DEPARTMENT 

of HEALTH 

and HUMAN 

SERVICES

ADMINISTRATION 

ON AGING 

FY 2011 Report to Congress 
ii

THIS PAGE INTENTIONALLY LEFT BLANK 
iii

FROM THE ADMINISTRATION ON AGING 

I am pleased to present the Administration on Aging (AoA) Report to Congress for FY 2011. 

AoA advances the concerns and interests of older people, and works with and through the 

national aging services network to promote the development of comprehensive and coordinated 

systems of home and community-based care that are responsive to the needs and preferences of 

older people and their caregivers. The network is comprised of 56 state and territorial units on 

aging (SUA), 629 area agencies on aging (AAA), 256 Indian tribal and Native Hawaiian 

organizations, nearly 20,000 direct service providers, and hundreds of thousands of volunteers. 

AoA’s core programs, authorized under the Older Americans Act (OAA), help seniors remain at 

home for as long as possible. These services complement existing medical and health care 

systems, help prevent hospital readmissions and support some of life’s most basic functions, 

such as bathing or preparing food. 

An estimated 60 million older adults age 60 and over resided in the U.S. in 2011.1 In this same 

year, persons born in the post World War II baby boom generation between 1946 and 1964 

started turning age 65. The well known growth in the older adult population will continue until 

2030 when the last of the baby boomers turn 65. By then 20 percent of the population, or one in 

five Americans will be age 65 or over.2 As these baby boomers age, the ranks of the oldest old 

(age 85+) will continue to swell. 

This expanding population translates into an equally expanding number of seniors with severe 

disabilities – defined as three or more limitations in activities of daily living – who are at greatest 

risk of nursing home admission. In 2010, 8.3 percent or an estimated 3.3 million community 

dwelling seniors age 65 and over had severe disability.3 If this trend continues, by 2020, 4.4 

million community dwelling seniors age 65 and will be living with severe disability, a 33 percent 

increase.4

Maintaining support for community-based services for assisting this growing population is 

important because reports indicate that making reductions in these services could lead to higher 

 

1

 Table 1. Annual Estimates of the Resident Population by Sex and Five-Year Age Group for the United States: 

April 1, 2010 to July 1, 2011 (NC-EST2011-01). Source: U.S. Census Bureau, Population Division. Release Date: 

May 2012. < http://www.census.gov/popest/data/national/asrh/2011/index.html> Accessed 28 August 2012. 

Estimates for U.S. Territories are taken from U.S. Census. International Data Base (IDB). 

<http://www.census.gov/population/international/data/idb/informationGateway.php> Accessed 28 August 2012. 

2

 Table 12. Projections of the Population by Age and Sex for the United States: 2010 to 2050 (NP2008-T12). 

Source: Population Division, U.S. Census Bureau. Release Date: August 14, 2008 

<http://www.census.gov/population/www/projections/summarytables.html> Accessed 28 August 2012. 

3 Data extrapolated by AoA from U.S. Census Bureau, 2010 Census. Summary File 1, Tables P12, P13, and PCT12. 

And Health Data Interactive, NCHS, CDC, “Functional limitation among Medicare beneficiaries , ages 65+: US, 

1992 – 2010 Accessed 28 August 2012

4

 Data extrapolated by AoA from Table 12. Projections of the Population by Age and Sex for the United States: 

2010 to 2050 (NP2008-T12). Source: Population Division, U.S. Census Bureau. Release Date: August 14, 2008, and 

Health Data Interactive, NCHS, CDC, “Functional limitation among Medicare beneficiaries , ages 65+: US, 1992 –

2010 Accessed 28 August 2012 
iv

government expenditures in areas such as Medicaid.5 Several state efforts to measure the impact 

of home and community-based programs on Medicare and Medicaid funding have shown signs 

of potential for savings. Because AoA’s services assist people to remain independent and in 

their communities, they have the potential to prevent or delay institutionalization, which is more 

expensive to the government. If even a small percentage of service recipients are able to delay 

the institutionalization, it could have a significant impact on Medicaid expenditures. 

For example, a recent AARP study found that in 2009, approximately 42.1 million family 

caregivers provided assistance to adults with limitations in daily activities.6 These unpaid 

caregivers provided an estimated $450 billion in services. Were caregivers more limited in their 

ability to provide this care, these costs could otherwise be borne by Medicare and Medicaid.7

The long-term care needs of today’s growing numbers of older Americans place tremendous 

strain on families, and underscore the critical importance of continuing to invest in OAA

programs, since if they become overwhelmed by the burdens of caregiving, the costs of 

providing this care could fall upon already overtaxed government resources. 

We look forward to working with the Congress to strengthen these critical programs and further 

build the capacity of the national aging services network to continue to deliver high-quality 

services that improve the health, safety, and well-being of older Americans. 

Kathy Greenlee 

Assistant Secretary for Aging 

 

5

 Shapiro, Adam and Loh, Chung-Ping. (August 2010). Advanced Performance outcome Measures Project (POMP): 

Estimates of Medicaid and General Revenue Cost-Avoidance from HCBS Utilization: Final Report (Contract #XQ867). 

 Tallahassee, FL: Florida Department of Elder Affairs. https://www.gpra.net/ppt/POMP2010_UNF_Final_Report.pdf 

Chapin, R., Zimmerman, M., Macmillan, K., Rachlin, R., Reed, C., Hickey, A., Baca, B., Wiebold-Lippisch, L., Henning, 

E., Oslund, P., Hayes, J., Katz, B., & Shea, J. (2003). Examination of the Use of Medicare Home Health Services and 

Informal Caregiving and Their Relationship to Successful Community Tenure and Appendices. Lawrence, KS: University 

of Kansas School of Social Welfare Office of Aging and Long Term Care. 

http://www.oaltc.ku.edu/Reports/Community%20Tenure%20Study%20Report%20SFY%202003.pdf 

6

Valuing the Invaluable: 2011 Update, The Growing Contributions and Costs of Family Caregiving. AARP Public Policy 

Institute. July 2011. http://assets.aarp.org/rgcenter/ppi/ltc/i51-caregiving.pdf 

7

Ibid.
5

Table of Contents

 Page Number

 

Introduction iii

Executive Summary 7

National Program Data on Services Provided 10

 

Part I: Health and Independence 12

Home and Community-Based Supportive Services 12 

Nutrition Services 15 

Preventive Health Services 19

Chronic Disease Self-Management Program 21

Caregiver Services 22

National Family Caregiver Support Program 23

Lifespan Respite Care 25

Alzheimer’s Disease Supportive Services Program 28

Part II: Older American Indians, Alaska Natives & Native Hawaiians 30

Nutrition and Supportive Services 30

Caregiver Support Services 31

 

Part III: Protection of Vulnerable Older Americans 32 

Prevention of Elder Abuse & Neglect 33

Model Approaches to Statewide Legal Assistance Systems 34

National Legal Assistance and Support Projects 36

Pension Counseling and Information 37

Senior Medicare Patrol Program 38

Health Care Fraud and Abuse Control 40

Long-Term Care Ombudsman Program 41

Part IV: Supporting the National Aging Services Network 49

Aging and Disability Resource Centers 49

Aging Network Support Program Activities 52

Part V: Program Innovations 55 

Community Innovations for Aging in Place 55

Appendix: Formula Grant Funding Allocation by 59

 State, Territory and Tribal Organization
6

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7

EXECUTIVE SUMMARY 

The mission of the Administration on Aging (AoA), an agency of the U.S. Department of Health 

and Human Services (DHHS), is to lead and support a comprehensive, coordinated and costeffective system of home and community-based services that help elderly individuals maintain 

their health and independence in their homes and communities. AoA advances the concerns and 

interests of older people, and works with and through the national aging services network of 56 

state and territorial units on aging (SUA), 629 area agencies on aging (AAA), 254 tribal 

organizations, two Native Hawaiian organizations, and nearly 20,000 direct service providers, to 

promote the development of comprehensive and coordinated home and community-based care 

that is responsive to the needs and preferences of older people and their caregivers. 

AoA’s core programs, authorized under the Older Americans Act (OAA) and administered by 

the national aging services network, help families keep their loved ones at home for as long as 

possible. The network also helps consumers learn about and access the services and supports 

that are available in the community and addresses issues related to caregivers. OAA services are 

less expensive than institutional care and performance data show that they are very effective. 

The most recent data available show that AoA and its national network rendered direct services 

to 11.3 million elderly individuals age 60 and over (nearly 20 percent of the country’s elderly 

population) and their caregivers, including nearly three million clients who received intensive inhome services.8

 Critical supports, such as respite care and a peer support network, were 

provided to nearly 730,000 caregivers. 

In the ongoing management of its programs and strategic planning process, AoA is guided by a 

set of core values in developing and carrying out its mission. These values include listening to 

older people, their family caregivers, and AoA partners who serve them; responding to the 

changing needs and preferences of our increasingly diverse and rapidly growing elderly 

population; producing measurable outcomes that significantly impact the well-being of older 

people and their family caregivers; and valuing and developing AoA staff. 

Overview of Performance 

The fundamental purpose of OAA programs, in combination with the legislative intent that the 

national aging services network actively participate in supporting community-based services 

with particular attention to serving economically and socially vulnerable elders, led AoA to

focus on three measures: 1) improving efficiency; 2) improving client outcomes; and 3) 

effectively targeting services to vulnerable elder populations. Each measure is representative of 

several activities across the OAA program budget, and progress towards achieving each measure 

is tracked using a number of indicators. The efficiency measure and corresponding indicators are 

reflective of the Office of Management of Budget (OMB) requirements to measure efficiency for 

all program activities. The client outcome measure includes indicators focusing on consumer 

assessment of service quality and outcome indicators focusing on nursing home predictors, 

successful caregiver program operation and protection of the vulnerable elderly. The targeting 

measure and indicators focus on ensuring that states and communities serve the most vulnerable 

 

8 Data from AoA’s FY 2011 State Program Report are preliminary and should not be taken as final. 
8

elders. Taken together, the three measures and their corresponding performance indicators are 

designed to reflect AoA’s goals and objectives and in turn measure success in accomplishing 

AoA’s mission. 

An analysis of AoA’s performance trends shows that through FY 2011, most outcome indicators 

have steadily improved. While service counts are declining due to flat funding, an increase in the 

population aged 60 and over, and challenging economic times, AoA’s outcome indicators 

demonstrate that services are continuing to be effective in helping older persons remain at home. 

Some key successes are indicative of the potential of AoA and the national aging services 

network to meet the challenges posed by the growth of the vulnerable older adult population, the 

changing care preferences of aging baby boomers, the fiscal difficulties faced by state budgets, 

and the expanding needs of both older Americans and their caregivers. Below are some examples 

of these successes: 

OAA programs help older Americans with severe disabilities remain independent and 

in the community: Older adults that have three or more impairments in Activities of Daily 

Living (ADL) are at a high risk for nursing home placement. Measures of the national aging 

services network’s success at serving this vulnerable population is a proxy for success at 

nursing home delay and diversion. In FY 2003, the national aging services network served 

home-delivered meals to 280,454 clients with three or more ADL impairments and by FY 

2011 that number grew by 30 percent to 367,387 clients.9 Another approach to measuring 

AoA’s success is the nursing home predictor score. The components of this composite score 

are predictive of nursing home placement based on scientific literature and AoA’s 

Performance Outcomes Measurement Project (POMP) which develops and tests performance 

measures. The components include such items as the percent of clients who are transportation 

disadvantaged and the percent of congregate meal clients who live alone. As the score 

increases, the prevalence of nursing home predictors in the OAA service population 

increases. In 2003, the nursing home predictor score was 46.57. Preliminary data indicate it 

has increased to 60.62 in FY 2011. 

OAA programs are efficient: The national aging services network is providing high quality 

services to the neediest elders and doing so in a very prudent and cost-effective manner. AoA 

has significantly increased the number of clients served per million dollars of OAA Title III 

funding over the last decade. In FY 2011, the national aging services network served 8,881 

people per million dollars of OAA Title III funding. Since this measure’s introduction in FY 

2005, AoA and the national aging services network have met or exceeded efficiency targets. 

OAA programs build system capacity: OAA programs stay true to their original intent to 

“encourage and assist state agencies and area agencies on aging to concentrate resources in 

order to develop greater capacity and foster the development and implementation of 

comprehensive and coordinated systems.” (OAA Section 301). This is evident in the 

leveraging of OAA funds with State/local or other funds (almost $3 in other funds for every 

dollar of OAA funds expended), as well as in the expansion of projects such as the Aging and 

 

9 Data from AoA’s FY 2011 State Program Report are preliminary and should not be taken as final. 
9

Disability Resource Center initiative, which has grown to 467 sites across 51 states and 

territories to date. 

OAA clients report that services contribute in an essential way to maintaining their 

independence and they express a high level of satisfaction with these services. In 2011, 

over 98 percent of transportation clients rated services good to excellent and 94% of 

caregivers rated services good to excellent. To help ensure the continuation of these trends in 

core programs, AoA uses its discretionary funding to test innovative service delivery models 

for state and local program entities that show promise for generating measurable 

improvements in program activities. For example, AoA has worked with CMS and the 

Department of Veterans Affairs to better integrate funding for long-term care service 

delivery, eliminate duplication and improve access to services through Aging and Disability 

Resource Centers. 

The tables on the next page provide a summary of the persons served during FY 2011 through 

the OAA’s programs. Additionally, a listing of grant funding allocations by state, territory and 

tribal organization can be viewed in the Appendix. 
10

FY 2011 National Program Services Summary Report 10

FY 2011

Total Clients 11,294,823

Total Registered Clients 2,879,521

% Minority Clients 25.11%

% Rural Clients 36.62%

% Clients Below Poverty 29.517%

# Senior Centers 10,951 (6,466 receive OAA funding)

Service Persons 

Served

Units of 

Service11

Title III 

Expenditure

Total 

Expenditure

Personal Care 103,676 13,459,110 $14,558,411 $250,399,808

Homemaker 144,251 12,240,759 $27,894,405 $236,335,572

Chore 35,120 1,309,433 $5,704,231 $19,028,596

Home Delivered 856,471 139,145,530 $238,779,637 $774,212,155

Adult Day Care 18,977 8,013,251 $10,787,816 $83,479,297

Case Mgt. 453,005 3,644,394 $27,018,597 $259,808,722

Assisted Trans. 32,526 1,196,617 $4,173,099 $15,563,095

Congregate 1,656,585 88,587,614 $278,150,943 $632,291,636

Nutrition 

Counseling

31,917 64,412 $1,384,209 $3,155,498

Transportation 24,726,402 $68,701,262 $200,167,641

Legal Assistance 847,286 $26,096,826 $51,477,675

Nutr. Education 2,584,238 $4,808,267 $8,478,261

I&A 13,155,106 $61,224,971 $152,774,793

Outreach 4,052,347 $10,505,737 $25,544,367

Other $106,423,264 $738,280,510

 

10 Data from AoA’s FY 2011 State Program Report are preliminary and should not be taken as final. 

11 Service Units Definitions: 

Personal Care = 1 Hour 

Homemaker = 1 Hour 

Chore = 1 Hour 

Home-Delivered Meal = 1 Meal. 

Adult Day Care/Adult Day Health = 1 Hour 

Case Management = 1 Hour 

Assisted Transportation = 1 One Way Trip 

Congregate Meal = 1 Meal 

Nutrition Counseling = 1 session per participant 

Transportation = 1 One Way Trip 

Legal Assistance = 1 hour 

Nutrition Education = 1 session per participant 

Information and Assistance = 1 Contact 
11

Caregivers Serving Elderly Individuals

Service Caregivers 

Served

Service 

Units12

Title III 

Expenditure

Total 

Expenditure

Counseling, Support 

Groups, Training 119,609 496,047 $17,196,730 $24,815,521

Respite 63,878 6,070,280 $47,345,010 $82,765,456

Supplemental Services 35,493 996,829 $12,127,899 $17,039,012

Access Assistance 565,665 1,256,417 $26,113,093 $37,130,615

Unduplicated Caregivers 

Provided Service or 

Access

819, 973

 

12 Title III-E service units definition: 

Counseling = 1 session per participant 

Respite Care = 1 hour 

Supplemental services = variable 

Access Assistance = 1 contact 
12

PART I: HEALTH AND INDEPENDENCE 

AoA’s Health and Independence Programs provide a foundation of supports that assist older 

individuals to remain healthy and independent in their homes and communities, avoiding more 

expensive nursing home care. For example, 60 percent of congregate and 92 percent of homedelivered meal recipients reported that the meals enabled them to continue living in their own 

homes and 54 percent of seniors using transportation services rely on them for the majority of 

their trips to doctors’ offices, pharmacies, meal sites, and other critical daily activities that help 

them to remain in the community.13

Between 2011 and 2015, the number of Americans age 60 and older will increase by nearly six 

million older adults, to reach 65.7 million seniors.

14

 During this period, the number of seniors 

age 65 and over with severe disabilities (defined as 3 or more limitations in activities of daily 

living) who are at greatest risk of nursing home admission and Medicaid eligibility (through the 

“spend down” provisions) will increase by more than 13 percent.15 These programs help seniors 

in need maintain their health and independence. 

In concert with other OAA programs, these services assist over 11 million elderly individuals 

and caregivers. AoA’s services are especially critical for the nearly three million seniors who 

receive intensive in-home services, half a million of whom meet the disability criteria for nursing 

home admission. These services help to keep these individuals from joining the 1.8 million 

seniors who live for extended periods of time in nursing homes.16 

Home and Community-Based Supportive Services 

(Title III-B of OAA; FY 2011: $367,611,000) 

The Home and Community-Based Supportive Services (HCBS) program, established in 1973, 

provides grants to states and territories based on their share of the population age 60 and over to 

fund a broad array of services that enable seniors to remain in their homes for as long as 

possible. AoA’s programs, including the HCBS program, serve seniors holistically; while each 

service is valuable in and of itself, it is often the combination of supports, when tailored to the 

needs of the individual that ensures older persons can remain in their own homes and 

communities instead of entering nursing homes or other types of institutional care. 

 

132011 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.

14 Data compiled by AoA from U.S. Census Bureau, “2008 National Population Projections”, released August 2008, 

<http://www.census.gov/population/www/projections/2008projections.html> and Table 1. Annual Estimates of the 

Resident Population by Sex and Five-Year Age Group for the United States: April 1, 2010 to July 1, 2011 (NCEST2011-01). Source: U.S. Census Bureau, Population Division. Release Date: May 2012. < 

http://www.census.gov/popest/data/national/asrh/2011/index.html> Accessed 28 August, 2012. 

15 Ibid, and National Center on Health Statistics, Centers for Disease Control and Prevention, “Functional limitations 

among Medicare beneficiaries, ages 65+: US, 1992-2010.” Accessed 28 August, 2012. 

16 Centers for Medicare & Medicaid Services, The characteristics and perceptions of the Medicare population 

(2010) [data tables 1.1]. http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/DataTables-Items/2010-Char-and_Perc.html. Accessed 30 August, 2012 
13

The services provided to seniors through the HCBS program include access services such as 

transportation; case management, and information and referral; in-home services such as 

personal care, chore, and homemaker assistance; and community services such as adult day care 

and physical fitness programs. In addition to these services, the HCBS program also funds multipurpose senior centers, which coordinate and integrate services for the elderly. 

