DEPARTMENT

of HEALTH

and HUMAN

SERVICES

FY 2016 Report to Congress:

Older Americans Act

Prepared by

ADMINISTRATION 

ON AGING

ADMINISTRATION FOR 

COMMUNITY LIVING
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FROM THE ADMINISTRATION FOR COMMUNITY LIVING

The Administration for Community Living (ACL) is committed to the fundamental principle that 

older adults and people of all ages with disabilities should be able to live where they choose, with 

the people they choose, and fully participate in their communities. ACL’s programs provide 

individualized, person-centered home and community-based services and supports, and invest in 

research and best practices, to make that principle a reality for millions of people. It does so by 

working with other federal agencies, states, localities, Tribal organizations, nonprofit 

organizations, businesses, and families to help older adults and people with disabilities live in their 

homes and fully participate in their communities. Those with disabilities or functional limitations 

of any type, regardless of age, have a common interest: access to home and community-based 

supports and services that help individuals fully participate in all aspects of society, including 

having the option to live at home, which can be vital to an individual’s well-being, instead of 

moving into an institutional setting.

ACL’s mission is to maximize the independence, well-being, and health of older adults, people 

with disabilities, and their families and caregivers. As part of this important mission, the 

Administration on Aging (AoA) advances the concerns and interests of older people, whether 

living in their own home or in a long-term care facility, and works with and through the national 

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

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

and their caregivers. 

The national aging services network is comprised of 56 state and territorial units on aging (SUA), 

622 area agencies on aging (AAAs), 264 Indian tribal and Native Hawaiian organizations, more 

than 20,000 direct service providers, and hundreds of thousands of volunteers. AoA’s core 

programs, authorized under the Older Americans Act (OAA), help older adults aged 60 and over

remain at home for as long as possible, promote the rights of older individuals, and advocate for 

individuals who live in long-term care facilities (nursing homes, board and care, assisted living,

and similar settings). 

For more than 50 years, the OAA has provided critical services that have better enabled millions 

of older Americans to live independently, with dignity, in their homes and communities. Its 

programs are highly successful because they are flexible and focus on the needs of each individual, 

better ensuring that their rights, choices, needs, and independence are maintained through their 

input and participation. I am pleased to present AoA’s Report to Congress for Fiscal Year (FY) 

2016. 

Lance Robertson

Administrator and Assistant Secretary for Aging

Administration for Community Living
3

Table of Contents

EXECUTIVE SUMMARY .......................................................................................................... 5

PART I: HEALTH AND INDEPENDENCE............................................................................. 9

Home and Community-Based Supportive Services................................................................................10

Nutrition Services...................................................................................................................................12

Preventive Health Services.....................................................................................................................17

Chronic Disease Self-Management Education Programs.......................................................................19

Behavioral Health ...................................................................................................................................20

Falls Prevention Programs......................................................................................................................21

Caregiver Services..................................................................................................................................23

National Family Caregiver Support Program .........................................................................................24

Brain Health............................................................................................................................................27

Alzheimer’s Disease Supportive Services Program (ADSSP)................................................................28

Alzheimer’s Disease Initiative – Specialized Supportive Services (ADI-SSS)......................................29

PART II: OLDER AMERICAN INDIANS, ALASKA NATIVES & NATIVE 

HAWAIIANS............................................................................................................................... 31

Nutrition and Supportive Services..........................................................................................................31

Caregiver Support Services.....................................................................................................................32

PART III: ELDER RIGHTS ..................................................................................................... 34

Prevention of Elder Abuse and Neglect..................................................................................................34

National Legal Assistance and Support Projects ....................................................................................36

Model Approaches to Statewide Legal Assistance Systems...................................................................37

Pension Counseling and Information Program .......................................................................................39

Long-Term Care Ombudsman Program .................................................................................................42

PART IV: SUPPORTING THE NATIONAL AGING SERVICES NETWORK................ 49

Aging and Disability Resource Centers/No Wrong Door System..........................................................49

Aging Network Support Activities .........................................................................................................53

Appendix......................................................................................................58

Formula Grant Funding Allocations by State, Territory and Tribal Organizations.........................59
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EXECUTIVE SUMMARY

AoA’s core programs, authorized under the Older Americans Act (OAA), help people choose to 

remain in their homes and communities for as long as possible. These services complement efforts 

of the nation’s public health networks, as well as existing medical and health care systems, and 

support some of life’s most basic functions, such as bathing and preparing meals. These programs 

also support family caregivers; address issues of exploitation, neglect, and abuse of older adults;

and adapt services to the needs of Native Americans. In FY 2016, AoA and the national aging 

services network rendered direct services to over 11 million individuals age 60 and over (one out 

of every six older adults), including nearly three million clients who received intensive in-home 

services.1 Critical supports, such as respite care and a peer support network, were provided to over 

700,000 caregivers.2

Overview of Performance

AoA facilitates achievement of its mission through improvements in the analysis and availability 

of performance data while also enhancing the rigor of program evaluations. AoA program 

activities have a fundamental common purpose: to develop and support a comprehensive, 

coordinated, and cost-effective system of long-term services and supports that help older adults 

maintain their health and independence in their homes and communities and family caregivers. 

This purpose led AoA to focus on the following performance goals: 1) providing high quality 

services that result in positive consumer outcomes and reflect effective delivery systems; 2) 

effectively targeting services to at-risk populations; 3) improving program efficiency; and 

4) promoting rights and preventing abuse of older adults. Each performance goal reflects activities 

spanning across AoA programs; programs that address distinct issues and populations. AoA 

intentionally collects and reports information on a program-by-program basis to ensure that the 

results of programs that serve smaller numbers of people (e.g., chore services and adult day care) 

are not overwhelmed by the results of programs that serve much larger populations (e.g., nutrition 

services) and to ensure that the unique elements of the varied programs can be highlighted. 

Progress toward achievement is tracked using a number of performance measures. Taken together, 

the performance goals and their corresponding metrics are designed to reflect AoA’s goals and 

objectives and in turn measure success in accomplishing AoA’s mission. 

Performance Highlights

An analysis of AoA’s program performance trends through FY 2016 illustrates that AoA programs 

continue to help individuals remain independent and in the community. Most performance 

measures and indicators have been maintained or steadily improved. Following are some key 

successes that are indicative of the potential of AoA and the aging network to meet demographic 

and fiscal challenges.

AoA programs provide high quality services that result in positive consumer outcomes and reflect 

effective delivery systems. Consumers report that services contribute in an essential way to 

maintaining their independence with, for example, over 40 percent of the caregivers indicating that 

 

1 AoA’s FY 2016 State Program Report.

2

 Ibid. 
6

the care recipient would be unable to remain at home without caregiver support services. With 

regard to effective delivery of evidence-based programs, OAA grantees were able to meet their 

participation targets for Chronic Disease Self-Management Education. AoA expanded the 

provision of quality services, such as through funding an additional 11 new unique organizations 

to provide specialized supportive services in the area of Alzheimer’s Disease (ADI-SSS), to bring 

the total number funded to 32. Consumers also express a high level of satisfaction with these 

services. In 2016, over 97 percent of OAA transportation clients and nearly 94 percent of 

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

uses various mechanisms to promote innovative service-delivery models for state and local 

program entities that show promise for generating measurable improvements in program activities. 

AoA programs reach at-risk populations and target services to help individuals remain independent 

and in the community. For example, older adults who have three or more impairments in Activities 

of Daily Living (ADL) are at a high risk for nursing home entry. Increasing services to this 

population is one proxy for nursing home delay and diversion. In FY 2005, one-third of homedelivered nutrition clients lived with three or more ADL impairments. By FY 2016, the proportion 

grew to nearly 42 percent, a 26 percent increase. AoA maintains nine core performance indicators 

supporting AoA’s commitment to improving client outcomes and program quality. While some 

indicators experience year-to-year variation, all indicators have trended in the desired direction 

and the vast majority meet or exceed targets annually.

AoA programs are efficient. The aging network is providing high-quality services and doing so 

in a prudent and cost-effective manner. In FY 2016 the aging network served over 8,800 people 

per million dollars of OAA Title III funding. The result is an 18 percent increase over the 2005 

baseline. 

AoA programs effectively address complaints of abuse, neglect, or violation of rights; advocate 

for system improvements; and support innovation. The Long-Term Care Ombudsman Program

grantees are highly successful at meeting the needs of complainants. In FY 2016, 73 percent of 

all complaints were resolved to the satisfaction of the complainant. The program’s annual 

performance measure of reducing the number of complaints unresolved to the satisfaction of the 

complainant fell to below 9,000 exceeding the performance target. 

