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## 1995 State Program Report for Titles III an VII of theOlder Americans Act

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### Contents

#### IntroductionSummary of New Reporting Requirements Summary Highlights Profile of Clients ServedService Provision Service Expenditures Aging Network Staffing Developmental Accomplishments 

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### Introduction

Over thirty years ago the Older Americans Act (OAA) was passed. Since its initialpassage, the OAA has been an important force for change for programs and services forolder americans . The OAA fostered the creation of a national network of state and areaagencies on aging and Indian Tribal Organizations. Through the development efforts of theAging Network and OAA funding, an infrastructure of home and community based services hasemerged in every state. While much has been accomplished, the job ahead is still verylarge. OAA funds are small compared to the need. Each OAA dollar must be well spent inorder to address both current demand and, at the same time, prepare for emergent needs ofthe elderly in the 21st century.

This report summarizes programs and accomplishments reported by state units on agingwhich were supported by Titles III and VII of the OAA in Federal Fiscal Year 1995. Theinformation provided in this report are the result of new reporting requirementsintroduced by the Administration on Aging (AoA) for Title III and VII in 1995.Implementation of the new Title III program reporting requirements is a multi-yearprocess, with the 1995 performance report representing the first step toward reporting bythe Aging Network which is more client centered. 

To comply with the new reporting requirements, states are making major changes to long-standing reporting procedures. Every effort has been made by states and the AoA to reviewthe new data submitted for FY1995 and ensure its accuracy. Once states submitted the data,AoA prepared summaries that were sent to states for review and concurrence. Still, AoAfully expects it will take two to three years before all the reporting procedures are inplace to produce very accurate, comparable data. 

This 1995 report is designed to provide summary highlights of Title III and VII programperformance, including persons served, services provided, services expenditures, providersused, state and area agency staffing, developmental accomplishments and the use of seniorcenters. Both national and state specific summaries are included. This is the first timethe annual State Program Performance Report (SPR) includes information on individual stateactivities and performance supported by Titles III and VII. 

It should be noted that the AoA is required to produce a separate report to Congress onthe Long Term Care Ombudsman Program supported by the OAA. This report provides only abrief synopsis of the Ombudsman Program accomplishments. See the separate Ombudsman Reportfor a more detailed report on accomplishments for this program. 

#### Go back to Contents

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### Summary of NewReporting Requirements 

In 1995 AoA introduced a new set of reporting requirements for Titles III and VII,including special reporting for the Long-Term Care Ombudsman Program. The new Title IIIreporting requirements put more emphasis on accurate client counts and additionaldescriptive information on client characteristics. Key features of the new reportingrequirements include: - Consolidation and elimination of service reporting from 30 separate categories to 14; 
- Addition of new service categories reflecting priorities of the Aging Network -- case    management and adult day care/adult day health; 
- A requirement for client registration for nine services in order to produce accurate,    unduplicated client counts for the nine services (to be implemented in FY1997); 
- Elimination of reporting on clients and service units by individual Title III Parts; 
- Provision for optional reporting by states on Title III funded services not included by    the AoA list of 14 services; 
- Inclusion of the requirement for client registration for selected services; and,    - Electronic transmittal of the data by states to AoA. 

In 1995 several new data elements for Title III reporting were introduced. Additionaldata elements will be introduced in FY1997 tied to the requirement for client registrationof selected services. New data elements introduced in 1995 include: - Number of providers using Title III funds, by service; 
- Number of minority providers, by service; 
- Number of Area Agencies on Aging (AAAs) acting as direct service providers; 
- Program income for each listed service; 
- Total estimated persons served -- all services and all Title III parts; 
- Summary descriptions of Aging Network developmental accomplishments; 
- Staffing profiles for both state units on aging and area agencies on aging. 

Given these new requirements, many states are upgrading their reporting systems at alllevels. New procedures for client intake/registration are being implemented along with thecapacity to maintain a master client registry that can be kept up-to-date as new clientsare served, active clients drop out and current clients receive new or different services.AoA has encouraged the development of these new systems, recognizing each state hasdistinctive requirements and needs for information systems. 

New service definitions and terms were introduced as part of the amended reportingrequirements. Limited comparisons are possible of 1995 performance data with performancedata submitted by states for prior years. AoA plans to use 1995 as a new base year againstwhich future performance data will be compared. 
Go back to ContentsSummaryHighlights 
After thirty years, the Aging Network has put in place a program involving diverseservices and the use of thousands of providers. All fifty-seven state level jurisdictionsreceive OAA funds awarded annually by the AoA in the form of a grant, based on the size ofthe elderly population in each state. With these funds, designated state units on aging,supported by area agencies on aging in all but eight states, develop and administer adiverse set of home and community-based services.

Even though funding has not kept up with demand, the Aging Network has still been ableto implement and operate a far reaching, diverse program. Summary performance indicatorsfor 1995 show the breadth of services and capacities now in place: - Programs and services supported by the OAA served an estimated 7,453,575 persons age 60    and over; 
- Twenty percent of the program participants were minority; 
- Thirty-nine percent of the program participants had incomes at or below poverty; 
- Twelve percent of the total count of program participants had incomes below poverty who    were also minority participants; 
- Of the total clients in poverty, thirty-two percent were minority participants;    conversely, of those who were minority clients, 62% had incomes at or below the poverty    level; 
- Thirty-five percent of the program participants lived in rural areas; 
- The OAA puts a high priority on the provision of nutrition services to the elderly. In    1995 a total of 123.4 million congregate meals were provided and 119 million    home-delivered meals; 
- Title III federal expenditures reported by states totaled $673 million; and, 
- Title III federal funds comprised 39% of the total service expenditures reported by the    Aging Network in 1995. 
- A total of 6,397 senior centers were supported by Title III funds: 
- A total of 564 long-term care ombudsman program entities were in place; 
- A total of 1,182 staff in state units on aging were supported with Title III funds, 32%    of total state unit on agency staffing. 
- A total of 9,110 area agency on aging staff were supported by Title III funds, 48% of    the total paid area agency on aging staff. 

Three services account for the majority of OAA funding, congregate meals,home-delivered meals and transportation. In 1995 Title III federal expenditures forcongregate meals reached $250 million and $134 million for home-delivered meals.Transportation is the third largest services in terms of Title III funding, $63 million.Together these three services account for 66% of the total Title III federal funding.
Go back to ContentsProfile of ClientsServed
In 1995, the Title III program provided services to an estimated 7,453,575 persons,approximately 16% of the population age 60 and over in the U.S. This estimate takes intoaccount all services supported by Title III funds in the state. Five states (California,New York, New Jersey, Illinois and Michigan) account for 34% of the total persons served.These five states have 29% of the population aged 60 and over in the U.S. in 1995. Thefive states reporting the highest percent of the 60+ population served by OAA programsinclude Wyoming (64%), New Mexico (44%) Alaska (44%) North Dakota (43%) and Utah (39%).Twenty -three states report 20% or more of their population aged 60 and over were servedthrough OAA supported programs. 

