AREA AGENCIES ON AGING

SELECTED BEST PRACTICES

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OFFICE OF INSPECTOR GENERAL 
OFFICE OF ANAL YSIS AND INSPECTIONS 
September 1987
 , "

Off ice of Inspector General

General 
The mission of the OffIce of Inspector  (OIG) is to 
promote the efficiency, effecti  ness and integrity of 
programs in the United states D partment of Heal th and Human 
Services 
(HHS). It does this by developing methods to 
, waste and abuse. 
detect and prevent fraud Created by
statute in 
1976, the Inspector General keeps both the 
Secretary and the Congress fully and currently informed 
about programs or management problems and recommends 
corrective action. The OIG performs its mission by
conducting audi ts 
, investigations and inspections wi 
approximately 1 200 staff strategically located around the 
country. 
Off ice of Analysis and Inspections

This report is produced by the Office of Analysis and
Inspections 
(OAI), one of the three major offices within the
OIG. The other two are the Off  ice 
ice of Audi t and the Off 
of Investigations. OAI conducts inspections which are 
atypbicaully ssheort.- term studies designed to determine program
effectiveness 
, efficiency and vulnerability to fraud or
This Report

Entitled  Area Agencies on Aging --
Selected Best
practices 
" this study was conducted to identify innovative 
programs for the elderly established by Area Agencies on 
around the country. 
Ag ing 
The report was prepared by the Regional Inspector General 
and Inspections  I I. 
Off ice of Analys i s  , Reg ion I 
Participating in this project were the following people: 
Philadelphia Region  Atlanta Region 
Joy Quill (project Leader)  Judi th Morgan 
James Dorsey  Chr istopher Koehler 
Francesca Di Cosmo 
ion 
Kansas City Reg 
Headquarters Office  Doris Phillips
Alana Landey  James Wolf  AREA AGENCIES ON AGING

SELECTED BEST PRACTICES

RICHARD P. KUSSEROW 
AUGUST 1987 
INSPECTOR GENERA 
OAI-03-87-00021  INTRODUCTION 
The Older Americans Act of 1965, as amended in 1973, 
required state Units on Aging (SUAs) to divide their states 
into planning and service areas (PSAs) and designate 
(AAs) to 
networks of Area Agencies on Aging  plan and 
develop comprehensive systems of services for the elderly 
thin those areas. 
wi  Wi thin the framework of policies and
plans established by SUAS, AAs are responsible for being
focal points wi thin their PSAs and catalysts for planning, 
coordinating, developing and pooling resources to create 
comprehensive systems of services for the elderly. 
AAs is to  ties 
By law, the major function of  assist communi 
to plan, develop and implement comprehensive and coordinated 
elderly. AAs foster systems 
systems of services for the 
development through conducting needs assessments, developing 
area plans for state approval, contracting with local
agencies to provide specif ic services, and working with 
other community entities to promote awareness of elderly 
sources. 
concerns and stimulate additional funding 
An inspection was conducted at the request of the
Administration on Aging (AOA). Its purposes were to
determine whether AAs 
have created comprehensive systems of 
AAs are  percei ved within their 
services for the elderly, how 
whether AAs are 
communi ties,  part of a national aging 
network, and whether providing direct services interferes

' planning and coordination responsibil i ties. We 
wi th A.:aS 
0S and areas
so ide  e5t pr  ces in the Sta 
visited.  ie6
Fieldwork consisted of visits to 17 state Units on Aging and

25 AAs, 
and discussions with l79 community agencies and l22 
elderly clients. The sites visited were not based on a

statistically valid random sample, but were generally

selected based on recommendations from AOA. 
reports.
The results of our inspection are reflected in two 
This report, entitled "
Area Agencies on Aging -- Selected
Best practices, 
" describes innovative programs identified 
during the fieldwork phase of our inspection. The programs 
described in this report are in no way intended to be a

comprehensi ve listing. Rather, they were the programs which

particularly impressed our team members during field visits

AAs. 
to 17 states and 25  They are presented to serve as 
illustrative examples of the types of innovative practices

being undertaken by AAs 
visited which might be of interest 
AAs 
to other  around the country. 
- 1 
 The report is divided into sections on community systems
development, 
nutrition, promoting independence, outreach and 
the ombudsman program. Several of the best practices 
presented incorporate aspects of more than one of the above
categories. 
Nevertheless, we felt that it would be useful to 
have discrete sections, rather than to present the practices
in an undifferentiated listing. 
Under separate cover is a companion report, entitled