The tables on the next page provide a summary of the persons served during FY 2016 through the 

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

organization can be viewed in the Appendix.
7

National Program Data on Services Provided

Category FY 2016

Total Clients 11,310,796

Total Registered Clients 2,784,192

% Minority Clients330.32

% Rural Clients 35.43

% Clients Below Poverty 32.94

# Senior Centers 9,834 (5,595 receive OAA funding)

Service Persons 

Served

Units of 

Service4

Title III 

Expenditure

Total 

Expenditure

Personal Care 112,375 21,177,683 $57,129,043 $345,235.565

Homemaker 167,653 18,772,011 $36,186,526 $375,378,281

Chore 32,758 819,652 $4,769,073 $18,832,177

Home Delivered Meals 868,332 145,470,409 $294,07,725 $887,669,451

Adult Day Care 18,805 10,589,267 $12,954,116 $104,521,304

Case Management 443,982 3,695,835 $28,795,550 $251,226,076

Assisted Transportation 49,782 2,251,284 $4,636,126 $28,681,468

Congregate Meals 1,573,477 79,401,368 $295,905,120 $655,272,808

Nutrition Counseling 35,610 78,381 $1,205,182 $2,745,782

Transportation - 23,690,052 $27,313,621 $206,508,153

Legal Assistance - 958,668 $27,313,621 $50,570,912

Nutrition Education - 3,376,131 $3,384,495 $7,021,906

Information and 

Assistance

-

12,420,450 $56,307,803 $184,496,823

Outreach - 2,736,498 $9,364,332 $21,186,817

Health Promotion and 

Disease Prevention - - $21,643,471 $52,404,481

Self-Directed Care - - $135,077 $25,619,355

Other - - $80,139,778 $477,232,301

3 Minority client refers to individuals who self-report at least one of the following racial or ethnic identities: Asian, 

Black or African American, Hispanic or Latino, Native Hawaiian or Other Pacific Islandesr, American Indian or 

Alaska Native.

4 Service Units Definitions:

Personal Care = 1 Hour

Homemaker = 1 Hour

Chore = 1 Hour 

Home-Delivered Meal = 1 Meal. 

Adult Day Care/Adult Day Health = 1 Hour 

Case Management = 1 Hour 

Assisted Transportation = 1 One Way Trip 

Congregate Meal = 1 Meal

Nutrition Counseling = 1 session per participant

Transportation = 1 One Way Trip

Legal Assistance = 1 hour

Nutrition Education = 1 session per participant

Information and Assistance = 1 Contact
8

National Family Caregiver Support Program 

Service Caregivers 

Served

Service 

Units5

Title III 

Expenditure

Total 

Expenditure

Counseling, Support 

Groups, Training 120,340 453,453 $21,310,285 $32,267,469

Respite 62,096 5,960,760 $54,006,261 $97,042,538

Supplemental Services 35,915 645,477 $11,419,055 $16,693,122

Access Assistance 497,085

1,192,174 $31,334,251

$45,596,582

Self-Directed 1,245 $1,003,491 $1,537,660

Information Services 20,539,714 436,025 $12,178,248

$16,987,072

Unduplicated Caregivers 

Provided Service or Access 710,249

5 Title III-E service units definition:

Counseling = 1 session per participant

Respite Care = 1 hour

Supplemental services = variable

Access Assistance = 1 contact

Self-Directed = variable

Information Services = 1 activity
9

PART I: HEALTH AND INDEPENDENCE

Due in part to advances in public health and medical care, Americans are living longer and more 

active lives. The average life expectancy of an American has increased dramatically over the last 

century, from 54.5 years in 1915 to 78.6 years in 2016,

6 7

and one consequence of this increased 

longevity is the higher incidence of chronic conditions. Multiple chronic conditions negatively 

affect quality of life, contribute to declines in functioning and the ability to remain in the 

community, adversely impact individuals’ health, and contribute to increased hospitalizations and 

health care costs. Many of the most common chronic conditions such as hypertension, heart 

disease, diabetes, and osteoporosis are related to nutrition as a primary prevention, risk reduction, 

or treatment modality. Medicare beneficiaries with multiple chronic conditions are the heaviest

users of health care services. For example, almost two-thirds of Medicare beneficiaries have two 

or more chronic conditions and account for 94 percent of Medicare spending, while one-third of 

those with four or more chronic conditions account for three-fourths of Medicare spending.

8

Medicare beneficiaries with multiple chronic conditions are the heaviest users of health care 

services. For example, among Medicare beneficiaries age 65 and over who are not dually eligible

(enrolled in both Medicare and Medicaid), standardized Medicare per capita spending increases 

from $5,361 for persons with two to three chronic conditions to $30,071 for persons with six or 

more chronic conditions.9 Among Medicare beneficiaries age 65 and over who are dually eligible, 

standardized Medicare per capita spending increases from $7,604 for persons with two to three

conditions to $36,807 for persons with six or more chronic conditions.10

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

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

expensive nursing home care. For example, 65 percent of congregate and 92 percent of homedelivered meal recipients reported that the meals enabled them to continue living in their own 

homes and 55 percent of seniors using transportation services rely on them for the majority of their 

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

remain in the community.11

Between 2016 and 2020, the number of Americans age 60 and older will increase by over 8.9 

million older adults, to reach 77.6 million.12 During this period, the number of Americans age 65 

6Arias E, Heron M, Xu J. United States life tables, 2013. National vital statistics reports; vol. 66 no 3. Hyattsville, 

MD: National Center for Health Statistics. April 11, 2017. Accessed March 23, 2018 at 

https://www.cdc.gov/nchs/data/nvsr/nvsr66/nvsr66_03.pdf

7 Kochanek KD, Murphy SL, Xu JQ, Arias E. Mortality in the United States, 2016. NCHS Data Brief, no 293. 

Hyattsville, MD: National Center for Health Statistics. 2017. Accessed March 23, 2018 at 

https://www.cdc.gov/nchs/products/databriefs/db293.htm. 

8CMS Chartbook and Charts. Figure 13: Distribution of Medicare Fee-for-Service Beneficiaries and Medicare 

Spending by Number of Chronic Conditions: 2015. Chronic Condition Charts: 2015. Accessed at 

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ChronicConditions/Chartbook_Charts.html 

9 CMS Multiple Chronic Conditions Utilization/Spending State Level: All Beneficiaries by Medicare-Medicaid 

Enrollment and Age, 2007-2015. Accessed March 23, 2018 at https://www.cms.gov/Research-Statistics-Data-andSystems/Statistics-Trends-and-Reports/Chronic-Conditions/MCC_Main.html. 

10 Ibid. 

11 2017 National Survey of Older Americans Act Participants. http://www.agid.acl.gov.

12

 U.S. Census Bureau. Population Division. Annual Estimates of the Resident Population for Selected Age Groups 

by Sex for the United States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010 to 

July 1, 2016. Release Date: June 2017. Accessed January 2018. U.S. Census Bureau. Population Division. Table 
10

and over with severe disabilities (defined as three or more limitations in activities of daily living) 

who are most likely to receive nursing home admission and qualify for Medicaid eligibility 

(through the “spend down” provisions) will increase by 15 percent.13 AoA’s Health and 

Independence programs help older adults in need maintain their health and independence.

In concert with other OAA programs, these services assist 12 million elderly individuals and 

caregivers.

14

 AoA’s services are especially critical for the nearly three million older adults who 

receive intensive in-home services, more than 485,000 of whom meet the disability criteria for 

nursing home admission.

15

 These services help to keep these individuals from joining the 1.9 

million older adult residents who live for extended periods of time in nursing homes.16

Home and Community-Based Supportive Services

(Title III-B of OAA; FY 2016: $386,182,000)

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

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

fund a broad array of services. AoA’s programs, including the HCBSS program, serve seniors 

holistically: while each service is valuable in and of itself, it is often the combination of supports, 

when tailored to the needs of the individual that helps older persons remain in their own homes 

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

17

 

The services provided through the HCBSS program include access services such as transportation; 

case management and information and referral; in-home services such as personal care, chore, and 

homemaker assistance; and community services such as adult day care and physical fitness 

programs. In addition to these services, the HCBSS program also funds multi-purpose senior 

centers, which coordinate and integrate services for the elderly.

While age alone does not determine the need for these home and community-based services, 

statistics show that both disability rates and the use of long-term supports increase with advancing 

age. Among those aged 85 and older, 56 percent are unable to perform critical activities of daily 

living and require long-term support.

18

 Data also show that over 92 percent of older Americans

9. Projections of the Population by Sex and Age for the United States: 2015 to 2060 (NP2014-T9). Release Date:

December 2014. Accessed January 2018.

13

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

population. Data from the 2013 Medicare Current Beneficiary Survey. [Data tables 2.5a and 2.6a]. 

http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/Data-Tables-Items/2013CNP.html 

Accessed January, 2018.

14

 AoA’s FY 2016 State Program Report.

15 Ibid

16

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

from the 2013 Medicare Current Beneficiary Survey. [Table 1.2 Demographic and Socioeconomic Characteristics 

of Medicare Beneficiaries, by Age and by Gender and Age, 2013]. http://www.cms.gov/Research-Statistics-Dataand-Systems/Research/MCBS/Data-Tables-Items/2013CNP.html. Accessed January 2, 2018.

17

 Brock, D et al. “Risk Factors for Nursing Home Placement among OAA Service Recipients: Summary Analysis 

from Five Data Sources” Westat; U.S. Administration on Aging Contract No. 233-02-0087. 

http://www.aoa.gov/AoARoot/Program_Results/POMP/docs/Risk_Factors.pdf

18

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

from the 2013 Medicare Current Beneficiary Survey. [Data tables 2.5a and 2.6a]. 

http://www.cms.gov/ResearchStatistics-Data-and-Systems/Research/MCBS/Data-Tables-Items/2013CNP.html. 