Of the total participant population served, 1,497,916 persons were reported to beminority participants (20.1%). The distribution by race and ethnicity is estimated to beas follows: 

**Figure 1. Minority Participants**
**Race/Ethnicity****Number Of Minority Participants****% of Total Minority Participants****% of Total Participants**    **African-American**820,10554.7%11.0%**Hispanic-Origin, All Races**434,674 29.0%5.8%**American Indian/Alaskan Native**76,999 5.1%1.0%**Asian American/Pacific Islander**166,138 11.1%2.2%
California, New York, New Jersey, Texas and Illinois account for 39% of the minorityparticipants. All but three states had a percentage of minority clients served which wasequal to or greater than the percentage of the total 60+ minority population in the state.

States reporting the highest percentage of minority participants include Hawaii (75%),Mississippi (47%), New Mexico (45%), and South Carolina (45%). Puerto Rico reports 100% ofits participants are minority and the District of Columbia reports 82.1%. Approximately55% of the total minority participants are African-American with 29% beingHispanic-origin. 

An estimated 39% of the total participants have incomes at or below the federal povertythreshold. Among states, the poverty participant rate ranged from a low of 17.2% to a highof 86.9%. Of those below poverty, approximately 32% are minority participants. Low-income,minority participants comprise 12.5% of the total participant population. States with thehighest percentage of poverty level participants included Mississippi (86.9%), Oklahoma(68.8%) and Texas (68.7%). The District of Columbia reports 88.5%. Mississippi has thehighest percentage of participants who are both in poverty and minority (44.3%). Twelvestates report that at least one-half of the participants have incomes at or below thepoverty threshold. 

When the profile of clients served is compared to the state 60+ population, based onpoverty characteristics, every state is clearly targeting poverty clients. For the U.S.,in 1989, the Census reports approximately 12% of the 60+ population with incomes at orbelow poverty. Each state reported a substantially higher percentage of poverty clientsthan the equivalent percentage of the 60+ population in the state whose incomes fell at orbelow the poverty threshold. The same is true for targeting of minority persons whoseincome is below poverty. 

An estimated 2.6 million participants live in rural areas (35%). A total of 20 stateshave at least 50% or more of the total Title III participants who live in rural areas.States with the highest percentage of rural participants include Wyoming (100%),Mississippi (84.6%), Montana (80.9%), and Vermont (78.8%). States reporting the lowestpercentage of rural residents include Tennessee (6.4%), Rhode Island (7.9%), Connecticut(7.1%), Massachusetts (11.1%) and California (11.9%). 
Go back to ContentsServiceProvision 
Beginning in 1995 the SPR service reporting was changed. As already noted, the list ofservices individually reported was reduced from thirty to fourteen. States have differentservice priorities for Title III funding so the mix of services and level of funding forservices varies somewhat from one state to another. States could, at their option, provideinformation on other services supported by Title III and VII funding.

**A. Scope of Services**

Most states provide the majority of the listed services. To show the extent of servicecoverage, see Figure 3.

**Figure 3. Scope of Services Supported by Older Americans Act**

**Number of Listed Services Supported With State    Funding****Number of States****% of All States*****All 14 Listed Svcs Plus Other Svcs**5 11.5%**All 14 Services**1019.2% **13 Services**1426.9% **12 Services**611.5% **11 Services**47.7% **10 Services**611.5% **9 Services**47.7% **8 Services**23.8% 
* *Includes Puerto Rico and the District of Columbia*

Five states indicate all fourteen services are provided in their state plus otherservices as well. Fifty-eight percent of the states fund at least 13 of the listedservices and/or other services. No state reported providing less than eight of the listedservices. Five states, Delaware, Indiana, Michigan, Oklahoma, and Oregon did not provideany "other" services with Title III funding support. Looking at service supportfrom a different perspective, the number of states using Title III funds to support eachlisted service is shown in Figure 4.

**Figure 4: State Support for Selected Services**
**Home and Community-Based Service****# of States Funding the Service****% of All States (Inc DC and PR)****Personal Care**4178.8% **Homemaker**4790.4% **Chore**3873.0% **Home-Delivered Meals**52100.0%**Adult Day Care/Health**4076.9%**Case Management**4178.8% **Congregate Meals**52100.0% **Nutrition Counseling**1732.7%**Assisted Transportation**31 59.6%**Transportation**5096.2% **Legal Assistance**5096.2% **Nutrition Education**2955.8%**Information and Assistance**48 92.3%**Outreach**4586.5% **Other Services**4688.5% 
As expected, all the states provide home-delivered and congregate meals. All of thestates operate a long-term care ombudsman program supported by the OAA. In 1995, for theU.S., there were a total of 564 designated local ombudsman entities and a total of 1,546paid staff (full time equivalents) as well a 6,428 certified volunteers.

**B. Levels of Service Provision**

Levels of service provision vary by state due to both funding levels and servicepriorities. The profile of service units is summarized in Figure 5. 

**Figure 5. Levels of Service Provision**
**HCBC Service****Measure****Total Units (U.S.)****Top 3 States - Highest # of Units**    **Personal Care**Hour7,703,053 NY, PA, NC**Homemaker**Hour6,635,425 NY, OH, MI**Chore**Hour890,488 MN, IA, OH**Home-Delivered Meals**Meal119,000,053NY, CA, TX**Adult Day Care/Health**Hour 4,221,484NY,FL, IA**Case Management**Hour2,976,149 NY, IL, CA**Congregate Meals**Meal123,387,303NY, CA, TX**Nutrition Counseling**Hour100,069MA,NY, TX**Assisted Transportation**1WayTrip 2,232,027OH, WY, MD**Transportation**1WayTrip39,496,946NY, OH, TX**Legal Assistance**Hour1,396,519AZ, CA, WI**Nutrition Education**Session 1,142,379FL, MD, TN**Info and Assistance**Contact 12,526,537NY, CA, FL**Outreach**Contact2,643,830 MN, CA, NM
Levels of service use by individual participants were examined for the nine registeredservices. Considerable variation exists from state to state. See Figure 6. 