Communi ty Systems Development under the Older Americans
Act. 
" It contains the findings and recommendations of the 
AAs in fulfilling
inspection relating to the success of 
their community systems development responsibilities under 
icans Act. 
the Older Amer 
- 2 
 BEST PRACTICES IN COMMUNITY SYSTEMS DEVELOPMENT

The development of comprehensive systems of services for the 
elderly wi thin their planning and service areas (PSAs) is a
major AA responsibility which most AA 
directors consider to 
be their highest priority. The four examples presented below 
AAs 
illustrate how  have used their leverage and influence 
within their communities to serve as catalysts in bringing
together public and pr i vate 
entities to establish new services 
or improve existing services for the elderly. 
Senior Campus

The AA director for a midwestern city has forged a partnership 
with county agencies and the private sector to develop a 
citizens 
42-acre parcel of county-owned land into a senior 
housing complex with a variety of service agency offices on the
same " campus.  This long term plan for the senior citizen 
center is the latest use for the county property, which has at 
various times served as the site of a home for the aged, a
county hospital, a tuberculosis sani tar ium and a medical 
school campus.

The project, which is expected to take up to a decade to 
complete, will include a variety of residential facilities for 
the elderly, including shared, congregate and independent 
county has already put about $l. 
living arrangements. The 
million into the roads , parking lots and utilities which will
serve the complex. 
Construction funds are being loaned by a 
bank. 
loe al 
Numerous public and private agencies serving the elderly have 
agreed to locate offices in the senior citizen administration 
building, which is envisioned as the entry point for seniors to 
gain access to a network of available services and programs. 
In addition to a senior center and recreational programs, a 
service center for the well elderly will contain such 
businesses as beauty and barber shops, a pharmacy, a library 
and a medical supply store. A full range of services for 
functionally impaired individuals will also be available on 
the campus, including home-delivered meals, homemaker and 
care. 
chore service, respite care and adult day 
information: 
Contact for more 
Northwestern Ohio, Inc. 
Area Agency on Aging of 
2155 Arlington Avenue
Toledo, Ohio 
43609 
4l9-382-0624 
- 3 
 Senior Peer Counseling program

AA, the county
This program is a joint effort of the 
depart 
ment of human resources, the state welfare department 
and a local hospital. It was developed through efforts of the 
county aging and mental health task force, which consists of 
representatives from 22 county agencies and organizations with 
an interest in addressing the needs of the county s elderly. 
The program s goal is to respond to the mental health needs of 
the elderly using a volunteer corps of senior peer counselors. 
In addition to the types of mental illness common to people of 
all ages, the specific mental health needs of the elderly 
include coping problems associated with the multiple losses 
aging. 
commonly experienced through  Supportive counseling is 
also available to the caretakers of the elderly, who are
considered high risk. 
The program has three service objectives:

primary prevention, including maintenance and enhancement

of the mental health of the elderly.

Secondary prevention, including specific interventions and

attempts to reverse the course of and to eliminate an

acute disorder. 
Tertiary prevention, such as stabilizing as much as 
possible a chronic disorder, minimizing the handicapping
potential of the di 
sorder and preventing additional 
er i =ratic  heal th :rc  cDdary  problems. 
Since services began in 1985, about lO , 000 hours of counseling 
have been provided to 850 clients by 20 peer counselors, 
following initial interviews and screening by 4 paid
counselors. 
information: 
Contact for more 
Delaware County Services for the Aging

Government Center 
Media, Pennsylvania 19063 
2l5-89l-4463 
- 4 
 Soc ial Services Task Force

The establishment of a social services task force by one 

demonstrates how problems identified during the case management

process can be incorporated into an AA' s planning and systems

building acti vi ties. 
AA, 
which provides case 
Case managers at this New England 
management services directly, found long waitinagg elinsctise sf.o r 
Upon 
homemaker services at all area social service 
studying the problem, the AA planning staff found that the 
generally high socioeconomic status of PSA residents made it 
difficult to find homemakers willing to work at the rates which 
The AA also found 
local social service agencies could offer. 
there was a tendency on the part of social service agencies not 
to share their knowledge of available services with other 
social service agencies. 
The AA was the catalyst in convening a task force of local 
social service agencies to share information about these

limi ted community resources. The result has been that those 
most in need of homemaker services are now receiving the

highest priority for service.