While age alone does not determine the need for these long-term care supports, statistics show 

that both disability rates and the use of long-term supports increase with advancing age. Among 

those aged 85 and older, 55 percent are unable to perform critical activities of daily living and 

require long-term support. Data also show that over 80 percent of seniors have at least one 

chronic condition and 50 percent have at least two.17 Providing a variety of supportive services 

that meet the diverse needs of these older individuals is crucial to enabling them to remain 

healthy and independent in their homes and communities, and therefore to avoiding unnecessary, 

expensive nursing home care. 

Services provided by the HCBS program in FY 2011 include:18

Transportation Services provided nearly 25 million rides to doctor’s offices, grocery 

stores, pharmacies, senior centers, meal sites, and other critical daily activities. 

Personal Care, Homemaker, and Chore Services provided over 27 million hours of 

assistance to seniors unable to perform activities of daily living (such as eating, dressing, or 

bathing) or instrumental activities of daily living (such as shopping or light housework).

Adult Day Care/Day Health provided over 8 million hours of care for dependent adults in a 

supervised, protective group setting during some portion of a twenty-four hour day. 

Case Management Services provided over 3.6 million hours of assistance in assessing 

needs, developing care plans, and arranging services for older persons or their caregivers. 

Continuing AoA’s commitment to provide services to those in most need, nearly 43 percent of 

riders on OAA-funded transportation are mobility impaired, meaning they do not own a car or if 

they do own a car they do not drive, and are not near public transportation.19

 Many of these 

individuals cannot safely drive a car, as nearly 75 percent of transportation riders have at least 

one of the following chronic conditions that could impair their ability to navigate safely:20

 

68 percent of riders had a doctor tell them they had vision problems (including glaucoma, 

macular degeneration or cataracts); 

9 percent have Alzheimer’s or dementia; 

 

17 Anderson, Gerard, Chronic Care: Making the Case for Ongoing Care. Robert Wood Johnson Foundation. 2010 

Princeton, NJ. Available: http://www.rwjf.org/files/research/50968chronic.care.chartbook.pdf.

18 Data from AoA’s FY 2011 State Program Report are preliminary and should not be taken as final. 

19 Ibid 

20 Ibid 
14

2 percent have Multiple Sclerosis; 

19 percent have had a stroke; 

3 percent have epilepsy; and 

3 percent have Parkinson’s disease. 

 

Of the transportation participants, 98 percent take daily medications, with 14 percent taking 10 to 

20 medications daily.21 Data from AoA’s national surveys of elderly clients show that HCBSS 

services are providing these seniors with the assistance and information they need to help them 

remain at home. For example, 80 percent of clients receiving case management reported that as a 

result of the services arranged by the case manager they were better able to care for themselves.22

 

In addition, a study published in the Journal of Aging and Health shows that the services 

provided by the HCBSS program, what the article calls “personal care services,” are the critical 

services that enable frail seniors to remain in their homes and out of nursing home care.23

 

Nationally, about 25 percent of individuals 60 and older live alone.24 Living alone is a key 

predictor of nursing home admission, and HCBS services are critical for enabling them to remain 

at home, especially for those who do not have an informal caregiver to assist with their care. 

Recent research has also shown that childless seniors who live in a state with higher home and 

community-based service expenditures had significantly lower risk of nursing home 

admissions.25

 

Federal support for OAA programs is not expected to cover the cost of serving every older 

American. These programs have strong partnerships with state and local governments, 

philanthropic organizations, and private donations that contribute funding. States typically have 

leveraged resources of $2 or $3 per every OAA dollar, significantly exceeding the programs’ 

match requirements. 

 

21 2011 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID. 

22 2011 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID. 

23 Chen, Ya Mei and Elaine Adams Thompson. Understanding Factors That Influence Success of Home- and 

Community-Based Services in Keeping Older Adults in Community Settings. 2010. Journal of Aging and Health. 

V. 22: 267. Available: http://jah.sagepub.com/cgi/content/abstract/22/3/267.

24 U.S. Census Bureau; American Community Survey, 2010, Special Tabulation on Aging; generated by AoA; 

using AoA’s Aging Integrated Database (AgID) ; http://www.agidnet.org/CustomTables/; August 29, 2012.

25 Muramatsu, Naoko. “Risk of Nursing Home Admission Among Older Americans: Does States’ Spending on 

Home and Community-Based Services Matter?” May 2007. Journal of Gerontology: Psychological Sciences. 
15

Nutrition Services 

Nutrition Services help seniors remain healthy and independent in their communities by 

providing meals and related services in a variety of settings (including congregate facilities such 

as senior centers) and via home-delivery to seniors who are homebound due to illness, disability, 

or geographic isolation. Nutrition Services include: 

Congregate Nutrition Services (Title III-C1; FY 2011: $439,901,000): Provides funding 

for the provision of meals and related services in a variety of congregate settings, which 

helps to keep older Americans healthy and prevents the need for more costly medical 

interventions. Established in 1972, the program also presents opportunities for social 

engagement and meaningful volunteer roles, which contribute to overall health and wellbeing. 

Home-Delivered Nutrition Services (Title III-C2; FY 2011: $217,241,000): Provides 

funding for the delivery of meals and related services to frail seniors who are 

homebound. Established in 1978, home-delivered meals are often the first in-home 

service that an older adult receives and serve as a primary access point for other home 

and community-based services. Home-delivered meals also represent an essential service 

for many caregivers, helping them to maintain their own health and well-being. 

Nutrition Services Incentive Program (Title III-A; FY 2011: $160,693,000): Provides 

additional funding to states, territories, and eligible tribal organizations that is used 

exclusively to provide meals and cannot be used to pay for other nutrition-related 

services or for administrative costs. Funds are awarded to states and tribes based on the 

number of meals served in the prior federal fiscal year. States and tribes have the option 

to purchase commodities directly from the U.S. Department of Agriculture (USDA) with 

any portion of their award if they determine that doing so will enable them to better meet 

the needs of seniors. 

Formula grants for Congregate Nutrition Services and Home-Delivered Nutrition Services are 

allocated to states and territories based on their share of the population age 60 and over. 

Nutrition Services Incentive Program grants are provided to states, territories, and tribal 

organizations based on the number of meals served in the prior Federal fiscal year. The meals 

provided through these programs fulfill the standards set by the Dietary Guidelines for 

Americans and provide a minimum of 33 percent of the Dietary Reference Intake, as established 

by the Food and Nutrition Board of the Institute of Medicine of the National Academy of 

Sciences. 

Nutrition Services help approximately 2.5 million older adults receive the meals they need to 

stay healthy and decrease their risk of disability. Studies have found that 50 percent of all 

persons age 85 and over are in need of assistance with instrumental activities of daily living 
16

(IADLs)26, including obtaining and preparing food. These nutrition programs help address their 

needs. Serving Elders at Risk, a 1995 national evaluation of AoA’s nutrition program clients, 

found that recipients are older, poorer, more likely to live alone, more likely to be minorities, are 

sicker, in poorer health, in poorer nutritional status, more functionally impaired, and at higher 

nutritional risk than those in the general population. Nutrition Services provide an important 

opportunity for social interaction that helps to improve the general health status of participants, 

particularly homebound elders. A comparison of the number of social contacts of congregate 

and home-delivered meal participants reveals that nutrition program clients had significantly 

more social contacts than people who did not participate in the program. 

Data from AoA’s 2011 national surveys of elderly clients show that the Nutrition Services are 

effectively helping seniors to improve their nutritional intake and remain at home. For example, 

78 percent of congregate and 83 percent of home-delivered meal recipients say they eat healthier 

meals due to the programs, and 60 percent of congregate and 92 percent of home-delivered meal 

recipients say that the meals enabled them to continue living in their own homes.27 In addition, 

home-delivered meal and congregate meal participants had significantly better food energy 

intake, protein, vitamins A, B6 & D, Riboflavin, Calcium, Phosphorous, Potassium, Magnesium 

and Zinc intakes compared to a matched non-participant group of senior citizens.28

 Seniors with 

deficiencies of these nutrients can experience osteoporosis, night blindness, decreased resistance 

to infection, fatigue, vasodilatation, and other illnesses. 

Multiple medical conditions predispose older individuals to risk of increased limitations in 

activities of daily living as well as the possibilities of increased hospital and nursing home stays. 

In addition, self-reported health and well-being declines as multiple chronic conditions increase. 

Two-thirds of Medicare costs are associated with individuals who have multiple chronic 

conditions. Individuals who are poorly nourished have higher rates of hospital readmissions, 

especially for those with nutrition-related conditions such as heart disease/heart failure, 

pneumonia, chronic obstructive pulmonary disease, gastrointestinal problems or surgeries such 

as leg, hip, or bowel. Nutrition Services provide meals to high risk congregate and homedelivered participants to help ameliorate some of these factors. Data from the 2011 national 

surveys of OAA program participants indicate that fifty-one percent of congregate participants 

and sixty-three percent of home delivered participants have more than six chronic conditions.29

 

Multiple medication use is associated with multiple chronic conditions and predisposes 

individuals to increased risk for emergency room visits, hospitalizations and nursing home 

admissions. Data from AoA’s 2011 national surveys indicate that about thirty-one percent of 

congregate and fifty-one percent of home-delivered meal participants take six or more 

medications.30 Adequate nutrition support through meals as well as nutrition education and 

counseling help these vulnerable participants manage their chronic conditions as well as help 

them with their medication management issues. 

 

26 Hung et al.: Recent trends in chronic disease, impairment and disability among older adults in the United States. 

BMC Geriatrics 2011 11:47.

27 2011 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID. 

28 Serving Elders at Risk – National Evaluation of the Elderly Nutrition Program, 1993-1995, pp.117-118 

29 2011 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID 

30 Ibid. 
17

AoA’s annual performance data further demonstrate that these programs are an efficient and 

effective means to help seniors remain healthy and independent in their homes and in the 

community. Ninety percent of home-delivered meal clients rate service as good to excellent. 

Also, the number of home-delivered meal recipients with severe disabilities (3+ ADL) totaled 

nearly 367,000 in FY 2011. This level of disability is frequently associated with nursing home 

admission, and demonstrates the extreme frailty of a significant number of home-delivered meal 

clients. The most recent data on how these nutrition programs are helping seniors remain 

healthy and independent in their homes include: 

Home-Delivered Nutrition Services provided 139.1 million meals to over 

855,000 individuals in FY 2011.

Congregate Nutrition Services provided over 88.6 million meals to nearly 1.7 million 

seniors in a variety of community settings in FY 2011.

Consistent with AoA’s commitment to target services to those most in need to help them 

maintain their health and independence, approximately 73 percent of home-delivered meal 

recipients have annual incomes at or below $20,000. Meals are especially critical for the 

survival of the 29 percent of recipients who report these meals as the sole or majority of their 

food intake for the day. 

Federal support for Nutrition Services is not expected to serve every senior. These programs 

have strong partnerships with state and local governments, philanthropic organizations, and 

private donations that contribute funding. In FY 2011, state and local funding comprised 

approximately 63 percent of all the funding for home-delivered meals and congregate meals. 

Though all programs funded through OAA rely on state and local funding in some part, funding 

for congregate and home-delivered meals leverages more state and local financial support than 

many other OAA services. 

State and Territory Flexibility 

Under the core state formula grant programs for Home and Community-Based Supportive 

Services and Nutrition Services, states and territories have the flexibility to allocate resources to 

best meet local needs through intra-state funding formulas which distribute funds to area 

agencies on aging (AAAs). These formulas vary by state and allow states to take into account 

their own local circumstances to best serve their population. States are required to submit their 

formulas to AoA for approval and must take into account the geographic distribution of older 

persons and the distribution of older persons in greatest social and economic need. AAAs 

administer these grants and provide grants or contracts to local service providers based on 

identified needs. 

The OAA allows a state to transfer up to 40 percent of the funds between congregate and homedelivered meals for use as the state considers appropriate to meet the needs of the area served. 

Additionally, for any fiscal year if the transferred funds are insufficient to satisfy the need for 

nutrition services, then the Assistant Secretary for Aging may grant a waiver that permits the 

state to transfer an additional 10 percent of the funds to meet those needs. The OAA provides 
18

further flexibility to states by allowing them to transfer up to 30 percent for any fiscal year 

between Supportive Services programs and Nutrition Services programs, for use as the state 

considers appropriate. These are options open only to states and territories. A state agency may 

not delegate to an area agency on aging or any other entity the authority to make such transfers. 

In FY 2011, states transferred over $82 million from congregate nutrition to home and 

community-based services and home-delivered meals, as illustrated in the table below. 

Table 1. FY 2011 Transfer of Federal funds within Title III of the OAA 

Part B –

Home and CommunityBased Supportive Services

Part C1 –

Congregate Nutrition

Part C2 –

Home-Delivered Meals

Initial Allotment $365,402,129 $437,257,831 $215,935,133

Final Allotment after 

Transfers $415,949,696 $354,909,823 $247,735,574

Net Transfer +$50,547,567 ($82,348,008) +$31,800,441

Net Percent Change 13.83 (18.83) 14.73

 
19

Preventive Health Services 

(Title III-D of OAA; FY 2011: $20,984,000) 

Preventive Health Services, established in 1987, provides formula grants to states and territories, 

based on their share of the population aged 60 and over, to support activities that educate older 

adults about the importance of healthy lifestyles and promote healthy behaviors that can help to 

prevent or delay chronic disease and disability, thereby reducing the need for more costly 

medical interventions. Preventive Health Services gives states and territories flexibility to 

allocate resources among the preventive health activities of their choice to best meet local needs. 

Priority has been given to providing services to those elders living in medically underserved 

areas of the state or who have the greatest economic need. 

Due in large part to advances in public health and medical care, Americans are leading longer 

and more active lives. Average life expectancy has increased from less than 50 years at the turn 

of the 20th century to over 78 years today. On average an American turning age 65 today can 

expect to live an additional 19.2 years.

31

 The population of older Americans is also growing, 

particularly the population age 85 and over, which is growing very rapidly, totaling 5.7 million in 

2011 and projected to reach 8.7 million by the year 2030.32 One consequence of this increased 

longevity is the higher incidence of chronic diseases such as obesity, arthritis, diabetes, 

osteoporosis, and depression as well as the greater probability of injury from a fall, which 

quickly limits physical activity. 

In recent years, some states have increasingly shifted their funding to provide greater support to 

evidence-based approaches, especially to help individuals manage chronic diseases. Since 

evidence-based programs have demonstrated their effectiveness, AoA expects that states will be 

able to maximize the impact of these limited dollars. At the same time, if states wish to continue 

funding other health services, such as health screenings, they still have the flexibility to continue 

to use funds provided under the Home and Community-Based Services program for this purpose. 

Evidence-based programs are interventions that have been tested through randomized control 

trials and have been shown to be effective at helping participants adopt healthy behaviors, 

improve their health status, and reduce their use of hospital services and emergency room visits. 

Some examples of evidence-based interventions are: 

Enhanced fitness and enhanced wellness programs: Enhanced fitness is a multicomponent group exercise program designed for community-based organizations and 

intended to promote physical activity among older adults. Strength training using soft 

wrist and ankle weights; cardiovascular workout using dancing, aerobics, or walking; and 

balance and posture exercises are used to increase the physical health of older adults. In 

 

31 National Center of Health Statistics, Health, U.S., 2011: With Special Feature on Socioeconomic Status and 

Health. Table 22. Hyattsville, MD 2012. 

32 Data compiled by AoA from U.S. Census Bureau, “2008 National Population Projections”, released August 2008, 

<http://www.census.gov/population/www/projections/2008projections.html> and Table 1. Annual Estimates of the 

Resident Population by Sex and Five-Year Age Group for the United States: April 1, 2010 to July 1, 2011 (NCEST2011-01). Source: U.S. Census Bureau, Population Division. Release Date: May 2012. < 

http://www.census.gov/popest/data/national/asrh/2011/index.html> Accessed 28 August, 2012. 
20

addition exercise has been proven to improve depression, which studies have shown that 

nearly 20 percent of U.S. adults 65 years and older experience. Exercise may also act as 

a buffer against many illnesses impacted by stress. 

Falls prevention: Falls prevention programs help participants to achieve improved 

strength, balance, and mobility; provide education on how to avoid falls and reduce fall 

risk factors; involve medication reviews and modifications; provide referrals for medical 

care management for selected fall risk factors; and provide home hazard assessments of 

ways to reduce environmental hazards. Recent studies have shown that in the United 

States more than one-third of adults age 65 and over fall each year. Of those who fall, 

20 to 30 percent will experience serious injuries, such as head trauma, broken bones, or 

hip fractures. These injuries may limit the ability of older adults to get around or live 

independently. Those who are not injured may develop a fear of falling, which may 

increase their actual risk of falling. Many people limit their activity after a fall, which 

may reduce strength, physical fitness, and mobility.33

Medication management: Medication management programs focus on reviewing the 

multitude of medications that older adults are prescribed, focusing especially on high-risk 

medications. Medication management programs have been shown to reduce unnecessary 

duplication of prescriptions and cardiovascular problems. These programs have also been 

shown to improve medication usage rates and decrease medication errors among older 

adults. 

Depression Care Management: Depression is not a normal part of aging, yet it is a 

prevalent and disabling condition among older adults. A recent national study found that 

11.1 percent of Medicare beneficiaries age 65 and older living in the community reported 

feeling “sad or depressed much of the time over the previous year”.34 Older adults with 

depression “visit the doctor and emergency room more, use more medication, and stay 

longer in the hospital” than those without depression. 35

 Those with depression and 

certain chronic conditions have been shown to have substantially higher total health care 

costs than those with these conditions but no depression ($22,960 vs. $11,956 per year).36 

Cost-effective, evidence-based interventions, such as the Program to Encourage 

Rewarding Lives for Seniors (PEARLS), are available that have been shown to reduce 

depressive symptoms and improve quality of life in older adults.37

 

33 Even, Jennifer. 2009. Senior Series. The Ohio State University Extension. 20 May 2009.

34 Harris, Y., and J. K. Cooper (2006). “Depressive symptoms in older people predict nursing home admission”, 

Journal of the American Geriatrics Society, 54(4):593-597.

35 U.S. Centers for Disease Control and Prevention (2008). The State of Mental Health and Aging in America, 

Healthy Aging Program, Issue Brief #1.

36 Unützer J, Schoenbaum M, et al. (2009). “Health care costs associated with depression in medically ill fee-forservice Medicare participants”, Journal of the American Geriatric Society, 57:3, 375–584. 

37 Program to Encourage Rewarding Lives for Seniors (2012). Description available at: 

http://www.pearlsprogram.org/
21

Chronic Disease Self-Management Program 

The Chronic Disease Self-Management Program (CDSMP) is a low-cost, evidence-based disease 

prevention model that uses state-of-the-art techniques to help those with chronic disease address 

issues related to the management and treatment of their condition, improve their health status, 

and reduce their need for more costly medical care. 