**Figure 6. Units per Participant for FY1995**
**HCBC Service****Measure****Avg. Units/Client U.S.****Avg. Units/Client Highest State****Units/Client For the State**     Personal CareHour79.45 Virginia248HomemakerHour39.54 Arkansas/N. Car.*98ChoreHour13.42 Georgia366Home-Delivered MealsMeal120.36Florida*204 Adult Day Care/HealthHour 90.56Arkansas634 Case ManagementHour5.95 Massachusetts37Congregate MealsMeal51.15Florida *152 Nutrition CounselingHour2.70Texas13 Assisted Transportation1WayTrip 27.39Florida231 
**Note: The District of Columbia estimates 213 units per person for home deliveredmeals and 286 units per person for homemaker*. *Puerto Rico reports 223 units perperson for congregate meals.*

States use Title III funds to provide services other than those individually reportedto AoA. At the option of each state, information can be provided on these other services.The range of services optionally reported is extensive including such diverse services asbenefits counseling, senior center activities, health promotion, home repair andmodification, telephone reassurance, friendly visiting, adaptive/assistive technology,volunteer services coordination and more. 

**C. Service Providers**

For the first time, the Title III State Program Report contains summary information onthe number and type of service providers funded with Title III funds. Information wascollected on the number of providers for each of the 14 listed services. See Figure 7.Providers of other services supported by Title III funding were not identified. 

**Figure 7. Service Providers for Selected OAA Supported Services**
**HCBC Service****Total Providers****Total Minority Providers****% Minority Providers****Total Minority Providers (Less D.C and P.R.)**Personal Care
1,856
210 
11.3%
116Homemaker
2,032
186 
9.2%
92Chore
755
151 
20.0%
56Home-Delivered Meals
3,614 
397
11.0%
298 Adult Day Care/Health
905
210
23.2%
111 Case Management
821
71 
8.6%
61Congregate Meals
3,902
504
12.9%
405 Nutrition Counseling
505
138
27.3%
39Assisted Transportation
896 
203
22.7%
108 Transportation
2,965
433 
14.6%
325Legal Assistance
1,205
160
13.3%
66Nutrition Education
1,595
254
15.9%
153 Info and Assistance
2,370
233
9.8%
226Outreach
2,047
199 
9.7%
192
In 1995, AoA collected information on minority providers. It should bepointed out that Puerto Rico alone accounts for 94 minority providers in all but threeservices (case management, information and assistance and outreach) where Puerto Ricoreports seven minority providers. The District of Columbia also has a high percentage ofminority providers. In Figure 7 the count of minority providers is shown both with andwithout Puerto Rico and the District of Columbia.

As Figure 7 shows, the greatest number of providers are meals providers, closelyfollowed by transportation providers. Some of the meal providers are likely to provideboth home-delivered and congregate meals under Title III. Likewise, providers are likelyto be funded to provide more than one home and community-based service. 

Based on the reported data, the average level of service offered by a Title IIIsupported provider is relatively small. Two indicators were developed to establish thelevel of service of Title III-funded providers: 1) average service units and averagenumber of clients. See Figure 8. 

**Figure 8. Size of Provider Operations Supported in Whole or Part by Title III**
**HCBC Service****Measure****Average Units Per Provider****Average Clients Per Provider**Personal CareHour4,150 52HomemakerHour3,265 83ChoreHour1,179 88Home-Delivered MealsMeal34,010283Adult Day Care/HealthHour 4,66552Case ManagementHour3,625 NACongregate MealsMeal32,634638Nutrition CounselingHour632198Assisted Transportation1WayTrip 2,49190Transportation1WayTrip13,321*Legal AssistanceHour1,159*Nutrition EducationSession 865*Info and AssistanceContact 5,228*OutreachContact1,292 *
* *Data on persons served are not collected for these services.*

In certain cases area agencies on aging choose to provide services directly rather thanissue a contract with providers. The absence of a viable local provider is often thereason. In other cases, direct service provision helps the area agency on aging ensure avital feature of home and community-based care is in place; for example, the presence ofan independent, objective case management service. See Figure 9 for a profile of AAAdirect services provision. 

Almost one-third of the AAAs are involved in the direct provision of congregate meals(31%). Thirty percent of the AAAs are directly providing home-delivered meals. AAAs arealso likely to provide access services directly. Of all the AAAs, 36% are providing someform of case management directly and 61% provided information and assistance services and40% are involved in outreach activities. 

Looking at AAAs as a percentage of total providers, AAAs represent almost a third ofthe case management providers (29%). By contrast, AAAs represent less than 5% of theproviders of personal care, homemaker, adult day care, transportation and assistedtransportation. 

**Figure 9. Area Agency on Aging Service Provision, By Service**
**HCBC Service****# of AAAs Directly Providing Service****% Of All AAAs in U.S.****% AAAs Of Total Providers For Svc**Personal Care558% 3%Homemaker7612% 4%Chore508% 7%Home-Delivered Meals19530%5%Adult Day Care/Health274%3%Case Management23436% 29%Congregate Meals20558%5%Nutrition Counseling7512%15%Assisted Transportation53 8%6%Transportation15323% 5%Legal Assistance10616%9%Nutrition Education13921%9%Inform and Assistance401 61%17%Outreach25539% 13%
**D. Senior Centers and Focal Points**

Title III funds are an important source of support for senior centers. Every yearstates report on the number of focal points designated in the state, the number of seniorcenters considered focal points and the number of senior centers supported by the OlderAmericans Act.

In 1995 for the U.S. a total of 11, 463 senior centers were identified by states. Ofthose 6,397 were supported by OAA funding (55.8%). States report a total of 8,341designated focal points. Seventy-five percent of the focal points are senior centers. Forthe U.S. there were a reported 1.85 senior centers for every 10,000 persons age 60 andover in 1995. States with the highest percent of senior centers per 10,000 residentsinclude Alabama (52 per 10,000 persons 60 and over), New York (27/10,000) and North Dakota(17/10,000). 

Several states report that all of their senior centers receive some level of Title IIIsupport. They include Alaska, Alabama, Arizona, Arkansas, Maryland, Missouri,Pennsylvania, Utah, West Virginia and Wyoming. By contrast three states report none of thesenior centers in the state received Title III funding -- Delaware, Idaho, and NewHampshire. 
Go back to ContentsServiceExpenditures 
**A. OAA Appropriations for State and Community and Tribal Programs**

In 1965, total OAA funding was small and little funding was available for servicesprovision, approximately $5 million. However, in 1972 Congress enacted the NutritionProgram for the Elderly and made available in 1973 $167 million in grants for state andcommunity programs. By 1973 there were 30 million persons age 60 and over in the U.S. For1973, OAA service funding amounted to $5.44 per person age 60 and over. Since 1973 OAAfunding for state and community programs has steadily increased. By 1995 OAA funding forstate and community programs had increased four fold over the 1973 funding level. Despitethese increases the effects of inflation and population growth diminished the actualimpact of the increases in the annual OAA appropriation for state and community programs.See Figure 10 for an analysis of actual appropriations relative to the 1973 benchmarkappropriation.

