Annual Report on

2018 SUMMARY 

OF HIGHLIGHTS AND 

ACCOMPLISHMENTS

OLDER AMERICANS ACT

Title III Programs

Overview of
Acknowledgment

This report was prepared by Jennifer Tillery, Senior 

Aging and Disability Program Coordinator in the Office 

of Performance and Evaluation (OPE), Center for Policy 

and Evaluation, Administration for Community Living 

(ACL), U.S.Department of Health and Human Services 

(HHS) in partnership with New Editions Consulting, 

Inc., under contract number HHSP233201500113I/

HHSP23337002T. 

Disclaimer

The views, opinions, and content of this publication 

are those of the authors and do not necessarily reflect 

the views, opinions, or policies of OPE, ACL, or HHS. 

Nothing in this document constitutes a direct or indirect endorsement by ACL of any non-federal entity’s 

products, services, or policies, and any reference to 

non-federal entity’s products, services, or policies 

should not be construed as such.

Public Domain Notice 

All material appearing in this publication is in the public domain and may be reproduced or copied without 

permission from ACL. Citation of the source is required. 

However, this publication may not be reproduced or 

distributed for a fee without the specific, written 

authorization by ACL. 

Electronic Access 

This publication may be downloaded from https://acl.

gov/aging-and-disability-in-america/data-and-research.

Recommended Citation

Administration for Community Living. Older Americans 

Act Title III Programs: 2018 Highlights and Accomplishments. Washington, DC: Office of Performance and 

Evaluation. Administration for Community Living, 2021.
Annual Report on Older Americans Act Title III Programs | 1

Table of Contents

Foreword 2

Administration for Community Living 5

List of Graphs, Figures, Tables, and Exhibits 6

Introduction 7

Abbreviations and Acronyms 8

Older Americans Act 9

Older Americans Act Title III Data 28

OAA Title III 2018 Program Highlights and Accomplishments 31

Older Americans Act Title III Results 33

Part 1 | 2018 SPR Data Highlights 34

Part 2 | 2018 NSOAAP Data Highlights 46

Appendix A: Definitions (SPR) 60

Appendix B: Definitions (NSOAAP) 63

Administration for Community Living: 

Older Americans Act Program Contacts 64

References 65
2 | 

Enacted in 1965, the Older Americans Act 

created the foundation for a comprehensive 

system of services and supports that enables 

millions of older adults in this country to continue to live independently as they age. Today, 

programs funded by the Older Americans Act 

provide essential services to older adults (i.e., 

generally age 60 and older), targeting those 

with the greatest economic or social need, 

particularly low-income and minority persons, 

older individuals with limited English proficiency, and older persons living in rural areas. 

The programs play a vital role in helping to 

maintain the health and well-being of millions 

of seniors age 60 and older, reaching one in 

five older adults.

Older Americans Act Title III services account 

for the largest portion of the Act’s funding, 

supporting a comprehensive national network 

of federal, state, and local agencies. These 

are the agencies that plan and provide 

services to help older adults live independently 

in their homes and communities. This 

support includes case management, community services, in-home services, transportation, and information and referral; nutrition 

programs; family caregiver support; and 

health promotion and disease prevention 

services.

As the primary federal agency administering 

the Older Americans Act, the Administration 

for Community Living collects reports and data 

on the Title III programs. These data provide 

information about the performance of each 

program but also show the wide reach and 

positive impact the programs have on millions 

of older adults. 

In 2018, the Older Americans Act Title III Programs funded 56 state agencies, 1,050 local 

The United States is facing a surge in the aging population. By 2030, 73 million—

or one in five—people in the U.S. will be 65 or older. In addition to being historically large in size, this population is also living longer. Between 2020 and 2030, 

the number of people 85 and older is projected to rise by 35%.1

 Regardless of age, 

geographical location, income, or political affiliation, older adults generally agree 

on one thing: they want to age in their own homes and communities rather than 

in institutional settings.2

Older Americans Act Title III Programs

2018 Summary of Highlights

2 | 

FOREWORD
Annual Report on Older Americans Act Title III Programs | 3

BY 2030

1IN 5

PEOPLE IN U.S.

WILL BE OVER AGE 65

BETWEEN 2020-2030

THERE IS A 

35%

PROJECTED RISE IN 

PEOPLE OVER AGE 85

OAA PROGRAMS REACH

1IN 5

OLDER ADULTS

OAA FUNDED

56

STATE AGENCIES

OAA FUNDED

1,050

LOCAL AGENCIES

OAA SUPPORTED OVER

196,000

CAREGIVERS SERVING 

ELDERLY INDIVIDUALS

89-96%

OF SERVICE RECIPIENTS 

NOTED THAT THE OAA FUNDED 

SERVICES HELPED THEM STAY 

IN THEIR HOME

Annual Report on Older Americans Act Title III Programs | 3
4 | 

agencies that coordinated and offered services 

to older adults, and 11,212 senior centers. In 

addition, they provided support to more than 

196,000 caregivers serving older adults. More 

than 10.8 million older persons received Title III 

services including almost 147 million homedelivered meals; 74 million congregate meals; 

20 million rides to medical appointments, 

grocery stores, and other activities; and 21 

million hours of homemaker services. The 

majority of service recipients rated the services*

* Includes the following services: Caregiver, Case Management, 

Congregate Meals, Home-Delivered Meals, Homemaker, 

and Transportation

OAA CONTRIBUTED 

TO OVER

10.8

MILLION ELDERLY

RECEIVING SERVICES

OAA CONTRIBUTED 

TO OVER 

147

MILLION

HOME-DELIVERED MEALS

OAA CONTRIBUTED 

TO OVER 

74

MILLION

CONGREGATE MEALS

OAA CONTRIBUTED 

TO OVER

20

MILLION RIDES TO 

IMPORTANT ACTIVITIES

OAA CONTRIBUTED 

TO OVER

21

MILLION HOURS

OF HOMEMAKER SERVICES

as excellent, very good, or good. Most importantly, between 89% and 96% of service recipients noted that the services†

 helped them stay 

in their homes. 

This report is the first annual report on the 

Older Americans Act Title III Programs, summarizing highlights and accomplishments 

in 2018. It shows the immense value the 

programs have for reaching millions of older 

adults and allowing them to age in their own 

homes and communities.

† Includes the following services: Case Management, HomeDelivered Meals, Homemaker, and Transportation

4 | 
Annual Report on Older Americans Act Title III Programs | 5

Administration for Community Living

WHAT IS COMMUNITY LIVING?

IMPROVING THE LIVES OF OLDER ADULTS AND PEOPLE WITH DISABILITIES 

THROUGH SERVICES, RESEARCH, AND EDUCATION

WHY IS COMMUNITY LIVING 

IMPORTANT?

HOW DOES ACL SUPPORT 

COMMUNITY LIVING?

WHO ARE ACL’S PARTNERS?

Older Adults and People with Disabilities Have 

the Same Opportunities as Everyone Else to:

■ Choose Where to Live

■ Earn a Living

■ Participate in Society

■ Make Decisions About Their Lives

■ People Prefer it

■ It Costs Less

■ It’s a Legal Right

■ Everyone Benefits When Everyone 

Can Contribute

■ Funds Services That Help People Live

Independently

■ Invests in Research, Innovation, Training, 

and Education

■ Advocates for People with Disabilities 

and Older Adults

■ Nationwide Aging and Disability Networks

■ States, Tribes, and Communities

■ Colleges and Universities

■ Nonprofit, Faith-Based, and Industry Partners

■ Other Federal Agencies
6 | 

List of Graphs, Figures, Tables, and Exhibits

Graphs

Graph 1. Current and projected population of adults ages 60+, 65+, and 85+: 2018-2060 15

Graph 2. Percentage change in projected population of adults ages 60+, 65+, and 85+: 2020-2060 15

Figures

Figure 1. OAA Title III Network 16

Tables

Table 1. Older Americans Act Title III Services, Part B 19

Table 2. Older Americans Act Title III Services, Part C 21

Table 3. Older Americans Act Title III Services, Part D 25

Table 4. Older Americans Act Title III Services, Part E 26

Exhibits

Exhibit 1. Number of Providers by Service Type 34

Exhibit 2. Number of Title III Service Recipients by Service Type 35

Exhibit 3. Title III Service Recipients by Gender 36

Exhibit 4. Title III Service Recipients by Age 37

Exhibit 5. Title III Service Recipients by Race/Ethnicity 38

Exhibit 6. Caregivers and Other Older Caregivers Serving Children 39

Exhibit 7. Service Recipients by Living Alone Status 40

Exhibit 8. Caregivers Serving Older Adults and Grandparents and 

Older Caregivers Serving Children: Rural vs. Nonrural 41

Exhibit 9. Clients with Difficulty Performing Three or More ADLs by Cluster 1 Registered Service 42

Exhibit 10. Clients with Difficulty Performing Three or More IADLs by Cluster 1 Registered Service 43

Exhibit 11. Total Service Units, by Select Service Type, 2018 45

Exhibit 12. Services Units Provided per Client by Service 45

Exhibit 13. Reported Health Status by Services (in Percent) 46

Exhibit 14. Number of Medical Conditions Reported by Recipients of All Six Services 48

Exhibit 15. Percent of Service Recipients WITHOUT Overnight Stay in Hospital, 

Nursing Home, or Rehabilitation Center 50

Exhibit 16. Percent of Clients NOT Receiving Medicaid by Service 52

Exhibit 17. Length of Time Services Were Received, by Service 53

Exhibit 18. Rating of Services by Service Type (in Percent) 55

Exhibit 19. Percent of Clients Agreeing the Services Help Them Stay in Their Home by Service Type 56

Exhibit 20. Percent of Clients Who Would Recommend the Services to a Friend 57

Exhibit 21. Percent of Clients Receiving Additional Services by Service Type 59
Annual Report on Older Americans Act Title III Programs | 7

ACL’s Mission and Vision

Established in 2012, the Administration for Community Living 

(ACL) is one of 11 operating divisions within the U.S. Department of Health and Human Services (HHS). Its mission is to 

“maximize the independence, well-being, and health of older 

adults, people with disabilities across the lifespan, and their 

families and caregivers.”3 Therefore, all ACL programs are 

designed based on this principle:

All people, regardless of age or disability, should 

be able to live independently and participate fully 

in their communities. Every person should have the 

right to make choices and to control the decisions in 

and about their lives. This right to self-determination 

includes decisions about their homes and work, as 

well as all the other daily choices most adults make 

without a second thought.4

ACL provides national leadership to make this vision a reality 

for older Americans and persons with intellectual, development, physical, and other disabilities. Its programs support 

state, tribal, and local community efforts to meet the needs 

of these individuals and their families through advocacy, 

research, systems change, and capacity building. These 

ACL-supported efforts help older adults and those with disabilities to access needed community services and other kinds of 

assistance so that they can maintain self-determination, 

independence, productivity, and inclusion in all facets 

of community life.5

Introduction
8 | 

Among ACL’s many roles, it is the primary federal agency 

responsible for administering the Older Americans Act (OAA)—

the country’s leading vehicle for delivering services and 

supports to older people nationwide. Importantly, this responsibility includes supporting the national aging services network 

and the millions of older adults and individuals with disabilities 

who depend on it for their health, safety, well-being, and 

independence. 

In order to understand the reach, activities, and effectiveness of these programs, ACL conducts a number of program 

operations, management, and oversight processes designed 

to report regularly on program performance. These activities 

produce rich data that can inform program staff and policy 

makers at federal, state, and local levels. The data also can 

fuel needed research to help us understand how effectively 

these programs reach and improve the lives of older adults 

and individuals with disabilities in our communities. 

Abbreviations and Acronyms

AAA Area Agency on Aging

ACL Administration for Community Living

AoA Administration on Aging

HHS U.S. Department of Health and Human Services

NFCSP National Family Caregiver Support Program

NSOAAP National Survey of Older Americans Act Participants 

OAA Older Americans Act

SPR State Performance Report

SUA State Unit on Aging
Annual Report on Older Americans Act Title III Programs | 9

Originally enacted in 1965, the OAA was the first 

federal-level initiative aimed at comprehensively 

addressing the need for community social services 

for older adults. The Act supports a range of essential home- and community-based services—including 

home-delivered and congregate meals, family caregiver support, in-home assistance, preventive health 

services, transportation, job training, protection 

from abuse, and other supportive services—which 

help millions of older adults live as independently as 

possible in their homes and communities.6 In addition, 

OAA services play a key role in preventing more costly 

institutional services and hospitalizations by helping 

people remain in their own homes and assisting family 

caregivers. While the program is open to all older individuals, generally defined as 60 and older, states must 

target “older individuals with the greatest economic 

need and older individuals with the greatest social 

need, with particular attention to low-income minority 

individuals, older individuals residing in rural areas, 

low-income individuals, and frail individuals.”7

As part of the OAA, the Administration on Aging (AoA) 

was created to coordinate the OAA programs. The 

agency became part of ACL in 2012. Over the past 

5 decades, Congress has amended and reauthorized 

the Act. As a result, the Act has created an infrastructure, known as the national aging services network, 

that coordinates the delivery of comprehensive home 

and community-based supportive services in every 

state. At present, the network consists of 56 state units 

on aging (SUAs), 244 tribal organizations, two native 

Hawaiian organizations representing 400 tribes, 629 

area agencies on aging (AAAs), and nearly 20,000 local 

service providers.8 Today’s OAA statutory language 

contains seven titles9:

■ Title I: declares the Act’s objectives; provides 

definitions for various terms under the Act

■ Title II: establishes the AoA to carry out the 

provisions of the Act; establishes AAAs as local 

entities which, either directly or through contract 

with local service providers, oversee a comprehensive and coordinated service system to deliver 

social, nutrition, and long-term services and supports to older individuals

■ Title III: provides grants to states, tribes, and 

territories to advocate on behalf of older persons 

and their family caregivers, and to coordinate programs for them; covers supportive services, such 

as case management, community services, in-home 

services, transportation, information and referral, 

and legal assistance; nutrition programs, such as 

home-delivered meals and congregate meals; 

family caregiver support; and health promotion 

and disease prevention services

■ Title IV: provides support for training, research, and 

demonstration projects in the field of aging 

■ Title V: authorizes the Senior Community Service 

Employment Program, managed by the Department 

of Labor; provides support for part-time employment 

for individuals 55 and over who are low-income and 

unemployed and have poor employment potential

■ Title VI: provides funds for supportive and nutrition services for Native Americans—funds awarded 

directly by ACL to Indian tribal organizations, Native 

Alaskan organizations, and nonprofit groups representing Native Hawaiians

■ Title VII: provides support for programs to ensure 

protection of the rights of older adults, including 

the Long-Term Care Ombudsman Program (required 

to investigate and resolve complaints made by or on 

behalf of nursing facility residents or other institutionalized populations) and Elder Abuse, Neglect, 

and Exploitation Prevention Program

Older Americans Act
10 | 

History of Title III of the OAA10

1950’s

1950

President Truman initiated the first 

National Conference on Aging, 

sponsored by the Federal Security 

Agency.

1952

First federal funds were appropriated for social service programs 

for older persons under the Social 

Security Act.

1956

Special Staff on Aging were 

established within the Office of the 

Secretary of Health, Education, and 

Welfare, to coordinate responsibilities for aging.

Federal Council on Aging was 

created by President Eisenhower.

1958

Legislation was introduced in 

Congress, calling for a White House 

Conference on Aging.

1960’s

1961

First White House Conference on 

Aging was held in Washington, D.C.