Accessed January 2018.
11

have at least one chronic condition and 76 percent have at least two.19 Providing a variety of 

supportive services that meet the diverse needs of these older individuals is crucial to enabling 

them to choose to remain healthy and independent in their homes and communities, and therefore 

to avoiding unnecessary, expensive nursing home care that is often publicly financed. In light of 

limited long-term coverage under Medicare and constrictions in the long-term care insurance 

market, many Americans with few resources will continue to rely on Medicaid to furnish their 

long-term care. Supporting less costly community-based options is a critical function of 

government and will continue to be an important tool in managing federal expenditures. 

Services provided by the HCBSS program in FY 2016 include:20

Transportation Services provided 23.7 million rides to doctor’s offices, grocery stores, 

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

Personal Care, Homemaker, and Chore Services provided nearly 40.8 million hours of assistance to 

older adults unable to perform activities of daily living (such as eating, dressing, or bathing) or 

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

Adult Day Care/Day Health provided 10.5 million hours of care for program participants in a group 

setting that provides health, therapeutic, and social services and activities during some portion of a 

twenty-four hour day. 

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

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

Reflecting AoA’s and the national aging service network’s efforts to target services to those in 

most need, nearly 48 percent of riders on OAA-funded transportation are mobility impaired, 

meaning they do not own a car or, if they do own a car, they do not drive and are not near public 

transportation.21 Many of these individuals cannot safely drive a car, as nearly 73 percent of 

transportation riders have at least one of the following chronic conditions that could impair their 

ability to navigate safely:22

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

macular degeneration or cataracts);

• 5 percent have Alzheimer’s disease or dementia;

• 2 percent have Multiple Sclerosis;

• 14 percent have had a stroke;

• 3 percent have epilepsy; and

• 2 percent have Parkinson’s disease.

Of the transportation participants, 96 percent take daily medications, with about one in five (15

percent) reporting they take 10 to 20 medications daily.23 Data from AoA’s national surveys of 

19

 Ibid.

20

 AoA’s FY 2016 State Program Report. These data are preliminary and should not be taken as final

21 2017 National Survey of Older Americans Act Participants. http://www.agid.acl.gov.

22

 Ibid

23 Ibid,
12

elderly clients show that HCBSS are providing these seniors with the assistance and information 

they report help them to remain at home.24 For example, over 82 percent of clients receiving case 

management reported that as a result of the services arranged by the case manager they were better 

able to care for themselves.25 In addition, a study published in the Journal of Aging and Health

shows that the services provided by the HCBSS program, “personal care services,” are the critical 

services that enable frail seniors to remain in their homes and out of nursing home care.26 

Nationally, 24 percent of individuals 60 and older live alone.27 OAA programs serve a 

disproportionate number of people who live alone compared to the general population. For 

example, 67 percent of transportation clients live alone.

28 Living alone is a key predictor of nursing 

home admission, and HCBSS are critical for enabling them to remain at home, especially for those 

who do not have an informal caregiver to assist with their care. Research has also shown that 

childless older adults who live in a state with higher home and community-based services

expenditures had significantly lower risk of nursing home admissions.29 

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

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

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

leverage resources of between two and three dollars per every federal OAA dollar, significantly 

exceeding the programs’ match requirements.

Nutrition Services

Nutrition Services help older adults remain healthy and independent in their communities by 

providing nutritious meals and other nutrition services in a variety of settings (such as senior 

centers, public housing locations, religious buildings or community centers) and via home-delivery 

to older adults who are homebound due to illness, disability, or geographic isolation. Nutrition

Services include:

Congregate Nutrition Services (Title III-C1; FY 2016: $438,191,000): Provides funding for the 

provision of nutritious meals and nutrition-related services in a variety of congregate settings, 

which helps keep older adults healthy and may decrease or prevent the need for more costly 

medical interventions. Established in 1972, the program centers around serving health-promoting 

meals, but it also presents opportunities for social engagement, health and wellness activities, and 

meaningful volunteer roles, all of which contribute to overall health and well-being.

Home-Delivered Nutrition Services (Title III-C2; FY 2016: $216,397,000): Provides funding 

for nutritious meals, the delivery of meals and nutrition-related services to homebound frail and/or 

 

24 Ibid.

25Ibid.

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

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

V. 22: 267. Accessed March 23, 2018 at: http://jah.sagepub.com/cgi/content/abstract/22/3/267.

27 Administration for Community Living, http://www.agid.acl.gov/DataGlance/. Data-at-a-Glance: American 

Community Survey (ACS) Public Use Microdata Sample (PUMS) 1-Year Files (2015), accessed January 2018. .

28 2017 National Survey of Older Americans Act Participants. http://www.agid.acl.gov

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

and Community-Based Services Matter?” May 2007. Journal of Gerontology: Psychological Sciences.
13

isolated older adults. The deliveries provide opportunities for social engagement and, in many 

cases, an informal ‘safety check.’ Established in 1978, home-delivered meals are often the first 

in-home service that an older adult receives and serve as a primary access point for other homeand community-based services. Home-delivered meals are a key element in helping older adults 

who may not be able to prepare their own meals remain in the community.

Nutrition Services Incentive Program (Title III-A; FY 2016: $160,069,000): Provides 

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

procure food products for use in the Title III- C-1 and C-2 and Title VI meal programs, and cannot 

be used to pay for other nutrition-related services or for administrative costs. Funds are awarded 

to states and tribes based on the number of meals served in a prior federal fiscal year. States and 

tribes have the option to purchase USDA Foods (previously referred to as commodities) directly 

from the U.S. Department of Agriculture (USDA) with any portion of their award if they determine 

that doing so will enable them to better meet the needs of older adults. In FY 2016, six states and 

one tribe elected to take some portion of the allotment in USDA Foods.

The meals provided through these programs fulfill the standards set by the current Dietary 

Guidelines for Americans and provide a minimum of 33 percent of the Dietary Reference Intake, 

as established by the Food and Nutrition Board of the Institute of Medicine of the National 

Academy of Sciences.

30 Meals also comply with applicable provisions of state and local food 

safety codes, are appealing, and meet special dietary needs such as health, religious, and 

cultural/ethnic needs, as feasible. The nutrition-related services provided through these programs 

may include nutrition education, nutrition counseling, and other nutrition services, as appropriate, 

based on the needs of meal participants.

Nutrition Services help approximately 2.4 million older adults receive the meals they need to stay 

healthy and decrease their risk of disability.31 Because the prevalence of multiple chronic 

conditions is higher among congregate and home-delivered program participants than for the 

general Medicare population, the provision of healthy meals, access to lifestyle modification 

programs and evidence-based advice such as nutrition education and counseling are important. 

Overall, 76 percent of community-living Medicare beneficiaries age 65 or older have multiple

chronic conditions.32 Data from AoA’s FY 2017 National Survey of Older Adult Participants 

indicate that 95 percent of home-delivered and congregate participants have multiple chronic 

conditions, and that 47 percent of congregate and 64 percent of home-delivered participants have 

six or more illnesses or conditions. Over 21 percent of congregate and 40 percent of homedelivered participants take more than six medications per day and some take more than 20 

medications. The congregate and home-delivered program participants are significantly less 

healthy than the general Medicare population and access to adequate healthy meals is essential to 

their well-being. Meals are also an important element in deferral or delay of institutional 

placement.

 

30 https://health.gov/dietaryguidelines/2015/guidelines/ and https://www.nal.usda.gov/fnic/dietary-reference-intakes

31 AoA’s FY 2016 State Program Report.

32 Centers for Medicare & Medicaid Services, The characteristics and perceptions of the Medicare population. Data 

from the 2013 Medicare Current Beneficiary Survey. [data tables 2.5a]. http://www.cms.gov/Research-StatisticsData-and-Systems/Research/MCBS/Data-Tables-Items/2013CNP.html. Accessed 02 January 2018.
14

Older adults served in the congregate and home-delivered nutrition programs demonstrate a need 

for healthy, prepared meals, rather than simply access to food. While the 75 year-old and over 

cohort makes up 30 percent of the U.S. population age 60 and over, half (51 percent) of congregate 

and almost two-thirds (64 percent) of home-delivered meal participants are aged 75 years or 

older.33

Approximately 10 percent of congregate and over 41 percent of home-delivered participants 

indicate that they have three or more impairments in instrumental activities of daily living 

(IADLs).

34

 The data also indicate that 15 percent of congregate and 54 percent of home-delivered 

participants have difficulty getting outside the house, thus limiting their ability to shop for food 

themselves.35 The number of home-delivered meal recipients with severe disabilities (three or 

more activities of daily living) totaled nearly 364,000 in FY 2016.

36 This level of disability is 

frequently associated with nursing home admission, and demonstrates the extreme frailty of a 

significant number of older adults receiving home-delivered meals. 

Nationally, 24 percent of persons age 60 years and older live alone.37 However, due to the OAA’s 

requirement to target services to older adults most in need to help them maintain their health and 

independence, 47 percent of congregate and 58 percent of home-delivered participants live alone.38 

Living alone is a risk factor for social isolation, poorer health, and nursing home placement.