Data show that as an individual’s number of chronic conditions increases, there is a 

corresponding escalation in adverse outcomes including mortality, poor functional status, 

unnecessary hospitalizations, adverse drug events, duplicative tests, and conflicting medical 

advice, all of which lead to higher health costs and greater outlays for programs like Medicare 

and Medicaid. CDSMP has been shown repeatedly, through multiple studies (including 

randomized control experiments, with both English and Spanish speaking populations) to be 

effective at helping participants adopt healthy behaviors, improve their health status and reduce 

their use of hospital stays and emergency room visits. Studies indicate that the program 

significantly improves participant health status, reduces the use of hospital care and physician 

services

38

, and reduces health care costs. 

CDSMP emphasizes an individual’s role in managing his/her chronic condition(s). The program 

consists of a series of workshops that are conducted once a week for two and a half hours over 

six weeks in community settings such as churches, libraries, YW/MCAs, senior centers, public 

housing projects, community health centers and cooperative extension programs. People with 

differing chronic health conditions attend workshops together, and the workshops are facilitated 

by two leaders who are certified trainers. One or both of the leaders are non-health professionals 

or lay people with one or more chronic conditions themselves. Topics covered include: 1) 

techniques to deal with problems such as frustration, fatigue, pain and isolation; 2) appropriate 

exercise for maintaining and improving strength, flexibility, and endurance; 3) appropriate use of 

medications; 4) communicating effectively with health professionals; and 5) nutrition. 

AoA funds CDSMP through competitive grants awarded to states. External experts review 

project proposals, and AoA awards grants for periods of one to three years. In FY 2011, AoA 

tracked the progress of the 47 sate grantees funded through the American Recovery and 

Reinvestment Act of 2009. By September 30, 2011, grantees had already reached 52,200 

completers, exceeding their 2-year goal of 50,000 completers (73 percent were age 60 or older 

and 60 percent reported having multiple chronic conditions). AoA also funded a Technical 

Assistance Resource Center through a grant to the National Council on Aging to provide 

technical assistance to the state grantees, evaluate progress in building sustainable distribution 

and delivery systems, and implement a national study to assess the impact of CDSMP activities 

in settings across the country. This study of over 1,000 participants is evaluating self-reported 

participant outcomes in general health, health interference in daily activities, symptoms, physical 

activity, use of medications, communication with health providers, and health care utilization.

 

38 Sobel, DS, Lorig,KR, Hobbs,M. Chronic Disease Self-Management Program: From Development to 

Dissemination. Permanente Journal; Spring 2002. 
22

Caregiver Services 

Families are the nation’s primary provider of long-term care, but a number of factors including 

financial constraints, work and family demands, and the many challenges of providing care place 

great pressure on family caregivers. Caregiving responsibilities demand time and money from 

families who too often are already strapped for both. AoA’s caregiver programs provide services 

that address the needs of unpaid, informal caregivers, allowing many of them to continue to work 

while providing critically needed care. 

Better support for informal caregivers is critical because often it is their availability - whether 

they are informal family caregivers, paraprofessionals or unrelated friends and neighbors who 

volunteer their time - that determines whether an older person can remain in his or her home. In 

2009, approximately 43.5 million adult caregivers provided uncompensated care to those 

50 years of age and older.39 AARP estimated the economic cost of replacing unpaid caregiving in 

2009 to be about $450 billion, an increase from $375 billion in 2007 (cost if that care had to be 

replaced with paid services).40 

The demands of caregiving can lead to a breakdown of the caregiver’s health, and the illness, 

hospitalization, or death of a caregiver increases the risk for institutionalization of the care 

recipient. Caregivers suffer from higher rates of depression than non-caregivers of the same age, 

and research indicates that caregivers suffer a mortality rate that is 63 percent higher than noncaregivers.41 Providing support that makes caregiving easier for family caregivers, such as 

information, counseling and training, respite care, or supplemental services, is critical to 

sustaining caregivers’ ability to continue in that role. Seventy-eight percent of the caregivers 

served by OAA programs report that these services allow them to provide care longer than they 

otherwise could.42

 

At the same time, AoA recognizes that it must also address the growing need for more caregivers 

every day. By 2020, it is projected that there will be over 15 million non-institutionalized seniors 

age 65 and over with 1+ ADL deficits, an increase of almost four million seniors (or a 36 percent 

increase since 2010) needing caregiver assistance.43

 

 

39 Valuing the Invaluable: 2011 Update, The Growing Contributions and Costs of Family Caregiving. AARP Public 

Policy Institute. July 2011. http://assets.aarp.org/rgcenter/ppi/ltc/i51-caregiving.pdf 

40 Valuing the Invaluable: 2011 Update, The Growing Contributions and Costs of Family Caregiving. AARP Public 

Policy Institute. July 2011. http://assets.aarp.org/rgcenter/ppi/ltc/i51-caregiving.pdf 

41 Schulz R, Beach SR. Caregiving as a risk factor for mortality. The Caregiver Health Effects study. JAMA 

December 15, 1999;282:2215-9.

42 2011 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID. 

43 Data extrapolated by AoA from U.S. Census Bureau, “2008 National Population Projections,” released August 

2008, http://www.census.gov/population/www/projections/2008projections.html and Health Data Interactive, 

National Center on Health Statistics, Centers for Disease Control and Prevention, “Functional limitations among 

Medicare beneficiaries, ages 65+: US, 1992-2006.” Accessed 31 August 2009. 
23

National Family Caregiver Support Program

(Title III-E of OAA; FY 2011: $153,912,000) 

The National Family Caregiver Support Program (NFCSP) provides grants to states and 

territories, based on their share of the population age 70 and over, to fund a range of supports 

that assist family and informal caregivers to care for their loved ones at home for as long as 

possible. The program includes five basic system components: information; access assistance; 

counseling and training; respite care; and supplemental services. These services work in 

conjunction with other OAA services - including transportation services, homemaker services, 

home-delivered meals, and adult day care - to provide a coordinated set of supports for seniors 

which caregivers can access on their behalf. 

The NFCSP provides a variety of supports to family and informal caregivers. In FY 2011, 

services provided included:44

Access Assistance Services provided over 1.3 million contacts to caregivers assisting 

them in locating services from a variety of public and private agencies. 

Counseling and Training Services provided over 128,000 caregivers with counseling, 

peer support groups, and training to help them better cope with the stresses of caregiving. 

Respite Care Services provided nearly 67,000 caregivers with 6.3 million hours of 

temporary relief - at home, or in an adult day care or nursing home setting - from their 

caregiving responsibilities. 

Family and other informal caregivers are the backbone of America’s long-term care system. On 

a daily basis, these individuals assist relatives and other loved ones with tasks ranging from 

personal care and homemaking to more complex health-related interventions like medication 

administration and wound care. Research has shown that caregiving exacts a heavy emotional, 

physical, and financial toll. As reported in AoA’s 2011 National Survey of OAA Participants, 

24 percent of caregivers are assisting two or more individuals. Sixty-eight percent of Title III 

caregivers are 60 or older, making them more vulnerable to a decline in their own health, and 

thirty-four percent describe their own health as fair to poor.45 The demands of caregiving can 

lead to a breakdown of the caregiver’s health, and the illness, hospitalization, or death of a 

caregiver increases the risk for institutionalization of the care recipient. Additionally, caregivers 

often experience conflicts between work and caregiving, with 25 percent reporting that they have 

had to make adjustments such as retiring or taking time away from work due to their caregiving 

responsibilities. 

Studies have shown that the types of supports provided through the Family Caregiver Support 

Services Program can reduce caregiver depression, anxiety, and stress and enable them to 

provide care longer while often continuing to work, thereby avoiding or delaying the need for 

costly institutional care for their loved ones. For example, a study, Intervention to Delay Nursing 

 

44 Data from AoA’s FY 2011 State Program Report are preliminary and should not be taken as final. 

45 2011 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID. 
24

Home Placement of Patients with Alzheimer’s Disease, indicates that counseling and support for 

caregivers of individuals with Alzheimer’s disease can permit the care recipient to stay at home, 

at significantly less cost, on average, for an additional year before being admitted to a nursing 

home. 

Additionally, data from AoA’s national surveys of caregivers of elderly clients also shows that 

OAA services, including those provided through Family Caregiver Support Services, are 

effective in helping caregivers keep their loved ones at home. Approximately 78 percent of 

caregivers of program clients reported in 2011 that services enabled them to provide care longer 

than otherwise would have been possible.46 Caregivers receiving services were also asked 

whether the care recipient would have been able to live in the same residence if the services had 

not been available. Forty-five percent of the caregivers of nursing home eligible care recipients 

indicated that the care recipient would be unable to remain at home without the support services. 

Those respondents were then asked to identify where the care recipient would be living without 

services. A significant majority of those caregivers, 78 percent, indicated that the care recipient 

would most likely be living in a nursing home or assisted living (see below). 

(based on responses from care recipients unable to live independently) 

 

46 2011 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID. 
25

Lifespan Respite Care

(FY 2011: $2,495,000) 

Family caregiving for persons with disabilities occurs across the age spectrum from birth to 

death, with caregivers often being called upon to provide care to individuals of varying ages and 

disabilities. Most do so willingly, and often for many years. AARP estimated in 2009 that 65.7 

million people served as unpaid family caregivers to an adult or child with special needs. For 

many of these caregivers, providing care can take a toll: a majority of caregivers (51 percent) 

caring for someone over age 18 have medium or high levels of burden and 31 percent of all 

family caregivers indicated they experienced high levels of stress.47

Numerous studies have shown respite to be among the most frequently requested supportive 

service for family caregivers.48 49 Respite is second only to direct financial assistance as a key 

policy priority of surveyed family caregivers. Even though respite services are often the 

preferred mode of family caregiver support, they are often under used, difficult to find and 

access, and are often unaffordable or in short supply. A 2009 survey found that “finding time for 

myself” was reported by 32 percent of family caregivers along with managing both physical and 

emotional stress (34 percent) and balancing work and family responsibilities (27 percent). 

Despite these compelling numbers, nearly 90 percent of family caregivers receive no respite at 

all.50

 

The barriers to accessing and using respite services are often significant for specific populations 

such as family caregivers of individuals with Multiple Sclerosis, persons with intellectual and 

developmental disabilities, and for caregivers of veterans and individuals with Alzheimer’s 

disease, spinal cord injuries, autism, and serious emotional disorders. 51 52 The populationspecific barriers reported by caregivers include provider shortages and inadequate training, 

mistrust of formal service delivery systems, hesitancy to ask for help and lack of awareness of 

available programs and supports. 

The Lifespan Respite Care program focuses on easing the burdens of caregiving by providing 

grants to eligible state organizations to improve the quality of, and access to, respite care for 

family caregivers of children or adults of any age with special needs while promoting the 

statewide dissemination and coordination of community-based respite care services. Unlike the 

National Family Caregiver Support Program, which focuses on broad caregiver support via a 

number of services, Lifespan Respite Care programs focus on providing a test bed for needed 

infrastructure changes, and on filling gaps by putting in place coordinated systems of accessible, 

 

47 National Alliance for Caregiving and AARP. Caregiving in the U.S.: A Focused Look at Those Caring for the 

50+. 2009. http://www.aarp.org/research/surveys/care/ltc/hc/articles/caregiving_09.html 

48 The Arc. (2011). Still in the Shadows with Their Future Uncertain: A Report on Family and Individual Needs 

for Disability Supports (FINDS 2011). Wash, DC: Author 

49 National Family Caregivers Association. (2011). Allsup Family Caregiver Survey. Kensington, MD. 

50 National Alliance for Caregiving and AARP, 2009. 

51 National Alliance for Caregiving. (2012). Multiple Sclersosis Caregivers. Washington, DC: Author. 

52 The Arc, 2011. 
26

community-based respite care services for family caregivers of children and adults with special 

needs. 

The systems funded through the Lifespan Respite Care program bring together and seek to 

coordinate respite care services for family caregivers; training and recruitment of respite care 

workers and volunteers; and provision of information, outreach, and access assistance. They also 

seek to identify and to fill gaps in services. Within this context, Lifespan Respite Care Program 

grantees have focused their efforts in a number of broad areas, including: 

Conducting needs assessments/environmental scans to determine the respite funding 

streams available, programs in existence, populations served and gaps in each area; 

Broadening stakeholder collaborations to ensure representation of all age and disability 

groups, as well as the broadest possible cross section of the provider network; 

Engaging respite consumers to inform project activities; and 

Capacity building and network development at the local level to recruit and train 

volunteers to fill gaps in respite services, particularly in rural areas through partnerships 

with universities, community-based organizations and communities of faith. 

Lifespan Respite also supports resource center activities designed to maintain a national database 

on lifespan respite care; provide training and technical assistance to grantees and state, 

community, and nonprofit respite care programs; and conduct public information, referral, and 

education programs on respite care. 

Respite care services are highly valued by caregivers. By providing opportunities for family 

caregivers to receive this much needed short-term relief, the Lifespan Respite Care program 

helps to sustain family caregiver health and well-being, reduces the likelihood of abuse and 

neglect, and allows care recipients to remain in their own homes for as long as possible. 

To illustrate the importance of respite, in a recent national survey of OAA service recipients a 

random sample of 1,795 caregivers (which represented over 223,626 active caregivers) answered 

questions about the impact of the caregiver program on their lives.53 Eighty-four percent of 

caregivers received respite care with services from the National Family Caregiver Support 

Program within the past twelve months. The respite care service recipients reported that as a 

result of the services they received: 

80 percent had less stress; 

89 percent said it was easier to care for their loved one; 

76 percent reported that it was the most helpful service they received; 

 

53 2011 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID. 
27

97 percent reported the care recipient benefited from the service; and 

87 percent said that the services enabled them to care longer. 

Since 2009, twenty-nine states and the District of Columbia have been awarded grants of up to 

$200,000 each for three year projects. Additionally, in FY 2011, eight states were awarded 

expansion grants to focus specifically on providing respite services to meet demand and fill gaps 

in service where identified. Examples of grantee accomplishments include: 

Development or enhancement of existing training programs for respite care providers and 

volunteers to expand the cadre of trained respite professionals; 

Replication and expansion of respite delivery models with a particular focus on person 

centered planning and consumer direction;

Expansion of toll-free “helplines” to provide caregivers with information about available 

respite programs. 

Development and deployment of marketing and awareness campaigns designed to educate 

caregivers about the importance of their work and the necessity to take a break; 

Development and launch of dedicated web sites to facilitate access to information about,

and referral to, respite services; 

The creation or expansion of respite voucher programs; 

Mini-grant programs to promote the development of unique community-based respite 

options; and 

The development of data collection methodologies to track service provision and outcomes 

development. 

Grants for Lifespan Respite Care are awarded to eligible state organizations with a 25 percent 

matching requirement. Eligible state agencies include any of the following: the state agency that 

administers OAA programs, the state’s Medicaid program, or any other state-level agency 

designated by the governor. Additionally, the eligible state agency must work in collaboration 

with Aging and Disability Resource Centers and a public or private non-profit statewide respite 

care coalition or organization. Priority consideration is given to applicants which demonstrate 

the greatest likelihood of implementing or enhancing lifespan respite care statewide and are 

building or improving the capacity of their long-term care systems to respond to the 

comprehensive needs of care recipients. 
28

Alzheimer’s Disease Supportive Services Program

(FY 2011: $11,441,000) 

Established under Section 398 of the Public Health Services Act, as amended, (42 U.S.C. 280c3), the Alzheimer’s Disease Supportive Services Program (ADSSP) funds competitive grants to 

states to expand the availability of evidence-based interventions that help persons with dementia 

and their caregivers remain independent in the community for as long as they desire. The 

primary components of the ADSSP program include delivering evidence-based supportive 

services; translating and replicating evidence-based interventions for persons with dementia and 

their caregivers at the community level; incorporating evidence-based research in the 

formulation of innovative projects; and advancing changes to a state’s overall system of home 

and community-based care. 

These changes are focused on expanding the aging services network’s capacity to assist those 

with dementia and their families by providing individualized and public information, education, 

and referrals about diagnostic, treatment and related services; as well as sources of assistance for 

services and legal rights assistance for people affected by dementia throughout a state’s long 

term services and support system. 

FY 2011 grant projects focused on integration of a statewide set of programs that includes a 

Single Entry Point/No Wrong Door access for individuals and ensuring access to a 

comprehensive, sustainable set of high quality services relevant to the population residing in the 

state’s service area with an emphasis on incorporating dementia capability in services for people 

with dementia. These three-year projects are being implemented in Georgia, Minnesota, New 

York and Ohio. 

Through projects funded in prior years, sixteen states are in the process of translating 

ten evidence-based interventions into practice. One example of these promising evidence-based 

interventions is the New York University Caregiver Intervention, a spousal caregiver support 

program that in a randomized-control trial delayed institutionalization of persons with dementia 

by an average of 557 days.54 In 2011, the average nursing home cost was $214 daily for a semiprivate room and $239 daily for a private room ($78,110 and $87,235 annually), which would mean 

an average savings of between $120,000 and $133,000 in institutional costs per person with 

dementia.55 California, Florida, Georgia, Minnesota, Utah and Wisconsin are translating this 

intervention now; early results confirm the original study. In addition, 25 states, DC and Puerto 

Rico are offering innovative programming for caregivers and their loved ones with dementia. 

States funded to implement innovative programs are focusing in areas of great need, such as 

 

54 Mittleman M, et al. (1996). “A Family Intervention to Delay Nursing Home Placement of Patients with 

Alzheimer’s Disease: a randomized, controlled trial,” Journal of the American Medical Association, 276; 1725-

1731.

55 Metlife. (October 2011), “MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and 

Home Care Costs”, p. 5, Accessed 31 August, 2012 

from: http://www.metlife.com/assets/cao/mmi/publications/studies/2011/mmi-market-survey-nursing-homeassisted-living-adult-day-services-costs.pdf 
29

programs to ensure that the states’ long term services and supports system are dementia capable. 

Overall, these demonstrations offer direct services and other supports to thousands of families, as 

well as support the continuous quality improvement and evaluation of long term services and 

supports. Family caregivers remain the major source of support for most people with 

Alzheimer’s disease. The nature of the disease - a slow loss of cognitive and functional/physical 

independence - means that most people with Alzheimer’s disease are cared for in the community 

for years. They may access a variety of services from many different systems including the 

aging, medical, and mental health service systems. As the number of people with Alzheimer’s 

disease grows, it is increasingly important that service delivery and health care systems are 

responsive to persons with dementia and are effectively coordinated. It is also important to 

ensure the availability of dementia capable community-based long term services and supports. 
30

PART II: OLDER AMERICAN INDIANS, ALASKA NATIVES 

 & NATIVE HAWAIIANS 

Nutrition and Supportive Services 

Native American Nutrition and Supportive Services provides grants to eligible tribal 

organizations to promote the delivery of nutrition and home and community-based supportive 

services to Native American, Alaskan Native, and Native Hawaiian elders. According to the 

2011 American Community Survey, approximately 301,000 persons age 60 and over identified 

themselves as Native Americans or Alaskan Natives, and another 242,000 persons age 60 and 

over identified themselves as part Native American or Alaskan Native. 

Native American Nutrition and Supportive Services grants support a broad range of services to 

older Native Americans, including adult day care, transportation, congregate and home-delivered 

meals, information and referral, personal care, chore, and other supportive services. Currently, 

AoA’s congregate meal program reaches 32 percent of eligible Native American seniors in 

participating tribal organizations, home-delivered meals reach 14 percent of such persons, and 

supportive services reach 52 percent of such persons. These programs, which help to reduce the 

need for costly nursing home care and medical interventions, are responsive to the cultural 

diversity of Native American communities and represent an important part of each community’s 

comprehensive services. 