**Figure 10. Analysis of OAA Appropriations for State and Community and TribalPrograms**
**FundingYear *****Actual OAA Appropriation (In Mill. $)****OAA $/60+ (Uninflated)****Inflation Rate Multiplier (CPI)****Inflation Adjusted OAA$/60+****OAA 1973 Parity $ (In Mill. $)****Shortfall (Actual to Parity - In Mill. $)****% Shortfall Relative to 1973****1973**$167.0$5.44 100.0     **1974**172.85.51 104.9$5.78$181.3 $8.54.67**1975**207.06.45 109.47.06226.5 19.58.59**1976**285.58.72 112.59.81321.2 35.711.11**1977**325.79.73 116.211.31378.5 52.813.94**1978**423.012.37 120.814.95511.0 88.017.22**1979**443.012.66 128.216.23568.0 124.922.00**1980**572.915.98 138.022.05790.6 217.727.54**1981**630.117.23 146.525.24923.2 293.031.74**1982**612.416.39 152.124.94931.4 319.034.25**1983**649.418.03 155.428.021,009.1 359.835.65**1984**666.918.23 159.529.081,063.7 396.837.30**1985**676.417.65 163.228.811,103.9 427.538.73**1986**647.316.65 165.227.511,069.3 422.039.47**1987**700.517.34 169.229.331,185.2 484.740.90**1988**701.317.14 173.929.811,219.6 518.342.50**1989**726.017.54 179.631.501,304.0 577.944.32**1990**722.117.25 186.332.141,345.3 623.246.32**1991**766.618.10 191.834.721,470.3 703.747.86**1992**802.118.78 195.836.791,571.3 769.248.95**1993**797.018.53 200.137.071,594.8 797.850.02**1994**828.219.16 203.839.041,687.9 859.750.93**1995**830.919.07 206.339.331,714.1 883.251.53
Taking into account both annual inflation, as measured by the CPI, and net increases inthe 60 and over population, the 1995 appropriation for state and community programs shouldhave been $1.7 billion dollars to maintain parity with the 1973 funding level. Adjustingfor inflation, per capita appropriations should have been $39 per person in 1995. Actualper capita funding was $19 per person. As a result actual appropriations have shrunk byjust over 50% relative to the equivalent level in 1973. **(NOTE: Figure 11 not shownin html version.)**

**B. Expenditures by Service**

Total federal Title III expenditures for 1995 reported by states were $673 million.Typically Title III expenditures represent but a portion of the total expenditures forservices supported through the OAA. State units on aging, area agencies on aging andservice providers are able to leverage the federal Title III funding in the form of matchresources, program income, and other state and federal funding sources. Total servicesexpenditures for OAA supported services are estimated to be $1.714 billion for 1995. TitleIII federal expenditures in 1995 were 39% of the total service expenditures *which wereeither contractually or administratively linked to Title III funding.*

Beginning in 1995, AoA is examining service expenditures by service category. Fourteenlisted services are divided into three categories (clusters) plus an "other category.Cluster 1 services include personal care, homemaker, chore, home-delivered meals, adultday care/health and case management. Cluster 2 services include congregate meals,nutrition counseling and assisted transportation. Cluster 3 services include informationand assistance, transportation, legal assistance, nutrition education and outreach. 

As can be seen in Figure 12 below, the 14 listed services account for the largemajority of federal Title III expenditures (87.8%). The same 14 services account for 88.5%of total services expenditures reported by states. 

**Figure 12. Title III Expenditures by Service, U.S.**
**HCBC Service****Title III Federal Expenditures****% of Total Title III $****Total Service Expenditures *****% Title III Exp. of Total Service Expenditures*****Cluster 1 Services:******$203,377,533******30.3%******$679,580,533******29.9%***Personal Care11,572,8411.887,850,17413.2 Homemaker23,775,3563.568,792,39334.6 Chore4,406,2150.7 8,726,80650.5Home-Delivered Meals134,119,129 19.9396,689,61133.8 Adult Day Care/Health7,084,660 1.130,659,63923.1 Case Management22,239,332 3.386,861,91025.6 ***Cluster 2 Services:******253,915,539******37.7%******536,309,087******47.4%***Congregate Meals249,687,321 37.1523,043,99447.7 Nutrition Counseling1,284,944 0.22,303,27555.8 Assisted Transportation2,943,274 0.410,961,81826.9 ***Cluster 3:******133,288,911******19.8%******297,874,198******44.8%***Transportation62,657,467 9.3158,007,25039.7 Legal Assistance20,134,558 3.036,903,42954.6 Nutrition Education3,267,008 0.54,685,25269.7 Info. and Assistance31,765,708 4.769,871,06045.4 Outreach15,464,1702.3 28,407,20654.4***Other******82,024,622******12.2%******200,411,675******40.9%****Total**$672,606,605**100.0%**$1,714,175,492**39.2%*
**See definitions in Appendix II of the full report for an explanation of totalservice expenditures.*

 

Cluster one services account for approximately 30% of the Title III expenditures.Registered services (clusters 1 and 2 services) account for two thirds (67%) of Title IIIexpenditures.

Data were collected on total services expenditures and the portion of total servicefunding provided through Title III. Figure 12 data show that Title III expenditures areapproximately 40% of the total expenditures. Some services rely more heavily on Title IIIfunding to cover the costs of services. Title III funding for nutrition educationapproaches 70% for the U.S. Approximately 56% of the nutrition counseling expenditures areattributable to Title III. By contrast Title III funding covers only 13% of the totalservices expenditures for personal care. 

**Figure 14. Distribution of Title III Funding by Service Category and Cluster**
  **State With Highest % Of Title III $** **State With Lowest % for The Cluster** **HCBC Services****U.S. %****State****State %****State****State %***Cluster 1 Services:*30.2% Delaware65.2%New Mexico 11.9%Personal Care1.8%Delaware 15.7%  Homemaker3.5%Nevada 10.6%  Chore0.7%Minnesota 5.1%  Home-Del. Meals19.9%Massachusetts43.6%.  Adult Day Care/Hlth1.1%Dist of Col.10.7%  Case Management3.3%S. Dakota 18.7%  *Cluster 2 Services:*37.7% Kansas 66.3%Maine 18.1%Congregate Meals37.1%Kansas66.2%  Nutrition Counseling0.2%Alabama2.4%  Assisted Transport.0.4%Alaska11.6%  *Cluster 3:*19.8%Maine45.2%Delaware 2.9%Transportation9.3%S. Carolina 31.0%  Legal Assistance3.0%Vermont7.9%  Nutrition Education0.5%Oklahoma4.5%  Info. and Assistance4.7%Rhode Island22.7%  Outreach2.3%Maine 30.1%  *Other*12.2%Pennsylvania 35.4%DE, IN, MI, OK, OR 0.0%*Total*100.0%    
There are notable differences in the distribution of Title III funding by servicecluster and individual service by state. Figure 14 shows the variation.