Data from AoA’s national surveys of older adult participants show that Nutrition Services are 

effectively helping older adults improve their nutritional intake and remain at home. For example, 

data indicate that 81 percent of congregate and 79 percent of home-delivered meal participants say 

they eat healthier meals due to the programs, and 65 percent of congregate and 92 percent of homedelivered meal recipients say that the meals enable them to continue living in their homes.39

 

Independent research has found that states that invest more in delivering OAA home-delivered 

meals to older adults’ homes have lower rates of “low-care” older adults in nursing homes after 

adjusting for several other factors.40 For every $25 per year per older adult that states spend on 

home-delivered meals, the state reduces their percentage of these lower needs nursing home 

residents by one percent when compared to the national average.41 This evidence is a testimonial 

to the savings gained from this foundational home- and community-based service.

 

33 U.S. Census Bureau, Population Division. Annual Estimates of the Resident Population for Selected Age Groups 

by Sex for the United States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010 to 

July 1, 2016. Release Date: June 2017

https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=PEP_2016_PEPAGESEX&pro

dType=table Accessed January 2018 and AoA’s FY 2016 State Program Report. 

34 2017 National Survey of Older Americans Act Participants. http://www.agid.acl.gov and AoA’s FY 2015 State 

Program Report.

35 Ibid.

36 AoA’s FY 2016 State Program Report.

37 Administration for Community Living, http://www.agid.acl.gov/DataGlance/. Data-at-a-Glance: American 

Community Survey (ACS) Public Use Microdata Sample (PUMS) 1-Year Files (2015), accessed January 2018.

38 2017 National Survey of Older Americans Act Participants. http://www.agid.acl.gov.

39 Ibid

40 Thomas, K & Moe, V. The relationship between Older Americans Act Title III State Expenditures & Prevalence 

of Low-Care Nursing Home Residents. Health Services Research. 12.3.12. Accessed March 23, 2018 at: 

http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12015/abstract

41 Ibid.
15

AoA’s annual performance data further demonstrate that these programs are highly valued by older

people who need assistance in order to remain healthy and independent in their homes. Nearly 82

percent of home-delivered meal clients and over 90 percent of congregate participants rate the 

meal as good to excellent.

42

 The most recent data on how these nutrition programs are helping 

older adults remain healthy and independent in their homes include:

Home-Delivered Nutrition Services provided over 145 million meals to over 868,000 individuals 

in FY 2016.

43

Congregate Nutrition Services provided over 79 million meals to more than 1.57 million older 

adults in a variety of community settings in FY 2016.

44

Consistent with the OAA’s requirement to target services to those most in need to help them 

maintain their health and independence, approximately 71 percent of home-delivered meal 

recipients have annual incomes at or below $20,000.45 Meals are especially critical for the 

61 percent of home-delivered and 53 percent of congregate recipients who report these meals 

provide half or more of their food intake for the day.46

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

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

donations that contribute funding. In FY 2016, state and local funding comprised two-thirds (67 

percent) of all the funding for home-delivered meals and nearly 55 percent for congregate meals.

47

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

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

many other OAA services.

State and Territory Flexibility

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

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

best meet local needs through intra-state funding formulas that distribute funds to area agencies on 

aging (AAAs). These formulas vary by state and allow states to take into account their own local 

circumstances to best serve their population. States are required to submit their formulas to AoA 

for approval and must take into account the geographic distribution of older persons and the 

distribution of older persons in greatest social and economic need. AAAs administer these grants 

and provide grants or contracts to local service providers based on identified needs.

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

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

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

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

 

42 2017 National Survey of Older Americans Act Participants. http://www.agid.acl.gov.

43 AoA’s FY 2016 State Program Report. These data are preliminary and should not be taken as final

44 Ibid.

45 2017 National Survey of Older Americans Act Participants. http://www.agid.acl.gov.

46 Ibid. 

47 AoA’s FY 2016 State Program Report.
16

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

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

appropriate. These are options open only to states and territories. A state agency may not delegate 

to an area agency on aging or any other entity the authority to make such transfers.

Table 1. FY 2016 Transfer of Federal funds within Title III of the OAA

Category

Part B –

Home and CommunityBased Supportive Services

Part C1 –

Congregate Nutrition

Part C2 –

Home-Delivered Meals

Initial Allotment $345,166,956 $445,047,800 $224,673,820

Final Allotment after 

Transfers $403,913,406 $348,260,376 $262,714,794

Net Transfer $58,746,450 (-$96,787,424) $38,040,974

Net Percent Change 17.02 (-21.75) 16.93
17

Preventive Health Services

(Title III-D of OAA; FY 2016: $19,848,000)

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

based on their share of the population age 60 and over to support evidence-based disease 

prevention and health promotion programs. Older Americans are disproportionately affected by 

chronic disease and unintentional injury. There are many evidence-based health promotion 

programs that have been shown to be effective in reducing illness and injury, and improving older 

adult health. Preventive Health Services provide states and territories with the flexibility to 

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

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

of the state or who have the greatest economic need. 

Evidence-based programs empower older adults to take control of their health by increasing 

knowledge, changing behavior, and improving self-efficacy and self-management techniques. 

They are established activities, inputs, and resources for implementing health interventions that 

have been tested in a controlled trial setting and have been shown to be effective at improving 

health and/or reducing disease, illness, or injury. Some examples are:

• Physical activity: Maintaining (or increasing) physical activity is a necessary component 

for staying healthy. There are a number of evidence-based programs focused on 

empowering older adults to stay or become active through strength training, cardiovascular 

workouts, balance exercises, and more.

• Falls prevention: Falls prevention programs help older adult participants improve strength, 

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

and some involve medication reviews and provide home assessments of ways to reduce 

environmental hazards. 

• Medication management: Medication management programs focus on reviewing the 

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

medications. Medication management programs have been shown to reduce unnecessary 

duplication of prescriptions and cardiovascular problems.48 These programs have also been 

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

adults.49

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

prevalent and disabling condition among older adults. Claims data (2014) reported by the 

Centers for Medicare & Medicaid Services (CMS) reveal that 13.6 percent of Medicare 

 

48 Meredith, S., Feldman, P., Frey, D., Giammarco, L., Hall, K., Arnold, K., Ray, W. A. (2002). Improving 

medication use in newly admitted home healthcare patients: A randomized controlled trial. Journal of the 

American Geriatrics Society, 50(9), 1484–1491. PubMed abstract available at 

http://www.ncbi.nlm.nih.gov/pubmed/12383144. Accessed March 23, 2018. 

49 A summary of these studies can be found at: https://www.acl.gov/programs/strengthening-aging-and-disabilitynetworks/aging-and-disability-evidence-based-programs
18

beneficiaries age 65 and older have a depression diagnosis.50 Depression in older adults 

has been associated with high direct medical costs (i.e., hospitalizations), as well as 

significant indirect costs (i.e., unpaid caregiving).51 Cost-effective, evidence-based 

interventions, such as the Program to Encourage Rewarding Lives for Seniors (PEARLS), 

developed in CDC’s Prevention Research Centers, have been shown to reduce depressive 

symptoms and improve quality of life in older adults.52

Starting in 2012 and continuing every year since, ACL’s appropriations language has specified

that funds from OAA Title III-D can be used “only for disease prevention and health promotion 

programs and activities which have been demonstrated through rigorous evaluation to be evidencebased and effective.” Even before this evidence-based requirement, states had already begun to 

shift their Preventive Health Services funding toward evidence-based approaches to achieve better 

results with limited funding. Since 2012, all Preventive Health Services funding has been used for 

evidence-based programs. States can continue funding other health services, such as blood 

pressure screenings, using OAA funding for supportive services (Title III-B).

50 https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ChronicConditions/CC_Main.html. 

51 Snow, C.E.; Abrams, R.C. The Indirect Costs of Late-Life Depression in the United States: A Literature Review 

 and Perspective. Geriatrics 2016, 1, 30.

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

http://www.pearlsprogram.org/
19

Chronic Disease Self-Management Education Programs

(FY 2016: $8,000,000)

In the United States, nearly 70 percent of Medicare beneficiaries have two or more chronic 

conditions.

53 This burden places older adults at greater risk for premature death, poor functional 

status, unnecessary hospitalizations, adverse drug events, and nursing home placement.54,55

Chronic conditions also impact health care costs: 95 percent of health care costs for older 

Americans can be attributed to chronic diseases.56

Chronic Disease Self-Management Education (CDSME) programs, such as the evidence-based 

Chronic Disease Self-Management Program (CDSMP) originally developed at Stanford 

University, are low-cost, evidence-based disease prevention models that use proven techniques, 

allowing peer leaders to help individuals with chronic disease address issues related to the 

management and treatment of their condition, improve their health status, and potentially reduce 

their need for more costly medical care.57 In addition to the CDSMP, which is appropriate for any 

type of chronic condition, there are other proven CDSME programs, including Tomando Control 

de su Salud (Spanish CDSMP), the Diabetes Self-Management Program (DSMP), Programa de 

Manejo Personal de la Diabetes (Spanish DSMP), Chronic Pain Self-Management Program, 

Positive Self-Management Program for HIV, Cancer: Thriving and Surviving, and online versions 

of many programs, as well.