Services provided by this program in FY 2011 include:56 

Transportation Services, which provided over 855,000 rides to meal sites, medical 

appointments, pharmacies, grocery stores, and other critical daily activities. 

Home-Delivered Nutrition Services, under which 2.5 million meals were provided to 

nearly 37,694 homebound Native American elders; the program also provides critical 

social contacts that help to reduce the risk of depression and isolation experienced by 

many home-bound Native American elders. 

Congregate Nutrition Services, which provided 2.1 million meals to more than 

59,754 Native American elders in community-based settings, as well as an opportunity 

for elders to socialize and participate in a variety of activities, including cultural and 

wellness programs. 

Information, Referral and Outreach Services, which provided over 900,000 hours of 

outreach and information on services and programs to Native American elders and their 

families, thereby, empowering them to make informed choices about their service and 

care needs. 

 

56 Title VI FY 2010 are the most recently available data. 
31

The Native American Nutrition and Supportive Services program also provides training and 

technical assistance to tribal organizations to support the development of comprehensive and 

coordinated systems of services to meet the needs of Native American elders. Training and 

technical assistance is provided through national meetings, site visits, e-newsletters, telephone 

and written consultations, and through the Native American Resource Centers (funded under 

Aging Network Support Activities).

Eligible tribal organizations receive nutrition and supportive services formula grants based on 

their share of the American Indian, Alaskan Native, and Native Hawaiian population age 60 and 

over. Tribal organizations must represent at least 50 Native American elders age 60 and over to 

receive funding. There is no requirement for matching funds. In addition, tribes may decide the 

age at which a member is considered an elder and thus eligible for services. 

Caregiver Support Services 

Native American Caregiver Support Services provide grants to eligible tribal organizations to 

provide support for family and informal caregivers of Native American, Alaskan Native and 

Native Hawaiian elders. This program, which helps to reduce the need for costly nursing home 

care and medical interventions, is responsive to the cultural diversity of Native American 

communities and represent an important part of each community’s comprehensive services. 

Native American Caregiver Support Services funding is allocated to eligible tribal organizations 

based on their share of the American Indian, Alaskan Native, and Native Hawaiian population 

aged 60 and over. Tribal organizations must represent at least 50 Native American elders age 60 

and over and be receiving a grant under Title VI Part A or B to receive funding. There is no 

requirement for matching funds. Tribes may also decide the age at which a member is considered 

an elder and thus eligible for services. In addition, there is no limit on the percentage of funds 

that can be used for services to grandparents caring for grandchildren. 

Grants assist American Indian, Alaskan Native and Native Hawaiian families caring for older 

relatives with chronic illness or disability and grandparents caring for grandchildren. The 

program provides a variety of direct services that meet a range of caregiver needs, including 

information and outreach, access assistance, individual counseling, support groups and training, 

respite care, and other supplemental services. Tribal organizations coordinate with other 

programs, including the Volunteers In Service To America (VISTA) program, to help support 

and create sustainable caregiver programs in Native American communities (many of which are 

geographically isolated). A core value of the Native American Caregiver Support Services, as 

expressed by tribal leaders, is that the program should not replace the tradition of families caring 

for their elders. Rather, it provides support that strengthens the family caregiver role. 
32

PART III: PROTECTION OF VULNERABLE OLDER ADULTS 

Protection of Vulnerable Americans consists of several distinct but complementary programs 

designed to prevent, detect, and respond to elder abuse, neglect, and exploitation. As the 

population of older Americans increases, the problem of elder abuse, neglect, and exploitation 

continues to grow. While there is no single set of national elder abuse prevalence data, the 

number of reported cases of elder abuse, neglect, and exploitation are on the rise. A 2004 

national survey of State Adult Protective Services (APS) programs conducted by AoA’s National 

Center on Elder Abuse showed a 16 percent increase in the number of elder abuse cases from an 

identical study conducted in 2000.57 According to a 1998 national incidence study (the only such 

study ever conducted), 84 percent of all elder abuse incidents go unreported, meaning that for 

every reported case of abuse there are over five that go unreported.58 Together, these data 

suggest that a minimum of 5 million elders are abused, neglected, and/or exploited annually. 

The negative effects of abuse, neglect, and exploitation on the health and independence of 

seniors is extensive. Research has demonstrated that older victims of even modest forms of abuse 

have dramatically higher (300 percent) morbidity and mortality rates than non-abused older 

people.59 Additional adverse health impacts include an increased likelihood of heart attacks, 

dementia, depression, chronic diseases and psychological distress. The result of these 

unnecessary health problems is a growing number of seniors who access the healthcare system 

more frequently (including emergency room visits and hospital admissions), and are ultimately 

forced to leave their homes and communities prematurely.60 Protection of Vulnerable Adults 

programs address this problem through a full array of services designed to prevent, detect, and 

respond to elder abuse, neglect, and exploitation, both at home and in institutional settings. 

These elder rights and elder justice programs will build a foundation and establish best practices 

for states to develop programs to expand and improve the protection of individuals living in their 

communities and in long-term care settings; increase the information and technical assistance 

available to the public, states, and localities in preventing and addressing abuse; protect the rights 

of older adults and prevent their exploitation; reduce health-care fraud and abuse; and provide 

assistance to Tribes in developing elder justice systems. This multifaceted approach to 

preventing, detecting, and resolving elder abuse, neglect, and exploitation is essential to 

successfully fulfilling the shared mission of the Older Americans Act and the Elder Justice Act 

to maintain the health and independence of older Americans and adults with disabilities. 

 

57 Teaster, Pamela, et al. The 2004 Survey of State Adult Protective Services: Abuse of Adults 60 Years of Age and 

Older. http://www.ncea.aoa.gov/NCEAroot/Main_Site/pdf/2-14-06%20FINAL%2060+REPORT.pdf 

58

 Tatara, Toshio, et al. The National Elder Abuse Incidence Study Final Report. 1998. 

http://www.aoa.gov/AoARoot/AoA_Programs/Elder_Rights/Elder_Abuse/docs/ABuseReport_Full.pdf 

59 Lachs, M.S., Williams, C.S., O'Brien, S., Pillemer, K.A., & Charlson, M.E. (1998). “The Mortality of Elder 

Mistreatment.” JAMA. 280: 428-432. and Baker, M.W. (2007). “Elder Mistreatment: Risk, Vulnerability, and 

Early Mortality.” Journal of the American Psychiatric Nurses Association, Vol. 12, No. 6, 313-321. 

60 Lachs M. S., Williams C., O'Brien S., Hurst L., Kossack A., Siegal A., et al. (1997). “ED use by older victims of 

family violence.” Annals of Emergency Medicine. 30:448-454.
33

Prevention of Elder Abuse and Neglect 

(FY 2011: $5,046,000) 

The Prevention of Elder Abuse and Neglect program provides formula grants to states and 

territories based on their share of the population 60 and over for training, education, and 

promoting public awareness of elder abuse. The program also supports state and local elder 

abuse prevention coalitions and multi-disciplinary teams. These activities are important elements 

of AoA’s focus on elder rights and elder justice. The program coordinates activities with state 

and local Adult Protective Services programs (over half of which are directly administered by 

State Units on Aging) and other professionals who work to address issues of elder abuse and 

elder justice. The importance of these services at the state and local level is demonstrated by the 

fact that states significantly leverage OAA funds to obtain other funding for these activities. In 

FY 2011, over $27.5 million of the Elder Abuse Prevention services expenditures was leveraged 

from non-OAA funds, a ratio of over $6 of non-OAA funds for every $1 investment of AoA 

funds.61

Examples of State elder abuse prevention activities include: 

In Kentucky, the local area agencies on aging participate in the Local Coordinating 

Councils on Elder Abuse, which have developed emergency elder shelters, developed 

informational cards for law enforcement officers to have in the patrol cars which contain 

crucial resource information for victims of elder abuse, provided training on a regular 

basis to first responders, provided a friendly visitor program for home-based seniors, and 

produced a prevention tool called the Kentucky Fraud Fighter Form. 

In Illinois, the Illinois Department on Aging utilizes its elder abuse funds to support 

volunteer community based multi-disciplinary teams (M-Teams) that serve in a technical 

advisory role to more than 40 elder abuse provider agencies throughout the state. The 

objectives of the M-Team are to provide case consultation and assistance to caseworkers 

and to encourage cooperation among various service agencies. Each M-Team is 

composed of the M-Team Coordinator and representatives of the mental health, medical, 

legal, law enforcement, faith community, and financial professions. 

The Prevention of Elder Abuse and Neglect program demonstrates AoA’s ongoing commitment 

to protecting the rights of vulnerable seniors and promoting their dignity and autonomy. 

Through education efforts, exposing problems that would otherwise be hidden from view, and 

providing a voice for those who cannot act for themselves, the program helps ensure that all 

older Americans are able to age with dignity in a safe environment. 

National Center on Elder Abuse 

To support and enhance the activities of state and local programs to prevent Elder Abuse, Neglect, 

and Exploitation, AoA funds the National Center on Elder Abuse (NCEA). NCEA disseminates 

information to professionals and the public; collaborates on research; provides consultation; 

identifies and provides information about promising practices and interventions; answers inquiries 

 

61 Data from AoA’s FY 2011 State Program Report are preliminary and should not be taken as final. 
34

and requests for information; operates a listserv forum for professionals; and advises on program and 

policy development. 

Model Approaches to Statewide Legal Assistance Systems 

(FY 2011: $1,999,569) 

The Model Approaches to Statewide Legal Assistance Systems (Model Approaches) 

demonstration grants represent an innovative departure from AoA’s past approach to the funding 

of Senior Legal Helplines (SLHs). Thirty-one states have been awarded Model Approaches 

grants as of the end of FY 2011. Model Approaches seeks to address the nationwide challenge 

of what are often fragmented, inconsistent, and inefficient legal service delivery systems that fail 

to achieve optimal access to quality service for older adults most in need. Model Approaches 

helps states develop and implement cost-effective, replicable approaches for integrating SLHs 

and other essential low cost mechanisms into the broader spectrum of state legal service delivery 

networks. Ultimately, legal assistance provided through well integrated and cost-effective service 

delivery systems as demonstrated through Model Approaches directly impacts the ability of 

seniors most in need to remain independent, healthy, and financially secure in their homes and 

communities. 

Model Approaches features strong leadership at the state level to achieve its service delivery 

integration objectives. State legal assistance developers have demonstrated effective leadership 

in incorporating the use of SLHs and other low-cost mechanisms into the state legal services 

planning and development process. Key project partners and service delivery components also 

include Title III-B legal services providers, private bar pro-bono attorneys, law school clinics, 

and self-help sites. By promoting the seamless integration of these vital legal service delivery 

components, Model Approaches enables seniors most in need to access quality legal services in 

priority legal issue areas involving income security, healthcare financing, consumer fraud, 

housing, foreclosure prevention, and elder abuse. This approach is also designed to increase the 

leveraging of limited resources within statewide legal service delivery systems. 

In addition, by ensuring strong leadership at the state level, Model Approaches projects have 

created important partnerships and linkages between the existing legal assistance community and 

the broader community-based aging and elder rights networks, including AAAs, Aging and 

Disability Resource Centers, State Long-Term Care Ombudsmen, and Adult Protective Services. 

As a key centerpiece of the Model Approaches projects, SLHs assist seniors in accessing quality 

legal services to ensure their rights and enhance their independence and financial security. In 

2011, Model Approaches projects assisted over 21,838 older consumers in the most social or 

economic need on a wide range of priority legal issues related to public benefits, health care, 

housing, advance planning, and consumer protection. Some recent examples of the success of 

SLHs’ experience in assisting seniors include:

o A 93 year-old woman with a very low income called SLH to seek assistance with a 

termination notice. She had recently come home from a hospital admission and brief stay in 

a rehab facility convalescing from a fall. The hospital and her doctor cleared her to return 

home. She had prearranged a support system that included a visiting nurse, a 

housekeeper/shopper, and regular visits by her daughter and son. The SLH lawyer helped the 

client write a letter of response to the Housing Manager asserting her rights under the Federal 
35

Fair Housing Act. The letter resulted in the rescission of the termination notice and allowed 

the client to stay in her residence. 

o A 71 year-old man and his wife were struggling to pay their adjustable rate mortgage on a 

fixed income. They applied for a mortgage modification through a lender designated by the 

federal government to offer loan modifications to qualified homeowners. Due to inaction on 

the part of the lender, interest and late fees continued to accrue on the loan balance. An SLH 

attorney called the lender reminding them of federal rules governing loan modifications and 

provided additional documentation. Two weeks later, the lender offered the senior a 

mortgage modification, which resulted in a 20 percent reduction in the monthly mortgage. 

In addition to providing assistance on priority legal issues, SLHs under Model Approaches have 

been very successful in reaching low-income populations with over 70 percent of older clients 

having incomes at or below 200 percent of the federal poverty guidelines. Also, minority clients 

receiving assistance through SLHs in the last reporting period constituted 33 percent of all clients 

served. These figures illustrate the effectiveness of Model Approaches states in reaching key 

target populations under the Older Americans Act with much needed “priority” legal assistance.

An important purpose of the Model Approaches demonstrations is to position SLHs as 

coordinated and essential components of high quality and high impact legal service delivery 

systems that effectively target scarce resources to older persons most in need. Model Approaches 

partners across the country recognize the enormous value of the network relationships forged in 

pursuit of essential project goals and objectives. Several Model Approaches states with 

completed grant award cycles (e.g., CT, FL, IA, KY, MD, MI, ND, NV, and PA) demonstrate 

that SLHs continue to serve seniors as well-integrated and essential components of statewide 

senior legal services delivery systems, thus illustrating the sustainability of these projects beyond 

the demonstration period. 

Other legal service delivery system outcomes achieved in FY 2011 and anticipated for all Model 

Approaches projects include: 

Comprehensive statewide legal needs assessments that identify the legal issues impacting 

seniors in target populations and assess the capacity of existing service delivery systems to 

meet those identified needs; 

Enhanced collaboration among area agencies on aging, ADRCs, SLHs, and legal providers in 

identifying and serving seniors most in need of assistance on priority legal issues; 

Enhanced service delivery capacity of legal services programs and SLHs through the 

leveraging of low cost service delivery mechanisms such as SLHs, private bar pro-bono 

attorneys, law school clinics, and self-help sites; and 

Strengthened systems that reach underserved and hard-to-reach seniors most in need through 

effective targeting and outreach methodologies. 
36

National Legal Assistance and Support Projects 

National Legal Assistance and Support grants fund a comprehensive national legal assistance 

support system serving professionals and advocates working in legal and aging services 

networks. These grants collectively form the National Legal Resource Center (NLRC) which is 

designed to empower professionals in aging and legal networks with the tools and resources 

necessary to provide older clients and consumers with high quality legal assistance in areas of 

critical importance to their independence, health, and financial security. 

As a streamlined and accessible point of entry, the NLRC supports the leadership, knowledge, 

and systems capacity of legal and aging provider organizations in order to enhance the quality, 

cost effectiveness, and accessibility of legal assistance and elder rights protections available to 

older persons with social or economic needs. The audience targeted to receive support services 

through the NLRC includes a broad range of legal, elder rights, and aging services professionals 

and advocates. These include legal assistance providers, legal assistance developers, long-term 

care ombudsmen, state unit on aging directors, AAA and ADRC personnel, senior legal helplines 

(SLHs), and others involved in protecting the rights of older persons. 

The NLRC provides core resource support through a strategic combination of case consultation, 

training, and technical assistance on a broad range of legal issues and systems development 

issues. Examples of common legal issues on which the NLRC provides assistance include 

preventing the loss of a senior’s home through foreclosure; protecting against consumer scams 

and creditor harassment; addressing elder abuse in the community and in long-term care 

facilities; and difficulties in accessing public benefits essential to financial security, 

independence, and health. The NLRC also provides technical assistance on the efficient, costeffective, and targeted provision of state-wide legal and elder rights advocacy services. 

In FY 2011, economic circumstances gave rise to a host of legal challenges for older consumers 

and the legal providers who serve them. In response to an increasing demand for legal resource 

support, the NLRC provided training and case consultation to over 9,120 aging and legal service 

professionals nationwide. NLRC partners also provided important technical support in the 

implementation of the Model Approaches projects in ten states, featuring the provision of 

expertise in legal needs and capacity assessments, effective targeting and outreach 

methodologies, statewide reporting systems, and legal service delivery standards. With regard to 

technical support directed at SLHs, the NLRC provided assistance to 21 SLHs and provided 

resources to aging services professionals in an additional 13 states. 

An essential foundational premise of the NLRC is that the combined efforts of several partnering 

organizations with high levels of subject matter expertise are required to achieve its broad 

resource support objectives. Through effective collaborations, interlocking work plans, and the 

leveraging of organizational resources, NLRC partners have demonstrated the ability to achieve 

effective national coverage on high priority legal issues areas. In FY 2011, over 97 percent of 

professionals responding to surveys rated the quality and usefulness of the support service 

provided by the NLRC as either good or excellent. 
37

In addition, the NLRC website continues to serve as a single entry point into a national legal 

assistance support system providing high quality resources and expertise on a broad range of 

legal and systems development issues: www.nlrc.gov The NLRC website received 1,019,915 

hits in FY 2011. 

Pension Counseling and Information Program 

(FY 2011: $1,715,562) 

In 1992, Congress directed AoA to develop demonstration projects specifically designed to help 

individuals with pension problems. These demonstrations were so successful that Congress 

established pension counseling as a permanent program under Title II of the OAA in 2000. 

Today, there are more than 700,000 private (as well as thousands of public) pension and 

retirement plans in the United States. Thousands of Americans reach retirement age each year, 

only to be told that they will not receive the pension benefits they expected. Because individuals 

have generally worked for several employers, which may have merged, sold their plans, or gone 

bankrupt, it is very difficult for most persons to know where to get help in finding out whether or 

not they are receiving all of the pension benefits to which they are entitled. 

Benefits from employer-sponsored pensions and retirement savings plans are as critical today to 

the retirement security of Americans as they were when the pension counseling program was 

first established. The pension questions which people face are just as complex, and good help is 

just as hard to find – even more so for those with only modest benefits at stake. The role of the 

Pension Counseling and Information Program is to help ensure that all older Americans have 

access to the help they need in order to secure the employer-sponsored retirement benefits they 

have earned --- benefits that are critical to their ability to live independently and with dignity 

after a lifetime of productive employment. The Pension Counseling & Information Program 

provides help that would be otherwise unavailable, by assisting individuals in understanding and 

exercising their pension rights. The program promotes the financial security of older individuals 

by offering them the help they need to receive the pension benefits they have earned. The 

income, in turn, provides increased opportunities for choice and independence. 

AoA currently funds six regional counseling projects covering 29 states and a technical 

assistance resource center to assist older Americans in accessing information about their 

retirement benefits and to help them negotiate with former employers or pension plans for due 

compensation. The projects help with cases that private pension professionals are reluctant to 

take, where the benefits in question are small, as is often the case with low-income workers and 

those with limited English proficiency, but to whom these modest amounts make a huge 

difference in maintaining their financial security and independence. 