Contact for more information:

Minuteman Home Care Corporation

83 Hartwell Avenue

Lexington, Massachusetts 02173 
f17-862-620C 
- 5 
 Dental Care for the Homebound

This program uses volunteer dentists and private donations to 
nutritional 
provide free dental care for the elderly. A 
assessment of 220 home-delivered meals program participants 
AA in 
conducted by the  1985 found that only l7 percent were
recei ving regular dental care, as compared wi th 80 percent 
physician. 
About 25 percent 
who have regular visits with a 
of the respondents could not eat meat, salads or other 
fibrous foods, such as asparagus or crackers, and were in 
danger of being malnourished. 
The AA sent 
letters to all dentists in one rural county 
describing the survey findings. In response to the AA I 
request, all of the dentists agreed to set aside one 
afternoon to provide free dental examinations, x-rays and 
teeth cleanings to three homebound individuals. The 
provided transportation to and from the dentists ' offices and 
paperwork. 
assisted in completing the necessary 
Many of the 36 clients who received the free dental exams had 
not seen a dentist for several years, and were pleasantly 
surprised to learn that a visit to the dentist need not be 
the painful and traumatic experience they remembered from 
years past. Eighty percent of those who were found to need
addi tional dental treatment decided to have the recommended
treatment at their own expense. 
Twenty percent were unable
to afford followup care. 
To meet this continuing need, the
AA has 
begun to approach area service organizations to 
sponser a seni2r or make a contribution.

The AA plans to repeat the program later this year in the

same county, and expand it to the remainder of the PSA next

year. 
Contact for more information:

East Central Florida Area Agency on Ag i ng
lOll 
Wyore Road 
Winter Park, Florida 32789 
305-645-3339 
- 6 
 :;  :::'  ;" 
BEST PRACTICES IN NUTRITION

The Older Americans Act has supported an extensive program of 
congregate and home-delivered meals since the early 1970s' 
In recent years, some AAS have expanded their efforts to 
focus on individuals with special needs who cannot be 
accommodated by the regular AA-funded nutrition programs. 
Three examples are described: one for patients recently 
discharged from the hospital, one for individuals who need 
companionship as much as a meal, and the third for low-income 
homebound seniors in need of an evening meal. 
Senior Crisis Meals

A southwestern AA has 
developed a special emergency meals 
program for discharged hospital patients funded entirely by 
contributions. The program was established in response to a 
AA staff for 
need identified by  a brief period of post-
hospitalization in-
home supportive services, including 
emergency home-delivered meals, for elderly recuperating 
after stays in the hospital. 
After a year of education and negotiation, the AA convinced 
the local restaurant association to cosponsor the .Senior 
crisis Meals" program. Small collection cannisters placed 
next to cash registers in half of the 200 member restaurants 
donations. 
are now generating $800 per month in 
All funds collec 9d are used to buy food.  Meals are 
:::' r: 3.:: ecl \..Jrt (":  let:;.  d. '2  :' 4  .:: S:J  Pi? J. 2. .:: r l.l s ed  he  F-. 
heme-delivered meals C0:1t;:actor , who delivers them to 
system. 
individuals using their regular delivery  Meals are 
provided on an emergency basis only, for an average of 3 days 
discharge. 
following hospital  While there is no charge for
meals , voluntary contributions are welcome. 
Most clients are 
referred to the program by hospital discharge planners or the 
delivered meals contractor. 
home-
The program has been operating for over 2 years. The AA is 
now working to expand the program to area hotels and resorts 
through discussions with the local innkeepers' association. 
information: 
Contact for more 
pima Council on Aging

l03 East Alameda

Tucson, Arizona 8570l 
602-624-4419 
- 7 
 Happy Nooners Program

Since last sumer, the community council in a popular

seniors to 
suburban retirement area has been locating lonely 
participate in a once-a-week lunch at a local nursing or
retirement home. The program operates 7 days a week at 7
different nursing and retirement homes. Each day, a 
different nursing or retirement home hosts 8 to l2 seniors
for lunch. 
Altogether, about 60 seniors now participate in
I s food 
the program. The home  costs are partially defrayed by 
a $2 lunch charge collected from the participants.

