Care Transition models; • Assessing your agency’s 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

13. Key Initiative: Care Transitions • For more information about the Partnership for Patients, visit http://www.HealthCare.gov/center/programs/partnership. • For more information about the Community-based Care Transitions Program funding opportunity, visit http://www.cms.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?itemID=CMS1239313. • For more information about AoA’s Aging & Disability Resource Centers Evidence-Based Care Transitions Program, visit: http://www.aoa.gov/AoARoot/AoA_Programs/HCLTC/ADRC_caretransitions/index.aspx

14. 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

15. 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 HHS’s Healthy People 2020.

16. 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.

17. 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.

18. 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/CurrentNewsLetter.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.”

19. OAA Overview

20. 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

21. 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).

22. 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

23. OAA Reauthorization

25. 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.

26. 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.

27. 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. 

28. 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.

29. Historical Evolution of the Older Americans Act • 1980’s, 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.

30. 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.

31. 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.

32. 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

33. 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

34. 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)

35. 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)

36. FFY 2012 Budget • FY 2012 President’s 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

38. 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: 312-886-8536 Fax: 312-886-8533 Email: amy.wiatr@aoa.hhs.gov