Data for the program shows that since the Program’s inception in 1993, the Pension Counseling

projects have recovered over $130 million in retirement benefits for individual claimants. With a 

relatively small federal investment, the program has brought in a return of nearly $7.00 for every 

Federal dollar invested in the program. These recoveries demonstrate that pension counseling is 

not only necessary, but that it can be provided efficiently and effectively. For example, during a 

six-month reporting period in FY 2011, a single regional counseling project recovered nearly 

$1,200,000 in benefits (lump-sum benefits totaling $46,298 and monthly benefits with an 

estimated actuarial value of $1,098,672). 
38

The significance of the projects’ work is best demonstrated through discussion of a typical case 

successfully resolved during this period: 

A 72-year-old widow with an overpayment problem had a legitimate claim, but needed the project’s 

expertise, knowledge and diligence to file the overpayment waiver claim with the plan administrator 

and to negotiate with the plan’s attorney on her behalf. Her disability pension benefits should have 

stopped seven years earlier when her regular retirement began but, instead, through the corporation’s 

error, she was overpaid $16,723, and was now being told she owed the corporation this amount. 

Collection agency letters had been received, and her efforts to deal with the large corporation’s 

benefits center were fruitless, leaving her anxious and frightened that she might lose her home. Due 

to the complexity of the matter and the widow’s limited financial resources, it is extremely unlikely 

that she would have been able to pursue the case on her own or find a private attorney to assist her. 

Without the assistance of the project, she may have been forced to forfeit all, or nearly all, of her 

monthly lifetime retirement benefit. Instead, an agreement was reached to reduce the client’s 

pension by $25 per month to allow the corporation to partially recoup the overpaid amount. 

Even when Pension Counseling projects are unable to secure benefits for clients, the information 

and assistance the projects provide can bring peace of mind to vulnerable elderly individuals, 

often after months or even years of searching for answers. 

A critical component of the AoA Program is the National Pension Assistance Resource Center 

(the Center) which provides support to the counseling projects and facilitates coordination 

among the projects, SUAs, AAAs, legal services providers, and others by providing substantive 

legal training, technical assistance, and programmatic consultation. The Center also assists 

individuals in states not currently served by AoA’s pension counseling projects by providing 

nationwide referral and information services, both telephonically and through the PensionHelp 

America website, a nationwide database of pension assistance and information resources: 

http://www.PensionHelp.org. 

Senior Medicare Patrol Program 

(FY 2011: $9,420,000) 

The Senior Medicare Patrol (SMP) program provides competitive grants to 54 states and 

territories to support a national volunteer-based network of volunteers whose purpose is to 

educate older adults on preventing and identifying healthcare fraud and abuse. Projects use the 

skills of these volunteers to conduct community outreach and education and provide information 

that empowers Medicare beneficiaries and their families to prevent, identify and report fraud. 

Activities are carried out in partnership with the Centers for Medicare & Medicaid Services, the 

Office of Inspector General (OIG), healthcare providers, and other aging and elder rights 

professionals from around the country. 

Annually, the OIG gathers and analyzes the data housed in the SMARTFACTS data tracking 

system. This data is published as a report on the SMP program. This report for Calendar Year 

201162 shows that SMP projects: 

 

62 “Performance Data for the Senior Medicare Patrol Projects: June 2012 Performance Report”. OEI-02-12-00190. 

http://oig.hhs.gov/oei/reports/oei-02-12-00190.asp
39

Had 5,671 active volunteers who worked over 88,169 hours to educate beneficiaries about 

how to prevent Medicare and Medicaid fraud; 

Educated 431,128 beneficiaries in 11,109 group education sessions and held 66,303 oneon-one counseling sessions with or on behalf of beneficiaries; 

Conducted 8,800 community outreach education events; and 

Resolved 76,224 inquiries for information or assistance from beneficiaries. 

In addition, the report shows that since the program’s inception in 1997, SMP projects have:

Educated over 3.5 million beneficiaries in 94,077 group education sessions and held 

1,179,190 one-on-one counseling sessions; 

Conducted 83,862 community outreach education events; and 

Documented over $106 million in savings, including Medicare and Medicaid funds 

recovered, beneficiary savings, and other savings as directly attributable to the project as 

a result of beneficiary complaints. This does not attempt to quantify the total savings 

that occur as a result of SMP program’s sentinel effect, impact on fraud deterrence, or 

calls to fraud hotlines or other non-SMP contacts. 

The SMP program historically has been supported by approximately $3.3 million in Health Care 

Fraud and Abuse Control (HCFAC) funding authorized by the Health Insurance Portability and 

Accountability Act of 1996 (HIPAA) for infrastructure, technical assistance, and other SMP 

program support and capacity-building activities designed to enhance program effectiveness. 

Activities funded by HCFAC resources include support for project training and technical 

assistance provided by AoA’s National Consumer Technical Resource Center (Center). 

The important role of the SMP program continued to be recognized by partners in Medicare 

fraud prevention in the private and public sectors. In 2010, and again in 2011, the Centers for 

Medicare & Medicaid Services (CMS) provided funding for the award of an additional $9 

million in grants from its Program Integrity funding, administered by AoA, targeted to help the 

54 Senior Medicare Patrol (SMP) programs fight Medicare fraud in high fraud states and expand 

the capacity of the program to reach more beneficiaries. In FY 2012, SMP projects will receive 

an additional $7.3 million from HCFAC funds to maintain expanded efforts to fight Medicare 

fraud, with added focus on high-fraud states.

In November 2010, the Administration on Aging received a national level commendation for the 

SMP program from the National Health Care Anti-Fraud Association (NHCAA), considered the 

leading national organization focused exclusively on the fight against health care fraud. The 

NHCAA’s members comprise more than 100 private health insurers and those public sector law 

enforcement and regulatory agencies having jurisdiction over health care fraud committed 

against both private payers and public programs. The award, given annually by the NHCAA, 

recognizes an organization or individuals “who have done the most in the past year to raise 

public awareness about the problem of health care fraud in our nation’s health care system.” This 
40

organization’s decision to award the Senior Medicare Patrol program the NHCAA 2010 

Excellence in Public Awareness Award is a major achievement, and a notable acknowledgement 

of the value of the SMP program. 

Health Care Fraud and Abuse Control (HCFAC) 

(FY 2011: $3,312,000) 

The Administration on Aging has received Health Care Fraud and Abuse Control (HCFAC) 

funding since FY 1997, as authorized by the Health Insurance Portability and Accountability Act 

(HIPAA) of 1996 (P.L. 104-191), as a partner in the Department’s efforts to fight error, fraud 

and abuse in the Medicare and Medicaid programs. HCFAC funds provide Federal support -

infrastructure, technical assistance, program support and capacity building - to state Senior 

Medicare Patrol (SMP) programs. 

HCFAC funds allow AoA to maintain effective oversight of and partnerships with each of the 54 

SMP Projects. The National Consumer Protection Technical Resource Center (the Center), 

which provides training, technical assistance, support and information to SMP grantees, is 

supported by HCFAC funding. The Center has focused on: 

information and strategies to increase awareness of current scams and fraud schemes, 

such as wheelchair and scooter fraud; 

outreach strategies for educating minority and non-English-speaking individuals, 

information and training, including fraud awareness information; 

volunteer recruitment and training; 

education to rural, geographically isolated, and low literacy individuals, including tribal 

members; and 

partnership strategies to involve health care providers, family caregivers, and health care 

professionals. 

Approximately eight FTEs, supported with HCFAC funds, provide technical assistance and 

oversight in support of SMP projects. HCFAC funds also are used to provide ongoing technical 

support for the SMP management, tracking and reporting system. 
41

Long-Term Care Ombudsman Program 

(FY2011: $16,793,000) 

The Long-Term Care Ombudsman Program serves residents of long-term care facilities (nursing 

homes, board and care, assisted living and similar settings); and works to resolve resident 

problems related to poor care, violation of rights, and quality of life. Ombudsmen also advocate 

at the local, state and national levels to promote polices and consumer protections to improve 

residents’ care and quality of life. 

Each state has an Office of the State Long-Term Care Ombudsman, headed by a full-time State 

Long-Term Care Ombudsman who directs the program statewide. Thousands of local 

ombudsman staff and volunteers, designated by the State Ombudsman as representatives, assist 

residents and their families by resolving complaints and providing information related to longterm care. The Long-Term Care Ombudsman is the local problem-solver for individuals living in 

long-term care facilities an invaluable resource to residents, their families and facility staff. 

Section 712 of the Older Americans Act requires State Long Term Care Ombudsmen to: 

Identify, investigate and resolve complaints made by or on behalf of residents; 

Provide information to residents about long-term care services; 

Ensure that residents have regular and timely access to ombudsman services; 

Represent the interests of residents before governmental agencies and seek 

administrative, legal and other remedies to protect residents; and 

Analyze, comment on and recommend changes in laws and regulations pertaining to the 

health, safety, welfare and rights of residents. 

This report provides data for FY 2011 from the Long-Term Care Ombudsman Program 

nationwide, based on state and local level activities. The data and other information presented 

and analyzed in this report are collected annually by AoA from State Long-Term Care 

Ombudsmen through the National Ombudsman Reporting System (NORS). 

Complaint Investigation and Resolution 

Long-Term Care Ombudsmen provide an alternative dispute resolution service, resolving 

complaints for or on behalf of long-term care facility residents. 

 Ombudsmen nationwide completed resolution work on 204,044 complaints. 

 Ombudsmen resolved or partially resolved 73 percent of these complaints to the 

satisfaction of the resident or complainant. 

 Of the 132,325 cases closed by ombudsmen,63 99,305 (75 percent) were associated with 

 
42

Ombudsman Program in Action: Case Example

The ombudsman received a call from a nursing home resident. He said his brother had placed him 

in the nursing home after a hospitalization. The brother took his wallet and credit cards, would not 

let him go home and would not put any money in his account at the nursing home. Previously, the 

resident had given his brother Power of Attorney (PoA) for Health Care and now the brother was 

not relinquishing his responsibilities after the resident recovered. 

The ombudsman suggested a Care Plan transition meeting so nursing home staff and family 

members could begin planning for his return to the community. All agreed except the resident’s 

brother who stated that the resident would have to hire an attorney to rescind the POA. The brother 

felt he had the right to make decisions and he felt the resident needed to stay in the nursing home 

even though nursing home medical staff said he had recuperated sufficiently and could go home. 

The ombudsman and facility staff supported the right of the resident to return home. The resident 

hired an attorney who assisted the resident in rescinding the Power of Attorney. The brother 

returned the wallet and credit cards and the resident went home the next day.

nursing facility settings. Of the remaining cases, 30,796 (23 percent) were related to board 

and care and other similar facilities (including assisted living); and 2224 (two percent) 

were associated with non-facility settings or services to facility residents by an outside 

provider. 

 Most cases were initiated by residents or friends and relatives of residents, with the 

residents themselves initiating 40 percent of cases in nursing facilities and 31 percent in 

board and care and other similar facilities (including assisted living). 

 Ombudsmen proactively identified issues in nearly 13 percent of cases in all settings. 

 The five most frequent nursing facility complaints in 2011 were: 

improper eviction or inadequate discharge/planning; 

unanswered requests for assistance; 

lack of respect for residents, poor staff attitudes; 

medications – their administration and organization; and 

accident or injury of unknown origin, falls, improper handling

 The five most frequent board and care and similar facilities complaints were:

quality, quantity, variation and choice of food; 

medications – administration and organization; 

inadequate or no discharge/eviction notice or planning; 

 equipment or building hazards; and 

 lack of respect for residents, poor staff attitudes. 

 

63 In FY 2011, ombudsmen opened 134,775 new cases (a case contains one or more complaints originating from 

the same person(s), and completed resolution work on 132,325 closed cases, containing 204,044 complaints. 
43

Ombudsman Program in Action:

Protecting Residents’ Rights

The State Ombudsman Program 

reported involvement in many 

facility foreclosures and 

bankruptcies involving both large 

facilities and small group homes 

(classified as Board & Care)

In one particular case an owner of a 

large group home licensed for 129 

beds declared bankruptcy. The 

ombudsman was called in to 

investigate a complaint regarding 

resident trust accounts, it was 

discovered that many of these trust 

accounts had little to no balance. 

The residents involved had not been 

receiving their monthly personal 

needs allowance nor were they able 

to draw money out for personal 

needs. The LTC Ombudsman 

Program made a referral to the 

Attorney General’s Office / 

Medicaid Fraud Control Unit which

initiated a full investigation.

With the assistance of the LTC 

Ombudsman Program resident funds 

were re-deposited and access to 

accounts were granted to the 

involved residents. Further 

investigation revealed the owner 

was co-mingling operating funds 

and trust account funds. 

Ombudsman staff and volunteers provided a regular 

presence to facility residents, visiting residents of 70 

percent of nursing facilities and 33 percent of board and 

care and similar homes (including assisted living) at 

least quarterly. 

 Ombudsmen provided 289,668 

consultations to individuals in 2011. 

Consultations most frequently addressed such 

topics as alternatives to institutional care, how to 

select and pay for a long-term care facility, 

residents’ rights, and federal and state rules and 

policies impacting residents. 

 Ombudsmen provided 115,798

consultations to long-term care facility staff in 

FY 2011 on a wide range of issues, including 

residents’ rights, observations about care, 

working with resident behavioral issues, and 

transfer and discharge issues. 

 In FY 2011, ombudsmen nationwide: 

Provided information to resident councils 

(20,958 sessions) and family councils (3,321 

sessions); 

Trained long-term care facility staff (5,144 

sessions); 

Educated the community (12,456 sessions); and 

Served as resident advocates and provided 

information to surveyors as part of long-term 

care facility surveys conducted by regulatory 

agencies (participating in 22,640 survey 

related activities). 

 A vital long-term care ombudsman function is 

systemic advocacy: analyzing, commenting on 

and recommending changes in laws, regulations, and government policies and actions to 

benefit long-term care residents. 
44

Examples of Systems Issues Identified & Addressed by LTC Ombudsmen in 2011 

A vital long-term care ombudsman function is systemic advocacy: analyzing, commenting on 

and recommending changes in laws, regulations, and government policies and actions to benefit 

long-term care residents. The following are a few examples of long-term care ombudsman 

systems advocacy efforts: 

 Long-Term Care Ombudsmen are frequently appointed as Patient Care Ombudsmen 

under the Federal Bankruptcy Abuse Prevention and Consumer Protection Act of 2005. 

LTC Ombudsmen monitor facility activities to ensure that residents receive their required 

goods and services and report regularly to the Bankruptcy Court. 

 Promoting community living options and assisting nursing home residents, who wish to 

return to the community to access programs, such as Money Follows the Person. 

 Recommending laws and government actions to prevent and improve responses of abuse, 

neglect and financial exploitation of vulnerable adults, including the elders. 

 Working to improve facility standards in board and care settings. 

 Training of facility staff on strategies to reduce anti-psychotics in nursing homes. 

Providing Ombudsman Services 

There are 53 state ombudsmen (50 states, plus the District of Columbia, Puerto Rico, and Guam). 

In most states, the office of the State Long-Term Care Ombudsman is housed within the state 

unit on aging or another state agency. In others, the office is housed in a private non-profit 

agency. Most states have contracts with or through area agencies on aging to provide direct 

ombudsman services to residents locally. There are 576 designated local entities across the 

nation. 

In FY 2011, long-term care ombudsman services to residents were provided by 1,185 full-time 

equivalent staff and 9065 volunteers, trained and certified to investigate and resolve complaints. 

An additional 3,320 volunteers also served residents or assisted in program operations in ways 

other than complaint resolution. 

Long-Term Care Ombudsmen: Partners in Abuse Prevention: 

Partnership with Resident Councils - Residents often fear raising concerns and reporting 

abuse, neglect and exploitation out of fear of retaliation. One program worked with a 

statewide association of resident councils to develop a training video: “Voices Speak Out 

against Retaliation.” This video gives residents an opportunity to tell their story, including 

examples of mistreatment and steps taken to resolve their harm. It is now a training tool for 

facility staff, resident and family councils and ombudsmen. 
45

 Ombudsman Program in Action: 

 Advocating for Quality Care 

Nursing Home Initiatives – Reducing the Use of Inappropriate Medications:

Ending overmedication of nursing home residents and halting the misuse of antipsychotic 

drugs as chemical restraints are issues and concerns that have garnered national and state 

attention. Inappropriately prescribed antipsychotic drugs, when prescribed for elders with 

dementia, can have serious medical complications, including death, loss of independence, 

over-sedation, confusion, and falls. 

Twenty-six percent of all nursing home residents are on antipsychotic medications. Use is 

substantially higher (40 percent) among those with cognitive impairments and behavioral 

symptoms. The Food and Drug Administration has issued “Black Box” warnings that 

antipsychotics greatly increase the risk of death in persons with dementia. 

 Three local Long-Term Care Ombudsman Programs and a statewide citizen’s advocacy 

organization hosted approximately 1,000 people working in long-term care (LTC) at three, full 

day symposia on the topic of Dementia without Drugs. Local Ombudsman Programs in these 

counties each hosted their own event. Speakers presented on different aspects of the overuse 

of psychotropic medication for the treatment of dementia care. Issues discussed included the 

liabilities of prescribing psychotropic medications without the consent of the resident, the 

dangers of prescribing drugs for off label usage, and the importance of the licensing agency 

ensuring that facilities are obtaining informed consent from residents or their legal 

representatives. 

Program Funding 

 Total FY 2011 funding from all sources for the Ombudsman Program nationwide was 

$87,261,158, an overall decrease of $579,066 (less than one percent) from the FY 2010 

level. 

 The federal government is the primary entity funding the Ombudsman Program, providing 

58 percent of total funding in FY 2011. States provided 36 percent of funds, and other 

non-federal sources funded the remaining six percent. Figure 3 shows the percentage of 

total program funding by source. 
46

2011 Long-Term Care Ombudsman Programs - Sources of funding 

Where Long-Term Care Facility Residents Live 

Increasingly, long-term care residents live in residential settings other than nursing homes, 

including board and care homes and assisted living (known by various names under state laws). 

While the number of beds and facilities in nursing homes are relatively stagnant, the growth of 

beds in these other residential settings is steadily increasing. Federal policy continues to 

accelerate the growth of home and community-based long-term care services. In many states, 

Medicaid funding provides services in these non-nursing home residential settings as part of the 

“home and community-based services” array. 

 In the five years between 2007 and 2011, the number of board and care and similar facilities 

(including assisted living) increased by 8 percent to 52,903, while the number of nursing 

facilities decreased by nearly 1 percent from 16,746 in 2007 to 16,605 in 2011. 
47

 National Long-Term Care Ombudsman Resource Center Activities: 

In order to effectively advocate for residents, ombudsmen must remain up-to-date on the latest 

long-term care developments. Therefore, AoA supports the National Ombudsman Resource 

Center (NORC), which provides training, technical assistance, and program management 

expertise to state and local ombudsmen. In FY 2010, the NORC was operated by the National 

Consumer Voice for Quality Long-Term Care (formerly NCCNHR), in conjunction with the 

National Association of States United for Aging and Disabilities (NASUAD). 