Volunteers, mostly from local churches, pubalritciiczlee tsh.e  
program through flyers, ads and newspaper  They 
The AA 
also provide transportation and greet participants. 
funds the volunteer coordinator position. 
The program has benef i ts for both the seniors and the 
nurs ing and retirement homes. For seniors, it is an 
opportunity to socialize with new friends while having a

meal. 
nutr i tious  For those who may someday become permanent 
residents of the homes, the chance to visit and beocnom.e 

For 
familiar with them can ease the transition later 
retirement and nursing homes, the program serves as public

residents. 
relations and outreach to potential future 
Efforts are underway to expand the program to more nursing

and retirement homes. 
This will enable current seniors to 
participate more than one day a week, and will eventually

ogram to accoIT  odate more participants.
allow 
information: 
Contact for more 
Maricopa Council  on Aging 
1366 East Thomas Road 
Phoenix, Arizona 85016 
602-264-2255 
- 8 
 Evening Meals for the Homebound

This program in the midwest is the result of a partnership

between a local developmental disability agency and a private

nonprof i t community center, with homebound seniors as the 
beneficiaries. Two years ago, the developmental disability
off ice established a food service training program to prepare 
the developmentally disabled for jobs in the food service
industry. 
The training takes place at the local community 
food. 
center, which also pays for the 
The AA assisted with information and technical assistance 
AA nutritionist continues 
dur ing the start-up phase, and the 
to review planned menus to insure that meals will be 
nutri tionally balanced. 
The local restaurant association has 
been involved in approving the student curriculum. 
Every weekday evening, developmentally disabled students

prepare and deliver nutritionally balanced dinners to some

65 low income individuals, of whom about 60 are homebound

seniors. 
Many are also disabled. Efforts are now underway 
to expand the program, as well as to find ways to make it

self-supporting. 
information: 
Contact for more 
Eastern Nebraska Off ice  on Aging

885 South 72nd Street

Omaha, Nebraska 68114

402-444-6536 
- 9 
 BEST PRACTICES IN PROMOTING INDEPENDENCE

One of the broad policy objectives upon which the Older

Americans Act is based is to assure older Americans maximum

independence, financial as well as personal, in planning and 
managing their own lives. The following are examples of 
efforts to enable the elderly to continue living independently 
wi thin their commusnio t.i es as long as they wish to and are 
capable of doing  One enables senior home owners to work 
taxes. 
in exchange for credit toward local property  The other 
matches trained retirees with the elderly and their families 
in need of respite care in their own homes. 
Senior Tax Work-Off

In one western county, senior property owners are able to work 
off part or all of their city and county property taxes through
AA. 
a program administered by the  Now in its sixth year , the 
program was the brainchild of a senior citizen who approached 
idea. 
the city with his 
To be eligible to participate, individuals must own their homes 
(65 for the city program). 
and be at least 60 years old  While 
AA does try 
there are no income guidelines, the  to target low 
income applicants. Some 60 individuals are participating in

the county program this year.