CDSME programs have been shown repeatedly, through multiple studies (including randomized 

control trials with both English and Spanish speaking populations) to be effective at helping 

participants adopt healthy behaviors and improve their psychological and physical health status.58 

A 2013 national study with over 1,100 CDSMP participants in 17 states documented many 

significant improvements relevant to CMS’s goals to promote better care, healthier communities, 

and wiser spending of health care dollars. Participants demonstrated improved communication 

with physicians, medication compliance, health literacy, self-reported health, less depression, and 

better quality of life, as well as reduced emergency room visits and hospitalizations and an 

estimated $360 per person net savings. The research team projected a national savings of $3.3 

billion if CDSMP workshops were delivered to 5 percent of adults with multiple chronic 

conditions.59

 

53 Lochner KA, Cox CS. Prevalence of Multiple Chronic Conditions Among Medicare Beneficiaries, United States, 

2010. Prev Chronic Dis 2013.

54 Parekh, AK, et al. 2011. Managing Multiple Chronic Conditions: A Strategic Framework for Improving Health 

Outcomes and Quality of Life. Public Health Rep. 126(4):460-71.

55 Kramarow, E et al. 2007. Trends in Health of Older Americans, 1970-2005. Health Affairs (Milwood). Sep-Oct; 

26 (5):1417-25.

56 Centers for Disease Control and Prevention. The State of Aging and Health in America 2013. Atlanta, GA: 

Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013.

57 Brady, T.J., et al. 2013. “A Meta-analysis of Health Status, Health Behaviors, and Health Care Utilization 

Outcomes of the Chronic Disease Self-Management Program.” Prev Chronic Dis 10:120112.

58 Centers for Medicare & Medicaid Services, Report to Congress: The Centers for Medicare & Medicaid Services’ 

Evaluation of Community-based Wellness and Prevention Programs under Section 4202 (b) of the Affordable 

Care Act. http://innovation.cms.gov/Files/reports/CommunityWellnessRTC.pdf Accessed March 23, 2018.

59 Ahn S et al. The Impact of Chronic Disease Self-Management Programs: Healthcare Savings through a 

Community-Based Intervention. BMC Public Health. 2013. 13:1141. doi:10.1186/1471-2458-13-1141 Available 

at: http://www.biomedcentral.com/1471-2458/13/1141 Accessed March 23, 2018. 
20

CDSMEs emphasize an individual’s role in managing his/her chronic condition(s). For example, 

the CDSMP in-person programs consist of a series of sessions that are conducted once a week for 

two and a half hours over six weeks in community settings such as senior centers, faith-based 

organizations, health care organizations, libraries, residential facilities, and tribal centers. CDSME 

workshops are facilitated by two trained leaders, and people with varying chronic conditions 

participate together. One or both of the leaders are non-health professionals who also have a 

chronic condition. Workshop topics include: 1) techniques to deal with problems such as 

frustration, fatigue, pain, and isolation; 2) appropriate exercise for maintaining and improving 

strength, flexibility, and endurance; 3) appropriate use of medications; 4) communicating 

effectively with health professionals and family/friends; and 5) nutrition. 

AoA funds CDSME through competitive grants awarded to domestic public or private nonprofit 

entities. External experts review project proposals. AoA awarded eight grants for a two-year 

forward funded project period beginning September 1, 2015, as well as 12 forward-funded grants 

for a two-year project period beginning August 1, 2016. Additionally, a cooperative agreement 

for a National Chronic Disease Self-Management Education Resource Center was awarded for a 

five-year project period. The Resource Center assists states, the aging, disability and public health 

networks, and their partners to increase access to and sustain evidence-based prevention programs, 

particularly CDSME programs that improve the health and quality of life of older adults and adults 

with disabilities. The Center also serves as a national clearinghouse of tools and information on 

CDSME.

By September 30, 2016, grantees and various partners had reached a cumulative total of over 

178,000 participants. During FY 2016, there were over 37,700 participants and over 28,800

“completers” (i.e., who attended at least four out of six classes, a retention rate of 73 percent

[retention rate is specific to only those interventions with standard start/end dates, not ongoing 

interventions]). Grantees were successful in reaching their targeted underserved populations: of 

those participants reporting relevant data, 74 percent were age 60 or older, 78 percent reported 

having multiple chronic conditions, 32 percent reported a disability, and 41 percent were 

racial/ethnic minorities.60

Behavioral Health

Behavioral health is essential to overall health. Behavioral health issues, such as depression, 

anxiety, substance misuse, and suicidal thoughts or actions, are not a normal part of aging – yet 

one in four persons aged 55 and over have experienced a behavioral health disorder.

61

 Behavioral 

health issues can greatly impact the independence, health, and well-being of older adults and their 

family caregivers. Untreated behavioral health disorders can exacerbate health conditions, 

 

60 Racial and/or ethnic minorities refer to individuals who self-report at least one of the following racial or ethnic 

identities: Asian, Black or African American, Hispanic or Latino, Native Hawaiian or other Other Pacific 

Islanders, American Indian or Alaska Native.

61 Substance Abuse and Mental Health Services Administration (SAMHSA). (2012). Older Americans Behavioral 

Health Issue Brief: Series Overview. Accessed January 5, 2018 at: https://www.ncoa.org/wpcontent/uploads/Series-Overview-Issue-Brief-1.pdf
21

decrease life expectancy, and increase overall healthcare costs.62 Distinctive barriers to the 

treatment of behavioral health disorders among the older adult population exist, such as 

discrimination, under-diagnosis, and inappropriate treatment.

The good news is that prevention, brief intervention, self-directed treatment, and recovery from 

behavioral health disorders are possible for individuals of all ages, including older adults. While 

the 2006 reauthorization of the OAA included new provisions focused on the prevention and 

treatment of mental disorders, there is no funding in the OAA specifically designated for 

prevention, intervention, and treatment services. States and communities have had to be creative

in how they support these programs and services. Many aging network providers are working 

closely with behavioral health, primary care, and other partners to connect older adults with 

existing behavioral health resources. In addition, some providers are delivering evidence-based 

community interventions, such as the Program to Encourage Rewarding Lives for Seniors 

(PEARLS), using a braided funding approach (i.e., using a combination of funds, such as those 

from the OAA, Substance Abuse and Mental Health Services Administration (SAMHSA) block 

grants, private foundations, etc.).

In FY 2016, ACL and SAMHSA continued their partnership to provide technical assistance aimed 

at increasing states’ capacities for reaching older adults who are experiencing or are at-risk for 

behavioral health disorders. Most recently, they worked together to support the development of a 

variety of tangible materials, such as epidemiological profiles, toolkits, issue briefs, and learning 

opportunities, such as webinars. The materials developed through this partnership have been 

successful in helping many states enhance their efforts to reach older adults who are experiencing 

or are at-risk for behavioral health disorders. 

Falls Prevention Programs

(FY 2016: $5,000,000)

Falls can have a widespread and significant impact on health, can be deadly, and often result in 

high costs. One out of four older adults (those aged 65 or older) fall each year,

63 but fewer than 

half of those who have suffered a fall talk to their healthcare providers about it.64 In 2014, 2.8

million nonfatal falls among older adults were treated in emergency departments and more than 

800,000 of these patients were hospitalized.65 In 2014, adjusted for inflation, the direct medical 

costs for fall injuries were $31 billion annually.

66

Research has shown that falls, and the risk of falls, can be reduced through systematic risk 

identification and targeted intervention, including a combination of clinical and community-based 

 

62 World Health Organization (2016). Mental Health and Older Adults: A Fact Sheet. Retrieved March 23, 2018 at

http://www.who.int/mediacentre/factsheets/fs381/en/

63 U.S Centers for Disease Control and Prevention. (2016). Facts About Falls. Accessed March 23, 2018 at: 

http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html 

64 Stevens JA, Ballesteros MF, Mack KA, Rudd RA, DeCaro E, Adler G. Gender differences in seeking care for falls 

in the aged Medicare Population. American Journal of Preventive Medicine 2012; 43:59–62.

65 Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web–based Injury 

Statistics Query and Reporting System (WISQARS) [online]. Accessed August 5, 2016.

66 Burns EB, Stevens JA, Lee RL. (2016). The direct costs of fatal and non-fatal falls among older adults—United 

States. Journal of Safety Research, 
22

interventions.

67

 Community-based falls prevention programs are low-cost, evidence-based disease 

prevention models that help reduce falls and/or fall risk factors in older adults, and potentially 

reduce their need for more costly medical care. Examples of these programs include: A Matter of 

Balance (MOB); Tai Chi: Moving for Better Balance (Tai Chi: MBB); Otago; and Stepping On. 

A recent CMS report to Congress indicated that MOB is associated with medical cost savings,68

and a recent study showed a positive return on investment for the implementation of Tai Chi: 

MBB, Stepping On, and Otago.

69

 ACL continues to collaborate with our partners at CDC’s Injury 

Prevention Center to leverage their research, data surveillance, and clinical provider education 

efforts.