In FY 2011, NORC provided ombudsmen with training from national experts on such issues as: 

Volunteer management training and technical assistance; 

Training on the National Ombudsman Reporting System (NORS) data coding and 

collection; 

Long-Term Services, Supports and Housing: Choices and Advocacy 

Resident transitions from nursing homes to other settings, including through 

implementation of federal initiatives such as: 

 MDS 3.0, Section Q – a new version of the Minimum Data Set (MDS) 

resident assessment tool used by Medicare and/or Medicaid-certified 

nursing facilities and implemented in FY 2010 by the Centers for 

Medicare & Medicaid Services (CMS). Section Q of the MDS instructs 

nursing facilities to ask all residents if they would like information 

regarding returning to the community and to link residents to local contact 

agencies for further information; and 

 Money Follows the Person – a demonstration project to assist individuals 

receiving Medicaid to move out of nursing homes and into other settings 

to receive long-term services and supports. 

Culture Change and Person-Centered Care.

The NORC provided access to quarterly orientation training activities for all new state 

ombudsmen and developed resource materials, the NORC website (www.ltcombudsman.org), 

and monthly newsletters, customized for long-term care ombudsman staff and volunteers. 
48

Program Results and Challenges

Value of Volunteers – Over $16 million was donated in FY 2011:64 Volunteers designated to act 

on behalf of the State Long-Term Care Ombudsman add an invaluable service which benefits 

residents, their families and facility staff. Volunteers across the county donated their time to 

visit residents, listen to their concerns and take action. For some residents the ombudsman may 

be their only visitor. Volunteer Ombudsmen frequently provide the routine ombudsman 

presence in many facilities and provide cost-effective complaint resolution. The Independent 

Sector places the value of the volunteer time at $21.79 per hour placing the value of 737,289 

hours at $16,065,527. 

Ombudsmen solve problems at the facility level -- Long-term care ombudsman programs 

resolve hundreds of thousands of complaints every year on behalf of long-term care facility 

residents. The largest group that requested ombudsman assistance in resolving complaints were 

residents themselves, indicating that residents depend on ombudsmen to help them resolve their 

concerns. By resolving the vast majority of these complaints to the satisfaction of the resident or 

complainant, the work of ombudsmen improved the quality of life and quality of care for many 

residents of our nation’s long-term care facilities. 

Home and community-based services are increasing demands for ombudsman services --

Originally created a service for nursing facility residents in 1978, providing a regular presence 

for nursing home residents continued to be a priority for ombudsman programs. Since the 

program authority expanded to other types of long-term care facilities in 1981, and as the number 

of residents in these settings has been rapidly increasing since that time, ombudsman programs 

are challenged to also serve individuals living in board and care and other similar facilities. 

Long-Term Care Ombudsman Programs are credible sources of information --

Ombudsman programs served as a credible source of information for residents (including 

through resident councils), their families (including through family councils), and facility staff. 

Based on their extensive experience resolving resident problems, ombudsmen represented 

resident interests to policymakers, influencing public policy related to long-term care. 

Ombudsman programs leverage federal dollars -- Federal funds leveraged resources from 

other sources for ombudsman programs. 42 percent of program funds came from non-federal 

sources during FY 2011. 

 

64 The Independent Sector places the value of volunteer time at $21.79 per hour placing the estimated value of 

$735,411 hours at $16,024,605. http://independentsector.org/volunteer_time . 
49

PART IV: SUPPORTING THE NATIONAL 

AGING SERVICES NETWORK

Older Americans and Americans with disabilities face a vast array of choices when trying to 

determine the right services and supports to assist them to remain active and independent in their 

communities. As the number of choices available to assist them grows, so too does the 

complexity of navigating these programs and selecting among them so as to determine which 

best suit the needs of each individual. 

A key part of AoA’s emphasis on community living is providing consumers with the information 

they need to make decisions about their independence and connecting them with the right 

services. Aging and Disability Resource Centers (ADRCs) help to address this need by providing 

information, outreach, and assistance to seniors and people with disabilities so that they can 

access the services necessary for their independence. ADRCs serve as community-level “one 

stop shop” entry points into long-term care - including home and community-based services that 

can enable people to remain in their homes - for people of all ages who have chronic conditions 

and disabilities. 

Aging and Disability Resource Centers 

Aging and Disability Resource Centers (ADRCs) support state efforts to develop more efficient, 

cost-effective, and consumer-responsive systems of information and integrated access by 

creating “one-stop shop” entry points into long-term care at the community-level. ADRCs help 

states make better use of taxpayer dollars by streamlining access to community services and 

supports and diverting individuals from more costly forms of care, including institutional care 

and unnecessary hospital re-admissions. 

ADRCs are a key component in transforming states’ long-term supports and services programs. 

Since 2003, the Administration on Aging and the Centers for Medicare & Medicaid Services 

(CMS) have provided grants to states to develop the foundational infrastructure for delivering 

person-centered systems of information, one-on-one counseling, and access that make it easier 

for individuals to learn about and access their health and long-term services and support options. 

ADRCs grew out of best practice innovations known as “No Wrong Door”65 and “Single Points 

of Entry” programs, where people of all ages may turn for objective information on their longterm services and support options. ADRCs provide services including: 

“one-on-one” options counseling and advice to help consumers, including private pay 

individuals, and their caregivers fully understand the options available to them. 

streamlined access to all publicly supported long-term care services and support 

programs; 

 

65 In a “No Wrong Door” entry system, multiple agencies retain responsibility for their respective services while 

coordinating with each other to integrate access to those services through a single, standardized entry process that is 

administered and overseen by a coordinating entity (Allison Armor-Garb, Point of Entry Systems for Long-Term Care: 

State Case Studies, prepared for the New York City Department of Aging, 2004).
50

targeted discharge planning, care transition and diversion support that integrates the 

medical and social service systems on behalf of older adults and individuals with 

disabilities to help them remain in their own homes and communities after a 

hospitalization, rehabilitation or skilled nursing facility visit; 

outreach and assistance to Medicare beneficiaries on their Medicare benefits including 

prevention and low-income subsidies; and

integrated options counseling and access-point to care transition and diversion support for 

veterans served through the ACL/Department of Veterans Affairs (VA) Veteran-Directed 

Home and Community Based Services Program partnership. 

AoA and CMS have invested over $100 million in the ADRC program since 2003. As a result of 

these investments: 

More than 467 ADRC sites have been established across 51 states, territories, and 

Washington, DC, by increasing the coordination and capacity of existing infrastructure in 

the aging, disability and Medicaid networks. Together these ADRC sites can reach 

roughly 69 percent of the U.S. population. 

Twenty-seven states and territories have achieved statewide coverage, and an additional 

13 states have achieved 50 percent or more of statewide coverage. 

Thirty-eight states with ADRC programs sites currently conduct care transitions through 

formal intervention with an additional 10 states currently planning to conduct activities 

also through formal interventions 

Thirty-seven states have developed statewide web-based directories available to 

consumers and service providers which improve the quality and consistency of the aging 

services network information and assistance provided across the state. 

Effective high performance ADRC Options Counseling Programs perform the following five key 

operational functions: 

 

Access Points of Referral to Option Counseling: ADRCs include numerous participating 

agencies which serve as local access points to refer individuals to their local ADRC 

Options Counseling Program. ADRCs serve as a highly visible and trusted source of 

objective information and assistance where people of all ages, disabilities, income levels 

and cultural backgrounds know they can turn to help in accessing the full range of longterm service and support options available in their communities. These referral 

partnerships should involve a wide array of local agencies and organizations within 

states’ systems, including all agencies providing services to older adults and individuals 

with disabilities across the lifespan. An ADRC system should also ensure that individuals 

can access the system virtually or in person and receive the same set of information from 

any location within the state and have the knowledge to refer individuals to One-on-One 

Options Counseling. 
51

One-on-One Options Counseling: ADRCs provide options counseling to all persons and 

their respective family caregivers making long term support decisions regardless of their 

income or financial assets. This includes individuals who can pay for supports, but can 

also be targeted across various settings and/or populations. Options Counseling is a 

seamless approach to helping individuals and their families to identify and understand 

their needs and assist them in making informed decisions about appropriate long-term 

service and support choices, with the goal of meeting individuals at the moment when 

they seek out services, including before they need them. Options Counseling includes the 

key components of (1) a personal interview, (2) a facilitated decision-support process 

and (3) development of a service plan which connects people to the supports they need: 

 

Streamline Access to Public Programs: ADRCs serve as the front door for publiclyfunded long-term services and supports through a standardized process by which all 

individuals enroll, including those funded by Medicaid, the OAA, and other state and 

federal programs and services. ADRCs must have the necessary protocols and 

procedures in place to facilitate an integrated and fully coordinated approach to 

performing the administrative functions for home and community-based and institutionalbased publicly funded programs. The goal is to create a process that is seamless for 

consumers regardless of which service they choose. This should include assisting and/or 

completing the comprehensive assessment, helping individuals in completing and 

submitting all required information and documentation, determining eligibility for 

programs and services, and ensuring that people receive the services need and want, and 

for which they are eligible. 

Person-Centered Transition Support: ADRCs create formal linkages between and among 

the major pathways that people travel while transitioning from one service setting to 

another (e.g. hospital, nursing home, community, etc.), or from one public program payer 

to another. These linkages ensure that people, including those with chronic conditions 

and disabilities, have the information they need to make informed decisions about their 

service and support options as they pass through critical transition points in the health and 

long-term services and support systems that cut across all payers and settings. These 

critical activities help individuals break the cycle of readmission to the hospital, avoid 

unnecessary admission to a nursing home or other institution, and live longer in the 

community with enhanced quality of life. 

Quality Assurance: ADRCs must ensure they adhere to the highest standard of service in 

all areas. ADRCs should continually monitor the quality of their services and evaluate 

their impact on consumers’ lives, system efficiencies and public and private investments. 

ADRCs will also continue, with Department of Veterans Affairs (VA) funding, to serve clients 

under the current ACL/VA partnership. In FY 2008, the VA and AoA began working together to 

develop the Veterans Directed Home and Community Based Services Program (VD-HCBS), 

which is designed to serve veterans of any age who are at risk of admission to a nursing home by 

providing them the opportunity to self-direct their care and access services to help them remain 

in the community. Rather than build a separate infrastructure to serve veterans, the VA made a 

strategic decision to use the aging network infrastructure – including using the ADRC as the 

integrated access point to empower the veterans to set-up their own service plan for long-term 
52

supports and services – as a delivery vehicle for VD-HCBS. Since inception of the program the 

VA has invested $40.8 million to help expand this program nationwide. HHS and the VA have 

worked together to develop program guidelines/national standards, web-based tools to track 

program activities and implemented a national training program for the VD-HCBS. Currently, 

19 states and the District of Columbia are operating VD-HCBS programs with 33 operational 

VAMCs, 82 operational AAA/ADRCs and over 775 veterans served (132 or 17 percent under 

age 60). 

Aging Network Support Program Activities 

(FY 2011: $8,184,000) 

Aging Network Support Activities provide competitive grants and contracts to support ongoing 

activities of national significance which help seniors and their families to obtain information about 

their care options and benefits, and which provide technical assistance to help states, tribes, and 

community providers of aging services to develop service systems that help older people remain 

independent and able to live in their own homes and communities. These activities provide critical 

and ongoing support for the national aging services network and help support the activities of AoA’s 

core service delivery programs. 

Competitive grants, cooperative agreements, and contracts for Aging Network Support Activities are 

awarded to eligible public or private agencies and organizations, states and area agencies on aging 

(AAAs), institutions of higher learning, and other organizations representing and/or serving older 

people, including faith-based organizations. Grantees are required to provide a match equal to 

25 percent of the project’s total cost. Project proposals are reviewed by external experts, and project 

awards are made for periods of one to four years. In FY 2011, Aging Network Support Activities 

funded 24 grants with an average award of $279,465. 

National Eldercare Locator 

Older Americans and their caregivers face a complicated array of choices and decisions about 

health care, pensions, insurance, housing, financial management, and long-term care. The 

Eldercare Locator, created in 1991, helps seniors and their families navigate this complex 

environment by connecting those needing assistance with state and local agencies on aging that 

serve older adults and their caregivers. The Eldercare Locator can be accessed through a toll-free 

nationwide telephone line (800-677-1116) or website (http://www.eldercare.gov). The phone line 

and website both connect those in need to providers in every zip code in the nation. The 

Eldercare Locator website continues to grow as a resource tool for older adults and their 

caregivers, serving over 525,000 individuals a year. 

National Alzheimer’s Call Center

The National Alzheimer’s Call Center is a national information and counseling service for 

persons with Alzheimer’s disease, their family members, and informal caregivers. In the 

12-month period ending January 31, 2012, the National Alzheimer’s Call Center handled over 

257,000 calls through its national and local partners, and its on-line message board community 

recorded over 12 million page views and over 110,000 individual postings. The National 

Alzheimer’s Call Center is available to people in all states, 24 hours a day, 7 days a week, 

365 days a year to provide expert advice, care consultation, and information and referrals at the 

national and local levels regarding Alzheimer’s disease. Trained professional customer service 

staff and masters degree social workers are available at all times. The Call Center is accessible 
53

by telephone, website or e-mail at no cost to the caller. Services focus on consumers, not 

professionals. Information provided may include basic information on caregiving; handling legal 

issues; resources for long-distance caregiving; and tips for working with the medical 

community. Local community-based organizations are directly involved to ensure local, on-theground capacity to respond to emergencies and on-going needs of Alzheimer’s patients, their 

families, and informal caregivers. The Call Center has multilingual capacity and responds to 

inquiries in at least 140 languages through its own bilingual staff and with the use of a language 

interpretation service.

National Education and Resource Center on Women and Retirement Planning 

The National Education and Resource Center on Women and Retirement Planning, established in 

1998, provides women with access to a one-stop gateway that integrates financial information 

and resources on retirement, health, and planning for long-term care. This project has made userfriendly financial education and retirement planning tools available to traditionally hard-to-reach 

women, including low-income women, women of color, women with limited English speaking 

proficiency, rural, and other “underserved” women. Information is offered through financial and 

retirement planning programs, workshops tailored to meet women’s special needs, and 

publications in hard copy and web-based formats. Since its establishment, the Center has 

conducted more than 20,000 workshops on strategies to access financial and retirement planning 

information for women and disseminated financial and retirement planning information tailored 

to the specific needs of hard-to-reach women. 

National Resource Centers on Native American Elders 

The National Resource Centers on Native American Elders enhance knowledge about older 

Native Americans and thereby increase and improve the delivery of services to them. Each 

Resource Center addresses at least two areas of primary concern which are specified in the OAA. 

These include health issues, long-term care (including in-home care), elder abuse, mental health, 

and other problems and issues facing Native communities. The Resource Centers are 

administered under cooperative agreements by institutions of higher education. The Resource 

Centers partner with Native American organizations and communities, educational institutions 

including Tribal Colleges and Universities, and professionals and paraprofessionals in the field. 

Resource centers have specialized areas of interest. The University of North Dakota Resource 

Center has assisted Title VI grantees in assessing needs of tribal elders to determine program 

planning and direction. This process has developed a database of information about American 

Indian, Alaska Native and Native Hawaiian Elders. The University of Hawaii Resource Center 

has focused on long term care needs of Native Hawaiian Elders. The University of Alaska 

Resource Center has focused on elder abuse and neglect issues within Native communities.

National Minority Aging Organizations Technical Assistance Centers 

The National Minority Aging Organizations (NMAO) Technical Assistance Centers Program 

works to reduce or eliminate health disparities among racial and ethnic minority older 

individuals. These Centers design and disseminate front line health promotion and disease 

prevention information that is culturally and linguistically appropriate for older individuals of 

African American, Hispanic, Asian American and Pacific Islander descent, and American Indian 

and Alaska Native elders. For example, the Center for American Indian and Alaska Native 

elders is developing a culturally appropriate caregiver manual/toolkit for caregivers caring for 

elders with dementia. Each NMAO project pilots a practical, nontraditional, community-based 

intervention for reaching older individuals who experience barriers to accessing home and 
54

community-based services. Interventions are focusing on barriers due to language and low 

literacy as well as those directly related to cultural diversity. Strategies developed under this 

program incorporate the latest technology and facilitate the generation and dissemination of 

knowledge in forms that can assist racial and ethnic minority older individuals to practice 

positive health behaviors and strengthen their capacity to maintain active, independent life styles. 

Examples of products resulting from these grants include a chronic disease self management 

curricula and manual tailored for racial and ethnic minority seniors, a series of bilingual 

Influenza Vaccination Promotion materials, and a referral database of Chronic Disease SelfManagement (CDSMP) workshops. 

National Technical Assistance Resource Center for LGBT Elders 

Older lesbian, gay, bisexual and transgender (LGBT) adults face a number of unique challenges 

as they strive to maintain their independence. The Resource Center was established in 2010 to 

meet three primary objectives: educate mainstream aging services organizations about the 

existence and special needs of LGBT elders; sensitize LGBT organizations about the existence 

and special needs of older adults; and educate LGBT individuals about the importance of 

planning ahead for future long-term care needs. The national Resource Center formally began 

services in September 2010 with the launching of a website. The website includes sections 

directed towards each of the three target populations as well as a general resources section with 

resources on a variety of topics of interest. In addition, training curricula were developed for 

both mainstream aging and LGBT organizations to provide them with the knowledge they need 

to effectively serve these populations. 

Multigenerational Civic Engagement 

The Multi-Generational Civic Engagement (MGCE) initiative enhances discovery, 

documentation and support for existing, exceptional locally-developed program models and 

volunteer engagement strategies. Eighteen model programs launched in FY 2011 engage older 

adults in civic engagement projects aimed at increasing services to frail elders, families of 

children with special needs, and grandparents raising grandchildren. These model programs also 

partner with the Corporation for National and Community Service. 

Program Performance and Technical Assistance 

This activity supports cooperative efforts between AoA and selected states and AAAs to develop 

and test various performance measurement instruments that can be used to effectively and 

efficiently identify the results produced through OAA programs on an ongoing basis. It also 

supports partnerships with national aging organizations to foster innovation and provide 

technical assistance to states, AAAs, and tribal organizations in strategic planning, program 

assessment, and performance measurement. 
55

PART V: PROGRAM INNOVATIONS 

(FY 2011: $19,068,000) 

Program Innovations grants provide a source of funding to use as a catalyst for tapping new 

approaches, translating cutting-edge research and evaluation results into practice, and 

demonstrating techniques and best practices that can be replicated across the states and 

communities in the network to strengthen core OAA programs. It also provides funds to address 

key AoA priorities to help seniors stay healthy, active, independent, and living in their own 

homes and communities. 

Generally, these innovations are modeled after best practices developed within the aging services 

network that need further support, modeling, and evaluation before widespread replication and 

adoption. This effort, for instance, provided the seed money for developing Aging and Disability 

Resource Centers and Evidence-Based Disease Prevention projects that are now successfully 

implemented across the nation. 

Program Innovation grants also provide a vehicle for the exploration of emerging opportunities 

or risks facing seniors and caregivers where the aging services network has limited expertise. In 

these cases, universities, consumer-focused organizations, and other entities may be brought 

collaboratively into the aging network as technical assistance partners to assist with these 

emerging challenges. 