Seniors wishing to participate in the program complete an
applicati 
D de5s=  heir skills and capabilities and are
inte  bing
v iewed b  he P=O;Z3ID coordi  terself a senior tax
ato= 
work-off program participant. City and county agencies submit

work orders to the coordinator, who then matches individuals

wi th available tasks. While most work orders were initially

for clerical help, seniors now perform tasks as varied as

drafting and engineering, 5-year capital improvement plan

development, driving a city van, and rototilling at public

parks. 
participants earn credit toward their taxes at the rate of 
hourly minimum wage, with total credit limited to $250 for the 
has no upper limit. 
county program. The city  credit for both 
programs cannot exceed the total taxes owed. 
Contact for more information

Larimer County Area Agency on Aging

Department of Human Development

O. Box ll90 
525 South Oak Street

Fort Collins, Colorado 
80522 
303-22l-7440 
- 10 
 :.  :;, 
Real Help and Respite Care Registry 
In an east coast suburban area, the Retired Senior Volunteer

Program (RSVP) established Real Help, a program which matches 
retirees with elderly individuals who pay for a variety of 
small tasks, such as minor repairs, chores and help with
shopping. 
The retired workers are paid by the elderly
rates. 
indi viduals at mutually agreed upon 
In 1983, recognizing the increasing need for respite care, and

mindful of the fact that most caregiving is done through

informal systems, the AA approached RSVP to create a Respite 
Care Registry in conjunction with the Real Help program.

To be enrolled in the Respite Care Registry, applicants must

complete a 25-hour Respite Care Training Course offered by the

American Red Cross. The curriculum covers emergency

first-aid, as well as such topics as grooming, toileting,

bathing, dressing, eating and walking.

After completion of training, workers are enrolled in the

Registry. 
When inquiries are received, the Registry 
Coordinator matches a worker with the requesting individual or 
family, who together determine the terms, cornadtieti.o ns and 
Hourly rates 
length of employment as well as the hourly 
range from $5 to $8. 
AA funding covers a full-time Registry Coordinator and the 
Care Training Course. The AA also pays for the cost
Respi te 
clier 
s unable to purchase the service on
cacf  ore?snD=ist2i idv ercee  d pcaayrre  t ais lSv ate pro:-v:f:; ider:s:r,  no:Jt r )( e2m1-plo:1y::e 2e. s:.  i  ochf. i Ri ScallV  P. For 
AA subsidi zes the payments, the 
those clients for whom the 
respi te workers are considered contract employees.

Last year, an average of 40 respite workers were listed on the

registry. 
Some 40 people received subsidized respite care 
and about 30 individuals paid for respite care each month.

Over 2, 500 hours of care were delivered each month, of which 
80 percent was on a private pay basis.

information: 
Contact for more 
Delaware County Services for the Aging

Government Center 
Pennsylvania 19063 
Media , 
215-891-4463 
- 11 
 BEST PRACTICES IN OUTREACH

Identifying those in need of services was mentioned by AAs
visit.ad as one 
of the most difficult responsibilities to
carry out using traditional methods. 
The following two 
examples illustrate outreach programs which have proven to be 
particularly effective. 
Neighbor to Neighbor

For the past 3  AA has 
years, a midwestern  been recrui tipg and 
training elderly volunteers for the neighbor to neighbor 
program.  local 
Neighbor to neighbor was designed to use 
residents to help their homebound elderly neighbors to live 
independently in their own homes. 
Each volunteer is provided with a copy of the AA' s aging 
services directory, and is trained to provide information and
referral services to their elderly neighbors. Volunteers  call
basis. 
fact 
or visit their neighbors on a daily or weekly  The 
that the volunteers are their neighbors, rather than 
professional outreach or social service workers, has resulted 
in greater receptivity and a high degree of trust among the 
elderly homebound. When problems are identified, the 
volunteer helps the elderly resident to make contact with the 
agency. 
appropr ia te serv ice 
Vol unteers are recrui tea through churches, local senior clubs
media. Altt0  tel 
here is t rnover, approxi, 
trained neighbor to neighoor volunteers are active at all
times. 
Well over l, 
000 elderly residents have been 
started. 
identified and helped since the program 
information: 
Contact for more 
Eastern Nebraska Off ice  on Aging 
885 South 72nd Street 
Omaha, Nebraska 68114 
402-444-6536 
- l2 
 Gatekeeper Project

is a joint ini tiati ve of the state 
This statewide program 
aging network and the State s major utility company.