1962

Legislation was introduced in 

Congress to establish an independent and permanent Commission 

on Aging.

1965

OAA was signed into law on July 14, 

1965. It established the AoA within 

the Department of Health, Education, and Welfare and called for the 

creation of SUA.

1967

OAA was extended for 2 years, and 

provisions were made for the AoA 

to study the personnel needs in the 

aging field.

1969

OAA Amendments provided grants 

for model demonstration projects, 

Foster Grandparents Program, and 

Retired Senior Volunteer Program.

1970’s

1971

Second White House Conference on 

Aging was held in Washington, D.C.

1972

A new Title VII was created under 

the OAA, authorizing funds for a 

national nutrition program for the 

elderly.

1973

OAA Comprehensive Services 

Amendments established AAAs. The 

amendments added a new Title V, 

which authorized grants to local 

community agencies for multipurpose senior centers and created the 

Community Service Employment 

grant program for low-income 

persons age 55 and older, administered by the Department of Labor.

1974

OAA amendments added transportation under Title III model projects.

1975

OAA Amendments authorized 

grants under Title III to Indian 
Annual Report on Older Americans Act Title III Programs | 11

tribal organizations. Transportation, home care, legal services, 

and home renovation/repair were 

mandated as priority services.

1977

OAA Amendments required changes in Title VII nutrition program, 

primarily related to the availability 

of surplus commodities through the 

Department of Agriculture.

1978

OAA Amendments consolidated 

the Title III AAA administration and 

social services, the Title VII nutrition 

services, and the Title V multipurpose senior centers, into a new Title 

III and added a new Title VI for grants 

to Indian Tribal Organizations. The 

old Title V became the Community 

Service Employment grant program 

for low-income persons, age 55 

and older (created under the 1978 

amendments as Title IX).

OAA amendments required each 

state to establish a long-term care 

ombudsman program to cover 

nursing homes

1980’s

1981

Third White House Conference on 

Aging was held in Washington, D.C.

OAA was reauthorized; it emphasized supportive services to help 

older persons remain independent 

in the community.

The Act expanded ombudsman 

coverage to board and care homes.

1984

The reauthorization of the OAA was 

clarified, and the accountability of 

SUAs and AAAs for coordinating 

community-based services and 

funding national priority services 

(legal, access, & in-home) was 

reaffirmed.

1987

The reauthorization of the OAA 

authorized appropriations for six 

additional services: in-home 

services for the frail elderly; longterm care ombudsman; assistance 

for special needs; health education 

and promotion; prevention of elder 

abuse, neglect, and exploitation; 

and outreach activities for persons 

who may be eligible for benefits 

under supplemental security income, Medicaid, and food stamps. 

Additional emphasis was given to 

serving those in the greatest economic and social need, including 

low-income minorities. 

The Nursing Home Reform Act 

(Omnibus Budget Reconciliation 

Act) mandated that nursing facility 

residents have “direct and immediate access to ombudspersons when 

protection and advocacy services 

become necessary.” Simultaneously, the OAA reauthorization 

charged states to guarantee ombudsman access to facilities and 

patient records, provided important 

legal protections, authorized state 

ombudsmen to designate local ombudsman programs, and required 

that ombudsman programs have 

adequate legal counsel.
1990’s

1992

Reauthorization of the OAA placed 

increased focus on caregivers, 

intergenerational programs, 

protection of elder rights, and calls 

for a 1995 White House Conference 

on Aging.

OAA Amendments added a new 

Title VII, “Vulnerable Elder Rights 

Activities,” which included the 

long-term care ombudsman; prevention of elder abuse, neglect and 

exploitation; elder rights and legal 

assistance development; and benefits outreach, counseling, and assistance programs. The legislation 

emphasized the value of the four 

programs coordinating their efforts. 

The amendments highlighted the 

role of local ombudsman programs 

and the state ombudsman’s role 

as leader of the statewide program 

and advocate and agent for systemwide change.

1995

White House Conference on Aging 

was held in Washington, D.C.

OAA, Medicare, Medicaid, and 

the Foster Grandparent Program 

observed 30th anniversaries.

2000’s

2000

OAA Amendments of 2000 were 

signed into law (P.L. 106-501), 

establishing the new National 

Family Caregiver Support Program 

and reauthorizing the OAA for 5 

years on November 13, 2000.

2001

HHS Secretary Tommy G. 

Thompson released $113 million 

for first National Family Caregiver 

Support Programs grants to states 

on February 15, 2001.

2002

Kick-off of 30th Anniversary of the 

OAA Nutrition Program took place 

in March.

2005

The fifth White House Conference on 

Aging was held in Washington, D.C.

2006

OAA Amendments of 2006 were 

signed into law (P.L. 109-365), 

reaffirming the principles of 

consumer information for long-term 

care planning, evidence-based 

prevention programs, and selfdirected community-based services 

to older individuals at risk of institutionalization. OAA was reauthorized 

for 5 years on October 17, 2006.

12 | 

“One of the best measures of a country 

 is how it treats its older citizens.”

 — Former President Barack Obama, 

 speaking at the 2015 White House 

 Conference on Aging
2010’s

2010

The Affordable Care Act was enacted.

2011

The OAA authorization expired 

on September 30, 2011. Although 

the authorizations of appropriations 

under the OAA expired at the end of 

FY 2011, Congress continued to appropriate funding for OAA-authorized 

activities through FY 2016.

2012

ACL was established on April 18, 

2012, bringing together the AoA, the 

Office on Disability, and the Administration on Developmental Disabilities.

2016

On April 19, 2016, President 

Obama signed the OAA Reauthorization Act of 2016 into law to 

further improve access and quality 

of comprehensive services to older adults in our country. The 2016 

OAA reauthorized programs for FY 

2017 through FY 2019. It included 

provisions to protect vulnerable 

elders by strengthening the LongTerm Care Ombudsman program and 

elder abuse screening and prevention efforts. It also promoted the delivery of evidence-based programs, 

such as falls prevention and chronic 

disease self-management programs.

Future Actions

The OAA expired on 

September 30, 2019. 

On March 25, 2020, President 

Trump signed H.R. 4334, the 

Supporting Older Americans Act 

(SOAA) into law. The SOAA 

reauthorizes the OAA for 5 years 

and includes a 7% increase in 

funding in the initial year and a 6% 

increase annually for the remainder 

through FY 2024. Along with these 

increases, the SOAA establishes 

a new Research, Demonstration, 

and Evaluation Center for the Aging 

Network within the AoA, requires 

additional research into the impact 

of social isolation on senior health, 

and affirms the importance of local 

control and flexibility in the administration of OAA programs.

Annual Report on Older Americans Act Title III Programs | 13

The Inaugural White House

Conference on Aging in 1961
14 | 

Projected Growth of 

the Aging Population 

Today, the mission of the OAA is even more imperative 

than when the Act was signed into law 5 decades ago, 

as the large U.S. baby boom generation drives an unprecedented growth of the population age 65 and older. 

As shown in the two graphs below, the number of older 

adults is projected to increase substantially over the 

next 40 years. The number of adults 60 and older will 

increase by more than 41 million, the number of adults 

65 and older will increase by more than 38 million, and 

the number of adults 85 and older will increase by more 

than 12 million. These figures represent population increases of 53%, 69%, and 184%, respectively, for these 

three groups of older adults between 2020 and 2060.

OAA Funding

Unfortunately, funding for OAA programs has not kept 

pace with the increase in the aging population, leaving 

many older adults without the essential services they 

need to remain independent in their communities. 

Funding for most OAA programs is provided in annual 

HHS appropriations, with the exception of Title V, which 

is part of annual Department of Labor appropriations. 

In addition, states are required to provide a non-federal 

match of 25% for family caregiver support and 15% for 

supportive services, preventive health, and meals.11

In 2016, the OAA Reauthorization Act of 2016 (S. 192) 

was signed into law (P.L. 114-144) by President Obama, 

increasing OAA funding by $17.1 million, or 0.8%, for 

a total FY19 funding amount of $2.06 billion. On March 

25, 2020, President Trump signed H.R. 4334, the 

Supporting Older Americans Act (SOAA), into law. The 

SOAA reauthorizes the OAA for 5 years and includes 

a 7% increase in funding in the initial year and a 6% 

increase annually for the remaining years, through 

FY 2024. Along with these increases, the SOAA establishes a new National Research, Demonstration, and 

Evaluation Center for the Aging Network in the Office 

of the Assistant Secretary of HHS, and requires 

additional research into the impact of social isolation 

on senior health.

In response to the coronavirus disease 2019 (COVID-19) 

pandemic, supplemental appropriations have provided 

additional funding for OAA programs. For example, the 

Coronavirus Aid, Relief and Economic Security (CARES) 

Act provided $480M for nutrition programs under Title 

III-C and $100M for the National Family Caregiver Support 

Program under Title III-E. In addition, the Families First 

Coronavirus Response Act provided $250 million in supplemental funding for expanded food assistance for OAA 

nutrition services to states and tribal organizations.12

Continued and increasing federal funding for OAA programs is critical to help current and future generations 

of older adults live as independently as possible in their 

homes and communities. This is especially true for the 

Title III programs, which provided many different types of 

services (see Table 1-4) to 10.8 million people in 2018.

OAA Title III Distribution of Funding

The majority of funding for OAA Title III programs flows 

from the federal to the state level and from there to 

the local level. Specifically, the AoA within ACL allots 

formula grants to SUAs in all 50 states, the District of 

Columbia, Puerto Rico, and the U.S. territories. Funds 

for Title III programs are distributed to each state and 

its aging network according to a formula based on the 

state’s share of the U.S population age 60 or older or, 

in the case of caregiver support programs, age 70 or 

older. The formula takes into account the geographical 

distribution of older individuals as well as the distribution of older individuals with the greatest economic 

and social need (with particular attention to low-income, minority older individuals) among specified 

planning and service areas. 

A significant amount of funding for the Title III programs 

is also provided by other sources, such as federal 

Medicare and Medicaid, states, private donations, and 

voluntary contributions from seniors for services 

received.13 The states and territories, in turn, award 

funds to the 629 regional programs known as AAAs, 

which facilitate the delivery of services to local areas. 

Eligible individuals can obtain a range of services to 

provide them with the help they need. States, DC, and 

territories use their federal program income and other 

income to pay for these important services.
Annual Report on Older Americans Act Title III Programs | 15

Graph 1. Current and projected population of adults ages 60+, 65+, and 85+: 2018-206014

120

100

80

60

40

20

 2020 2025 2030 2035 2040 2045 2050 2055 2060 

7

56

19 19 14

9

77

118

 ■ 60+ ■ 65+ ■ 85+

MILLION

93

100

108

73

81

86

95

Graph 2. Percentage change in projected population of adults ages 60+, 65+, and 85+: 2020-2060 GRAPH 2 Percentage change in projected population of adults 15

 ages 60+, 65+, and 85+: 2020-206012

200%

160%

120%

80%

40%

0%

 2020 2025 2030 2035 2040 2045 2050 2055 2060

30%

35% 44%

115%

53%

69%

53%

41%

30% 20%

177% 184%

 ■ 60+ ■ 65+ ■ 85+

Note. Percent reflects the change in population in reference to 2020.
16 | 

advance the mission of the OAA and to improve the 

delivery of home- and community-based services in 

each of the 10 HHS Regions. 

OAA Title III Network 

The OAA established a national network of federal, 

state, and local agencies to provide services that maximize the independence and well-being of older adults 

in their homes and communities.

U.S. Department of Health and Human Services: HHS 

has designated ACL to carry out the provisions of the 

OAA and to administer the OAA programs. HHS also 

provides funding for the OAA programs.

Administration for Community Living: ACL is the 

primary federal agency responsible for administering 

the OAA programs and authorizes grants to SUAs and 

AAAs to act as advocates on behalf of older persons 

and to coordinate programs and services for older 

persons. ACL cherishes the continued collaboration 

with the Aging Services Network, consisting of the 

SUAs, AAAs, tribal organizations, and local service 

providers. 

ACL’s OAA Title III State Performance Report (SPR) 

Program Manager: ACL’s OAA Title III SPR Program 

Manager develops, supports, and leads collaborative 

initiatives across AoA and the regions to engage target 

populations and ensure home- and community-based 

services for older adults are a constant priority across 

the nation. In addition to overseeing the contract that 

supports the development and maintenance of the 

SPR, the Program Manager conducts and prepares 

periodic reports to communicate important regional 

and state trends, issues, and policies affecting OAA 

programs, grantees, and stakeholders. The OAA Title 

III SPR Program Manager frequently collaborates with 

ACL’s Regional Administrators to oversee the OAA Title 

III data, providing technical assistance and guidance 

on program performance and the systematic collection of data. Once the SPR data are final, they are 

shared publicly through a series of pathways, including ACL’s budget justification, the HHS justification, 

AGID, and a number of stakeholder platforms.

ACL Regional Administrators: ACL’s Regional 

Administrators have an important role, serving as a 

liaison between state and federal staff. In that role, 

they participate in programs and initiatives focused 

on older adults and tribal elders. They also work to 

Figure 1. OAA Title III Network16

Department of Health and Human Services

State Units on Aging

The Administration for Community Living: 

Regional Administrators

Service Providers/Direct Services

Area Agencies on Aging

FEDERAL

STATE

LOCAL

CONSUMERS
Annual Report on Older Americans Act Title III Programs | 17

State Units on Aging17: SUAs are designated statelevel agencies that are responsible for the planning 

and policy development as well as the administration of OAA activities. In that role, SUAs develop and 

administer multi-year state plans that advocate for and 

aid older residents, their families, and, in many states, 

adults with physical disabilities. The 56 SUAs are in 

each of the 50 states, the District of Columbia, Guam, 

Puerto Rico, American Samoa, the Northern Mariana 

Islands, and the Virgin Islands. “State Unit on Aging” 

is a general term. The specific title and organization 

of the governmental unit varies, and it may be called 

a Department, Office, Bureau, Commission, Council, 

or Board for the elderly, seniors, aging, older adults, 

and/or adults with physical disabilities. SUAs also 

coordinate with AAAs to collect and report state performance data to ACL on Title III program performance. 

Area Agency on Aging18: AAAs serve as local entities 

that, either directly or through contract with local 

service providers, oversee a comprehensive and coordinated service system for the delivery of home- and 

community-based services.

An AAA is a public or private nonprofit agency designated by a state to address the needs and concerns of all 

older persons at the local levels. AAA is a general term; 

names of local AAAs may vary. AAAs are “on-the-ground” 

organizations primarily responsible for a geographic 

area, also known as a planning and service area, that is 

either a city, a single county, or a multi-county district. 

AAAs may be categorized as representing a county, city, 

regional planning council, or council of governments. 

AAAs vary widely in size as each state determines how 

many service areas to establish, which then determines 

the number of operating AAAs.

AAAs coordinate and offer services that help older adults 

remain in their homes, if that is their preference, aided 

by services such as home-delivered meals, homemaker

assistance, and whatever else it may take to make 

independent living a viable option. By making a range 

of supports available, AAAs make it possible for older 

adults to choose the services and living arrangements 

that suit them best. The agencies focus on older adults 

in greatest need of supports, including people with low 

incomes, people with limited English proficiency, those in 

rural areas, those at risk for institutional placement, and 

members of minority groups.