ACL received dedicated funding for falls prevention programs through the Prevention and Public 

Health Fund (PPHF) in FY 2016. ACL published a competitive funding announcement, and 

external experts reviewed applications for this opportunity. ACL awared a total of seven grants to 

domestic public and private nonprofit entities, including state agencies, a university, and

community organizations. These two-year grants are intended to increase the number of older 

adults and adults with disabilities who participate in evidence-based community programs to

reduce falls, fall risks, and fear of falling. All of the grantees identified underserved target 

populations and partnering organizations to reach these populations, such as those living in rural 

areas, and organizations serving ethnically-diverse and/or limited English speaking populations. 

The funding is also fostering the development of innovative funding arrangements to support these 

falls prevention programs, while embedding the programs into an integrated, sustainable evidencebased prevention program network. Grantees have a cumulative goal of reaching 16,876 older 

adults and/or older adults with disabilities over the two-year period. 

Through financing from the FY 2016 PPHF, AoA also funded the National Falls Prevention 

Resource Center to work collaboratively – on behalf of the public, aging services network, and 

other stakeholders – to increase public education about the risks of falls and how to prevent them, 

as well as to support and stimulate the implementation and dissemination of evidence-based 

community programs and strategies that have been proven to reduce the incidence of falls among 

seniors. 

 

67 Tinetti, M.E., Dorothy I. Baker, D.I., King, M, Gottschalk, M.,Murphy, T.E., Acampora,D., Carlin, B.P., Linda 

Leo-Summers, L., and Allore, H.G. (2008) Effect of Dissemination of Evidence in Reducing Injuries from Falls. 

N Engl J Med;359:252-61. 

68 Report to Congress: The Centers for Medicare & Medicaid Services’ Evaluation of Community-based Wellness 

and Prevention Programs under Section 4202 (b) of the Affordable Care Act. Accessed February 13, 2018 from: 

http://innovation.cms.gov/Files/reports/CommunityWellnessRTC.pdf 

69 Carande-Kulisa, V., et al. (2015), A cost–benefit analysis of three older adult fall prevention interventions, Journal 

of Safety Research, Accessed February 13, 2018 from: 

http://www.cdc.gov/homeandrecreationalsafety/Falls/steadi/index.html#practice 
23

Caregiver Services

Families are the nation’s primary providers of care, but a number of factors including financial 

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

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

who often are strapped for both. AoA’s caregiver programs provide services that address the needs 

of informal caregivers, allowing many of them to continue to work while providing critically 

needed care. 

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

are informal family caregivers or unrelated friends, neighbors, and others who have a significant 

relationship with the person who volunteers their time – that determines whether an older person 

can remain in his or her home. In 2014, approximately 34.2 million adult caregivers provided 

uncompensated care to those 50 years of age and older.70 In other words, approximately 14.3

percent of all adults provided care to someone age 50 years and older.71 AARP estimated the 

economic cost of replacing unpaid caregiving in 2013 to be about $470 billion, an increase from 

$450 billion in 2009 (cost if that care had to be replaced with paid services).72 Another recent study 

by the Rand Corporation estimated the economic cost of replacing unpaid caregiving to be about 

$522 billion annually.73 The cost to replace that care with unskilled paid care at minimum wage 

was estimated at $221 billion, while replacing it with skilled nursing care could cost $642 billion 

annually. These estimates differ because of differences in methodology and definitions rather than 

contradictory data.

The demands of caregiving can be considerable. Recent research has demonstrated that caregiving 

tasks can, and do, go well beyond providing regular assistance with activities of daily living 

(ADLs) and instrumental activities of daily living (IADLs). A 2012 study by AARP and United 

Hospital Fund revealed that, while family caregivers continue to perform the traditional 

ADL/IADL supports, their roles are expanding dramatically to include performing 

medical/nursing tasks of the type and complexity typically seen only in hospitals and other acute 

care settings.74 

Such demands on family caregivers can lead to a breakdown of their health and can increase the

risk for institutionalization of the care recipient. While research is mixed on the exact physical 

health impacts of family caregiving, several recent studies show that caregivers reporting mental 

 

70 Research Report: Caregiving in the U.S. 2015: A Focused Look at Caregivers of Adults Age 50+. National 

Alliance for Caregiving and AARP Public Policy Institute. June 2015. http://www.caregiving.org/wpcontent/uploads/2015/05/2015_CaregivingintheUS_Care-Recipients-Over-50_WEB.pdf. Accessed February 15, 

2018.

71 Ibid.

72 Valuing the Invaluable: 2015 Update, The Growing Contributions and Costs of Family Caregiving. AARP Public 

Policy Institute. July 2015. http://www.aarp.org/ppi/info-2015/valuing-the-invaluable-2015-update.html. 

Accessed February 15, 2018. 

73 The Opportunity Costs of Informal Elder-Care in the United States. The Rand Corporation, 2014. 

http://www.rand.org/pubs/external_publications/EP66196.html. Accessed February 15, 2018. 

74 Home Alone: Family Caregivers Providing Complex Chronic Care. AARP and United Hospital Fund. October 

2012. https://www.aarp.org/content/dam/aarp/research/public_policy_institute/health/home-alone-familycaregivers-providing-complex-chronic-care-rev-AARP-ppi-health.pdf. Accessed February 15, 2018.
24

and emotional strain as a result of their caregiving role are at higher risk for earlier mortality.

75,76,77

Providing support that makes caregiving easier for family caregivers, such as information, 

counseling and training, respite care, or supplemental services, is critical to sustaining caregivers’ 

ability to continue in that role. Seventy seven percent of the caregivers served by OAA programs 

report that these services allow them to provide care longer than they otherwise could.78 

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

every day. By 2020, it is projected that there will be 16.4 million older adults living in the 

community age 65 and over with one or more ADL limitations, an increase of over two million 

seniors (or a 15 percent increase between 2016 and 2020) needing caregiver assistance.79 

National Family Caregiver Support Program

(Title III-E of OAA; FY 2016: $150,586,000)

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

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

and informal caregivers to care for their family member at home for as long as possible. The 

NFCSP includes five basic system components: information, access assistance, counseling and 

training, respite care, and supplemental services. These services work in conjunction with other 

OAA services – including transportation services, homemaker services, home-delivered meals, 

and adult day care – to provide a coordinated set of supports for older individuals that caregivers 

can access on their behalf.

The NFCSP provides a variety of supports to family and informal caregivers. In FY 2016, services 

provided included:80

• Access Assistance Services, which provided over 1.2 million contacts to caregivers 

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

 

75 Perkins, M., Howard, V. J., Wadley, V. G., Crowe, M., Safford, M. M., Haley, W. E., Roth, D. L. (2013). 

Caregiving strain and all-cause mortality: Evidence from the REGARDS Study. Journals of Gerontology Series 

B: Psychological Sciences and Social Sciences, 68, 504-512. doi:10.1093/geronb/gbs084.

76 Roth, D. L., Haley, W. E., Hovater, M., Perkins, M., Wadley, V. G., & Judd, S. (2013). Family caregiving and allcause mortality: Findings from a population-based propensity-matched analysis. American Journal of 

Epidemiology, 178, 1571-1578. doi:10.1093/aje/kwt225

77 Roth, D. L., Fredman, L., & Haley, W. E. (2015, Special Issue). Informal caregiving and its impact on health: A 

reappraisal from population-based studies. The Gerontologist, 55, 309-319. doi:10/1093/geront/gnu177

78 2017 National Survey of Older Americans Act Participants. http://www.agid.acl.gov

79 U.S. Census Bureau. Population Division. Annual Estimates of the Resident Population for Selected Age Groups 

by Sex for the United States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010 to 

July 1, 2016. Release Date: June 2017. Accessed January 2018, and U.S. Census Bureau. Population Division. 

Table 9. Projections of the Population by Sex and Age for the United States: 2015 to 2060 (NP2014-T9). Release 

Date: December 2014. Accessed January 2018, and Centers for Medicare & Medicaid Services, The 

characteristics and perceptions of the Medicare population. Data from the 2013 Medicare Current Beneficiary 

Survey. [data tables 2.5a and 2.6a]. http://www.cms.gov/Research-Statistics-Data-andSystems/Research/MCBS/Data-Tables-Items/2013CNP.html Accessed January 2018.

80 AoA’s FY 2016 State Program Report.
25

• Counseling and Training Services, which provided over 120,000 caregivers with 

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

caregiving.

• Respite Care Service, which provided nearly 62,000 caregivers with approximately 6

million hours of temporary relief – at home or in an adult day care or nursing home setting 

– from their caregiving responsibilities. 

To evaluate the degree to which the NFCSP is meeting its goals and objectives, ACL undertook 

its first national evaluation of the program since implementation began. The first part of the 

evaluation was completed and the results were released in March, 2016. Known as a “process 

evaluation,” it focused on two broad research questions: 1) how the program meets its goals, and; 

2) has the program contributed to long-term care system efficiency. Results of this portion of the 

evaluation show the program has served as a catalyst for states to focus specifically on the needs 

of family caregivers and has resulted in meaningful progress in including family caregivers in 

broader systems of long-term services and supports. 

For example, analysis of services available to caregivers before and after the NFCSP started, as 

reported by state units on aging (SUAs) found a 247 percent increase in support group services, a 

227 percent increase in training and education services, and a 93 percent increase in the availability 

of respite care services. The NFCSP has also fostered the growth of partnerships among aging 

services network agencies and other organizations in supporting the needs of family caregivers. 

