William F. Benson Consultant, CDC’s Healthy Aging Program and Principal, Health Benefits ABCs

1. The Older Americans Act & the Nation’s Aging Network: "The Unique Role of the Aging Services Network in Public Health Policy for Healthy Aging" William F. Benson Consultant, CDC’s Healthy Aging Program and Principal, Health Benefits ABCs January 13, 2010

2. 1965 – The Great SocietyA Remarkable Year for Older Americans • Medicare (SSA, Title XVIII) • Medicaid (SSA, Title XIX) • Older Americans Act (OAA)

3. Older Americans Act • Dual Mission • Service System Development – “the development and implementation of comprehensive and coordinated systems to serve older individuals” • Advocacy (more later) • National Infrastructure • Federal • State • Local

4. Older Americans Act 7 Titles – Approx. $1.8 Billion Annually • I Objectives • II Administration on Aging – DHHS • III “Aging Network” – SUAs, AAAs & Community Services • IV Activities for Health, Independence & Longevity (R & D Discretionary Funds) • V Senior Employment Program (DoL) • VI Programs for American Indians, Alaska Natives & Native Hawaiians (Grants to Tribes) • VII Elder Rights

5. Older Americans Act Title I Declaration of Objectives “The Congress hereby finds and declares that, in keeping with the traditional American concept of the inherent dignity of the individual in our democratic society, the older people of our Nation are entitled to, and it is the joint and several duty and responsibility of the governments of the United States, of the several States and their political subdivisions, and of Indian tribes to assist our older people to secure equal opportunity to the full and free enjoyment of the following objectives.”

6. Older Americans Act Title 10 Objectives: Examples • (2) The best possible physical and mental health which science can make available and without regard to economic status. • (9) Immediate benefit from proven research knowledge which can sustain and improve health and happiness.

7. Older Americans ActTitle III • State Units on Aging – GA Division of Aging Services; MD Department of Aging; FL Department of Elder Affairs • Departments (several cabinet level) • Agencies in Umbrella Departments • Commissions • AAAs – GA -- Atlanta Regional Commission; MD – Baltimore City, Baltimore County, Upper Peninsula • County/City Government • Regional Councils • Non-Profits • Several states with small 60+ population – SUA serves as AAA (AK, DE, ND, NH, SD, RI, WY, DC & territories)

8. Older Americans Act & Other Aging Network Services Local Community Services (est. 27,000+ providers): e.g., • Home-delivered & congregate meals • I & A (I & R) • Adult day care • Transportation • Case management • Medicaid waiver services • Home repair • Senior centers • Family caregiver support • Disease prevention/health promotion • Evidence-based Prevention Grants

9. Older Americans Act & Other Aging Network Services • Legal assistance • Long-term care ombudsman program – nursing homes, assisted living, B & C • Senior Medicare Patrols • SHIP program (CMS-funded) • Elder abuse prevention • State Alzheimer’s Disease Demo Grants • ADRCs • Adult Protective Services (approx. ½ of states)

10. Older Americans ActTitle III – Part D Disease Prevention & Health Promotion Services • Grants to States – • The Assistant Secretary shall carry out a program for making grants to States under State plans approved under section 3027 of this title to provide disease prevention and health promotion services and information at multipurpose senior centers, at congregate meal sites, through home delivered meals programs, or at other appropriate sites. • In carrying out such program, the Assistant Secretary shall consult with the Directors of the Centers for Disease Control and Prevention and the National Institute on Aging.

11. Older Americans ActTitle III – Part D • DP/HP services defined as: • Risk assessments • Routine screenings • Nutrition counseling and education • Health promotion programs • Physical fitness, music, art/dance therapy • Home injury control • Depression screening • Education on preventive health services under Medicare • Medication management • Info on age-related diseases/chronic disabling conditions • Counseling

12. Older Americans ActPrevention Funding • Funding – FY 2010 • Part D -- $21,000,000 • Health & Long-Term Care Programs – Evidence-based prevention grants, ADRCs & Nursing Home Diversion (formerly “Choices for Independence) -- $31 million • Project 2020

13. Parallel Networks: Aging Services and Public Health Department of Health and Human Services AoA CDC NACDD Nat’l Assn of Chronic Disease Directors NASUA Nat’l Assn of State Units on Aging 57 SUAs 58 SHDs NACCHO National Assn of County & City Health Officials N4A National Assn of Area Agencies on Aging 655 AAAs 3,000 LHDs Community Orgs Community Orgs

14. Aging: In-depth knowledge of those served Broad range of issues addressed Providing variety of essential services Extensive outreach capability Public Health: Experience in state-based disease prevention programs Scientific expertise Collection and application of data Prevention research (identifying what works) Public Health and Aging Partnerships: A Formula for Healthy Aging

15. State Readiness Project 2009: SUA & SHD Collaboration • 93% reported having a current relationship • 50% informal • 21% formal • 29% mandated • Types of activities: • Participate on boards and committees • Programs and activities at the state and local levels • Planning/development of programs • Grant writing • Policy maker education

16. Advocacy & the Aging Network • The Aging Network’s Extra Ingredient – perhaps the yeast • Possibly unique within federal law • A mandate to engage in advocacy at all levels: federal, state & local – more than a tool or “right” • Tremendous potential – a powerful tool • Underutilized – misunderstood and threatening