In coordination with consumers, service providers, and 

other interested stakeholders, each AAA also develops 

an Area Plan that outlines the needs and proposed 

recommendations for programs and services targeted 

to the needs of older adults. AAAs then update the 

plan every few years to reflect emerging trends. AAAs 

are also tasked by the OAA to serve as advocates for 

older adults, enabling the agency’s leaders to engage 

on local and state issues beyond the programs and 

services they fund or deliver.19

The OAA does not address specific implementation 

issues. It is the responsibility of the SUA to develop 

regulations, policies, procedures, guidance, and technical assistance to address program accountability. 

The OAA requires that SUA/AAA consult with local services providers to develop the best method of program 

administration. Administrative procedures should not 

prevent or discourage participation.

Local Service Providers/Vendors: Local service providers or vendors deliver aging services, such as meals, 

transportation and in-home services. 

Consumers: Consumers are older adults receiving 

Title III services. 

Some OAA services also expand eligibility to other 

groups. For example, under Title III Part C (see description below), programs can offer meals to spouses (of 

any age) of older adults; people who provide volunteer 

services during meal hours; people with disabilities 

who live in housing facilities, where mainly older 

adults live and which also provide congregate nutrition 

services; and people with disabilities who reside with 

eligible older adults.
18 | 

Target Populations and Eligibility: Except for recipients of Information Services, those receiving senior 

services must be 60 years of age or older, regardless 

of income, assets, or ability to pay. Priority for services 

must be given to low-income older persons, including 

low-income minority older individuals, older individuals with limited English-speaking ability, and older 

individuals who live in rural areas. In addition, the 

following criteria are used to reach older adults with 

the greatest need for Chore, Homemaker, and Assisted 

Transportation services:

■ Chore services are targeted toward individuals who 

have difficulty with heavy housework, yard work, or 

sidewalk maintenance. 

■ Homemaker services are targeted toward individuals 

who have difficulty with one or more instrumental 

activities of daily living (IADLs), such as preparing 

meals, shopping for food or other personal items, 

managing money, using the telephone, or light 

housekeeping.

■ Assisted Transportation services are targeted toward 

individuals who have difficulty (physical or cognitive) 

with using private or public transportation.

Program Highlights: Millions of older adults rely on 

the supportive services provided under Title III-B. For 

example, in 2018, almost half a million older adults 

received case management services, and more than 

160,000 older adults received homemaker services.26

Recent data from the National Survey of OAA Participants (NSOAAP)27 show positive outcomes for the 

support services programs. For example:

■ The large majority of Case Management Service 

recipients rated the services as good, very good, or 

excellent (87.8%) and reported that these services 

helped them stay in their homes (90.4%).

■ Almost all Homemaker Service recipients rated the 

services as good, very good, or excellent (94%) and 

reported that these services helped them stay in 

their homes (95.8%).

■ Almost all Transportation Service recipients rated the services as good, very good, or excellent 

(94.4%), and most reported the services helped 

them stay in their homes (88.9%).

Older Americans Act Title III Services 

Title III provides four categories of services, designated under parts B, C, D, and E. Part B covers, among 

other things, supportive services and senior centers, 

including transportation, help with homemaker tasks 

and personal care, and adult day care.20 Part D covers 

evidence-based prevention and health promotion 

services.21 Part C covers nutrition services, including 

home-delivered and congregate meals.22 Part E authorizes the National Family Caregiver Support Program, 

which provides counseling, support groups, and relief 

from caregiver duties (respite services) 

for caregivers.23

Title III Part B: Support Services and Senior Centers

Purpose of the Support Services and Senior Centers 

Programs: Support services and senior centers are authorized under Title III-B of the OAA. The programs are 

designed to ensure that local communities can meet 

the individual needs of older adults and caregivers in 

their communities. The services are intended to help 

older adults remain independent in their own homes 

and communities.

Support Services and Senior Centers Programs: The 

funding for services provided through Title III-B is 

flexible, allowing agencies to develop programming to 

reflect community needs and provide tailored supports 

for older adults. There are more than 25 authorized 

services that local agencies can fund through Title 

III-B. These include services to help older people 

access supports, such as transportation, case management, and legal assistance, as well as home- and 

community-based long-term services and supports like 

personal care and adult day care services. The program 

also funds multi-purpose senior centers.24

Senior centers are the most visible presence of OAA 

programs and services in local neighborhoods. They are 

important gathering places, where people participate in 

educational, nutrition, social, and cultural programs as 

well as physical activities, health education, and health 

screenings. Though senior centers vary widely, they are 

all community centers that bring together older adults 

and provide critical programs and services.25
Annual Report on Older Americans Act Title III Programs | 19

Table 1. Older Americans Act Title III Services, Part B.28

Service Category Description of Services

Adult Day Care/Health Personal care for dependent older adults in a supervised, protective, and 

congregate setting (group setting) during some portion of a day. Services 

offered typically include social and recreational activities, training, counseling, and services such as rehabilitation, medications assistance, and 

home health aide services for adult day health.

Assisted Transportation Assistance and transportation, including escort, for a person who has difficulties (physical or cognitive) using regular transportation.

Transportation Transportation from one location to another (e.g., to a medical appointment or grocery store). Does not include any other activity.

Case Management Assistance with access or care coordination for an older person who has 

diminished functioning capacities, personal conditions, or other characteristics and so needs to receive services from formal service providers or 

family caregivers. Activities of case management include assessing needs, 

developing care plans, authorizing and coordinating services among providers, and providing follow-up and reassessment as required. 

Chore Services Assistance with such activities as heavy housework, yard work, or sidewalk 

maintenance.

Health Promotion and 

Disease Prevention

Services that include health screenings and assessments; organized physical 

fitness activities; evidence-based health promotion programs; medication 

management; home injury control services; and/or information, education, 

and prevention strategies for chronic disease and other health conditions that 

would reduce the length or quality of life of a person 60 or older. 

Homemaker A service assisting a consumer with routine tasks to achieve and maintain 

a clean, safe, and healthy environment—e.g., preparing meals, shopping 

for personal items, managing money, using the telephone, or doing light 

housework.

Information and Assistance A service that provides individuals with information on services available 

within communities; links individuals to services and opportunities available within communities; and, as much as possible, establishes adequate 

follow-up procedures. 

Legal Assistance Legal advice, counseling and representation by an attorney or other person 

acting under the supervision of an attorney.
20 | 

Service Category Description of Services

Outreach Intervention with individuals initiated by an agency or organization for the 

purpose of identifying potential clients (or their caregivers) and encouraging them to use existing services and benefits.

Personal Care Service that that help a consumer to achieve optimal functioning with ADL 

and/or IADL—e.g., personal assistance, stand-by assistance, supervision, 

or cues.

Self-Directed Care An approach to providing services (including programs, benefits, supports, 

and technology) under this Act intended to assist an individual with activities of daily living, in which 

■ the services (including the amount, duration, scope, provider, and location of those services) are planned, budgeted, and purchased under the 

direction and control of the person served; 

■ the service recipient is given the appropriate information and assistance necessary to make informed decisions about his or her care 

options; and

■ the AAA (or AAA-designated agency) assesses the service needs, capabilities, and preferences of the individual to be served as well as that 

individual’s ability to direct and control the receipt of services.

Other Services A service provided using Older Americans Act funds that does not fall into 

the listed service categories. 
Annual Report on Older Americans Act Title III Programs | 21

Title III Part C: Nutrition Services

Purpose of the Nutrition Programs: Nutrition services 

are authorized under Title III-C of the OAA. The services 

aim to

■ reduce hunger, food insecurity, and malnutrition,

■ promote the health and well-being of older people by 

assisting them in gaining access to nutrition and other 

disease prevention and health promotion services,

■ promote socialization, and

■ delay the onset of adverse health conditions 

resulting from poor nutritional health or sedentary 

behavior.

Nutrition Programs: Through the OAA Nutrition Program, 

ACL’s AoA provides grants to states to help support nutrition services for older people throughout the country. 

The nutrition program is the oldest, largest, and bestknown of all OAA programs. It is funded (in part) by AoA, 

as well as state and local governments, foundations, 

direct payment for services, fundraising, and participants’ voluntary contributions (time and/or money). 

Program services include the Congregate Nutrition 

Program and the Home-Delivered Nutrition Program, 

which provide healthy meals in group settings such as 

senior centers and faith-based locations, as well as in 

the homes of older adults who live alone. Title III also 

funds the Nutrition Services Incentive Program. Through 

the Aging Network’s meal providers, the programs 

provide a range of services, including nutrition screening and assessment as well as nutrition education and 

counseling.29 In addition, nutrition services provide an 

important link to other supportive in-home and community-based supports, such as homemaker and home 

health aide services, transportation, physical activity 

and chronic disease self-management programs, home 

repair and modification, and falls prevention programs.

Table 2. Older Americans Act Title III Services, Part C30

Service Category Description of Services

Congregate Meals Meals provided to an eligible individual in a group setting (e.g., senior 

center, senior housing sites, restaurant programs, faith-based locations). 

Home-Delivered Meals A meal provided by a qualified nutrition project provider to an eligible 

individual and is consumed in his or her place of residence. Meals may be 

provided via home delivery, pick-up, carry-out or drive-through.

Nutrition Counseling A standardized service as defined by the Academy of Nutrition & Dietetics 

that provides individualized guidance to individuals who are at nutritional 

risk because of their health or nutrition history, dietary intake, chronic 

illness, or medication use, or to caregivers. Counseling is provided one-onone by a registered dietitian, and addresses the options and methods for 

improving nutrition status with a measurable goal.

Nutrition Education An intervention targeting OAA participants and caregivers that uses information dissemination, instruction, or training with the intent to support 

food, nutrition, and physical activity choices and behaviors (related to 

nutritional status) in order to maintain or improve health and address nutrition-related conditions. Content is consistent with the Dietary Guidelines 

for Americans; is accurate, culturally sensitive, regionally appropriate, and 

considers personal preferences; and is overseen by a registered dietitian 

or individual of comparable expertise as defined in the OAA. 
22 | 

Congregate Nutrition Services 

(OAA Section 331, sometimes called C1)

The Congregate Nutrition Program, established in 

1972, serves healthy meals while also presenting 

opportunities for social engagement, health and 

wellness activities, and meaningful volunteer roles, 

all of which contribute to health and well-being. The 

Congregate Nutrition Services section of the OAA 

authorizes meals and related nutrition services in 

group settings, which help to keep older Americans 

healthy and prevent the need for more costly medical interventions. The Congregate Nutrition Program 

serves individuals age 60 and older, their spouses, 

and, in some cases, their caregivers and/or persons 

with disabilities who are not older individuals, but 

who reside in housing facilities occupied primarily 

by older individuals at which congregate nutrition 

services are provided.

Home-Delivered Nutrition Services 

(OAA Section 336, sometimes called C2)

Established in 1978, The Home-Delivered Nutrition 

Services section of the OAA authorizes meals and 

related nutrition services for older individuals and 

their spouses of any age. Home-delivered meals 

are often the first in-home service that an older 

adult receives, and the program is a primary access point for other home- and community-based 

services. The program often serves frail, food-insecure, or isolated individuals age 60 and over, their 

spouses, and, in some cases, their caregivers, 

and/or persons with disabilities. This program 

serves much more than food. It provides a safety 

check and sometimes the only opportunity for faceto-face contact or conversation that day.

Nutrition Services Incentive Program 

(OAA Section 311)31

The Nutrition Services Incentive Program of the OAA 

provides grants to states, territories, and eligible 

tribal organizations to support the Congregate and 

Home-Delivered Nutrition Programs by providing an 

incentive to serve more meals. Grantees can choose 

to receive their grants as cash, commodities (food) 

from the United States Department of Agriculture, 

or a combination of cash and commodities.

Congregate Meal Programs: 

A Value Proposition

CONGREGATE MEAL PROGRAMS

■ Serve adults 60+ (and in some cases, 

caregivers, spouses, and/or younger 

people with disabilities)

■ Provide meals in senior centers, schools, 

churches, farmer markets, and other 

community settings

■ Offer healthy meals, social engagement, 

access to community resources, volunteer roles

FEWER HOSPITAL

ADMISSIONS

8.5%

vs. 13.7%

FEWER ER VISITS

leading to admissions

5.4%

vs. 10.4%

HOW THE HEALTH CARE SYSTEM 

BENEFITS

DEMAND ON THE HEALTH CARE SYSTEM

WILL GROW WITH THE POPULATION

Nutrition/malnutrition 

have a tremendous 

impact on overall 

health and health 

care utilization

*Projected

Participants vs. non-participants

Population 

of Americans 

60+

2016 2020* 2040*

69M 77M 102M
Annual Report on Older Americans Act Title III Programs | 23

HOW MEAL PROGRAM PARTICIPANTS BENEFIT

Access to food

is a social determinant 

of health

4.9 million seniors

do not have reliable 

access to enough affordable, nutritious food

GREATER FOOD SECURITY

Staying connected

is an important part

of health aging

Social isolation is linked

to higher blood 

pressure, earlier onset 

of dementia, and other 

serious illnesses

INCREASED SOCIALIZATION

SOURCES: ACL’s 2018 Evaluation of the Older Americans Act Nutrition Services 

Program Outcomes Report-Part II; U.S. Census Bureau Populations Data; The 

National Foundation to End Senior Hunger and Feeding America’s “The State of 

Senior Hunger in America 2016.”

54%

54% of participants 

say their social 

opportunities have 

increased because of 

a meal program

80%

80% of participants 

say a congregate meal 

program improved 

their health

A healthy diet 

is essential 

to overall wellness

1 out of 2 older adults 

is at risk or is 

malnourished

HIGHER QUALITY DIET

54%

54% of participants 

say a congregate meal 

supplies 50% or more 

of total food for the day

According to the NSOAAP
24 | 

The OAA requires that all OAA-funded meals adhere to 

the current Dietary Guidelines for Americans, provide 

at least one third of the Dietary Reference Intakes, 

meet state and local food safety and sanitation requirements, and be appealing to older adults. Because services are state administered, each State Unit on Aging 

has the responsibility and authority (OAA Section 305) 

to implement the nutritional standards (OAA Section 

339) to best meet the needs of the older adults that 

they serve. For example, a state may choose to use its 

funds to provide meals that focus nutrient standards on 

prevalent statewide chronic disease(s) or predominant 

health issues affecting older individuals. In practice, 

some states may require that menus for meals served 

using OAA funds be developed using nutrient analysis, 

meal patterns, or a combination.

Target Population and Eligibility: Services are not 

intended to reach every individual in the community. In 

general, under the OAA, a person must be 60 years of 

age or older to be eligible for the nutrition programs. 

However, the programs specifically target adults age 60 

and older who are in greatest social and economic need, 

with particular attention to the following groups32:

■ Low-income older adults

■ Minority older individuals

■ Older adults in rural communities

■ Older individuals with limited English language ability

■ Older adults at risk of institutional care

Program Highlights: In 2018, over 7,500 providers 

delivered congregate and home-delivered meals to 

over 2.3 million recipients.33 Recent data from the 

NSOAAP34 show that Congregate Nutrition Programs 

are effectively targeting their services, as indicated by 

the following outcomes:

■ More than 50% of recipients are 75 years or older, 

compared to 30% of the US population over 60 

years old.

■ 54% of recipients indicated that one congregate 

meal provides half or more of their total food for 

the day.

■ 90% of recipients rate the meal as good to 

excellent.

■ 80% of recipients say they eat more healthily 

because of a meal program.

■ About three quarters of recipients (76%) believe 

their health has improved as a result of a lunch 

program.