Community Innovations for Aging in Place 

The intent of the Community Innovations for Aging in Place (CIAIP) program is to assist 

communities in their efforts to enable older adults to sustain their independence and age in place 

in their homes and communities. In 2009, Congress directed the Assistant Secretary for Aging to 

award three-year grants, on a competitive basis, to develop and carry out model aging in place 

projects. Entities eligible to submit applications included community-based non-profit 

organizations, area agencies on aging, local government agencies, as well as tribal and other 

appropriate organizations. Successful applications promoted older individuals sustaining their 

independence and aging in their community with a targeted audience that included individuals 

residing in Naturally Occurring Retirement Communities (NORCs). Congress directed that the 

proposed innovative projects under the CIAIP initiative include a needs assessment, which 

examines the needs of older individuals, as well as the service strengths and gaps within the 

community. 

In FY 2009, the Assistant Secretary for Aging funded fourteen organizations representing 

diverse communities from across the country to implement innovative initiatives in support of 

older individuals aging within their communities. Funding for an additional grant to provide 

training and technical assistance to the grantees is also part of the program. 

Many of the CIAIP grantees share characteristics that contribute to their promise for success and 

sustainability including: 
56

Strong leadership and support from the parent agency;

Experienced and highly committed program staff; 

Shared leadership and staff vision and capability to articulate it; 

Organizational coherence and effectiveness; 

A positive relationship with and reputation within the community; 

High aptitude for identifying and engaging appropriate program partners;

Pre-existing relationships with a wide array of stakeholders, including those outside the 

aging network; 

Engagement of community leaders, and 

Ability to adapt as programmatic opportunities or barriers present themselves. 

All of the CIAIP grantees have developed and are implementing unique aging in place initiatives 

tailored to their own community. Common themes, strategies, and benefits continue to emerge 

across the funded programs including: 

Capacity Building The CIAIP program is providing both an impetus and framework for 

strengthening a community’s ability to provide the services and supports necessary to allow 

older individuals the opportunity to age in place. The programmatic partnerships assist 

communities in leveraging existing community resources and decreasing potential and existing 

service redundancies. Many grantees are also exploring opportunities to enhance community 

infrastructure in support of aging in place. 

Forging New Partnerships CIAIP grantees are reaching beyond the aging network and 

engaging with non-traditional organizations to support older adults’ aging in their communities. 

The partnership strategy underscores the message that aging is a community-wide issue and 

provides an opportunity for these disparate sectors to work together to create a common 

community agenda. Non-traditional community partnerships that support aging in place include 

local disability networks, affordable housing providers, faith-based organizations, tribal 

organizations, community planning departments, transportation networks, health care providers, 

public and affordable housing providers and others. 

Tapping Social Capital Grantees are mobilizing community members to identify and make use 

of the skills of volunteers of all ages. Contributions of time and expertise support the effort to 

develop a viable network for older individuals remaining in their homes and communities. 

Providing Leadership Participation in the CIAIP program is allowing area agencies on aging 

and others within the aging network to assume new community leadership roles. 

Developing a Community of Practice With the support of the technical assistance provider, 

grantees are cross-fertilizing experiences and ideas that are leading to joint problem-solving and 

innovative approaches to addressing common issues. In addition to learning about best and 

evidence-based practices, grantees are sharing information about financial and programmatic 

resources, as well as experiencing the value of technical assistance in a variety of areas, 

including business plan development. 

As the grantees wrap up the final year of funding in FY 2011, they are focusing a portion of their 

efforts on program sustainability. In addition to providing continued support in the communities 

they serve, grantees, with the assistance of the technical assistance team, are identifying and 

applying for public and private funding in an effort to sustain their activities once federal funds 

are exhausted. Extensive program evaluations are also taking place, as grantees strive to 

understand better the impact of the work that has occurred over the life of the program. The 
57

grantees and their partners have implemented a variety of programs with varied levels of success 

and deriving valuable lessons throughout the project period. The lessons learned compiled 

through CIAIP program activities, relative to successes and struggles, will inform the work of 

future innovators committed to assisting individuals in remaining in their homes and 

communities. In addition to the evaluative activities in which the grantees are engaged, they are 

also collecting and analyzing valuable data relative to the efforts to support older individuals 

remaining in their homes. 
58

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59

Appendix 

Formula Grant Funding 

Allocation by 

State, Territory and 

Tribal Organization 

U.S. Administration on Aging 

Department of Health and Human Services
60

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61
62

State/Territory

Supportive 

Services

Congregate 

Meals

Home 

Meals

Preventive 

Services NFCSP Total Title III

Alabama $5,610,623 $6,728,841 $3,380,743 $332,502 $2,386,588 $18,439,297 

Alaska $1,827,011 $2,186,289 $1,079,676 $104,920 $764,933 $5,962,829 

Arizona $7,448,464 $8,932,970 $4,488,153 $404,463 $3,227,992 $24,502,042 

Arkansas $3,543,506 $4,249,740 $2,135,178 $211,162 $1,518,422 $11,658,008 

California $36,232,873 $43,454,221 $21,832,514 $2,127,762 $15,356,773 $119,004,143 

Colorado $4,862,516 $5,831,634 $2,929,963 $255,659 $1,902,436 $15,782,208 

Connecticut $4,404,337 $5,241,452 $2,533,609 $260,652 $1,821,050 $14,261,100 

Delaware $1,827,011 $2,186,289 $1,079,676 $104,920 $764,933 $5,962,829 

District of Columbia $1,827,011 $2,186,289 $1,079,676 $104,920 $764,933 $5,962,829 

Florida $26,238,773 $31,468,259 $15,810,460 $1,554,456 $12,255,674 $87,327,622 

Georgia $9,194,575 $11,027,088 $5,540,292 $486,684 $3,567,093 $29,815,732 

Hawaii $1,827,011 $2,186,289 $1,079,676 $104,920 $764,933 $5,962,829 

Idaho $1,827,011 $2,186,289 $1,079,676 $104,920 $764,933 $5,962,829 

Illinois $14,524,890 $17,286,541 $8,295,464 $839,479 $5,908,033 $46,854,407 

Indiana $7,165,491 $8,593,601 $4,317,645 $426,268 $3,059,403 $23,562,408 

Iowa $4,260,878 $5,081,501 $2,243,404 $231,787 $1,707,953 $13,525,523 

Kansas $3,432,908 $4,089,903 $1,895,162 $191,313 $1,392,604 $11,001,890 

Kentucky $4,989,594 $5,984,038 $3,006,534 $291,748 $2,069,945 $16,341,859 

Louisiana $4,838,530 $5,802,867 $2,915,509 $295,110 $2,025,081 $15,877,097 

Maine $1,827,011 $2,186,289 $1,079,676 $105,122 $764,933 $5,963,031 

Maryland $6,149,883 $7,375,577 $3,705,679 $360,430 $2,509,470 $20,101,039 

Massachusetts $8,209,095 $9,780,267 $4,663,308 $464,535 $3,356,283 $26,473,488 

Michigan $11,646,647 $13,967,867 $7,017,815 $692,606 $4,908,737 $38,233,672 

Minnesota $5,783,935 $6,936,695 $3,485,174 $338,416 $2,496,717 $19,040,937 

Mississippi $3,272,711 $3,897,686 $1,958,298 $195,859 $1,387,772 $10,712,326 

Missouri $7,118,429 $8,467,047 $4,251,524 $422,405 $3,040,466 $23,299,871 

Montana $1,827,011 $2,186,289 $1,079,676 $104,920 $764,933 $5,962,829 

Nebraska $2,294,938 $2,738,802 $1,227,879 $124,650 $919,551 $7,305,820 

Nevada $2,755,306 $3,304,449 $1,660,240 $151,459 $1,066,391 $8,937,845 

New Hampshire $1,827,011 $2,186,289 $1,079,676 $104,920 $764,933 $5,962,829 

New Jersey $10,262,972 $12,190,488 $6,073,137 $619,704 $4,364,136 $33,510,437 

New Mexico $2,237,028 $2,682,876 $1,347,946 $127,140 $944,416 $7,339,406 

New York $24,283,431 $28,963,855 $13,639,815 $1,373,850 $9,759,795 $78,020,746 

North Carolina $10,484,174 $12,573,709 $6,317,354 $576,505 $4,306,356 $34,258,098 

North Dakota $1,827,011 $2,186,289 $1,079,676 $104,920 $764,933 $5,962,829 

Ohio $13,816,810 $16,533,997 $8,307,104 $834,207 $5,990,792 $45,482,910 

Oklahoma $4,278,286 $5,104,353 $2,564,558 $256,914 $1,827,039 $14,031,150 

Oregon $4,576,322 $5,488,400 $2,757,513 $254,403 $1,880,893 $14,957,531 

Pennsylvania $17,879,977 $21,279,716 $9,854,900 $1,016,515 $7,442,187 $57,473,295 

Rhode Island $1,827,011 $2,186,289 $1,079,676 $104,920 $764,933 $5,962,829 

South Carolina $5,479,859 $6,572,016 $3,301,949 $294,842 $2,237,296 $17,885,962 

South Dakota $1,827,011 $2,186,289 $1,079,676 $104,920 $764,933 $5,962,829 

Tennessee $7,364,949 $8,832,811 $4,437,831 $415,981 $3,033,344 $24,084,916 

Texas $22,440,012 $26,912,390 $13,521,475 $1,250,740 $9,215,393 $73,340,010 

Utah $2,181,148 $2,615,859 $1,314,275 $114,870 $910,038 $7,136,190 

Vermont $1,827,011 $2,186,289 $1,079,676 $104,920 $764,933 $5,962,829 

Virginia $8,499,074 $10,192,972 $5,121,210 $483,960 $3,446,280 $27,743,496 

Washington $7,221,988 $8,661,357 $4,351,688 $396,896 $2,900,557 $23,532,486 

West Virginia $2,773,538 $3,305,947 $1,494,917 $152,831 $1,067,786 $8,795,019 

Wisconsin $6,539,594 $7,842,960 $3,940,504 $390,666 $2,853,414 $21,567,138 

Wyoming $1,827,011 $2,186,289 $1,079,676 $104,920 $764,933 $5,962,829 

American Samoa $472,317 $594,843 $136,498 $13,115 $95,617 $1,312,390 

Guam $913,505 $1,093,145 $539,838 $52,460 $382,467 $2,981,415 

Northern Mariana 

Islands

$228,376 $273,286 $134,959 $13,115 $95,617 $745,353 

Puerto Rico $4,825,219 $5,786,903 $2,907,489 $269,207 $2,022,170 $15,810,988 

Virgin Islands $913,505 $1,093,145 $539,838 $52,460 $382,467 $2,981,415 

TOTAL $365,402,129 $437,257,831 $215,935,133 $20,983,948 $152,986,623 $1,192,565,664 
63

State Ombudsman Elder Abuse Total Title VII

Alabama $262,233 $77,924 $340,157 

Alaska $83,746 $25,163 $108,909 

Arizona $348,130 $103,449 $451,579 

Arkansas $165,619 $49,214 $214,833 

California $1,693,475 $503,223 $2,196,698 

Colorado $227,267 $67,534 $294,801 

Connecticut $196,524 $59,907 $256,431 

Delaware $83,746 $25,163 $108,909 

District of Columbia $83,746 $25,163 $108,909 

Florida $1,226,365 $364,420 $1,590,785 

Georgia $429,742 $127,700 $557,442 

Hawaii $83,746 $25,163 $108,909 

Idaho $83,746 $25,163 $108,909 

Illinois $643,452 $197,384 $840,836 

Indiana $334,905 $99,519 $434,424 

Iowa $174,013 $55,927 $229,940 

Kansas $147,001 $45,843 $192,844 

Kentucky $233,207 $69,299 $302,506 

Louisiana $226,146 $68,518 $294,664 

Maine $83,746 $25,163 $108,909 

Maryland $287,437 $85,413 $372,850 

Massachusetts $361,717 $109,606 $471,323 

Michigan $544,348 $161,756 $706,104 

Minnesota $270,333 $80,331 $350,664 

Mississippi $151,899 $45,198 $197,097 

Missouri $329,777 $97,995 $427,772 

Montana $83,746 $25,163 $108,909 

Nebraska $95,242 $29,770 $125,012 

Nevada $128,779 $38,267 $167,046 

New Hampshire $83,746 $25,163 $108,909 

New Jersey $471,073 $143,950 $615,023 

New Mexico $104,556 $31,069 $135,625 

New York $1,057,995 $318,066 $1,376,061 

North Carolina $490,016 $145,611 $635,627 

North Dakota $83,746 $25,163 $108,909 

Ohio $644,354 $197,185 $841,539 

Oklahoma $198,924 $60,208 $259,132 

Oregon $213,891 $63,559 $277,450 

Pennsylvania $764,412 $242,944 $1,007,356 

Rhode Island $83,746 $25,163 $108,909 

South Carolina $256,121 $76,108 $332,229 

South Dakota $83,746 $25,163 $108,909 

Tennessee $344,228 $102,289 $446,517 

Texas $1,048,816 $311,661 $1,360,477 

Utah $101,944 $30,293 $132,237 

Vermont $83,746 $25,163 $108,909 

Virginia $397,235 $118,040 $515,275 

Washington $337,546 $100,303 $437,849 

West Virginia $115,956 $36,736 $152,692 

Wisconsin $305,652 $90,826 $396,478 

Wyoming $83,746 $25,163 $108,909 

American Samoa $10,468 $3,145 $13,613 

Guam $41,873 $12,582 $54,455 

Northern Mariana Islands $10,468 $3,145 $13,613 

Puerto Rico $225,524 $67,016 $292,540 

Virgin Islands $41,873 $12,582 $54,455 

TOTAL $16,749,234 $5,032,634 $21,781,868 
64

State/Territory

Nutrition Services 

Incentive Program

Alabama $2,757,851 

Alaska $355,155 

Arizona $2,137,183 

Arkansas $2,631,552 

California $12,422,425 

Colorado $1,412,481 

Connecticut $1,504,816 

Delaware $390,542 

District of Columbia $601,892 

Florida $7,752,196 

Georgia $2,827,339 

Hawaii $474,893 

Idaho $652,845

Illinois $7,020,289 

Indiana $1,900,591 

Iowa $1,887,333 

Kansas $1,996,745 

Kentucky $1,852,778 

Louisiana $3,201,511 

Maine $583,674 

Maryland $1,899,261 

Massachusetts $4,703,430 

Michigan $7,267,382 

Minnesota $1,974,728 

Mississippi $1,201,461 

Missouri $4,055,146 

Montana $865,316 

Nebraska $1,266,994 

Nevada $1,016,007 

New Hampshire $1,103,997 

New Jersey $3,813,364 

New Mexico $1,980,506 

New York $15,419,528 

North Carolina $3,361,424 

North Dakota $806,432 

Ohio $5,577,024 

Oklahoma $2,045,615 

Oregon $1,797,863 

Pennsylvania $7,162,223 

Rhode Island $537,442 

South Carolina $1,710,911 

South Dakota $953,291 

Tennessee $1,647,948 

Texas $12,539,020 

Utah $1,332,354 

Vermont $755,471 

Virginia $2,473,229 

Washington $2,074,062 

West Virginia $1,619,809 

Wisconsin $2,651,426 

Wyoming $788,892 

Guam $393,221 

Northern Mariana Islands $62,962 

Puerto Rico $3,118,597 

Virgin Islands $200,210 

TOTAL $154,540,637 
65

State

Tribe 

No. Grantee Name

TITLE6 

A/B TITLE6 C NSIP

AK 01 Aleutian Pribilof Islands Association $94,700 $26,830 $19,809

AK 02 Association of Village Council Presidents $136,700 $2,054

AK 03 Bristol Bay Native Association $136,700 $46,950 $4,257

AK 04 Central Council Tlingit & Haida Indian Tribes of AK $179,510 $53,660 $1,873

AK 06 Copper River Native Association $83,390 $20,120 $2,495

AK 07 Hoonah Indian Association $73,490 $13,410 $1,291

AK 08 Kodiak Area Native Association (Northern Section) $73,490 $13,410 $833

AK 09 Kodiak Area Native Association (Southern Section) $73,490 $13,410 $2,303

AK 10 Metlakatla Indian Community $94,700 $26,830 $2,877

AK 11 Native Village of Barrow $94,700 $26,830 $12,803

AK 12 Tanana Chiefs Conference for Kuskokwim subregion $73,490 $13,410 $3,184

AK 13 Tanana Chiefs Conference for Lower Yukon Subregion $73,490 $13,410 $4,311

AK 14 Tanana Chiefs Conference for Yukon Flats Subregion $73,490 $13,410 $2,705

AK 15 Tanana Chiefs Conference for Yukon Koyukuk Subregion $83,390 $20,120 $2,447

AK 16 Tanana Chiefs Conference for Yukon Tanana Subregion $73,490 $13,410 $1,188

AK 17 Fairbanks Native Association $136,700 $46,950

AK 19 Maniilaq Association $136,700 $46,950 $15,743

AK 20 Native Villiage of Unalakleet $73,490 $13,410 $4,437

AK 21 Chugachmiut $83,390 $20,120 $6,632

AK 22 Arctic Slope Native Association, Limited $73,490 $13,410 $7,705

AK 23 Denakkanaaga, Inc. $83,390 $20,120

AK 24 Klawock Cooperative Association $73,490 $13,410 $1,109

AK 25 Kootznoowoo Inc. $73,490 $13,410 $1,412

AK 26 Gwichyaa Zhee Gwich'in Tribal Government $73,490 $13,410 $3,720

AK 27 Native Village of Point Hope $73,490 $13,410 $2,743

AK 28 Seldovia Village Tribe, IRA $73,490 $914

AK 30 Sitka Tribes of Alaska $94,700 $26,830 $1,665

AK 32 Ketchikan Indian Community $136,700 $46,950 $2,591

AK 33 Kuskokwim Native Association $83,390 $20,120 $3,691

AK 35 Southcentral Foundation $179,510 $53,660 $7,615

AK 36 Kenaitze Indian Tribe $118,020 $40,250 $4,517

AK 37 Wrangell Cooperative Association $73,490 $13,410 $1,077

AK 38 Native Village of Savoonga $73,490 $13,410 $10,499

AK 39 Native Village of Gambell $73,490 $13,410 $5,794

AK 40 Native Village of Eyak $73,490 $13,410 $575

AK 41 Organized Village of Kake $73,490 $13,410 $1,480

AK 42 Chickaloon Native Village $83,390 $954

AK 43 Yakutat Tlingit Tribe & Craig Community Association $73,490 $13,410 $2,276

AK 44 Galena Village (aka Louden Village Council) $73,490 $13,410 $9,661

AK 45 Asa'carsarmiut Tribal Council $73,490 $5,340

AK 46 Orutsararmuit Native Council $94,700 $13,324

AK Total Total $3,751,160 $811,490 $179,904

AL 01 Poarch Creek Indians $136,700 $46,950 $19,659

AL Total Total $136,700 $46,950 $19,659

AZ 02 Colorado River Indian Tribes $106,710 $33,540 $6,010

AZ 03 Gila River Indian Community $136,700 $46,950 $19,279

AZ 04 Hopi Tribe $136,700 $46,950 $7,580

AZ 05 Hualapai Tribe $83,390 $20,120 $5,245

AZ 06 Navajo Nation $179,510 $53,660 $66,336

AZ 07 Pascua Yaqui Tribe $136,700 $46,950 $41,014

AZ 09 Salt River Pima-Maricopa Indian Community $106,710 $33,540 $7,148

AZ 10 San Carlos Apache Tribe $136,700 $46,950 $5,655

AZ 11 Tohono o'Odham Nation $136,700 $46,950 $2,518

AZ 12 White Mountain Apache Tribe $136,700 $46,950 $7,986

AZ 13 Ak-Chin Indian Community $73,490 $13,410 $1,442

AZ 14 Yavapai Apache Tribe $83,390 $1,535

AZ 15 Havasupai Tribe $73,490 $13,410 $8,233
66

AZ 16 Inter-Tribal Council of Arizona, Inc. $73,490 $13,410 $402

AZ 17 Cocopah Indian Tribe $73,490 $12,491

AZ 18 Quechan Indian Tribe $83,390 $20,120 $11,620

AZ Total Total $1,757,260 $482,910 $204,494

CA 01 Bishop Tribal Council $83,390 $20,120 $27,082

CA 02 Blue Lake Rancheria $83,390 $20,120 $21,307

CA 06 Karuk Tribe of California $83,390 $20,120 $2,695

CA 07 Pit River Health Services, Inc. $73,490 $2,813

CA 08 Picayune Rancheria of the Chukchansi Indians $73,490 $4,841

CA 09 Riverside-San Bernardino Co. Indian Health-for Morongo $73,490 $13,410 $7,818