Field staff and others with customer contact at the utility

company noticed that raises in utility rates were often

causing financial problems for elderly area residents living 
incomes. 
on fixed  They also noticed when individuals were 
other kinds of diff icul ties 
exper iencing  , but felt they were
powerless to help. 
After a comprehensive developmental process , the State Unit on 
Aging initiated a program to train utility employees who have 
customer contact to refer elderly customers who appear to be 
in diff icul ty by calling the elderly information and
assistance 
(I&A) agency in their county. Since the training 
could be completed in less than an hour, it was feasible to 
train virtually all utility employees with customer contact. 
During its initial pilot phase in one community, 27 percent 
of all referrals came from community "gatekeepers.  The 
program now covers the entire State, and has resulted in
countless referrals and inquiries to I&A off 
ices in each
county. 
This simple, yet effective, concept can also be used
with other " gatekeepers 
" such as pOlice, mail carriers, and
grocery clerks. 
information: 
Contact for more 
Bureau of Aging and Adult Services 
artrne  : of Social a d Eealth Services 
OB - 4 3 G 
Olympia, Washington 98504 
206-753-3768 
- l3 
 BEST PRACTICES IN THE OMBUDSMAN PROGRA

The nursing home ombudsman program was established to assist 
in the resolution of complaints and problems identified by 
nursing home residents or their families regarding living 
homes. 
conditions and quality of care provided by nursing  The 
ombudsman is seen as an interested but neutral third party who 
can mediate between the complainant and the nursing home to 
facilitate resolution of problem situations to everyone
satisfaction. 
Below are three examples of ombudsman programs which have made 
special efforts to establish the strongest and most effective 
programs possible, to meet needs identified by the AAs. 
Full-Service Ombudsman

This unique ombudsman program in a southwestern State is not
limi ted to 
nursing home residents. It assists anyone aged 60 
or over who is eligible for social services, as well as local 
services. 
organizations and agencies which provide the 
The rationale for the broadened coverage is that approximately

95 percent of the elderly do not live in nursing homes.

Although organizationally placed within the AA,  the

ombudsman  s salary is fully paid by the county.

The ombudsman responds to inquir ies and deals with a wide 
range of problems in such areas as Social Security, Medicare,
tra  ati 
spor  , sup?leffental security income , food stamps , and 
hospi tal s ays , as well as problems encountered by nursing 
home residents. He also responds to referrals from other
parts of the country. 
During a recent I-year period, nearly 
000 clients were served.

Contact for more information:

pima Council on Aging

103 East Alameda

Tucson , Arizona 8570l 
602-624-44l9 
- 14 
 Coordination with Case Management

AA there is 
In this western  a special arrangement between the 
ombudsman and the case management staff regarding referral of
elderly individuals to area nursing homes. 
The ombudsman, who 
is also a registered nurse, moni tors the treatment of nursing 
review. 
home residents, including patient chart  When she 
recei ves a complaint 
or identifies a problem at a particular
nursing home, she notif ies the AA case management staff, who 
discontinue referrals to that nursing home until the problem 
is resolved.

By interrelating the ombudsman and case management functions, 
referrals to problem facilities are avoided. This arrangement 
also serves as an incentive to nursing home owners to resolve 
problems and complaints quickly in order to avoid an 
AA to their 
interruption of referrals by the  homes. 
Contact for more information:

Marin County Area Agency on Aging

Civic Center

San Rafael, California 94903 
4l5-499-7396 
- 15 
 A Medical Component

AA does not 
While the ombudsman in a midwestern  have medical 
training, she has found a way to incorporate medical expertise
into 1the program.. 
Through an arrangement with a local medical 
school, geriatric residents accompany the ombudsman on nursing 
home visits as part of their regular training. 
The program has a du l benef it:

The ombudsman program s effectiveness has been enhanced by 
the residents ' knowledge and expertise. Nursing home
rlesident problems of a medical nature which might have 
escaped the notice or been beyond the competence of the 
ombudsman herself can be recognized and dealt with by this 
team effort. 
Program participation is considered a vi tal part of the
residents ' educational experience. 
They are learning
first-
hand about medical problems facing the elderly, as 
well as the psychosocial and environmental problems they 
experience which can affect their health and well being. 
information: 
Contact for more 
i ng of  Northwestern Ohio, Inc. 
Area Agency on Ag 
2155 Arlington Avenue
Toledo, Ohio 
43609 
4l9-382-0624 
- 16