For the Home-Delivered Nutrition Programs, recent 

NSOAAP data also indicate that the programs are 

effectively targeting services, as indicated by the 

following outcomes:

■ 62% of recipients are 75 years or older, compared 

to 30% of the US population over 60 years old.

■ 66% of recipients indicate that a home-delivered 

meal provides half or more of their total food for

 the day.

■ Nearly 88% of participants rate the meal as good to 

excellent.

■ The vast majority of recipients (90%) say that 

home-delivered meals help them to stay in their 

own homes.

■ 60% of recipients live alone.
Annual Report on Older Americans Act Title III Programs | 25

Title III Part D: Evidence- Based Disease Prevention 

and Health Promotion Services

Purpose of the Program: Title III-D of the OAA was established in 1987. It provides grants to states and territories, based on their share of the population aged 60 

and older and other factors, for programs that support 

healthy lifestyles and promote healthy behaviors. The 

FY 2012 Congressional appropriations law included, 

for the first time, an evidence-based practice requirement related to Title III-D funds. As a result, states that 

receive OAA funds under Title III are required to spend 

those funds on evidence-based programs* to improve 

health and well-being and reduce disease and injury. 

Evidence-Based Programs: Since 2003, the aging services network has been steadily moving toward wider 

implementation of disease prevention and health 

promotion programs based on scientific evidence and 

demonstrated to improve the health of older adults as 

they reduce the need for more costly medical interventions. Service activities may include programs related 

preventing and mitigating the effects of chronic disease (including osteoporosis, hypertension, obesity, 

diabetes, and cardiovascular disease), alcohol and 

substance abuse reduction, smoking cessation, weight 

loss and control, stress management, falls prevention, 

physical activity, and improved nutrition.

* ACL defines an evidence-based program as one demonstrated 

through evaluation to be effective for improving the health and 

well-being or reducing disease, disability, and/or injury among older 

adults; and proven effective with the older adult population, using 

experimental or quasi-experimental design; and research results 

published in a peer-review journal; and fully translated in one or more 

community site(s); and includes developed dissemination products 

that are available to the public.

Specific programs offered vary widely but include 

chronic disease self-management, falls prevention, 

medication management, fitness activities, mental 

health supports, and other interventions that have 

shown to be effective in enhancing health.35

The ACL National CDSME Resource Center maintains a 

database of evidence-based programs that meet ACL’s 

criteria for evidence-based programs under Title III-D.†

The database is updated periodically based on the 

results of an Evidence-Based Program Review Process. 

More information about that process is available here‡.

Target Population and Eligibility: Priority is given to 

serving older adults living in medically underserved 

areas of the state and those with the greatest economic 

need. Title III-D funds must be used to provide evidence-based disease prevention and health promotion 

programs at senior centers, at congregate meal sites, 

and/or through home-delivered meal programs in the 

client’s home or at other appropriate sites.

Program Highlights: Evidence- based programs 

empower older adults to take control of their health 

by maintaining a healthy lifestyle through increased 

self-efficacy and self-management. These programs 

are based on research and provide documented health 

benefits. Specifically, they demonstrate reliable and 

consistently positive changes in important health-related and functional measures, such as improved balance and strength as a result of attending a physical 

activity program or reduced chronic disease symptomatology as a result of a self-management program.

† https://www.ncoa.org/evidence-based-programs

‡ https://www.ncoa.org/article/apply-to-become-an-evidencebased-program

Table 3. Older Americans Act Title III Services, Part D

Service Category Description of Services

Evidence-Based Disease 

Prevention and Health 

Promotion Services

Funds are provided for evidence-based disease prevention and health 

promotion services, including programs related to physical fitness, 

medication management, chronic disease self-management education, 

psychosocial behavioral health intervention, HIV, arthritis, brain health, 

diabetes, falls prevention, depression, and chronic pain.
26 | 

Title III Part E: Caregiver Services

Purpose of the Caregiver Programs: Family caregivers 

are the backbone of America’s long-term care system, 

with more than 65 million Americans, or nearly 30% 

of the general population, caring for an older adult or 

someone living with an illness or disability.36 Family 

members are the people most likely to serve as caregivers to older adults, and when these caregivers become 

overwhelmed by the physical and emotional burden of 

caregiving, their older loved ones are at increased risk 

of institutionalization. 

Recognizing the critical role families play in the 

nation’s system of long-term services and supports, 

Congress established the National Family Caregiver 

Support Program (NFCSP) in 2000 as part of the reauthorization of the OAA. It was the first federal program 

making it possible for every state and community 

to provide family caregivers with a flexible base of 

services and supports to assist them in keeping their 

loved ones in the settings of their choice for as long as 

possible. Today, the NFCSP is an integral component 

of our nation’s fabric of long-term services and supports. It is a trusted and reliable resource to support 

the needs of family or other informal caregivers as they 

lend assistance to aging adults, as well as the needs 

of grandparents and older relatives caring for minor 

children or adults with disabilities.37

Table 4. Older Americans Act Title III Services, Part E38

Service Category Description of Services

Information for Caregivers 

About Available Services

A service for caregivers that provides them with information on resources 

and services available within their communities. 

Assistance to Caregivers in 

Gaining Access to Services

A service that assists caregivers in obtaining access to the services and resources available to them within their communities. As much as possible, 

it ensures that the individuals receive the services needed by establishing 

adequate follow-up procedures.

Caregiver Training/Education, Individual Counseling, 

Support Groups

Counseling to caregivers to assist them in making decisions and solving 

problems relating to their caregiver roles. This includes counseling to individuals, support groups, and caregiver training (of individual caregivers 

and families). These services help caregivers better manage their responsibilities and cope with the stress of caregiving.

Respite Care Services which offer temporary, substitute supports or living arrangements 

for care recipients in order to provide a brief period of relief or rest for caregivers. Respite Care includes in-home respite (personal care, homemaker, 

and other in-home respite); respite provided as the care recipient attends a 

senior center or other nonresidential program; institutional respite provided by placing the care recipient in an institutional setting such as a nursing 

home for a short period of time as a respite service to the caregiver; and, 

for grandparents caring for children, summer camps. 

Supplemental Services Services provided on a limited basis to complement the care provided by 

caregivers (e.g., transportation, home modifications, medical equipment, 

assistive technologies, and emergency response systems).
Annual Report on Older Americans Act Title III Programs | 27

years of age and older, or to individuals of any age 

with Alzheimer’s disease and related disorders

■ Older relatives (not parents), age 55 and older, 

providing care to children under the age of 18

■ Older relatives, including parents, age 55 and older, 

providing care to adults ages 18–59 with disabilities40

Program Highlights: In 2018, there were over 200,00 

caregiver program recipients.41 Recent data from the 

NSOAAP42 show positive outcomes for the Caregiver 

Programs. For example:

■ Almost all Caregiver Service recipients rated the 

services as good, very good, or excellent (93.1%).

■ The large majority of Case Management Service 

recipients rated the services as good, very good, or 

excellent (87.8%) and reported the services helped 

them stay in their homes (90.4%).

■ Almost all Homemaker Service recipients rated the 

services as good, very good, or excellent (94%) 

and reported the services helped them stay in their 

homes (95.8%).

Caregiver Programs: Through the NFCSP, states and 

territories offer five core services for caregivers, in 

partnership with AAAs and local service providers:

■ Information for Caregivers About Available Services

■ Assistance to Caregivers in Gaining Access 

to Services

■ Caregiver Education/Training, Individual 

Counseling, and Support Groups

■ Respite Care

■ Supplemental Services

The NFCSP provides grants to state and territories to 

fund supports that help caregivers of all ages balance 

caregiving with other responsibilities. This, in turn, 

helps ensure more adults can remain in their homes 

and communities.39

Target Population and Eligibility: The NFCSP was 

established in 2000 and is available for the following 

individuals: 

■ Adult family members or other informal caregivers 

age 18 and older providing care to individuals 60 
28 | 

for which data are collected in the SPR; however, 

these definitions are reasonably flexible to allow for 

state-by-state variation. For example, “supplemental service” recipients can receive items such as 

wheelchairs, adjustable beds, personal emergency 

response systems, and a number of various medical equipment or supplies to support caregivers. 

Although this level of flexibility does not apply to all 

services, it is important to note when considering 

state level comparisons. Additionally, not all states 

provide all the services measured in the SPR. 

■ Data systems. States differ in how they collect and 

maintain OAA Title III data. Depending on the age 

and sophistication of the data management system, 

states may collect additional information, such as 

age and living arrangement sizes and types across 

funding authorities. Budget and staffing limitations 

are often mentioned among the top difficulties with 

collecting and extracting OAA Title III data. 

■ Funding options. Some states administer services 

and programs in cooperation with local governments and with the contribution of state and county 

dollars. That constitutes a distinct difference with 

funding and the number of individuals served and 

availability of services. 

■ Client feedback. Although the NSOAAP is a national 

sample survey of clients receiving OAA Title III services, respondents may not be representative of all 

the OAA Title III clients receiving the services. 

We encourage readers to review SPR data in light of 

these complexities. Detailed information about the 

surveys and operational definitions used for OAA Title 

III data can be found on the AGing, Independence, and 

Disability* (AGID) program data portal website. It may 

also be helpful to check your state’s website or check 

with the SUA director if you need further clarification of 

a specific finding. 

* https://agid.acl.gov/

Older Americans Act Title III Data 

Using Title III Data

Policy makers, state leaders, advocates, and other 

stakeholders need accurate and timely information 

about OAA Title III programs to assess their reach, effectiveness, and potential impact. The information is also 

key for monitoring ACL’s progress toward achieving its 

strategic goals, objectives, and priorities; for supporting 

ACL’s budget justifications; for monitoring program performance; and for supporting program improvement.43

In addition, information about the programs can be 

used for research and analysis to inform federal, state, 

and local aging and social services policy.

The OAA Title III programs produce rich data covering 

the range of Title III services. These data can help 

answer key questions about the programs, such as 

the following:

■ How much funding is allocated to the individual 

service types?

■ How do expenditures differ by service type?

■ How many individuals receive Title III services?

■ What are the characteristics of Title III service 

recipients?

■ What is the health status of service recipients?

■ How helpful are the services?

Although the OAA provides minimum requirements and 

guidance to the aging service network on Title III, there 

is flexibility for states to tailor programs and services 

to best meet the needs of older adults they serve. It is 

important to consider similarities and differences such 

as the following across states when interpreting OAA 

Title III data:

■ Services. Although authorized services under Title 

III are defined in the OAA, specific service design 

and implementation varies from state to state. ACL 

provides detailed definitions to states on services 
Annual Report on Older Americans Act Title III Programs | 29

Title III Data Collection and Access 

As the primary federal agency responsible for administering the OAA, ACL collects information and reports on 

the performance of Title III programs through several 

data collection systems. The two primary data collection systems for Title III programs are the SPR and 

the NSOAAP. 

State Performance Report44

In compliance with the Government Performance and 

Results Act of 1993, the OAA and ACL’s AoA, 50 states, 

the District of Columbia, Guam, Puerto Rico, American 

Samoa, the Northern Mariana Islands, and the U.S. 

Virgin Islands submit an annual SPR on the activities 

carried out under the Older Americans Act.

The data collected by state agencies, area agencies on 

aging, and service providers include statistical data 

regarding the effectiveness of the state agency and 

area agencies on aging in targeting services to older 

individuals with greatest economic need and older 

individuals with greatest social need, with particular 

attention to low-income minority individuals, older 

individuals residing in rural areas, low-income individuals, and frail individuals (including individuals with 

any physical or mental functional impairments).

The SPR includes demographic and descriptive data, 

performance data on programs and services, and data 

on the infrastructure of home- and community-based 

services. These data are aggregated and examined on 

a national and regional (e.g., for each of the 10 HHS 

Regions) level. SPR data from 2005 to 2018 is available to the public and can be accessed on the ACL’s 

AGID program data portal without a login using two 

approaches:

■ Data-at-a-Glance† is a tool for generating quick 

estimates in table format, supplemented by map 

and chart graphical representations for SPRs by 

national, regional, or state level; allows users to 

examine a single data element by state and year to 

explore the data for patterns, anomalies, or areas 

of interest.

■ Custom Tables‡ provide detailed, multiyear tables 

designed to present data elements applicable to 

users’ needs and to further refine users’ results 

based on demographic stratifiers or geographic 

locations. Using a step-by-step process, users can 

choose multiple data elements to compare and 

download in a spreadsheet format. 

National Survey of Older Americans Act Participants45

In 2003, AoA began the NSOAAP, a national sample 

survey funded by Title III of the OAA, to assess the 

effectiveness of the Title III programs, maintain 

accountability, and demonstrate the program’s 

success in achieving legislative goals. 

NSOAAP is comprised of six annual, national surveys 

of recipients of select Title III services. The survey 

† https://agid.acl.gov/DataGlance/SPR/

‡ https://agid.acl.gov/CustomTables/NPS/Year/

“Our OAA network is making a real difference in the lives of people every day 

all across this nation. However, if we are to continue to be successful, we must 

evolve to meet the growth in demand and the increasingly complex combinations of needs of the people we serve. We also must keep pace with the changes occurring in the larger policy environment.” 

— ACL Administrator and Assistant Secretary for Aging Lance Robertson 
30 | 

instruments focus on the consumers’ assessment of 

service quality and outcomes. The instruments also 

measure client characteristics such as demographics 

and physical and social functioning.

These surveys are conducted annually through computer-assisted telephone interviewing. All responses 

are confidential and anonymous. The sample population of the NSOAAP is Title III service participants and 

their caregivers. Respondent participants are age 60 

and older. Respondents answering questions under 

the Caregiver module are adults age 18 and over.

A total of 312 AAAs are randomly selected to participate in the survey. A small sample of clients from each 

participating AAA is randomly selected to complete a 

survey about services they received during the past 

year. NSOAAP data include information for six Title 

III service areas (caregiver, home-delivered meals, 

congregate meals, homemaker, transportation, and 

case management) at the national level and by Census 

region. Some of the domains within each service area 

include the length of time and frequency of service 

use, ratings of quality, perceived benefits, social and 

physical function, and demographics.

The 12th NSOAAP was collected in 2017. Data can be 

accessed on AGID program data portal using the two 

approaches:

Custom Tables§: provide detailed, multiyear tables 

designed to present data elements applicable to 

users’ needs and to further refine users’ results 

based on demographic stratifiers or geographic 

locations. Using a step-by-step process, users can 

choose multiple data elements to compare and 

download in a spreadsheet format. 

Data Files¶: provide datafiles in CSV, ASCII, and SAS 

format for the six Title III service areas for use in a 

statistical package.

The following sections are program highlights and 

accomplishments based on 2018 SPR and NSOAAP data. 

§ https://agid.acl.gov/CustomTables/NPS/Year/

¶ https://agid.acl.gov/DataFiles/NPS/

Each May, AoA leads our nation’s 

celebration of Older Americans 

Month. Proclaimed by every 

President since John F. Kennedy, the 

observance is a time to recognize 

the contributions of older Americans 

and an opportunity to hightlight 

important aging issues and trends. 

AoA maintains the Older Americans 

Month website and creates all 

materials found at ACL.gov/OAM.