CA 10 Riverside-San Bernardino Co. Indian Health-for 

Pechanga

$73,490 $13,410 $3,894

CA 11 Riverside-San Bernardino Co. Indian Health-for Soboba $73,490 $13,410 $6,053

CA 12 Sonoma County Indian Health Project - Sonoma $73,490 $8,161

CA 13 Southern Indian Health Council, Inc. $73,490 $13,410 $12,104

CA 15 Toiyabe Indian Health Project, Inc. - Northern $73,490 $13,410 $5,533

CA 16 Tule River Indian Health Center, Inc. $83,390 $20,120 $20,804

CA 17 Coast Indian Community of Resighini Rancheria $83,390 $20,120 $8,474

CA 18 United Indian Health Services for Smith River $94,700 $26,830 $10,093

CA 20 Indian Senior Center, Inc. $83,390 $20,120 $9,816

CA 21 Sonoma County Indian Health Project - Manchester $73,490 $6,891

CA 25 Pala Band of Mission Indians $83,390 $13,039

CA 26 Redding Rancheria $136,700 $46,950 $5,769

CA 28 Toiyabe Indian Health Project, Inc. - Southern $73,490 $13,410 $7,453

CA 29 Hoopa Valley Tribe, K'ima:w Medical Center $83,390 $7,824

CA 30 Round Valley Indian Tribes $94,700 $3,523

CA 31 Fort Mojave Indian Tribe $73,490 $13,410 $4,616

CA 33 CA Indian Manpower Consortium, Inc. - Chico, $73,490 $13,410 $6,880

CA 34 CA Indian Manpower Consortium, Inc. - Big Sandy, $73,490 $13,410 $8,073

CA 35 CA Indian Manpower Consortium, Inc. - Berry Creek, $73,490 $13,410 $5,589

CA 36 CA Indian Manpower Consortium, Inc. - Coyote Valley, $83,390 $20,120 $3,879

CA 37 CA Indian Manpower Consortium, Inc. - Enterprise, $83,390 $20,120 $7,161

CA 38 Santa Ynez Band of Mission Indians $73,490 $2,877

CA Total Total $2,262,350 $368,840 $235,062

CO 01 Southern Ute Indian Tribe $83,390 $20,120 $3,723

CO 02 Ute Mountain Ute Tribe $83,390 $14,490

CO Total Total $166,780 $20,120 $18,213

HI 01 Alu Like, Inc. $1,505,000 $53,660 $33,996

HI 02 Hana Health $83,390 $5,831

HI Total Total $1,588,390 $53,660 $39,827

IA 01 Sac & Fox Tribe of the Mississippi in Iowa $94,700 $26,830 $8,941

IA Total Total $94,700 $26,830 $8,941

ID 01 Coeur d'Alene Tribe $83,390 $20,120 $16,313

ID 02 Nez Perce Tribe $118,020 $40,250 $11,894

ID 03 Shoshone-Bannock Tribes $136,700 $46,950 $23,862

ID Total Total $338,110 $107,320 $52,069

KS 01 The Kickapoo Tribe in Kansas $73,490 $13,410 $6,358

KS 02 Prairie Band of Potawatomi Nation $94,700 $26,830 $19,293

KS 03 Iowa Tribe of Kansas and Nebraska $73,490 $13,410 $6,338

KS Total Total $241,680 $53,650 $31,989

LA 01 Institute for Indian Development, Inc. $83,390 $7,281

LA Total Total $83,390 $7,281

MA 01 Wampanoag Tribe of Gay Head (Aquinnah) $73,490 $13,410 $1,180

MA Total Total $73,490 $13,410 $1,180

ME 01 Pleasant Point Passamaquoddy Tribe $94,700 $26,830 $15,649

ME 02 Penobscot Indian Nation $83,390 $4,408

ME 04 Aroostook Band of Micmacs $73,490 $13,410 $2,560

ME Total Total $251,580 $40,240 $22,617

MI 01 Grand Traverse Band of Ottawa & Chippewa Indians $94,700 $26,830 $7,911

MI 02 Inter-Tribal Council of Michigan, Inc. $83,390 $20,120 $4,286

MI 03 Keweenaw Bay Indian Community $83,390 $20,120 $13,295
67

MI 04 Sault Ste. Marie Tribe of Chippewa Indians $136,700 $24,236

MI 05 Little Traverse Bay Bands of Odawa Indians $83,390 $4,579

MI 07 Bay Mills Indian Community $83,390 $20,120 $4,706

MI 08 Pokagon Band of Potawatomi Indians $83,390 $3,200

MI 09 Little River Band of Ottawa Indians $94,700 $26,830

MI 10 Nottawaseppi Huron Band of the Potawatomi $73,490 $13,410 $3,611

MI Total Total $816,540 $127,430 $65,824

MN 01 Bois Forte Reservation Tribal Government $83,390 $20,120 $8,681

MN 02 Fond du Lac Band of Lake Superior Chippewa $118,020 $40,250 $51,563

MN 03 Leech Lake Band of Ojibwe $179,510 $53,660 $20,365

MN 07 Red Lake Band of Chippewa Indians $118,020 $21,377

MN 08 White Earth Reservation Tribal Council $106,710 $33,540 $37,908

MN 09 Grand Portage Band of Lake Superior Chippewa $73,490 $7,196

MN 10 Mille Lacs Band of Ojibwe $83,390 $20,120 $3,545

MN Total Total $762,530 $167,690 $150,635

MO 99 Eastern Shawnee Tribe of Oklahoma $94,700 $26,830 $14,978

MO Total Total $94,700 $26,830 $14,978

MS 01 Mississippi Band of Choctaw Indians $136,700 $46,950 $17,681

MS Total Total $136,700 $46,950 $17,681

MT 01 Assiniboine and Sioux Tribes $118,020 $40,250 $29,088

MT02 Blackfeet Tribe - Eagle Shield Center $136,700 $46,950 $28,194

MT 03 Chippewa Cree Tribe $106,710 $33,540 $46,807

MT 04 Confederated Salish and Kootenai Tribes $136,700 $46,950 $7,767

MT 05 Fort Belknap Indian Community $106,710 $33,540 $12,994

MT 06 Northern Cheyenne Elderly Program $106,710 $33,540 $19,064

MT 07 Crow Tribal Elders Program $136,700 $46,950 $36,550

MT Total Total $848,250 $281,720 $180,464

NC 01 Eastern Band of Cherokee Indians $179,510 $53,660 $38,782

NC Total Total $179,510 $53,660 $38,782

ND 01 Spirit Lake Tribe $94,700 $26,830 $23,225

ND 02 Standing Rock Sioux Tribe $136,700 $46,950 $83,748

ND 03 Three Affiliated Tribes $136,700 $46,950 $14,362

ND 04 Trenton Indian Service Area $94,700 $26,830 $2,396

ND 05 Turtle Mountain Band of Chippewa Indians $136,700 $46,950 $17,979

ND Total Total $599,500 $194,510 $141,710

NE 01 Omaha Tribe of Nebraska $83,390 $20,120 $8,786

NE 02 Santee Sioux Nation $73,490 $2,838

NE 03 Winnebago Senior Citizen Center $83,390 $20,120 $13,737

NE Total Total $240,270 $40,240 $25,361

NM 01 Eight Northern Indian Pueblos Council (Picuris, etc.) $179,510 $53,660 $5,811

NM 02 Eight N. Indian Pueblos Council(San Ildefonso, etc.) $94,700 $26,830 $4,690

NM 03 Five Sandoval Indian Pueblos, Inc. $94,700 $12,600

NM 04 Jicarilla Apache Nation $106,710 $33,540 $16,590

NM 05 Laguna Rainbow Corporation $136,700 $46,950 $14,464

NM 06 Mescalero Apache Tribe $94,700 $9,180

NM 07 Pueblo de Cochiti $83,390 $20,120 $7,661

NM 09 Pueblo of Isleta $118,020 $40,250 $21,711

NM 10 Pueblo of Jemez $106,710 $33,540 $6,444

NM 11 Pueblo of San Felipe $106,710 $33,540 $9,859

NM 12 Pueblo of Taos $106,710 $33,540 $7,934

NM 13 Zuni Tribe $136,700 $46,950 $25,910

NM 14 Ohkay Owingeh Senior Citizens Program $136,700 $46,950 $12,381

NM 15 Santa Clara Pueblo $179,510 $53,660 $13,091

NM 16 Santo Domingo Pueblo $136,700 $46,950 $9,643

NM 17 Pueblo of Tesuque $73,490 $13,410 $5,413

NM 18 Pueblo of Acoma $94,700 $26,830 $8,710

NM Total Total $1,986,360 $556,720 $192,092

NV 01 Fallon Paiute-Shoshone Tribes $83,390 $20,120 $19,379

NV 02 Inter-Tribal Council of Nevada, Inc. (McDermitt, etc.) $83,390 $20,120 $7,912

NV 03 Inter-Tribal Council of Nevada, Inc. (Duckwater, etc.) $83,390 $20,120 $4,669
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NV 04 Inter-Tribal Council of Nevada, Inc. (Ely, etc.) $73,490 $13,410 $4,868

NV 05 Shoshone-Paiute Tribes $83,390 $20,120 $8,843

NV 06 Walker River Paiute Tribe $83,390 $9,385

NV 07 Washoe Tribe of Nevada and California $83,390 $20,120 $35,829

NV 08 Yerington Paiute Tribe $73,490 $3,025

NV 09 Pyramid Lake Paiute Tribe $94,700 $26,830 $4,274

NV 10 Elko Band Council $73,490 $13,410 $7,192

NV 11 Reno-Sparks Indian Colony $83,390 $20,120 $10,445

NV Total Total $898,900 $174,370 $115,821

NY 01 St. Regis Mohawk Tribe $136,700 $46,950 $13,081

NY 02 Seneca Nation of Indians $136,700 $46,950 $18,634

NY 04 Oneida Indian Nation $73,490 $13,410 $3,831

NY 05 Shinnecock Indian Nation $73,490 $13,410 $4,585

NY Total Total $420,380 $120,720 $40,131

OK 01 Apache Tribe of Oklahoma $136,700 $46,950 $11,476

OK 02 Caddo Nation of Oklahoma $83,390 $20,120 $3,489

OK 03 Cherokee Nation $181,001 $54,967 $42,546

OK 04 Cheyenne & Arapaho Tribes $136,700 $46,950 $9,690

OK 06 Choctaw Nation of Oklahoma $179,510 $53,660 $24,711

OK 07 Citizen Potawatomi Nation $179,510 $53,660 $11,924

OK 08 Comanche Nation $136,700 $46,950 $15,055

OK 09 Delaware Nation $78,960 $13,410 $7,185

OK 10 Iowa Tribe of Oklahoma $136,700 $46,950 $8,339

OK 12 Kickapoo Tribe of Oklahoma $100,000 $20,120 $15,099

OK 13 Kiowa Tribe of Oklahoma $136,700 $46,950 $5,812

OK 14 Miami Tribe of Oklahoma $118,020 $40,250 $22,363

OK 15 Muscogee (Creek) Nation $179,510 $53,660 $154,576

OK 17 Otoe-Missouria Tribe of Indians $73,490 $13,410 $6,514

OK 18 Ottawa Tribe of Oklahoma $136,700 $46,950 $22,866

OK 19 Pawnee Nation of Oklahoma $83,390 $20,120 $10,532

OK 20 Peoria Tribe of Indians of Oklahoma $106,710 $33,540 $15,575

OK 21 Ponca Tribe of Oklahoma $83,390 $20,120 $17,617

OK 22 Quapaw Tribe of Oklahoma $118,020 $40,250 $16,640

OK 23 Sac and Fox Nation $83,390 $20,120 $11,981

OK 24 Seminole Nation of Oklahoma $179,510 $53,660 $11,966

OK 25 Seneca-Cayuga Tribe of Oklahoma $136,700 $46,950 $8,392

OK 26 Wichita and Affiliated Tribes $136,700 $46,950 $8,592

OK 27 Wyandotte Nation $136,700 $46,950 $14,566

OK 28 Absentee Shawnee Tribe $179,510 $53,660 $27,577

OK 29 Fort Sill Apache Tribe $106,710 $33,540 $4,251

OK 31 United Keetoowah Band of Cherokee Indians $136,700 $46,950 $16,507

OK 32 Chickasaw Nation $179,510 $53,660 $107,995

OK 33 Kaw Nation $83,390 $22,420

OK 34 Osage Nation of Oklahoma $179,510 $53,660 $19,623

OK 35 Delaware Tribes of Indians $136,700 $4,383

OK 36 Alabama-Quassarte Tribal Town $73,490 $13,410 $9,818

OK Total Total $4,133,621 $1,188,497 $690,080

OR 01 Confederated Tribes of Siletz Indians of Oregon $106,710 $33,540 $1,740

OR 02 Confederated Tribes of the Umatilla Indian Reservation $118,020 $40,250 $7,455

OR 03 Confederated Tribes of Warm Springs $106,710 $33,540 $6,352

OR 04 Confederated Tribes of Grand Ronde $94,700 $26,830 $10,770

OR 05 The Klamath Tribes $136,700 $46,950 $3,117

OR 06 Confed. Tribes of Coos, Lower Umpqua & $83,390 $20,120 $7,718

OR Total Total $646,230 $201,230 $37,152

RI 01 Narragansett Indian Tribe $94,700 $26,830 $2,973

RI Total Total $94,700 $26,830 $2,973

SC 01 Catawba Indian Nation Eldercare Program $83,390 $20,120 $6,695

SC Total Total $83,390 $20,120 $6,695

SD 01 Cheyenne River Elderly Nutrition Services, Inc. $136,700 $46,950 $10,695

SD 02 Crow Creek Sioux Tribe $83,390 $15,308
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SD 03 Lower Brule Sioux Tribe $83,390 $20,120 $12,607

SD 04 Oglala Sioux Tribe $179,510 $53,660 $152,292

SD 05 Rosebud Sioux Tribe $179,510 $53,660 $70,552

SD 06 Sisseton Wahpeton Oyate of $136,700 $31,396

SD 08 Yankton Sioux Tribe $94,700 $26,830 $9,715

SD Total Total $893,900 $201,220 $302,565

TX 01 The Alabama-Coushatta Tribe of Texas $83,390 $20,120 $10,375

TX 02 Kickapoo Traditional Tribe of Texas $73,490 $15,277

TX Total Total $156,880 $20,120 $25,652

UT 01 Ute Indian Tribe, Unitah & Ouray $94,700 $26,830 $7,198

UT Total Total $94,700 $26,830 $7,198

WA 01 Confederated Tribes of the Colville Reservation $136,700 $46,950 $17,716

WA 02 Lower Elwha Klallam Tribe $83,390 $20,120 $3,655

WA 03 Lummi Tribe $118,020 $40,250 $17,070

WA 04 Makah Nation $83,390 $20,120 $7,135

WA 05 Muckleshoot Indian Tribe $136,700 $46,950 $18,474

WA 09 Puyallup Tribe of Indians $136,700 $7,867

WA 10 Quinault Indian Nation $106,710 $33,540 $34,187

WA 13 Swinomish Indian Tribal Community $73,490 $13,410 $4,874

WA 14 Spokane Tribe of Indians $83,390 $20,120 $10,789

WA 16 The Tulalip Tribes $136,700 $9,967

WA 17 Jamestown S'Klallam Tribe $83,390 $20,120 $523

WA 19 Quileute Tribal Council $83,390 $20,120 $7,280

WA 20 S. Puget Intertribal Planning Agency - Shoalwater Bay $94,700 $26,830 $6,502

WA 21 Stillaguamish Tribe of Indians $94,700 $26,830 $1,661

WA 22 Upper Skagit Indian Tribe $73,490 $13,410 $2,406

WA 24 The Suquamish Tribe $94,700 $26,830 $12,466

WA 25 Port Gamble S'Klallam Tribe $73,490 $13,410 $2,214

WA 26 Samish Indian Nation $83,390 $20,120 $1,939

WA 27 Cowlitz Indian Tribe $94,700 $26,830 $3,512

WA 28 Skokomish Indian Tribe $94,700 $26,830 $3,440

WA 29 Confederated Tribes of the Chehalis Reservation $94,700 $26,830 $2,404

WA 30 Nooksack Indian Tribe $83,390 $20,120 $3,512

WA 31 Yakama Nation $73,490 $13,410 $3,371

WA 32 Snoqualmie Tribe $73,490 $13,410 $1,999

WA 33 S. Puget Intertribal Planning Agency - Nisqually $118,020 $40,250 $2,630

WA 34 S. Puget Intertribal Planning Agency - Squaxin Island $73,490 $13,410 $6,164

WA Total Total $2,482,420 $590,220 $193,757

WI 01 Bad River Band of Lake Superior Chippewa $83,390 $20,120 $8,829

WI 02 Forest County Potawatomi Community $83,390 $20,120 $7,369

WI 03 Lac Courte Oreilles Band of Lake Superior Chippewa $94,700 $26,830 $9,857

WI 04 Lac du Flambeau Band of Lake Superior Chippewa 

Indians

$94,700 $26,830 $19,316

WI 05 Menominee Indian Tribe of Wisconsin $136,700 $46,950 $16,354

WI 06 Oneida Tribe Elder Services $136,700 $46,950 $5,883

WI 07 Red Cliff Band of Lake Superior Chippewa $83,390 $20,120 $6,052

WI 08 St. Croix Chippewa Indians of Wisconsin $83,390 $20,120 $4,458

WI 09 Stockbridge-Munsee Community $83,390 $20,120 $2,380

WI 10 Ho-Chunk Nation $106,710 $33,540 $11,685

WI Total Total $986,460 $281,700 $92,183

WY 01 Northern Arapaho Tribe $83,390 $18,223

WY 03 Eastern Shoshone Tribe $94,700 $11,727

WY Total Total $178,090 $29,950

Total Total Total $27,479,621 $6,373,027 $3,192,920
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