Approximately one-half (51.8 percent) of area agencies on aging indicated that Aging and 

Disability Resource Centers (ADRCs) were a key partner in serving family caregivers while more 

than 40 percent indicated that health care providers were among the three most partners for 

administering the program.81

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

daily basis, these individuals, the majority of whom are women, assist relatives and other loved 

ones with tasks ranging from personal care and homemaking to more complex health-related 

interventions like medication administration and wound care. Data from AoA’s 2017 National 

Survey of OAA Participants show that over 20 percent of caregivers are assisting two or more 

individuals. Over 70 percent of Title III caregivers are 60 or older, making them more vulnerable 

to a decline in their own health, and over 30 percent describe their own health as fair to poor.82

The demands of caregiving can lead to a breakdown of the caregiver’s health. Nationally, 

approximately 11 percent of caregivers report that caregiving has caused their physical health to 

decline.83 Caregivers often experience conflicts between work and caregiving. Among working 

caregivers caring for a family member or friend, 60 percent report work impacts due to caregiving 

 

81 Process Evaluation of the Older Americans Act, Title III E: National Family Caregiver Support Program: Final 

Report (March 2016). Prepared for The Administration for Community Living by The Lewin Group, Inc. See: 

Final Report

82 2017 National Survey of Older Americans Act Participants. http://www.agid.acl.gov.

83 Center on Aging Society. (2005) How Do Family Caregivers Fare? A Closer Look at Their Experiences. (Data 

Profile, Number 3). Washington, DC: Georgetown University.
26

such as having to rearrange their work schedule, decrease their hours or take an unpaid leave in 

order to meet their caregiving responsibilities.84

Survey results from caregivers served by the NFCSP indicate that the types of supports provided 

through the NFCSP can enable them to provide care longer (77 percent) while often continuing to 

work,85 thereby avoiding or delaying the need for costly institutional care, including care financed 

by government. Additionally, another study indicates that counseling and support for caregivers 

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

significantly less cost, on average, for an additional year before being admitted to a nursing home.86

Data from AoA’s national surveys of caregivers of elderly clients also reveal that OAA services, 

including those provided through the NFCSP, are effective in helping caregivers assist their loved 

ones at home. Caregivers receiving services were asked whether the care recipient would have 

been able to live in the same residence if the services had not been available. Over 40 percent of

the caregivers indicated that the care recipient would be unable to remain at home without the 

support services.87 Those respondents were then asked to identify where the care recipient would 

be living without services. A significant majority of those caregivers, nearly 77 percent, indicated 

that the care recipient would most likely be living in a nursing home or an assisted living facility

(see the chart below).

88

 

84 Research Report: Caregiving in the U.S. 2015- A Focused Look at Caregivers of Adults Age 50+. National 

Alliance for Caregiving and AARP Public Policy Institute. June 2015. http://www.caregiving.org/wpcontent/uploads/2015/05/2015_CaregivingintheUS_Care-Recipients-Over-50_WEB.pdf. 

85 2017 National Survey of Older Americans Act participants. http://www.agid.acl.gov.

86 Mittelman, M., Ferris, S., Shulman, E., Steinberg, G., Levin, B. (1996). A family intervention to delay nursing 

home placement of patients with Alzheimer's disease - A randomized controlled trial. The Journal of the 

American Association, 276(21), 1725-1731.

87 2017 National Survey of Older Americans Act Participants. http://www.agid.acl.gov

88 Ibid.
27

Brain Health

The majority of older adults living in the community do not have problems with cognition; that is, 

the ability to think, learn, remember, and manage their lives. Aging can bring some changes in 

cognition that are normal, which includes some difficulty finding words, less ability to multi-task, 

and slight decreases in attentiveness. However, older adults can still learn new things, create new 

memories, improve vocabulary and language skills and manage their lives. 

Promoting brain health is critical to helping older adults maintain their cognition, independence 

and overall health. AoA works with the National Institutes of Health (NIH) and the Centers for 

Disease Control and Prevention (CDC) to develop and maintain a Brain Health Resource (the 

Resource) to promote brain health among older adults, people with disabilities, and their

caregivers. The Resource is available at: https://www.acl.gov/index.php/node/293

The Resource addresses a number of risks to brain health, including: accidents; medication use; 

smoking and alcohol misuse; health conditions like heart disease and diabetes; poor diet; 

insufficient sleep; and lack of physical and social activity. For each of these risks the Resource 

supplies evidence-based information and governmental resources that can help professionals, older 

adults, and people with disabilities promote brain health. Many of the resources, like AoA’s 

nutrition, chronic disease self-management education, falls prevention, and medication programs, 

promote overall health, including brain health. 
28

There are four parts to the Brain Health Resource. Brain Health Basics helps people learn and 

teach others about the risks related to brain health and how to reduce them. Medicine, Age and 

Your Brain explains the impact of some medicines can have on an older adult’s brain, and the 

importance of talking with a doctor about this topic. Brain Injury helps people learn and teach 

others about how to prevent brain injury and how to get help when someone has one. Dementia 

explains how to create “dementia-capable” long-term services and supports at the state and local 

levels to help people who have Alzheimer’s disease and other types of dementia and their 

caregivers.

AoA, NIH, and CDC will continue their collaboration on the Brain Health Resource over time. 

This work occurs under the direction of the U.S. Department of Health and Human Services’ 

National Plan to Address Alzheimer’s Research, Care and Services.89

Alzheimer’s Disease Supportive Services Program (ADSSP)

(FY 2016: $4,800,000)

Established under Section 398 of the Public Health Services Act, as amended, (42 U.S.C. 280c-3), 

the Alzheimer’s Disease Supportive Services Program (ADSSP) funds competitive grants to states 

to expand the availability of dementia-capable community-level supportive services for persons 

with Alzheimer’s disease and related dementias (ADRD), their families, and their caregivers. 

Alzheimer’s disease is an irreversible, progressive brain disorder that destroys memory and 

thinking. Symptoms usually appear in a person’s mid-60’s, but they can occur earlier. More than 

five million Americans may have the disease, and it is ranked as the sixth leading cause of death 

in the U.S.

In its effort to improve home and community-based services (HCBS) for persons with ADRD, 

AoA presently focuses its ADSSP resources toward building dementia-capable systems within 

states. Dementia-capable systems are those that are designed to improve the responsiveness of 

home and community-based services systems to persons with dementia and their caregivers by

ensuring access to sustainable, integrated long-term services and supports. The primary 

components of the ADSSP program includes delivery of supportive services for persons with 

dementia and their caregivers through dementia-specific, evidence-informed interventions, as well 

as advancing changes to the dementia-capability of states’ overall systems of home and 

community-based care. 

ADSSP expands the aging services network’s capacity to assist those with ADRD and their 

families through provision of services and education, building awareness of Alzheimer’s disease 

and related dementias, and referrals for diagnostic, treatment and related services; as well as 

sources of assistance for services and legal rights assistance for people affected by dementia 

throughout a state’s long-term services and support system.

ADSSP grant projects are designed to ensure that states provide people with ADRD and their 

family caregivers with access to a sustainable home and community-based services system that is 

 

89 https://aspe.hhs.gov/national-plan-address-alzheimers-disease-2015-update.
29

“dementia capable.” Such a system meets the unique needs of each person with ADRD by: 1) 

identifying those with a possible dementia and recommending follow-up with a physician; 2) 

ensuring that the staff they encounter have appropriate training, understand the unique 

needs/services available and knowing how to communicate with them; and 3) providing quality, 

person-centered services that help them remain independent and safe in their communities. 

Presently, there are 19 states implementing grants dedicated to the development of dementiacapable systems. 

Through projects funded in new ADSSP grant projects states continue to implement dementiaspecific, evidence-based and evidence-informed interventions into practice. Overall, these 

demonstration programs offer direct services and other supports to thousands of individuals and 

families, as well as supporting continuous quality improvement and evaluation of state HCBS

systems. 

Family caregivers remain the major source of support for most people with ADRD and, as such,

they access a variety of services from many different systems including the aging, medical, and 

mental health service systems. As the number of people living with ADRD grows, it is 

increasingly important to ensure the availability of dementia-capable HCBS. These important 

services, and the systems through which they are delivered, must be dementia-capable and 

efficiently and effectively coordinated. The ADSSP provides states the opportunity and resources 

to infuse dementia capability into their systems and provide appropriate direct services in support 

of persons living with ADRD and their caregivers. The delivery of dementia-capable services and 

supports that are cost-effective and result in demonstrated measureable outcomes in the 

communities they serve continue to be at the forefront of all ADSSP. 

Alzheimer’s Disease Initiative – Specialized Supportive Services (ADISSS)

(FY 2016 - $10,500,000)

In FY 2016, ACL received resources from the Prevention and Public Health Funds (PPHF-2015) 

within the Patient Protection and Affordable Care Act (PPACA) to fund cooperative agreements 

designed to fill identified gaps in long-term services and supports (LTSS) services for persons 

living with ADRD and their caregivers. In 2016, the ADI-SSS program was open to states and 

community-based entities operating within an existing dementia-capable system through which 

persons with ADRD and their caregivers receive quality, person-centered services to support their

remaining independence and safety in their communities.