The Eldercare Locator is AoA’s free 

public service that connects older 

adults, families, and caregivers with 

aging information and local resources. The website offers fact sheets 

and outreach materials as well as 

a database of community resources

that can be searched by topic or 

location. Information specialists are 

available by phone, online chat, and 

email. Hours of operation are Monday 

through Friday, 9 a.m. to 8 p.m. ET.

www.eldercare.acl.gov

880.667.1116 (toll-free)
Annual Report on Older Americans Act Title III Programs | 31

Touching the Lives of Every Older American 

As shown by the wide range of services, OAA Title III 

programs are comprehensive and provide essential 

supports for older adults. In fact, one way or another, 

OAA programs and services touch every older American’s life, directly or indirectly. For instance, senior 

centers are important gathering places where adults 

participate in essential programs focused on health, 

wellness, education, and social participation. The nutrition programs support food security for thousands of 

low-income and food-insecure people each day. Caregiver support programs help ensure that older adults 

can stay in their homes.46 At the local level, older adults, 

caregivers, and other community stakeholders directly 

determine how current and future programs are implemented, based on the needs of each community. 

Overall, the programs offer an impressive return on 

investment by leveraging state, local, and private 

dollars and mobilizing volunteers to help millions of 

older adults and caregivers age in their homes and 

communities every year. Also, because people aging 

in place are less likely to need more costly hospital 

and institutional care paid for through Medicare and 

Medicaid, the programs save taxpayer dollars as they 

enable older adults to remain independent and healthy 

in their own homes, where they prefer to be.47

Protecting the Most Vulnerable 

In 2018, OAA Title III program data shows Title III 

funded 56 state agencies, 1,050 local agencies that 

coordinated and offered services to older adults, and 

11,212 senior centers. In addition, it provided support 

to over 196,000 caregivers serving elderly individuals. 

More than 10.8 million older persons received Title III 

services, including almost 147 million home-delivered 

meals; 74 million congregate meals; 20 million rides to 

medical appointments, grocery stores, and other activities; and 21 million hours of homemaker services. 

One of the key goals of the OAA Title III programs is 

ensuring the nation’s most vulnerable older adults 

have the services they need to remain independent in 

their communities. Thus, even though all Americans 

over the age of 60 are eligible to receive OAA services, 

states must target individuals with the greatest economic and social need, with a particular emphasis on those 

who are most vulnerable. The 2018 OAA Title III program 

data show services are indeed reaching the most vulnerable older adults in the nation—those most in need 

OAA Title III 2018 Program Highlights and Accomplishments

Between 89% and 96% 

of service recipients noted 

that the services helped them 

stay in their home. 
32 | 

of services to remain independent. Specifically, the data 

reported by service recipients show that Title III services 

reached the following populations in 2018:

■ Older adults living in poverty: about one third of 

service recipients 

■ Older adults livening alone: about half of service 

recipients 

■ Older adults living in rural areas: over one third of 

service recipients 

■ Older adults who require assistance with activities 

of daily living (ADLs) or instrumental activities of 

daily living (IADLs): almost half of service recipients 

requiring assistance with ADLs, about three out of 

four requiring assistance with IADLs

■ The oldest of the older adults: almost a quarter of 

service recipients age 85+ 

These characteristics are often associated with worse 

health and diminished physical functioning. In fact, 

approximately half of Title III participants who received 

in-home services in 2018—those in the home-delivered 

meals, case management, homemaker services, and 

caregiver programs—generally reported being in poor 

or fair health. 

However, the data also show that OAA Title III services 

may make a difference in the lives of those individuals.

The majority of service recipients rated the services**

as excellent, very good, or good. Most importantly, 

between 89% and 96% of service recipients†† noted 

that the services helped them stay in their home. In 

addition, the services appear to help avoid overnight 

hospital and nursing home stays. On average less than 

one in five service recipients reported an overnight 

stay in a nursing home or rehabilitation center, and, on 

average, only about one in three service recipients reported an overnight stay in a hospital. The majority of 

service recipients also reported not receiving Medicaid 

benefits in 2018, highlighting that OAA Title III service 

could be associated with fewer healthcare needs.

** Includes the following services: Caregiver, Case Management, 

Congregate Meals, Home-Delivered Meals, Homemaker, and 

Transportation

“The stability that a finalized and current OAA reauthorization provides is 

critical to ensuring that the millions of older adults and caregivers served by 

the OAA can continue to live with dignity and independence in their homes and 

communities for as long as possible.” 

—James Appleby, CEO Gerontological Society of America 
Annual Report on Older Americans Act Title III Programs | 33

The following sections of the report summarize results from 

OAA Title III programs for 2018. The highlights are presented 

in two parts. Part I focuses on results from 2018 SPR data, 

including overall program information, number of service 

recipients and demographics, and service delivery. Part II

focuses on results from the 2018 NSOAAP, including service 

recipient characteristics and recipients’ ratings of services. 

SPRs distinguish between registered and unregistered OAA 

Title III services. Registered services include Personal Care, 

Homemaker, Chore, Home-Delivered Meals, Adult Day Care/

Health Services, Case Management, Congregate Meals, 

Nutrition Counseling, and Assisted Transportation. Unregistered services include Transportation, Legal Assistance, 

Nutrition Education, Information and Assistance, Outreach, 

Other Services, Health Promotion, and Cash and Counseling. 

SPRs also include Caregiver Services data, which are captured 

separately from registered and unregistered services data. 

Data on Caregiver Services are separated by caregiver type, 

including “Caregivers Serving Older Adults” and “Grandparents and Other Older Caregivers Serving Children.” NSOAPP 

provides data on six select Title III services (Homemaker, 

Home-Delivered Meals, Case Management, Congregate 

Meals, Transportation, and Caregiver Services).

This report focuses on six Title III services: Homemaker, 

Home-Delivered Meals, Case Management, Congregate 

Meals, Transportation, and Caregiver Services. These are 

the key services captured in both SPR and NSOAAP.

Older Americans Act Title III Results
34 | 

Number of Agencies and Providers

The majority of funding for OAA programs flows from 

the federal to the state level and from there to the local 

level. Most states and territories have a state-level 

office on aging or SUAs, responsible for developing 

and administering multiyear state plans that advocate 

for and aid older residents, their families, and, in many 

states, adults with physical disabilities. Most states 

and territories also have AAAs.48 These are public or 

private nonprofit agencies designated by a state to 

address the needs and concerns of all older persons at 

the regional and local levels. AAAs work with service 

providers, such as senior centers, to deliver the 

services to eligible clients.

Exhibit 1. Number of Providers by Service Type

Notes: Includes data from all 50 States, DC, and territories. 

Home-Delivered Meals

Congregate Meals

Case Management

Transportation

Homemaker

Caregivers Serving 

Older Adults

Grandparents and 

Other Older Caregivers 

Serving Children

0 2,500 5,000 7,500 10,000 12,500 15,000 17,500

 3,518

 3,175

 3,528

 15,334

 3,422

 4,078

 1,3641

Total Number of SUAs

56

Total Number of AAAs

1,050

Total Number 

of Senior Centers

11,212

Part 1 | 2018 SPR Data Highlights*

* Data on legal assistance will be available in future reports.
Annual Report on Older Americans Act Title III Programs | 35

Number of SUA Agency Staff

Total number of paid staff

6,273

In 2018, Caregivers Serving Older Adults programs 

reported by far the largest number of providers (15,334), 

followed by Congregate Meal programs (4,078).

Number and Characteristics 

of Service Recipients

Number of Title III Service Recipients

In 2018, states and territories reported an estimated 

total of more than 10 million (10,802,963) unduplicated Title III service recipients (including registered and 

unregistered service recipients). Of those, 2,716,201

were service recipients for registered services.

Number of AAA Staff

Total number of staff

51,894

Paid staff

25,943

Volunteer staff 

25,951

The following sections provide data for six service 

areas of interest. Data for recipients of Transportation 

services are not available. When available, data on 

service recipients for the Title III Caregiver programs 

are provided separately.

Number of Title III Service Recipients by Service Type

In 2018, Congregate Meal programs reported the highest number of service recipients (1,522,555), followed 

by Home-Delivered Meal programs (871,680).

Home-Delivered Meals

Congregate Meals

Case Management

Homemaker

Caregivers Serving 

Older Adults

Grandparents and 

Other Older Caregivers 

Serving Children

0 300,000 600,000 900,000 1,200,000 1,500,000

871,680

1,522,555

482,148

165,905

196,516

16,358

Exhibit 2. Number of Title III Service Recipients by Service Type

Notes: Clients may be receiving more than one service.
36 | 

Number of Title III Service Recipients by Gender 

In 2018, more than three out of five (63.2%) service 

recipients were female.

The majority of caregivers serving older adults or 

children in 2018 (63.8% and 78.53%, respectively) 

were female also.

Gender Number of 

Caregivers Percent

Caregivers Serving Older Adults – Male 45,209 23.0

Caregivers Serving Older Adults – Female 125,404 63.8

Missing 25,903 13.2

Total 196,516 100

Grandparents and Other Older Caregivers Serving Children – Male 2,174 13.3

Grandparents and Other Older Caregivers Serving Children – Female 12,846 78.5

Missing 1,338 8.2

Total 16,358 100

Caregivers Serving Older Adults by Gender

Exhibit 3. Title III Service Recipients by Gender

Male

Female

Gender Number of Service 

Recipients

Male 953,406

Female 1,717,076

Missing 45,719

TOTAL 2,716,201

Notes: Counts include those from all registered services. 

Counts do not include data from the Caregiver programs. 

36%

Male

64%

Female

Notes: Exhibit does not include missing data.
 | 37

Most caregivers serving older adults (62,294 caregivers) were in the age range of 60–74 years. Most 

caregivers serving children (12,408 caregivers) were in 

the age range of 55–74 years.

Number of Title III Service Recipients by Age 

In 2018, more than 39% of service recipients were 

between ages 60 and 74. Almost a quarter of service 

recipients (23.7%) were 85 years and older.

Age Range Number of 

Caregivers Percent

Caregivers Serving Individuals – Age under 60 64,345 32.7

Caregivers Serving Older Adults – Age 60–74 62,294 31.7

Caregivers Serving Older Adults – Age 75–84 28,613 14.6

Caregivers Serving Older Adults – Age 85+ 11,633 5.9

Missing 29,631 15.1

Total 196,516 100

Grandparents and Other Older Caregivers Serving Children – Age 55–74 12,408 75.9

Grandparents and Other Older Caregivers Serving Children – Age 75–84 1,631 10.0

Grandparents and Other Older Caregivers Serving Children – Age 85+ 434 2.7

Missing 1,885 11.5

Total 16,358 100

Notes: Data on age were missing for 95,756 service recipients. Counts were constructed by summing age data for service recipients for each age 

range, then summing to obtain the total. Percentages were calculated by dividing each age group by the total, then multiplying by 100. 

Age 60–74

Age 75–84

Age 85+

0 200,000 400,000 600,000 800,000 1,000,000 1,200,000

1,080,735

897,075

642,635

Exhibit 4. Title III Service Recipients by Age

39.9%

33.0%

23.7%

Missing –3.5%

Caregivers Serving Older Adults by Age

Notes: Clients may be receiving more than one service. Counts include those from all registered services. Counts do not include data from the Caregiver programs. Age was calculated by summing age counts across the 50 States, DC, and territories for each age range. To determine the number of 

missing data points, the total count of missing data (2,620,445) was subtracted from the total count of all clients receiving registered services. 
38 | 

Number of Title III Service Recipients by Race/Ethnicity

The majority of service recipients were white alone (Hispanic and not Hispanic), 

making up approximately 70% of service recipients.

Exhibit 5.

Title III Service 

Recipients 

by Race/Ethnicity

Notes: Exhibit does not include missing data.

Black/

African American 

Alone 13.8% White Alone, 

Not Hispanic

64.7%

White Alone, 

Hispanic

11.0%

Asian Alone

4.8%

Two or More Races 2.2%

Other Race 1.8%

Native American Alone 1.3%

Hawaiian Pacific Islander Alone 0.4%

Race/Ethnicity Number of 

Service Recipients Percent

White Alone, Not Hispanic 1,603,022 59.0

Black/African American Alone 340,860 12.6

White Alone, Hispanic 272,106 10.0

Asian Alone 119,187 4.4

Two or More Races 55,545 2.0

Other Race 44,786 1.7

Native American Alone 33,365 1.2

Native Hawaiian/Pacific Islander Alone 9,609 0.4

Missing 237,721 8.8

Total 2,716,201 100

Notes: Counts include those from all registered services. Counts do not include data from the Caregiver programs. 

70% |
Annual Report on Older Americans Act Title III Programs | 39

The largest racial/ethnic group of grandparents and other older caregivers serving children 45% were Black/African American, making up almost 45% of these caregivers. |

Race/Ethnicity Number of Caregivers Percent

White Alone, Not Hispanic 83,329 42.4

Black/African American Alone 57,966 29.5

White Alone, Hispanic 16,795 8.6

Asian Alone 5,031 2.6

Two or More Races 1,483 0.8

Other Race 5,617 2.9

Native American Alone 832 0.4

Native Hawaiian/Pacific Islander Alone 385 0.2

Missing 25,078 12.8

Total 196,516 100

Caregivers Serving Older Adults: A majority of the caregivers serving older adults were 51% white alone (Hispanic and not Hispanic), making up approximately 51% of these caregivers. |

Notes: Exhibit does not include missing data.

Black/

African American 

Alone 

44.1% (7,218)

White Alone, 

 Not Hispanic

 30.2% (4,939)

White Alone, 

Hispanic

7.3% (1,188)

Asian Alone 0.8% (122)

Two or More Races 

0.8% (126)

Other Race 1.1% (176)

Native American Alone 1.4% (226)

Exhibit 6. Hawaiian Pacific Islander Alone 0.5% (74)

Caregivers and 

Other Older 

Caregivers

Serving 

Children
40 | 

Number of Title III Service Recipients by Living Alone Status

People who live by themselves are at higher risk of nursing home entry because 

they may be isolated or lack supports to assist with ADLs. In part because of this 

risk, OAA targets services to those who live alone, and participants in many Title III 

programs are more likely to live by themselves than older Americans nationally.49

In 2018, about half (44.6%) of service recipients reported living alone.

Poverty Status Service Recipient Numbers Percent

In Poverty 911,393 33.6

Not in Poverty 1,386,211 51.0

Missing 418,597 15.4

Total 2,716,201 100

Notes: Counts include those from all registered services. Counts do not include data from the Caregiver programs. 

44.6% |

Number of Title III Service Recipients by Poverty Status 

About one third (33.6%) of Title III service recipients in 2018 lived in poverty. 33.6% |

Notes: Exhibit does not include missing data. Counts include those from all registered services. 

Counts do not include data from the Caregiver programs. 

Not Living 

Alone

45.5% 

(1,234,801)

Living Alone

44.6% 

(1,211,934)

Exhibit 7.

Service Recipients 

by Living Alone

Status
 | 41

Living Environment Number of 

Service Recipients Percent

Rural 939,959 34.6

Non-Rural 1,683,531 62.0

Missing 92,711 3.4

Total 2,716,201 100

Notes: Counts include those from all registered services. Counts do not include data from the Caregiver programs. 

Number of Title III Service Recipients by Rurality 

In 2018, over one third (34.6%) of service recipients reported living in rural areas. 34.6% |

In 2018, 22.3% of Caregivers Serving Older Adults reported living in rural settings. 

For grandparents and other older caregivers serving children, 19.2% reported living 22.3% 

in rural settings. |

Notes: Exhibit does not include missing data. Counts include those from all registered services. 

Counts do not include data from the Caregiver programs. 

Grandparents and Older Caregivers 

Serving Children – Rural 

19.2% (3,148)

Grandparents and Older Caregivers 

Serving Children – Nonrural 

73.8% (12,069)

Exhibit 8.