Delaware leads all states in funding for cluster 1 services (65%), while Kansas topsall states in funding for cluster 2 services (66%) and Maine leads in funding for cluster3 services (45%). Besides Pennsylvania, three other states spend more than 20% of TitleIII funds for other services -- Vermont (34.86%), Arizona (34.6%) and New Jersey (20.72%).

Pennsylvania puts most of the "other" services expenditures toward seniorcenters reporting Title III expenditures of approximately $12 million. The Pennsylvaniasenior centers report serving approximately 194,000 persons and providing over 7.3 millionclient days of service. By contrast, Vermont lists 22 different "other" servicesthat are supported by Title III funds ranging from assistive technology to utilityassistance.

Various performance measures related to expenditures can be calculated based on thereported data. However, such measures should be used with caution. The data systems usedto support Title III reporting are still under development and the data being reported arestill subject to refinement. Furthermore, there are many factors which can contribute tothe comparability of performance measures from one state to another such as differentinterpretation of service definitions, different cost determination methodologies anddifferent cost factors which are specific to a state or region within the state. Figure15, 16, 17 and 18 provide several basic performance measures. 

**Figure 15. Service Expenditure Measures, U.S.**
 **Title III Fed $****Title III Fed $****Total Svc $****Total Svc $****HCBC Service****Avg. Unit Cost****Avg. $/Client****Avg. Unit Cost****Avg. $/Client****Personal Care**$1.53$121 11.40$906**Homemaker**3.58142 10.37409**Chore**4.9566 9.80132**Home-Delivered Meals**1.131363.33401**Adult Day Care/Health**1.68 1537.26658 **Case Management**7.4745 29.19174**Congregate Meals**2.021044.24216**Nutrition Counseling**12.84 3523.0263 **Assisted Transportation**1.32 364.91134 **Transportation**1.59* 4.00* **Legal Assistance**14.42*26.43***Nutrition Education**2.86*4.10***Inform and Assistance**2.56 *5.64***Outreach**5.85* 10.74*
**No data are collected on the unduplicated count of persons served for theseservices.*

Unit costs in Figure 15 are shown for both Title III federal expenditures and totalservice expenditures. Unit costs are lower for Title III only because of the way the unitdata are reported. States were asked to report total service units associated with totalservice expenditures, not just those attributable to the federal Title III resources usedin the provision of the services. The unit costs, as calculated, reflect new servicedefinitions and refined unit definitions introduced in 1995 by AoA and should be used withcaution. Unit costs based on total service expenditures are the most useful performancemeasure for state comparison purposes. State and area agencies may only use small amountsof Title III funds to support a particular service. As a result, unit costs based on TitleIII expenditures reflect as much or more the funding strategies of the Aging Network asthey do the relative efficiency of the service providers. 

**Figure 16. Unit Costs (Excluding Upper and Lower 5% of the Reported Unit Costs)**
**Service****Mean Unit Cost****Median Unit Cost****Standard Deviation****Personal Care**$15.35$13.0 $9.30**Homemaker**11.5411.50 5.30**Chore**9.839.03 5.64**Home-Delivered Meals**3.353.310.87**Adult Day Care/Health**18.53 7.2038.30**Case Management**43.7920.1275.27**Congregate Meals**4.133.891.15**Nutrition Counseling**21.62 19.3917.56**Assisted Transportation**5.79 3.984.83**Transportation**3.793.48 1.83**Legal Assistance**39.1633.9924.05**Nutrition Education**12.334.9018.56**Inform. and Assistance**6.81 5.394.82**Outreach**13.7411.30 9.86
There is substantial variation in unit costs based on total service expenditures acrossstates for individual services. The extent of variation depends on the service. Outliersexist; some of which may be reporting inconsistencies. To compensate for the outliers(both high and low) the unit costs were reviewed by computing both the standard deviationand the variance. The results of this analysis are summarized in Figure 16. 

To address outliers, the data in Figure 16 for mean, median and standard deviationexclude the upper and lower 5% of the reported unit cost data, basically the two stateswith the most extreme values. The average unit cost includes all states. It should also benoted that average unit costs reported in Figure 14 were computed using the total serviceexpenditures for the service for the U.S. and the total reported units for all states. Themean and median unit costs are based on the average unit costs computed for each state.Except for meal services, there remains considerable variation in reported total unitcosts by service. 

A similar profile was developed for another basic performance measure -- units perperson served. The results are summarized below in Figure 17. The data in Figure 17 areorganized and computed in the same way as the data in Figure 16. The variance issubstantial for units per person. 

**Figure 17. Units Per Person Served (Excluded Upper and Lower 5%)**
**Service****Mean Units/Client****Median Units/Client****Standard Deviation****Personal Care**60.1949.18 41.38**Homemaker**44.0038.05 26.56**Chore**14.2612.55 8.58**Home-Delivered Meals**124.33 120.4829.63**Adult Day Care/Health**200.06 115.61117.91**Case Management**8.266.11 6.18**Congregate Meals**58.6548.4426.73**Nutrition Counseling**2.881.572.66**Assisted Transportation**27.29 16.4323.67
Another expenditure measure is the average level of funding for providers of individualservices. See Figure 18. 

Average Title III expenditures per provider are quite low except for home-deliveredmeals and congregate meals. Even the total service expenditures are relatively small formost services. While the average expenditures per provider are small, on a servicespecific basis, it is likely that many of the providers offer more than one service.Consequently the expenditures per provider, considering all services they provide, islikely to be higher. 