17. Advocacy & the Aging Network • “Advocacy is simply the support of an idea, cause, or – in this case, more aptly – a particular population. Successful advocacy requires a comprehensive understanding of the issues involved, and is almost always a byproduct of clear, concise communication and building positive relationships. Its key components include passion, persistence and patience; creativity, cooperation and collaboration; and energy, flexibility and resourcefulness in pursuit of an organization’s objectives. • “Area agencies on aging are not only encouraged to advocate for the older people in their districts, they are mandated to do so.” (Source: “Whys and Wherefores: An Introductory Manual for Members of Boards of Trustees and Advisory Councils,” by n4a and Scripps

18. Advocacy & the Aging Network • Administration on Aging (federal) – OAA Sec. 202: • (a) It shall be the duty and function of the Administration to— • (1) serve as the effective and visible advocate for older individuals within the Department of Health and Human Services and with other departments, agencies, and instrumentalities of the Federal Government by maintaining active review and commenting responsibilities over all Federal policies affecting older individuals; • (28) make available to States, area agencies on aging, and service providers information and technical assistance to support the provision of evidence-based disease prevention and health promotion services. (2006 Amendments)

19. Advocacy & the Aging Network • State Units on Aging (Sec. 305(a)(1)(D)) • (1) the State shall, in accordance with regulations of the Assistant Secretary, designate a State agency as the sole State agency to— • (D) serve as an effective and visible advocate for older individuals by reviewing and commenting upon all State plans, budgets, and policies which affect older individuals and providing technical assistance to any agency, organization, association, or individual representing the needs of older individuals;

20. Advocacy & the Aging Network • State Units on Aging (D) implementing (through area agencies on aging, service providers, and such other entities as the State determines to be appropriate) evidence-based programs to assist older individuals and their family caregivers in learning about and making behavioral changes intended to reduce the risk of injury, disease, and disability among older individuals (OAA 2006 Amendments)

21. Advocacy & the Aging Network • Area Agencies on Aging (local level) – OAA States: (B) serve as the advocate and focal point for older individuals within the community by (in cooperation with agencies, organizations, and individuals participating in activities under the plan) monitoring, evaluating, and commenting upon all policies, programs, hearings, levies, and community actions which will affect older individuals; (Sec. 306(a)(6)(B) (C) the area agency on aging will ensure that each activity undertaken by the agency, including planning, advocacy, and systems development, will include a focus on the needs of low-income minority older individuals and older individuals residing in rural areas;

22. Advocacy & the Aging Network • Area Agencies on Aging (local level) – AoA Regs: “shall serve as the public advocate for the development or enhancement of comprehensive and coordinated community-based systems of services in each community throughout the planning and service area” (45CFR:Sec.1321.61). Among other advocacy-related requirements, the regulations stipulate that area agencies shall: “Represent the interests of older personsto local level and executive branch officials, public and private agencies and organizations.” (Source: “Whys and Wherefores: An Introductory Manual for Members of Boards of Trustees and Advisory Councils,” by n4a and Scripps

23. Advocacy & the Aging Network Area Agencies on Aging (local level) – AoA Regs: • “Monitor, evaluate, and, where appropriate, comment on all policies, programs, hearings, levies, and community actions which affect older persons.” • “Undertake a leadership role in assisting communities throughout the planning and service area to target resources from all appropriate sources to meet the needs of older persons with greatest economic or social need, with particular attention to low income minority individuals.”

24. Advocacy & the Aging Network • Area Agencies on Aging (local level) & Evidence-Based Programs (7) provide that the area agency on aging shall, consistent with this section, facilitate the area-wide development and implementation of a comprehensive, coordinated system for providing long-term care in home and community-based settings, in a manner responsive to the needs and preferences of older individuals and their family caregivers, by— (C) implementing, through the agency or service providers, evidence-based programs to assist older individuals and their family caregivers in learning about and making behavioral changes intended to reduce the risk of injury, disease, and disability among older individuals;

25. Advocacy & the Aging Network • Advocacy vs. Lobbying vs. Political Activity vs. “Partisan” Political Activity “And though partisan “political activities” (defined by BoardSource as “activities intervening directly or indirectly in any political campaign on behalf of or in opposition to any candidate for public office”) are off-limits to nonprofit organizations, these organizations can conduct lobbying activities under certain circumstances. Lobbying (defined by BoardSource as attempting to “influence legislation”) by nonprofit organizations is permitted under the condition that the lobbying activities do not constitute “a substantial part of the organization’s total activities.” (Source: “Whys and Wherefores: An Introductory Manual for Members of Boards of Trustees and Advisory Councils,” by n4a and Scripps

26. Advocacy & the Aging Network • Advocacy vs. Lobbying vs. Political Activity vs. “Partisan” Political Activity • Practicalities: Realities & Limits • The Atlanta Regional Commission model • Actual Potential Remains Untested Especially with Another System – Huge Possibilities with Public Health

27. Advocacy & the Aging Network: Resources • Alliance for Justice Website re Nonprofit Advocacy (www.afj.org/nonprofit/; or call: 866-NPLOBBY, 866-675-6229) • BoardSource – www.boardsource.org • “Whys and Wherefores: An Introductory Manual for Members of Boards of Trustees and Advisory Councils,” n4a and Scripps • Older Americans Act – Statute and Regulations: www.aoa.gov