Caregivers Serving Older Adults and Grandparents and Older 

Caregivers Serving Children: Rural vs. Nonrural

Caregivers Serving 

Older Adults – Rural 

22.3% (43,736)

Caregivers Serving Older Adults – Nonrural 

71.6% (140,782)
42 | 

Need for Assistance With ADLs for Title III Service Recipients

People who have difficulty performing three or more ADL or IADLs are at increased risk of 

nursing home placement. ADLs include eating, dressing, bathing, toileting, transferring 

in and out of bed/chair, and walking.IADLs including preparing meals, shopping for personal items, medication management, managing money, using telephone, doing heavy 

housework, doing light housework, and transportation ability (transportation ability 

refers to the individual’s ability to make use of available transportation without assistance).50 Thus, it is critical that people who need assistance with ADLs or IADLS receive 

services that allow them to remain in their homes.

Almost half of service recipients (44%) reported requiring assistance with three or 

more ADLs. Most clients who had difficulty performing three or more ADLs were HomeDelivered Meal service recipients (356,452).

Notes: The results were constructed by summing across the 50 States, DC, and all 

territories for the ADL group of Three or More ADLs. These results only include clients 

receiving Cluster 1 registered services. Cluster 1 registered services are as follows: 

personal care, homemaker, chore, home-delivered meals, adult day care/health, and 

case management. Impairment in ADL counts are based on the inability to perform 

one or more of the following six ADLs without personal assistance or stand-by assistance, supervision, or cues: eating, dressing, bathing, toileting, transferring in and 

out of bed/chair, and walking.51

Exhibit 9. Clients with Difficulty Performing Three or More ADLs 

by Cluster 1 Registered Service

Homemaker

88,537

Case Management

181,179

Home-Delivered 

Meals

356,452

700,000

600,000

500,000

400,000

300,000

200,000

100,000

0

44% |

ADL Group Number of 

Service Recipients

0 ADLs 358,751

1 ADLs 153,024

2 ADLs 148,244

3+ ADLs 512,316

Notes: The results were constructed by summing 

across the 50 States, DC, and all territories for 

each ADL group. These results only include clients 

receiving Cluster 1 registered services. Cluster 

1 registered services are as follows: personal 

care, homemaker, chore, home-delivered meals, 

adult day care/health, and case management. 

Impairment in ADL counts are based on the 

inability to perform one or more of the following 

six ADLs without personal assistance or stand-by 

assistance, supervision, or cues: eating, dressing, 

bathing, toileting, transferring in and out of bed/

chair, and walking.52
 | 43

Need for Assistance With IADLs for Title III Service Recipients

About three out of four service recipients (79%) reported requiring assistance with three 

or more IADLs.

Most clients who require assistance with three or more IADLS were recipients of HomeDelivered Meal service (670,642).

Homemaker

149,829

Case Management

324,450

Home-Delivered 

Meals

670,642

1,200,000

1,000,000

800,000

600,000

400,000

200,000

0

Exhibit 10. Clients with Difficulty Performing Three or More IADLs 

by Cluster 1 Registered Service

79% |

IADL Group Number of 

Service Recipients

0 ADLs 117,830

1 ADLs 62,480

2 ADLs 69,701

3+ ADLs 915,224

Notes: The results were constructed by summing 

across the 50 States, DC, and all territories for 

each IADL group. These results only include 

clients receiving Cluster 1 registered services. 

Cluster 1 registered services are as follows: personal care, homemaker, chore, home-delivered 

meals, adult day care/health, and case management. Impairment in IADL counts are based on the 

inability to perform one or more of the following 

eight IADLs without personal assistance or standby assistance, supervision, or cues: preparing 

meals, shopping for personal items, medication 

management, managing money, using telephone, 

doing heavy housework, doing light housework, 

and transportation ability (the individual’s ability 

to make use of available transportation without 

assistance).53

Notes: The results were constructed by summing across the 50 States, DC, and all 

territories for the IADL group of Three or More IADLs. These results only include 

Cluster 1 registered services. Cluster 1 registered services are: as follows: personal 

care, homemaker, chore, home-delivered meals, adult day care/health, and case 

management. Impairment in IADL counts are based on the inability to perform one or 

more of the following eight IADLs without personal assistance or stand-by assistance, 

supervision or cues: preparing meals, shopping for personal items, medication 

management, managing money, using telephone, doing heavy housework, doing 

light housework, and transportation ability (the individual’s ability to make use of 

available transportation without assistance).54
44 | 

Transportation (1 One Way Trip) — 

Transportation from one location to 

another. Does not include any other 

activity.

Case Management (1 Hour) — Assistance in the form of either access or 

care coordination in circumstances 

where the older person is experiencing 

diminished functioning capacities, personal conditions or other characteristics 

which require the provision of services 

by formal service providers or family 

caregivers. Case management includes 

such activities as assessing needs, 

developing care plans, authorizing and 

coordinating services among providers, 

and providing follow-up and reassessment, as required.

Definition of Service Units for Different Services 

Homemaker (1 Hour) — Assistance 

such as preparing meals, shopping 

for personal items, managing money, 

using the telephone, or doing light 

housework.

Home-Delivered Meal (1 Meal) — A 

meal provided to an eligible individual 

in his/her place of residence. The meal 

is served in a program administered 

by SUAs and/or AAAs and meets all 

requirements of the OAA and state/

local laws.

Congregate Meal (1 Meal) — A meal 

provided to an eligible individual in a 

congregate or group setting. The meal 

as served meets all requirements of 

the OAA and State/Local laws.

Service Units

The following section provides data highlights for delivered Title III Service Units. Service 

units refer to a specified quantity of a service.
Annual Report on Older Americans Act Title III Programs | 45

Number of Service Units by Service Type

In 2018, the largest number of service units was provided for Home-Delivered Meal programs (146,995,222) 

followed by Congregate Meal programs (73,644,475). 

The fewest service units were provided for Case 

Management (3,515,04). 

Total Units per Client by Service Type

The most service units per client were provided for 

Home-Delivered Meal programs (168.6 units per client), 

followed by Homemaker programs (127.4 units served 

per client). The fewest service units per client were provided for Case Management (7.3 units per client).

Home-Delivered Meals

Congregate Meals

Homemaker

Transportation

Case Management

0 40,000,000 80,000,000 120,000,000 160,000,000

Exhibit 11. Total Service Units, by Select Service Type, 2018 

146,995,222

73,644,475

21,136,211

20,259,508

3,515,043

Home-Delivered Meals

Homemaker

Congregate Meals

Case Management

0 50 100 150 200

Exhibit 12. Services Units Provided per Client by Service

168.6

127.4

48.4

7.3
46 | 

Part 2 | 2018 NSOAAP Data Highlights

The highlights in this section refer to characteristics of the people who received OAA Title III 

services in 2018, including recipients’ health status, the number of medical conditions they 

reported, the percent of recipients who had an overnight hospital stay and/or a nursing home 

or rehabilitation center stay in 2018, the percent of recipients who received Medicaid, and the 

length of time during which recipients received services. All highlights are presented for each 

of the six Title III service types.

Service Recipient Characteristics — Care Recipient Health Status by Service Type

Caregiver1

Case Management2

Congregate Meals3

Home-Delivered Meals4

Homemaker5

Transportation6

0% 20% 40% 60% 80% 100%

Exhibit 13. Reported Health Status by Services (in Percent)

Poor Fair Good Very Good Excellent

33.8 31.4 25.3 7.6 1.9

19.8 38.2 30.6 9.5 1.8

5 22.6 36.3 27.1 9

17.5 32.1 33 11.3 6.2

17.5 33.2 35.2 10.9 3.2

13.5 27 37.9 16.7 4.9

NOTES—The results presented are at the national level. The question is stated in the survey as follows:

1 In general, how would you say the care recipient’s health is? The variable code is CGCRHL.

2-6 In general, how is your health? The variable code is PFHLTH.
Annual Report on Older Americans Act Title III Programs | 47

Caregiver Services

Almost two thirds (65.2%) of caregivers providing 

Caregiver services reported their care recipients’ 

health status to be fair or poor in 2018. In contrast, 

fewer than one in 10 (9.5%) care recipients were reported to be in excellent or very good health.

Case Management Services

Slightly more than half of Case Management service 

recipients (58%) reported being in fair or poor health 

in 2018. 

Congregate Meal Services

The majority of Congregate Meal service recipients 

(72.4%) reported being in good, very good, or excellent 

(72.4) health in 2018. 

Home-Delivered Meal Services

About half of Home-Delivered Meal service recipients 

(50.5%) reported being in good, very good, or excellent 

health, and about half (49.6%) reported being in fair or 

poor health in 2018. 

Homemaker Services

About half of Homemaker service recipients (49.3%) 

reported being in good, very good, or excellent health, 

and about half (50.7%) reported being in fair or poor 

health in 2018. 

Transportation Services

A little over half of Transportation service recipients 

(59.5%) reported being in good, very good, or excellent 

health in 2018. 

Reported Health Status for All Six Services

Exhibit 13 shows the self-reported health status for all 

six Title III services, highlighting that Caregiver service 

recipients were most likely to be in fair or poor health 

(65.2%, as reported by their caregivers), followed by 

Case Management service recipients (58%, self-reported). Congregate Meal Service recipients were most 

likely to report themselves being in good, very good, 

or excellent health (72.4%). (Recipients of all service 

types except Caregiver services self-reported their 

health status.)

Caregiver service recipients were

most likely to be in fair or poor

health (65.2%, as reported by 

their caregivers), 

65.2% |

Congregate Meal Service 

recipients were most likely 

to report themselves being in 

good, very good, or excellent 

health (72.4%).

72.4% |
48 | 

Congregate Meal Services

Over three quarters of Congregate Meal service recipients (84.8%) reported having three or more medical 

conditions in 2018. A little over half (51.2%) reporting 

having six or more medical conditions. 

Home-Delivered Meal Services

Nearly nine out of 10 Home-Delivered Meal service 

recipients (89.9%) reported having three or more 

medical conditions in 2018. Almost two thirds (63.7%) 

reported having six or more medical conditions.

Caregiver Services 

Almost all Caregiver service recipients (96.9%) reported having three or more medical conditions in 2018. Of 

those, more than two thirds (76.7) reported having six 

or more medical conditions.

Case Management Services

Almost all Case Management service recipients of 

(96.2%) reported having three or more medical conditions in 2018. Of those, more than two thirds reported 

having six or more medical conditions.

Service Recipient Characteristics — Medical Conditions by Service Type

Caregiver

Case Management

Congregate Meals

Home-Delivered Meals

Homemaker

Transportation

0% 20% 40% 60% 80% 100%

Exhibit 14. Number of Medical Conditions Reported by Recipients of All Six Services

0

Medical

Conditions

1

Medical

Condition

2

Medical

Conditions

3–5

Medical

Conditions

6 or More

Medical

Conditions

76.7 20.2 2.6 0.4

74.5 21.7 2.3 1.5

51.2 33.6 9.5 3.3

63.7 26.2 5.9 3

72.7 20.6 4.6 2.1

58.9 32.6 5.4 1.9

0.2

0

2.3

1.1

0

1.2

NOTES—The results presented are at the national level. The question is stated in the survey as follows:

Total number of medical conditions reported? The variable code is NUM_COND.
Annual Report on Older Americans Act Title III Programs | 49

Homemaker Services 

Almost all recipients of Homemaker services (93.3%) 

reported having three or more medical conditions in 

2018. Of those, more than two thirds (72.7%) reported 

having six or more medical conditions.

Transportation Services

Almost all Transportation service recipients (91.5%) 

reported having three or more medical conditions in 

2018. A little over half (58.9) reported having six or 

more medical conditions.

Number of Medical Conditions Reported 

by Recipients of All Six Services

Exhibit 14 shows the percent of service recipients 

with no medical condition or one or more medical 

conditions for all six Title III services. It highlights 

that Caregiver service recipients and Case Management service recipients were most likely to report 

six or more medical conditions (76.7% and 74.5%, 

respectively) in 2018, followed by Homemaker 

service recipients (72.7%).

Caregiver

service recipients 

76.7%

Case Management

service recipients

74.5%

Homemaker 72.7% | service recipients

Most likely 

to report six or 

more medical 

conditions
50 | 

Home-Delivered Meal Services 

In 2018, approximately two thirds of Home-Delivered 

Meal service recipients (65%) reported not having had 

an overnight hospital stay in the past 12 months.

Homemaker Services

In 2018, more than two thirds of Homemaker service 

recipients (69.4%) reported not having had an 

overnight hospital stay in the past 12 months.

Transportation Services

In 2018, the majority of Transportation service 

recipients (71.6%) reported not having had an 

overnight hospital stay in the past 12 months.

Caregiver Services

Not provided for Caregiver services.

Case Management Services

In 2018, the majority of Case Management service 

recipients (64.6%) reported not having had an 

overnight hospital stay in the past 12 months. 

Congregate Meal Services

In 2018, three out of four Congregate Meal service 

recipients (74.9%) reported not having had an overnight hospital stay in the past 12 months

Service Recipient Characteristics — Overnight Hospital Stay by Service Type

Case Management

Congregate Meals

Home-Delivered Meals

Homemaker

Transportation

0% 25% 50% 75% 100%

Exhibit 15. Percent of Service Recipients WITHOUT Overnight Stay in Hospital, Nursing Home, or Rehabilitation Center 

Hospital1

64.6

83.3

74.9

96.6

65

85.9

69.4

92.7

71.6

91

Nursing Home or Rehabilitation Center2

NOTES—The results presented are at the national level. The question is stated in the survey as follows:

1 In the past 12 months, did you have to stay overnight in a hospital? The variable code is HLMHOSP.

2 In the past 12 months, did you have to stay overnight in a nursing home or rehabilitation center? The variable code is HLMNH.
Annual Report on Older Americans Act Title III Programs | 51

Caregiver Services

Not provided for Caregiver services.

Case Management Services 

In 2018, more than four out of five Case Management 

service recipients (83.3%) reported not having had 

an overnight stay in a nursing home or rehabilitation 

center in the past 12 months.

Congregate Meal Services 

In 2018, almost none of the Congregate Meal service 

recipients (3.4%) reported having had an overnight 

stay in a nursing home or rehabilitation center in the 

past 12 months.

Home-Delivered Meal Services 

In 2018, very few Home-Delivered Meal service recipients (14.1%) reported having had an overnight stay 

in a nursing home or rehabilitation center in the past 

12 months.

Homemaker Services 

In 2018, less than one in ten Homemaker service recipients (7.3%) reported having had an overnight stay in a 

nursing home or rehabilitation center in the past 

12 months.

Transportation Services 

In 2018, fewer than one in 10 Transportation service 

recipients (9%) reported having had an overnight stay 

in a nursing home or rehabilitation center in the past 

12 months.

Percent of Service Recipients Reporting Having Had 

an Overnight Stay in a Hospital, Nursing Home, or 

Rehabilitation Center by Services

Exhibit 15 shows the percent of service recipients 

who reported not having had an overnight stay in a 

hospital, nursing home, or rehabilitation center in the 

past 12 months for five Title III services. It highlights, 

for all five services presented, the majority of recipients did not experience a level of care that required 

an overnight stay in one of these types of medical facilities. Of the five services, Congregate Meal service 

recipients were most likely to report not having had 

an overnight stay.