**Figure 18. Average Expenditures Per Provider, U.S.**
 **Total Providers****Average Title III $**
**Per    Provider****Average Total Svc $**
**Per    Provider****HCBC Service** ***Cluster 1 Services***   **Personal Care**1,856$13,502 $50,560**Homemaker**2,03213,553 47,623**Chore**7559,676 19,866**Home-Delivered Meals**3,614 56,348155,947**Adult Day Care/Health**90512,14550,510**Case Management**82146,745 142,738***Cluster 2 Services***   **Congregate Meals**3,902106,435219,758**Nutrition Counseling**5058772,220**Assisted Transportation**896 7,79963,406***Cluster 3 Services***   **Transportation**2,96521,088 55,752**Legal Assistance**1,20535,99470,205**Nutrition Education**1,5952,4393,848**Inform and Assistance**2,370 19,49934,596**Outreach**2,04711,276 22,528
Differences in average expenditures per provider are attributable to both availablelevels of funding and different approaches to use of providers. One area agency on agingmay choose to bundle funding for a service or a group of contracts into a single contract.Another area agency on aging may find it necessary to award several contracts, in lesseramounts, to account for such issues as access issues and cultural diversity of theparticipants. 

**C. Generation of Program Income**

OAA-supported programs have historically benefited from substantial generation ofprogram income. Until 1995 program income has been reported in aggregate. For 1995 data onprogram income are identified by individual service. Both home-delivered meals andcongregate meals stand out in terms of development of program income. For the balance ofthe services, program income is a small portion of the total revenues used to supportservices operations. In terms of program reporting, 1995 is the first year that statesreported program income by specific service. In the past, program income has only beenreported by Title III Part -- III B, C1, C2 etc. For this first year, no attempt has beenmade to reconcile the program income reported by states in their quarterly financialreports with the annual program report data reported here.

Based on fiscal (SF269) data, states generated approximately $200 million in programincome from Title III related grant activities. The breakdown by Title III part, excludingPart F, was: - Title III B. Supportive Services -- $30,898,999 
- Title III C.1. Congregate Meals -- $98,503,924 
- Title III C.2. Home-Delivered Meals -- $70,074,608 
- Title III D. In-Home Services -- $7,427,249 

**Figure 19. Program Income by Type of Home/Community Service**
**Type of HCBC Service****% of Total Program Income****% of Federal Title III $ For the Service****Supportive Services**14.9%10.6%**Congregate Nutrition Services**47.6% 39.4%**Home-Delivered Nutrition Services**33.9% 53.4%   **Total**100.0%30.8% 
For all but home-delivered meals and congregate meals, the level of program incomegenerated relative to the Title III expenditures appears quite limited, 1-2% of FederalTitle III funding. 

**D. Expenditures by Part**

Individual Parts of Title III of the OAA have specific legislative mandates thatidentify the nature of services to be supported. Titles C1 and C2 are for nutritionrelated-services, Title III B for supportive services and centers, Title III D for in-homeservices and III F for preventive health services. In 1995, total U.S. Title IIIexpenditures by part were reported to be: - Title III B -- 37% 
- Title III C1 -- 39% 
- Title III C2 -- 20.1% 
- Title III D -- 1.1% 
- Title III F -- 2.0% 

Another way to look at expenditures by part is to determine the distribution ofexpenditures for each Title III part by service; for example the percent of Title III Bexpenditures used for personal care. See Figure 20. 

**Figure 20. Distribution of Expenditures by Part for Each Service**
**Service****Total Title III Expenditures****Title III B****Title III C1****Title III C2****Title III D****Title III F*****Cluster 1 Services***30.2%      **Personal Care**1.8%3.77% 0.00%0.00%21.83% 0.20%**Homemaker**3.5%8.14% 0.00%0.00%28.82% 0.00%**Chore**0.7%1.58% 0.00%0.00%3.18% 0.01%**Home-Del. Meals**19.9%0.64%0.29%98.36% 12.73%0.41%**Adult Day Care**1.1%2.38% 0.01%0.01%8.30% 0.66%**Case Management**3.3%8.09% 0.18%0.05%2.44% 2.08%***Cluster 2 Services***37.7%      **Congregate Meals**37.1%1.88%95.74%0.06% 0.00%0.03%**Nutrition Counseling**0.2%0.07%0.22%0.12% 0.00%3.32%**Assisted Transport..**0.4%1.07%0.03%0.00% 0.65%0.00%***Cluster 3 Services***19.8%      **Transportation**9.3%23.12% 0.71%0.16%0.00% 0.07%**Legal Assistance**3.0%7.39%0.29%0.00% 0.06%0.05%**Nutrition Education**0.5%0.11%0.70%0.43% 0.00%4.45%**Info. and Assistance**4.7%11.76%0.21%0.01% 0.04%2.33%**Outreach**2.3%4.58% 0.91%0.51%0.58% 2.85%***Other Services***12.2% 25.41%0.72%0.30% 21.36%83.26% 100.0%100.00% 100.00%100.00%100.00% 100.00%
Part III B and D funding predictably fund cluster 1 services other than home-deliveredmeals. Cluster 2 services are supported principally by Title III C 1 funds and Cluster 3services are largely funded through Title III B funding.

As Figure 20 shows, the fourteen services account for 74% of the expenditures supportedby Part III B versus 99% of III C1 funding, 99% of C2 funding, 79% of Part D funding and17% of Part F funding. The greatest amount of Title III B is used for transportation and arange of "other" services. Case management and I&A comprise 20% of Title IIIB funding. 

**E. Transfers**

Each state has a transfer authority which permits states to transfer funding betweenTitle III, Parts B (supportive services), Subpart C-1 (congregate nutrition services) andSubpart C-2 (home-delivered nutrition services) with certain limitations specified in thelaw. For FY1995, no more than 30% may be transferred between Subparts C-1 and C-2 and nomore than 25% may be transferred between Part B and Part C. A state may request a waiverfrom the AoA to increase the amounts transferred. In this report the focus is on transfersbetween Title III B (supportive services), Title III C1 (congregate meals) and Title C2(home-delivered meals). See Figure 21.

**Figure 21. 1995 Transfers between Title III Subparts, U.S. Summary**
**Transfers****To Title III B****To Title III C1****To Title III C2****Total****Subpart Funding After Reallotment**$304,340,980 $372,584,827$93,331,778 $770,257,585**Transfers:**    **From III B** 0 1,050,9161,050,916**From III C1**22,971,599 43,879,83666,851,435 **From III C2**352,8890  352,889**Total**23,324,4880 44,930,75268,255,240**Final Allotment After Transfers**$327,665,468 $305,734,457$138,262,530 $770,347,585
Source: AoA, Division of Grants Management, 1996.

As can be seen, Subpart transfers, in aggregate, are principally between Title III C1and Title III C2. All but four states (including D.C. and Puerto Rico) transferred fundsout of Title III C1. The highest transfer percentages were for the following states: - To Title III B -- Minnesota (33% increase) 
- Twenty-six states were able to double Title III C2 funding through transfers. 