Service Recipient Characteristics — Nursing Home or Rehabilitation Center Stay by Service Type

For all five services presented, more than 64.6% 

of recipients did not experience a level of care 

that required an overnight stay in one a hospital, 

nursing home or rehabilitation center.

>64.6% |
52 | 

Homemaker Services 

About two thirds of Homemaker service recipients 

(66.8%) did not receive Medicaid benefits in 2018.

Transportation Services 

Approximately 60% of Transportation Service recipients (61.5%) did not receive Medicaid benefits in 2018.

Percent of Service Recipients Receiving

 Medicaid by Services

The exhibit below shows that, for all six services, the 

majority of recipients did not receive Medicaid benefits 

in 2018. Of the six services, Caregiver service recipients and Congregate Meal service recipients were most 

likely not to have received Medicaid benefits in 2018 

(79.2% and 79.1%, respectively).

Caregiver Services 

About four out of five Caregiver service recipients 

(79.2%) did not receive Medicaid benefits in 2018.

Case Management Services 

Approximately two thirds of Case Management service 

recipients (63.1%) did not receive Medicaid benefits 

in 2018.

Congregate Meal Services 

Nearly four out of five Congregate Meal service recipients (79.1%) did not receive Medicaid benefits in 2018.

Home-Delivered Meal Services 

Nearly two thirds (62.4%) of Home-Delivered Meal service 

recipients did not receive Medicaid benefits in 2018.

Service Recipient Characteristics — Medicaid Recipients by Service Type

NOTES—The results presented are at the national level. The question is stated in the survey as follows:

1 Is the care recipient receiving Medicaid? The variable code is SVC5C.

2 Are you receiving Medicaid? The variable code is SVC5C.

3 Are you receiving any other types of assistance, such as Medicaid? The variable code is SVC5C.

Caregiver1

Case Management2

Congregate Meals3

Home-Delivered Meals2

Homemaker2

Transportation3

0 20 40 60 80

Exhibit 16. Percent of Clients NOT Receiving Medicaid by Service 

79.2

63.1

79.1

62.4

66.8

61.5
Annual Report on Older Americans Act Title III Programs | 53

Caregiver Services 

Most Caregiver service recipients (84.5%) received 

Caregiver services for at least 2 years. Among this 

group, about half (42.9%) received Caregiver services 

for at least 5 years.

Case Management Services 

Most Case Management service recipients received the 

services for 6 months to 2 years (60.7%). Close to half 

of the recipients (44.4%) received the services for 6 

months to 1 year. 

Congregate Meal Services 

A little more than half of Congregate Meal service 

recipients (57.4%) received the services for 2 or 

more years.

Service Recipient Characteristics — Length of Time Services Received by Service Type

Caregiver1

Case Management2

Congregate Meals3

Home-Delivered Meals4

Homemaker5

Transportation6

0% 20% 40% 60% 80% 100%

Exhibit 17. Length of Time Services Were Received, by Service

5.3 10.2 41.6 42.9

44.4 16.3 31.4 8

22.4 20.1 29.7 27.7

42.9 23.2 25.4 8.4

41 21.1 29.3 8.7

26.5 16.7 33.8 23

5 or 

More Years

2–5

Years

1–2

Years

6 Months 

to 1 Year

NOTES—Results were rounded to one decimal place and may not add up to 100. The results presented are at the national level. 

The question is stated in the survey as follows: 

1 For how long have you been providing help to the care recipient? The variable code is CGHLONG.

2 How long have you been receiving the case management services? The variable code is CSHOWLG.

3 How long have you been attending the lunch program? The variable code is CMRECEV.

4 When was the last time you received a home-delivered meal? The variable code is HMDAYS.

5 How long have you been receiving homemaker services? The variable code is HCRECEV.

6 About how long ago did you start using this transportation service? The variable code is HOWLONG.
54 | 

recipients (87.9%) rated the services as good, very 

good, or excellent.

Homemaker Services 

Almost all Homemaker service recipients (94%) rated 

the services as good, very good, or excellent.

Transportation Services 

Almost all Transportation service recipients (94.4%) 

rated the services as good, very good, or excellent.

Rating of Services by Service Type

Exhibit 18 shows how service recipients rated the 

services they received in 2018. It highlights that, for 

all six services, the majority of service recipients rated 

services as good, very good or excellent.

Service Results — Rating of Services

Caregiver Services 

Almost all Caregiver service recipients (93.1%) rated 

the services as good, very good, or excellent.

Case Management Services 

The large majority of Case Management service recipients (87.8%) rated the services as good, very good, 

or excellent.

Congregate Meal Services 

The large majority of Congregate Meal service recipients (89.9%) rated the services as good, very good, or 

excellent.

Home-Delivered Meal Services

The large majority of Home-Delivered Meal service 

Percent of Service Recipients Receiving Services 

by Length of Time 

Exhibit 17 shows the length of time that 2018 service 

recipients received services. It highlights that the 

length of time services were received varied across the 

six types of services. Caregiver services were received 

for the longest time, with more than 40% of recipients 

(42.9%) receiving services for 5 or more years. This 

was followed by Transportation services (23% for 5 or 

more years) and Congregate Meal services (27.7% for 

5 or more years).

Home-Delivered Meal Services 

Most Home-Delivered Meal service recipients (66.1%) 

received the services for between 6 months and 2 years.

Homemaker Services 

Most Homemaker service recipients (62.1%) received 

the services for between 6 months and 2 years.

Transportation Services 

A little more than half of Transportation service recipients (56.8%) received the services for 2 years or more.

Service Results

The highlights in this section refer to service results, including service recipients’ ratings of 

services they received, helpfulness of the services, and recipients’ likelihood to recommend 

the services. All highlights are presented by the six Title III service types.
Annual Report on Older Americans Act Title III Programs | 55

H

Caregiver1

Case Management2

Congregate Meals3

Home-Delivered Meals4

Homemaker5

Transportation6

0% 20% 40% 60% 80% 100%

Exhibit 18. Rating of Services by Service Type (in Percent)

Excellent Very Good Good Fair Poor

42.2 34.5 16.4 4.5

43.2 26.7 17.9 6.3 5.9

 33.4 34.1 22.4 7.3

23.3 40.5 24.1 9.9

47.8 27.8 18.4 4

49.9 31.6 12.9 4.3

2.3

2.8

2.1

2.1

1.4

NOTES—Results were rounded to one decimal place and may not add up to 100. The results presented are at the national level. 

The question is stated in the survey as follows: 

1 How would you rate the caregiver services that you have received? The variable code is CGRATE.

2 How would you rate the case management services that you have received? The variable code is CSRATE.

3 How would you rate the lunch program overall? The variable code is CMRATE.

4 How would you rate the home-delivered meals program overall? The variable code is HMRATE.

5 How would you rate the quality of your homemaker service? The variable code is HCARATE.

6 How would you rate the transportation service that you received? The variable code is TRRATE.

Service Results — Helpfulness of Services

Caregiver Services

Not provided for Caregiver services.

Case Management Services 

About nine out of 10 Case Management service 

recipients (90.4%) reported the services helped 

them stay in their homes.

Congregate Meal Services 

Approximately two thirds of Congregate Meal service 

recipients (65%) reported the services helped them 

stay in their homes.

Home-Delivered Meal Services 

Almost all Home-Delivered Meal service recipients 

(93.9%) reported the services helped them stay in 

their homes.
56 | 

Homemaker Services 

Almost all Homemaker service recipients (95.8%) 

reported the services helped them stay in their homes.

Transportation Services 

About nine out of 10 Transportation service recipients 

(88.9%) reported the services helped them stay in 

their homes.

Percent of Service Recipients Reporting 

the Services Helped Them Stay in Their Home.

Exhibit 19 highlights that the majority of 

service recipients reported that these five services 

helped them stay in their homes. For four services, 

about 90 percent of recipients reported that the 

service helped them stay in their homes.

Case Management1

Congregate Meals2

Home-Delivered Meals3

Homemaker4

Transportation5

0 25% 50% 75% 100%

Exhibit 19. Percent of Clients Agreeing the Services Help Them Stay in Their Home by Service Type

95.8

93.9

90.4

88.9

65

NOTES—The results presented are at the national level. The question is stated in the survey as follows: 

1 Do the services you receive help you continue to live in your own home? The variable code is CSSTAYHM.

2 Do the meal programs help you to stay in your own home? The variable code is CMSTAYHM.

3 Do home-delivered meals help you continue to live in your own home? The variable code is HMSTAYHM.

4 Do the homemaker services you receive help you to continue to live in your own home? The variable code is HCSTAYHM.

5 Do the services help you continue to live in your own home? The variable code is TRSTAY.

About 90 percent of 

recipients reported that 

the service helped them 

stay in their homes

90%
Annual Report on Older Americans Act Title III Programs | 57

Caregiver Services

Not provided for Caregiver services.

Case Management Services

Not provided for Case Management services.

Congregate Meal Services 

Almost all Congregate Meal service recipients 

(95.5%) reported they would recommend the 

services to a friend. 

Home-Delivered Meal Services 

Almost all Home-Delivered Meal service recipients 

(96.1%) reported they would recommend the services 

to a friend. 

Homemaker Services

Almost all Homemaker service recipients (95.8%) 

reported they would recommend the services to a friend. 

Transportation Services 

Almost all Transportation service recipients (97.0%) 

reported they would recommend the services to a friend. 

Service Results — Likelihood of Recommending Services

Congregate Meals1

Home-Delivered Meals2

Homemaker3

Transportation4

0 25% 50% 75% 100%

Exhibit 20. Percent of Clients Who Would Recommend the Services to a Friend

95.8

96.1

97

95

NOTES—The results presented are at the national level. The question is stated in the survey as follows: 

1 Would you recommend this service to a friend? The variable code is CMRECOM.

2 Would you recommend this service to a friend? The variable code is HNRRECOM

3 Would you recommend the homemaker program to a friend? The variable code is HCRREC.

4 Would you recommend this service to a friend? The variable code is TRRECOM
58 | 

Transportation Services 

The majority of Transportation service recipients 

(37.5%) received no additional services. Approximately 

one third (31.4%) received one additional service. 

Percent of Service Recipients Who Also Received 

Additional Services.

Exhibit 21 shows the percent of service recipients who 

also received additional services in 2018. It highlights 

that, for all services except Congregate Meals, the 

majority of service recipients also received additional 

services. The majority of recipients of Congregate Meal 

Services did not receive additional services.

Caregiver Services

Not provided for Caregiver services.

Case Management Services 

The large majority of Case Management service recipients (88.8%) also received additional services. On 

average, service recipients received between 1 and 5 

additional services.

Congregate Meal Services 

The majority of Congregate Meal service recipients 

(57.8%) received no additional services. 

Home-Delivered Meal Services 

A little less than half of Home-Delivered Meal service 

recipients (40.9%) received no additional services.

Homemaker Services

The large majority of Homemaker service recipients 

(85%) also received additional services. Of those who 

received additional services, most (29.4%) received 

one additional service.

Additional Services

The highlights in this section refer to additional services Title III service recipients received.

An estimated 27 percent (about 16 million) of people age 60 and older likely 

need home-based care like the services provided by Title III 

programs because they report difficulties with one or more daily 

activities. [Government Accountability Office, 2015]. 

—Government Accountability Office (2015). OLDER AMERICANS ACT: 

Updated Information on Unmet Need for Services GAO-15-601R: 

Published: Jun 10, 2015. Publicly Released: Jun 15, 2015
Annual Report on Older Americans Act Title III Programs | 59

NOTES—Results were rounded to one decimal place and may not add up to 100. The results presented are at the national level. 

Variable code is SVCCOUNT.

Case Management

Congregate Meals

Home-Delivered Meals

Homemaker

Transportation

0% 20% 40% 60% 80% 100%

Exhibit 21. Percent of Clients Receiving Additional Services by Service Type

No

Additional 

Service

1

Additional 

Service

2

Additional 

Services

3–5

Additional 

Services

6 or More

Additional 

Services

6.1 26.9 29.6 26.2 11.3

1.1 4.5 9.1 27.3 57.8

1.9 22.6 13.7 20.8 40.9

3.8 26.6 25.2 29.4 14.9

2.8 13.9 14.4 31.4 37.5
60 | 

Congregate Meal (1 Meal): A meal provided to an 

eligible individual in a congregate or group setting. 

The meal as served meets all of the requirements of 

the Older Americans Act and State/Local laws.

Home-Delivered Meal (1 Meal): A meal provided to an 

eligible individual in his/her place of residence. The 

meal is served in a program administered by SUAs 

and/or AAAs and meets all of the requirements of the 

Older Americans Act and State/Local laws.

Homemaker (1 Hour): Assistance such as preparing 

meals, shopping for personal items, managing money, 

using the telephone or doing light housework.

Impairment in Activities of Daily Living (ADL): The 

inability to perform one or more of the following six 

activities of daily living without personal assistance, 

stand-by assistance, supervision or cues: eating, 

dressing, bathing, toileting, transferring in and out of 

bed/chair, and walking. 

Impairment in Instrumental Activities of Daily Living 

(IADL): The inability to perform one or more of the following eight instrumental activities of daily living without personal assistance, or stand-by assistance, supervision or cues: preparing meals, shopping for personal 

items, medication management, managing money, 

using telephone, doing heavy housework, doing light 

housework, and transportation ability (transportation 

ability refers to the individual’s ability to make use of 

available transportation without assistance). 

Living alone: A one-person household (using the 

Census definition of household) where the householder lives by his or herself in an owned or rented place 

of residence in a non-institutional setting, including 

board and care facilities, assisted living units and 

group homes.

Native Hawaiian or Other Pacific Islander: A person 

having origins in any of the original peoples of Hawaii, 

Guam, Samoa or other Pacific Islands. 

American Indian or Alaskan Native: A person having 

origins in any of the original peoples of North America 

(including Central America), and who maintains tribal 

affiliation or community attachment. 

Area Agency on Aging (AAA): public or private nonprofit agency designated by a state to address the needs 

and concerns of all older persons at the regional and 

local levels. AAA is a general term—names of local 

AAAs may vary. AAAs coordinate and offer services that 

help older adults remain in their homes, if that is their 

preference, aided by services such as home-delivered 

meals, homemaker assistance, and whatever else it 

may take to make independent living a viable option.

Asian: A person having origins in any of the original 

peoples of the Far East, Southeast Asia or the Indian 

subcontinent including, for example, Cambodia, China, 

India, Japan, Korea, Malaysia, Pakistan, the Philippine 

Islands, Thailand, and Vietnam 

Black or African American: A person having origins in 

any of the black racial groups of Africa. Hispanic or 

Latino—A person of Cuban, Mexican, Puerto Rican, 

South or Central American, or other Spanish culture or 

origin, regardless of race. 

Caregiver: An adult family member or another individual, who is an “informal” provider of in-home and 

community care to an older individual. “Informal” 

means that the care is not provided as part of a public 

or private formal service program.

Case Management (1 Hour): Assistance either in the 

form of access or care coordination in circumstances 

where the older person is experiencing diminished 

functioning capacities, personal conditions or other 

characteristics which require the provision of services 

by formal service providers or family caregivers. Activities of case management include such practices as assessing needs, developing care plans, authorizing and 

coordinating services among providers, and providing 

follow-up and reassessment, as required.

Appendix A: Definitions (SPR)
Annual Report on Older Americans Act Title III Programs | 61

■ Not Hispanic or Latino

Race:

■ American Indian or Alaskan Native

■ Asian

■ Black or African American

■ Native Hawaiian or Other Pacific Islander

■ White

Registered Client: A registered client is an individual 

who received at least one unit of the following specified services within the reported fiscal year. The services include: congregate meals, nutrition counseling, 

assisted transportation, personal care, homemaker, 

chore, home- delivered meals, adult day care/health, 

or case management. The count of registered clients 

does not include caregivers.

Registered Services: A service that requires demographic and client characteristics to be reported. 

Personal Care, Homemaker, Chore, Home-Delivered 

Meals, Adult Day Care/Health Services, Case Management, Congregate Meals, Nutrition Counseling, or 

Assisted Transportation. Does not include Caregiver 

Services.

Cluster 1 Registered Services: Personal Care, 

Homemaker, Chore, Home-Delivered Meals, Adult 

Day Care/Health Services, and Case Management.

Cluster 2 Registered Service: Assisted Transportation, Congregate Meals, and Nutrition Counseling.

Rural Provider: Providers of services to clients who live 

in rural areas. Rural providers are not necessarily providers of services only to rural clients. They may also 

be providers of services to clients in urban area.

Senior Centers: serve as a gateway to the nation’s 

aging network—connecting older adults to vital community services that can help them stay healthy and 

independent. More than 60% of senior centers are 

designated focal points for delivery of OAA services—

Other Paid Professional Staff: Personnel who are 

considered professional staff who are not responsible 

for overall agency management or direction setting but 

carry out key responsibilities or tasks associated with 

the state or area agency.

Poverty: Persons considered to be in poverty are those 

whose income is below the official poverty guideline (as 

defined each year by the Office of Management and Budget, and adjusted by the Secretary, DHHS) in accordance 

with subsection 673 (2) of the Community Services Block 

Grant Act (42 U.S.C. 9902 (2)). The annual HHS Poverty 

Guidelines provide dollar thresholds representing poverty levels for households of various sizes. 

Program Income: Gross income received by the grantee 

and all sub grantees such as voluntary contributions 

or income earned only as a result of the grant project 

during the grant period.

Provider: An organization or person which provides 

services to clients under a formal contractual arrangement with a AAA or SUA. Under Title III-E, in cases 

where direct cash payment is made to a caregiver and 

the ultimate provider is unknown, the number of 

providers may be omitted.

Race/Ethnicity Status: The following reflects the requirements of the Office of Management and Budget 

(OMB) for obtaining information from individuals 

regarding race and ethnicity. It constitutes what OMB 

classifies as the “two-question format.” When questions on race and ethnicity are administered, respondents are to be asked about their ethnicity and race 

as two separate questions. Respondents should ideally be given the opportunity for self-identification, 

and are to be allowed to designate all categories that 

apply to them. Consistent with OMB requirements, 

the following are the race and ethnicity categories to 

be used for information collection purposes:

Ethnicity:

■ Hispanic or Latino
62 | 

ability but for statistical purposes such as computing 

accurate service unit costs based on total service 

expenditures.

Transportation (1 One Way Trip): Transportation from 

one location to another. Does not include any other 

activity. 

Unregistered Services: Also known as an non-registered service. A service that does not require demographic and consumer characteristics to be reported. 

Transportation, Legal Assistance, Nutrition Education, 

Information and Assistance, Outreach, Other Services, 

Health Promotion, and Cash and Counseling.

Volunteer: An uncompensated individual who provides 

services or support on behalf of older individuals. Only 

staff working under the AAA, not the AAA contractors, 

shall be included.

White: A person having origins in any of the peoples of 

Europe, the Middle East, or North Africa. “(Alone)”—

When appended to a racial category (e.g., “White 

(Alone)” means that the individual only designated one 

race category.

allowing older adults to access multiple services in one 

place. Senior centers offer a wide variety of programs 

and services, including: Meal and nutrition programs, 

Information and assistance, Health, fitness, and 

wellness programs, Transportation services, Public 

benefits counseling, Employment assistance, Volunteer and civic engagement opportunities, Social and 

recreational activities, Educational and arts programs, 

Intergenerational programs To maintain operations, 

senior centers must leverage resources from a variety 

of sources. These include federal, state, and local governments; special events; public and private grants; 

businesses; bequests; participant contributions; inkind donations; and volunteer hours. Most centers rely 

on 3 to 8 different funding sources.

Total Service Expenditure: OAA expenditures plus all 

other funds administered by the SUA and/or AAA’s 

on behalf of older adults and caregivers for services 

meeting the definition of OAA services – both services 

which are means tested and those which are not. SUAs 

are encouraged to report expenditures in these service 

categories whether or not AoA funds were utilized for 

that purpose. This is not intended for financial account-
Annual Report on Older Americans Act Title III Programs | 63

note the question of length of service for caregivers is 

in terms of how long the caregiver has been providing 

care to their older adult.

Medical Conditions: Can be any of the following conditions: arthritis or rheumatism, high blood pressure 

or hypertension, heart disease, high cholesterol, 

diabetes or high blood sugar, emphysema, allergies, 

asthma, cancer, stroke, anemia, osteoporosis, kidney 

disease, glaucoma, cataracts, macular degeneration, 

or other eye or vision conditions, hearing problems, 

emotional, nervous or psychiatric problems, Alzheimer’s disease or dementia, seizures or epilepsy, 

Parkinson’s disease, persistent pain, aching, stiffness 

or swelling around joint, multiple sclerosis, urinary 

incontinence, or any other doctor diagnosed conditions. The range of the number of medical conditions in 

the tables above are constructed ranges. The original 

possible responses could be anywhere from 0 to 16 

medical conditions.

Additional Services: Could be any one or combination 

of the following services: Congregate Meals, HomeDelivered Meals, Homemaker/Housekeeping Services, 

Transportation, Adult Daycare, Personal Care, Chore, 

Service, Legal Assistance, or Information and Assistance. The range of the number of additional services 

in the tables above are constructed ranges. The original possible responses could be anywhere from 0 to 9 

additional services.

Length of Service-Related Questions: The range of 

the length of time receiving services in the tables 

above are constructed ranges. The original possible 

responses were as follows: 6 months or less, more 

than 6 months but less than 1 year, at least 1 year but 

less than 2 years, 2 to 5 years, or more than 5 years. 

Responses for Caregivers were the exception to these 

responses. Their responses were as follows: 6 months 

or less, more than 6 months but less than 1 year, at 

least 1 year but less than 2 years, 2 to 5 years, 5 to 10 

years, 11 to 20 years, or more than 20 years. Please 

Appendix B: Definitions (NSOAAP)
64 | 

Edwin Walker 

Deputy Assistant Secretary 

for Aging

Greg Link

Director, Office of Supportive 

and Caregiver Services 

• The Lifespan Respite Care Program

• The National Family Caregiver 

Support Program 

Hilary Dalin

Director, Office of Elder Justice 

and Adult Protective Services

• Legal Assistance Development

• Elder Abuse Prevention

Keri Ann Lipperini

Director, Office of Nutrition and 

Health Promotion Programs 

• Home-Delivered Meals

• NSIP Home-Delivered Meals

• Congregate Meals

• NSIP Congregate Meals

• Nutrition Counseling

• Nutrition Education

• Health Promotion and 

Disease Prevention 

Lance Robertson

Administrator and 

Assistant Secretary for Aging

Vicki Gottlich

Director, Center for Policy 

and Evaluation

Susan Jenkins 

Director, Office of 

Performance and Evaluation

Jennifer Tillery

Senior Aging and Disability 

Program Coordinator 

• Older Americans Act Title III SPR 

Program Manager

• Older Americans Act Title III SRT 

Program Manager

• Older Americans Act Title III OAAPS 

Program Manager

Administration for Community Living: 

Older Americans Act Title III Program Contacts
Annual Report on Older Americans Act Title III Programs | 65

11 AARP Public Policy Institute. February 2019. 

Spotlight: Older Americans Act. https://www.aarp.

org/content/dam/aarp/ppi/2019/02/older-americans-act.pdf

12 Government Accountability Office. (2010). Older 

Americans Act: Overview and Funding. https://

crsreports.congress.gov/product/pdf/R/R43414

13 Government Accountability Office. (2010). Older Americans Act: Preliminary Observations on 

Services Requested by Seniors and Challenges in 

Providing Assistance. https://www.gao.gov/new.

items/d101024t.pdf

14 U.S. Census Bureau. “Projected Population by Single Year of Age, Sex, Race and Hispanic Origin for 

the United States: 2016 to 2060 (revised 2018).” 

https://www.census.gov/data/datasets/2017/

demo/popproj/2017-popproj.html

15 U.S. Census Bureau. “Projected Population by Single Year of Age, Sex, Race and Hispanic Origin for 

the United States: 2016 to 2060 (revised 2018).” 

https://www.census.gov/data/datasets/2017/

demo/popproj/2017-popproj.html

16 Government Accountability Office. (2010). Older Americans Act: Preliminary Observations on 

Services Requested by Seniors and Challenges in 

Providing Assistance. https://www.gao.gov/new.

items/d101024t.pdf

17 Administration for Community Living. Eldercare 

Locator: The Aging Network. https://eldercare.acl.

gov/Public/Index.aspx?

18 Administration for Community Living. Eldercare 

Locator: The Aging Network. https://eldercare.acl.

gov/Public/Index.aspx?

19 National Association of Area Agencies on Aging. 

Area Agencies on Aging: Local Leaders in Aging 

and Community Living. https://www.n4a.org/

Files/LocalLeadersAAA2017.pdf

References

1 U.S. Census Bureau. “Projected Population by Single Year of Age, Sex, Race and Hispanic Origin for 

the United States: 2016 to 2060 (revised 2018).” 

https://www.census.gov/data/datasets/2017/

demo/popproj/2017-popproj.html

2 National Association of Area Agencies on Aging 

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3 Administration for Community Living. About ACL. 

https://acl.gov/about-acl

4 Administration for Community Living. About 

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5 Federal Register. Statement of Organization, Functions, and Delegations of Authority; Administration 

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6 AARP Public Policy Institute. February 2019. 

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org/content/dam/aarp/ppi/2019/02/older-americans-act.pdf

7 Older Americans Act, 42 U.S.C. § 3018 - U.S. Code.

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9 Congressional Research Report. (2018). Older 

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https://acl.gov/about-acl/authorizing-statutes/

older-americans-act
66 | 

31 The National Resource Center on Nutrition & Aging. 

(2020). Nutrition Services Incentive Program of 

the Older Americans Act and States. https://nutritionandaging.org/wp-content/uploads/2020/03/

Nutrition-Services-Incentive-Program-of-the-Older-Americans-Act.-FINAL-3.30.pdf

32 Administration for Community Living. Nutrition 

Services. https://acl.gov/programs/health-wellness/nutrition-services

33 Administration for Community Living. AGing, Independence, and Disability (AGID) Program Data Portal. National Survey of OAA Participants, Custom 

Tables. https://agid.acl.gov/CustomTables/NPS/

Year/

34 Administration for Community Living. AGing, Independence, and Disability (AGID) Program Data Portal. National Survey of OAA Participants, Custom 

Tables. https://agid.acl.gov/CustomTables/NPS/

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35 Administration for Community Living. The Older 

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36 Administration for Community Living. (2018). 

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37 Westat. (2018). Outcome Evaluation of the National 

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38 Title III and VII State Program Report Data Elements 

State Program Report Transmittal Requirements 

State Program Report Definitions. https://acl.gov/

sites/default/files/programs/2020-01/State_Program_Report_0985-0008_Expires12312022.pdf

39 Administration for Community Living. The Older 

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20 42 U.S.C. § 3030d.

21 Administration for Community Living. Health 

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22 42 U.S.C. §§ 3030e–3030g-22

23 1042 U.S.C. §§ 3030s–3030s-2.

24 Administration for Community Living. The Older 

Americans Act: Aging Well Since 1965. http://www.

ma4web.org/wp-content/uploads/2015/06/OAABrief-Final.pdf

25 Godfrey, D. M. (2015). The Older Americans Act: 

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the ABA Commission on Law and Aging, 36(6), 

123-144. https://www.americanbar.org/content/

dam/aba/publications/bifocal/BIFOCALJuly-August2015.pdf

26 Administration for Community Living. AGing, Independence, and Disability (AGID) Program Data Portal. State Program Reports (SPR), Custom Tables. 

https://agid.acl.gov/CustomTables/SPR/Year

27 Administration for Community Living. AGing, Independence, and Disability (AGID) Program Data Portal. National Survey of OAA Participants, Custom 

Tables. https://agid.acl.gov/CustomTables/NPS/

Year/

28 Title III and VII State Program Report Data Elements 

State Program Report Transmittal Requirements 

State Program Report Definitions. https://acl.gov/

sites/default/files/programs/2020-01/State_Program_Report_0985-0008_Expires12312022.pdf

29 Administration for Community Living. The Older 

Americans Act: Aging Well Since 1965. http://www.

ma4web.org/wp-content/uploads/2015/06/OAABrief-Final.pdf

30 Title III and VII State Program Report Data Elements 

State Program Report Transmittal Requirements 

State Program Report Definitions. https://acl.gov/

sites/default/files/programs/2020-01/State_Program_Report_0985-0008_Expires12312022.pdf
Annual Report on Older Americans Act Title III Programs | 67

49 Administration on Aging. (July 2010). Aging in 

Place: Do Older Americans Act Title III Services 

Reach Those Most Likely to Enter Nursing Homes? 

Research Brief Number 1.

50 Title III and VII State Program Report Data Elements 

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sites/default/files/programs/2020-01/State_Program_Report_0985-0008_Expires12312022.pdf

51 Title III and VII State Program Report Data Elements 

State Program Report Transmittal Requirements 

State Program Report Definitions. https://acl.gov/

sites/default/files/programs/2020-01/State_Program_Report_0985-0008_Expires12312022.pdf

52 Title III and VII State Program Report Data Elements 

State Program Report Transmittal Requirements 

State Program Report Definitions. https://acl.gov/

sites/default/files/programs/2020-01/State_Program_Report_0985-0008_Expires12312022.pdf

53 Title III and VII State Program Report Data Elements 

State Program Report Transmittal Requirements 

State Program Report Definitions. https://acl.gov/

sites/default/files/programs/2020-01/State_Program_Report_0985-0008_Expires12312022.pdf

54 Title III and VII State Program Report Data Elements 

State Program Report Transmittal Requirements 

State Program Report Definitions. https://acl.gov/

sites/default/files/programs/2020-01/State_Program_Report_0985-0008_Expires12312022.pdf

40 Administration for Community Living. National 

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41 Administration for Community Living. AGing, Independence, and Disability (AGID) Program Data Portal. State Program Reports (SPR), Custom Tables. 

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42 Administration for Community Living. AGing, Independence, and Disability (AGID) Program Data Portal. National Survey of OAA Participants, Custom 

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Year/

43 Department of Health and Humans Services. Fiscal 

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44 Administration for Community Living. Performance of 

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45 Administration for Community Living. Performance 

of Older Americans Act Programs. https://acl.gov/

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46 Godfrey, M. D. (2015). Celebrating 50 Years of the 

OAA. The Older Americans ACT: Seekign to Improve 

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47 National Association of Area Agencies on Aging. 

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Reauth_2019_FinalWeb.pdf

48 Godfrey, D. M. (2015). The Older Americans Act: 

Seeking to Improve Lives. BIFOCAL: A Journal of 

the ABA Commission on Law and Aging, 36(6), 

123-144. https://www.americanbar.org/content/

dam/aba/publications/bifocal/BIFOCALJuly-August2015.pdf
68 |