No state transferred funding to Title III C1. 
Go back to ContentsAging NetworkStaffing 
In each state there is a designated state unit on aging responsible for administeringthe Older Americans Act. The OAA funding pays for state unit on aging staffing to carryout administrative, development, advocacy and related activities. Area agencies on agingare funded to perform similar activities within planning and service areas of the state.Forty-four states, including Puerto Rico, have designated planning and service areas. In1995 there were 655 area agencies on aging. 

In many states, the state unit on aging and the area agencies on aging have assumedadditional responsibilities for aging services programs. Over half the state units onaging have a role in administration of a Medicaid waiver program. Many state unitsadminister state-funded programs that support the provision of home and community-basedcare services. As a result, the total staffing of state units on aging is frequentlysubstantially more than the staff paid for with the OAA funding. Many area anagencies onaging have similar staffing arrangements. 

In 1995 data were collected on the staffing profile of both state units on aging andarea agencies on aging. In aggregate, state units on aging report a total of 3,676 staff.Of those, 32% are supported by Title III funds. Of the total staff, 17% are minority and83% are paid professional staff. Few state units report the use of volunteers. The statestaffing profile by functional responsibility is shown in Figure 22. 

**Figure 22. State Unit on Aging Staffing, All States**
**Type of Staff And Functional Responsibility****Total Staff****% of Total Staffing****Minority Staff****% Minority Staff (By Resp.)****Paid By Title III****% Paid By Title III (By Resp.)****Paid Professionals:**      1. Admin/Develop      Executive/Mgt.34911.5% 6117.5%166 47.6%Other*130343.7% 26520.3%621 47.7%2. Services Provision      Access53717.6% 6011.2%61 11.4%Dir. Svcs Delivery86813.1%9010.4% 9911.4%**Other Staff:**      Clerical56518.2% 14826.2%236 41.7%Volunteer531.7% 815.1%  **Total Staff:**3,676100.0%63117.2% 1,18232.2%
* *Includes planning, development, administration, and other professional staffassigned to management and administrative responsibilities.*

Approximately 31% of the SUA staff are reported to be providing access/carecoordination or direct services. This is almost exactly the same percentage of area agencyon aging staff who are reported to be providing access/care coordination services and/ordirect services. It should be noted that Alaska accounts for 55% of the total stateagencies on aging staff reported to be involved in direct service provision. Alaska is asingle PSA state with no area agencies on aging. Arizona reports a high number of staff indirect services provision (134) as well. In Arizona, these staff are responsible for adultprotective services. 

Twenty-seven states report staff involved in direct services provision (e.g.,transportation and meals.) Twenty-nine states report staff involved in the provision ofaccess/care coordination functions. 

Looking at paid staff, ten states report more than 100 full time equivalent staff --Alaska, Arizona, California, Florida, Illinois, Missouri, New Hampshire, New York, Ohio,and Pennsylvania. 

For comparison purposes, a similar staffing profile has been prepared in Figure 23 forarea agencies on aging. There were 655 identified area agencies on aging in 1995. 

**Figure 23. Area Agency on Aging Staffing, All States**
**Type of Staff****Total Staff****% of Total Staffing****Minority Staff****% Minority Staff****Paid By Title III****% Paid By Title III****Paid Professionals:**      1. Admin/Develop      Executive/Mgt.1,2893.3% 15411.9%838 65.0%Other*3,97010.2% 93423.5%2,246 56.6%2. Access/Svcs Del11,34129.1%2,39721.1% 5,00644.1%**Other Staff:**      Clerical2,2215.7% 46120.8%1,020 45.9%Volunteer20,13751.7% 1,9189.5%  **Total Staff:**38,958  5,86415.1% 9,11023.4%
**Includes planning, development, administration, and other professional staffassigned to management and administrative responsibilities.*

Area agencies on aging report a total of 38,958 staff. Of this total, 52% arevolunteers. There were 18,821 paid area agency on aging staff. Of the total staff, 23% arepaid by Title III and 15% are minority staff. Looking just at paid staff, 48% of the staffare supported by Title III funding. 

At the AAA level, almost 30% of the staff are either providing access/care coordinationservices or other home and community services such as meals and transportation. Of the11,341 staff involved in the provision of access/care coordination or direct services, atotal of 3,219 are providing access services and 8,122 are providing direct services. 

Of the total staff involved in access/care coordination and direct services delivery,Title III funds 44% of the staff -- less than what Title III pays foradministrative/developmental staffing of area agencies on aging. Of the total staff, 3%are considered executive/management personnel. Taking out volunteers, executive/managementpersonnel comprise 7% of the total staff.
Go back to ContentsDevelopmentalAccomplishments 
State and area agency on aging staff are a primary source of development and advocacyon issues affecting the elderly in every state. States are required to report on threesignificant developmental accomplishments in each of two areas: 1) development of home andcommunity-based programs and 2) development of systems of elder rights. Clearly, the AgingNetwork in each state is responsible for many different developmental initiatives eachyear. As such, the data on developmental accomplishments submitted by states is not acomplete inventory of Aging Network accomplishments. The accomplishments which arereported are those considered as important achievements and provide a sense of thediversity and type of developmental accomplishments of the Aging Network in each state. 

As an overview, examples of the developmental accomplishments are summarized below ineach of the two major categories of development: 

**A. Home and Community-Based Programs**

Development of enhanced home and community-based services is a continuing priority ofthe national Network on Aging. A diverse set of developmental activities was pursued withmany successes and accomplishments. Seven different types of development activities wereused to classify developmental accomplishments related to home and community-based care:they were: - Public Education/Awareness 
- Resource Development 
- Training/Education 
- Research and Development 
- Policy Development 
- Legislative Development 
- Other

Of those states reporting developmental accomplishments accompanied by codes fordevelopmental type, almost half of the states reporting had accomplishments which wereconsider either public education or resource development in nature. About 30% of thestates reporting indicated accomplishments which were training and education or researchand development projects; Policy development was also an activity in which 30% of thestates reported accomplishments. Few states singled out legislative accomplishments during1995, although some states reported what were essentially legislative activities under theresource development category. 

Examples of developmental accomplishments by category and type of assistance includethe following: 

**Public Education/Awareness**- New Mexico initiated a three-part Alzheimer's Disease Program: respite, consultation,    and information and referral through an 800 number. 
- Puerto Rico developed a health promotion/disease prevention program including 8 radio    programs, a teleconference, 2 health campaign promotions and a training session. 

**Resource Development**- South Carolina continued its senior center development initiative, adding $1 million in    state funds to support the development of three new centers in 1995. 
- Utah applied for and received Medicaid Waiver renewal, including provision for two new    services - companion services and respite care outside the home. 
- Iowa's successful advocacy with the General Assembly expanded the case management    program by 35% allowing it to expand into additional counties. 
- Nevada obtained increased funding from $72,000 to $320,000 for home and community -based    services. 

**Training/Education**- Kansas convened a conference on managed long-term care. 
- North Carolina co-sponsored a six-day workshop series entitled " Improving the    Management and Supervision of In-Home Aide Services". 
- Oklahoma trained and certified 600 OAA network staff in the implementation of the    Uniform Comprehensive Assessment Tool as its single entry tool. 

**Research and Development**- Florida developed a screening and counseling program utilizing audiologists to conduct    screening sessions in 14 counties, 269 seniors were screened, and 90 clients received    volume control telephones from Florida Telecommunications Relay. 
- North Carolina implemented a pilot project in two counties to establish a single point    of entry for non-Medicaid eligible older adults who are at risk of out of home placement. 
- Virginia began the development of the Virginia Aging Information System with three    components - client assessment, service utilization and service spending. 
- North Dakota developed a computerized Title III service assessment to assess quality in    service delivery. 
- South Dakota developed an Intervention Care Program designed to respond to families and    individuals that need overnight care after a brief illness or hospitalization. 

**Policy Development**- Nevada implemented a Group Care Waiver Program, providing support services in group    homes for older adults at risk of nursing home care. 
- Arkansas developed regulations for assisted -living facilities. 
- Kentucky developed and implemented an adult day care certification process. 

**Legislative Development**- Missouri developed the Elderly Health and Nutrition Act that is designed to stimulate    collaboration among state and private agencies. 
- Virginia conducted a study for the state legislature on the feasibility of developing a    program using volunteers to assist older adults in time of crisis. 

**Other**- Ohio Department of Aging eliminated the Medicaid Waiver waiting list. ODA served 15,282    clients and ended the year with 10,000 active clients. 

Figure 24. Developmental Accomplishments for Home and Community -Based Care, ByDevelopment Type 
**Public Education****Resource Development****Training and Education****Research and Development****Policy Development****Legislative Development****Other**       ColoradoAlabama AlabamaColorado AlabamaColorado ArkansasConnecticutAlaska HawaiiConnecticut AlaskaIllinois Dist of Col.DelawareArkansas DelawareDelaware ArkansasIowa FloridaGeorgiaColorado Dist of Col. Georgia ColoradoNevada KansasHawaiiFlorida FloridaHawaii IllinoisS. Dakota OhioIdahoGeorgia HawaiiMaine IowaVermont  KansasIowa IdahoMaryland Maine  MaineMissouri MarylandNew Jersey Minnesota  MarylandNevada MissouriN. Carolina Missouri  MissouriN. Carolina New MexicoN. Dakota Nevada  New JerseyPennsylvania N. CarolinaOhio New Mexico  New MexicoPuerto Rico W. VirginiaVermont N. Dakota  New YorkS. Carolina  Virginia S. Carolina  North DakotaS. Dakota   S. Dakota   Puerto RicoUtah      Rhode IslandVirginia      S. CarolinaWashington      WashingtonW. Virginia      WyomingWyoming      New York      
**B. System of Elder Rights**

The Older Americans Act encourages the development of improved systems of elder rights.States enhance elder rights through a number of services such as the long-term careombudsman programs, legal assistance, benefits counseling and programs addressing abuseand neglect. Many states are active in the promotion of improved service delivery forelder rights. The accomplishments focus on activities undertaken to prevent abuse andneglect and to uphold/advocate for the rights of older adults. 

States with accomplishments in elder rights are listed in Figure 25. 

**Figure 25. Developmental Accomplishments for A System of Elder Rights, ByDevelopment Type**
**Public Education****Resource Development****Training and Education****Research and Development****Policy Development****Legislative Development****Other**AlabamaAlabama AlaskaAlabama ColoradoColorado VirginiaArkansasAlaska ArkansasColorado GeorgiaDist of Col  ColoradoArkansas ColoradoDelaware HawaiiGeorgia  ConnecticutColorado Connecticut New JerseyIowa  DelawareConnecticut Dist of Col New MexicoMaine  GeorgiaDist. of Col. Hawaii N. DakotaMissouri  IllinoisHawaii Illinois Puerto RicoNevada  IowaIdaho Iowa Rhode IslandPuerto Rico  KansasKansas Kansas S. DakotaVirginia  MarylandNew Mexico Minnesota Virginia  MinnesotaN. Carolina Missouri Wyoming  MissouriOhio N. Jersey    NevadaPennsylvania N. Carolina    New MexicoVermont N. Dakota    N. CarolinaWashington Pennsylvania    OhioWyoming S. Carolina    Puerto Rico S. Dakota    S. Carolina Washington    S. Dakota W. Virginia    Utah      Vermont      Washington      Wyoming      
Examples of state initiatives are reported by category.

Public Education/Awareness- Connecticut's information and referral program implemented the BOSS System to screen and    determine eligibility for elders seeking benefits information, 
- Hawaii developed plans and activities with the Elder Rights Section of the Hawaii Bar    Association. 

Resource Development- Washington DC Office on Aging supported the establishment of an imprest fund and legal    consultation fund for abused adults served by Adult Protective Services, when no other    resources are available. 
- Pennsylvania expanded the Abuse Intervention Program with $686,000 of state lottery    funds, a 10% increase. 

Training/Education- Illinois' Statewide Elder Abuse and Neglect Program utilized multi-disciplinary teams to    provide support to the program's service delivery activities. 
- Pennsylvania provided Protective Services Training for all staff involved in the    provision of Adult Protective Services - 700 persons attended. 
- Hawaii co-sponsored a training conference for nurses aides on elder abuse and neglect,    over 200 persons attended. 

Research and Development- Alabama co-chaired with the Department of Human Resources the Governor's Special    Commission on Elder Abuse and submitted policy recommendations to the Governor for his    consideration. 
- Colorado collected statistical and descriptive data to enhance the Elder Rights System. 

Policy Development- New Mexico expanded the Qualified Medicare Beneficiary outreach efforts statewide, using    simplified enrollment forms and on-site enrollment, screened approximately 2,200 persons. 
- New Jersey proposed regulations for Adult Protective Services. 

Legislative Development- Nevada advocated for revision of Elder Rights Statutes. The bill was drafted by the    Division Chief of Elder Rights. Division Staff discussed elder abuse issues with a variety    of professionals. 
- District of Columbia Office on Aging Adult Prevention Committee revised the District's    Guardianship legislation. 

Other- Arkansas took over direct administration of Adult Protective Services 

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