The existing gaps targeted through the ADI-SSS program align with the recommendations of the 

National Alzheimer’s Project Act Advisory Committee and include the following areas:

• Provision of effective supportive services to persons living alone with ADRD in the 

community.

• Provision of effective care/supportive services to persons living with moderate to severe 

impairment from ADRD and their caregivers.
30

• Improvement of the quality and effectiveness of programs and services dedicated to 

individuals aging with intellectual and developmental disabilities associated with ADRD 

or those at high risk of developing ADRD.

• Delivery of behavioral symptom management training and expert consultation for family 

caregivers.

All grantees are required to implement programs that contain components addressing a minimum 

of three of the four above referenced gaps.

In FY 2016, 11 unique organizations received ADI-SSS program awards, joining the 21

organizations funded in FYs 2014 and 2015. The FY 2016 program recipients will implement 

programs tailored to address the unique needs of the communities they serve, which include states

and local governments, a health system and several community-based organizations. Each of the 

funded programs meet the requirement for the implementation of at least one dementia related 

evidence-based or evidence-informed intervention, dedicate a substantial percentage of program 

resources to the provision of direct services and 25 percent cost-sharing through either in-kind or 

cash match. Through targeted partnerships and community engagement, grantees are able to 

implement a broad range of services and supports to persons with ADRD and their caregivers. 

Examples of program activities include, but are not limited to, support programs dedicated to both 

persons with dementia and their caregivers, behavioral symptom management training, dementia 

capable care coordination training, as well as development of dementia capable community 

initiatives which include awareness training for a broad range of community workers and first 

responders.

.
31

PART II: OLDER AMERICAN INDIANS, ALASKA NATIVES

& NATIVE HAWAIIANS

Nutrition and Supportive Services

(FY 2016: $31,158,000)

Native American Nutrition and Supportive Services provides grants to eligible tribal organizations 

for the delivery of nutrition and home and community-based supportive services to Native 

American, Alaska Native, and Native Hawaiian elders. An estimated 895,000 persons age 60 and 

over identify themselves as Native American or Alaska Native alone or in combination with 

another racial group.90 Over 520,000 of those elders identify as Native American or Alaska Native 

with no other racial group.

91

Between 2000 and 2010, the number of older American Indian and Alaska Native (AI/AN) adults 

increased by 40.5 percent, a growth that is 2.7 times greater than that of the overall population of 

older adults over the same 10-year period.92 In addition, this rapidly growing population is also 

experiencing some of the highest rates of disability,93 chronic disease, and poverty94 in the United 

States. Because of the combined factors of an aging population and high disability rates, AI/ANs 

have a great need for home and community-based services access in their communities.

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

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

meals, information and referral, personal care, help with chores, and other services. Currently, 

AoA’s congregate meals program reaches more than one-third (38 percent) of eligible Native 

American seniors in participating tribal organizations, home-delivered meals reach 13 percent of 

such persons, and supportive services reach 56 percent of such persons.95 These programs, which 

can help to reduce the need for costly nursing home care and medical interventions, are responsive 

to the cultural diversity of Native American communities and are an important part of each 

community’s comprehensive services. 

Services provided by this program in FY 2016 included:

 

90 U.S. Census Bureau, Population Division, Annual Estimates of the Resident Population by Sex, Single Year of 

Age, Race Alone or in Combination, and Hispanic Origin for the United States: April 1, 2010 to July 1, 2016 

Released June 2017, accessed January 2018.

91 U.S. Census Bureau, Population Division. Annual Estimates of the Resident Population by Sex, Single Year of 

Age, Race, and Hispanic Origin for the United States: April 1, 2010 to July 1, 2016. Released June 2017. 

Accessed January 2018. 

92 Administration on Aging, U.S. Population by Age: 65+ Minority Population Comparison using Census 2000 and 

Census 2010 (July 1, 2011).

93 National Council on Disability, “Understanding Disabilities in American Indian and Alaska Native Communities: 

Toolkit Guide” (2003).

94 Centers for Disease Control and Prevention, “CDC Health Disparities and Inequalities Report – United States” 

(2013).

95 ACL’s OAA Title VI Program Performance Report, PY 2016. Title VI of the Older Americans Act permits tribes 

to establish age of eligibility for services below age 60. Calculation based on eligible population as reported in 

grantee applications
32

• Transportation Services, which provided over 1,000,000 rides to meal sites, medical 

appointments, pharmacies, grocery stores, and other critical activities.96

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

20,300 homebound Native American elders; the program also provides critical social 

contacts that help to reduce the risk of depression and isolation experienced by many homebound Native American elders.97

• Congregate Nutrition Services, which provided over 2.6 million meals to nearly 

59,000 Native American elders in community-based settings, as well as an opportunity for 

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

programs.98

• Information, Referral and Outreach Services, which provided nearly 922,000 hours of 

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

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

needs.99

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

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

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

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

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

Aging Network Support Activities).

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

share of the American Indian, Alaska Native, and Native Hawaiian population age 60 and over. 

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

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

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

Caregiver Support Services

(FY 2016: $7,531,000)

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

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

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

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

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

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

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

 

96 ACL’s OAA Title VI Program Performance Report, PY 2016

97 Ibid.

98 Ibid.

99 Ibid
33

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

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

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

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

can be used for services to grandparents caring for grandchildren. 

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

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

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

and outreach, access assistance, individual counseling, support groups and training, respite care, 

and other supplemental services. Annually, tribal grantees provided over 100,000 hours of respite 

care, delivered just over 23,000 hours of caregiver training, and assisted 16,000 caregivers to 

access needed services.

100 Tribal organizations coordinate with other programs, including the 

Volunteers In Service To America (VISTA) program, to help support and create sustainable 

caregiver programs in Native American communities (many of which are geographically isolated). 

A core value of the Native American Caregiver Support Services, as expressed by tribal leaders, is 

that the program should not replace the tradition of families caring for their elders. Rather, it provides 

support that strengthens the family caregiver role. 

 

100 Ibid.
34

PART III: ELDER RIGHTS

AoA works to promote the rights of older adults through several distinct but complementary 

programs. Among other things, these programs provide a full array of services designed to prevent, 

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

settings. 

Prevention of Elder Abuse and Neglect

(FY 2016: $7,896,000)

The Prevention of Elder Abuse and Neglect program (Title VII, Section 721) provides states with

formula grants for training and education, promoting public awareness of elder abuse, and supports 

state and local elder abuse prevention coalitions and multi-disciplinary teams. These activities are 

important elements of AoA’s enhanced focus on elder justice. This program coordinates activities 

with state and local adult protective services programs (over half of which are directly administered 

by state units on aging) and other professionals who work to address issues of elder abuse and 

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

significantly leveraging OAA funds to obtain additional funding for these activities. 

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

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

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

State Adult Protective Services (APS) programs conducted by AoA’s National Center on Elder 

Abuse showed a 16 percent increase in the number of elder abuse cases from an identical study 

conducted in 2000.101 According to a 1998 national incidence study (the only such study ever 

conducted), 84 percent of all elder abuse incidents go unreported, meaning that for every reported 

case of abuse there are over five that go unreported.102 Together, these data suggest that a 

minimum of five million elders are abused, neglected, and/or exploited annually.

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

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

dramatically higher (300 percent) morbidity and mortality rates than non-abused older people.103

Additional adverse health impacts include an increased likelihood of heart attacks, dementia, 

depression, chronic diseases and psychological distress. One result of these unnecessary health 

problems is a growing number of seniors who access the healthcare system more frequently 

(including emergency room visits and hospital admissions), and are ultimately forced to leave their 

homes and communities prematurely.104

 

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

Older. https://ncea.acl.gov/resources/docs/archive/2004-Survey-St-Audit-APS-Abuse-18plus-2007.pdf. 

Accessed March 23, 2018. 

102

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

https://www.acl.gov/sites/default/files/programs/2016-09/ABuseReport_Full.pdf. Accessed March 23, 2018. 

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

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

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

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

family violence.” Annals of Emergency Medicine. 30:448-454.
35

Recent examples of state elder abuse prevention activities include:

In Vermont, the AAA in the remote Northeast Kingdom region has developed a coalition of 

community partners who meet together regularly to address elder justice and elder abuse through 

collective action. Partners include: Vermont State Police, Caledonia County State’s Attorney 

Office; Caledonia State’s Attorney Victim Advocate, DOC Victim Advocate, Northeast Kingdom 

Human Services, Adult Protective Services, St. Johnsbury Health and Rehab, the SIU-Caledonia 

Special Investigations Unit, the local transportation provider, local hospital, Legal Aid long-term 

care ombudsman, and Office of Public Guardian. In addition to regular meetings, the partners 

together organized a community awareness event focused on elder justice and elder abuse 

prevention on World Elder Abuse Awareness Day in June.

Louisiana has invested Section 721 funds to: meet the medical needs of abandoned, incapacitated 

seniors who have nobody to consent to their medical treatment; assist hospitals and other treatment 

facilities to reduce the number of abandoned, incapacitated senior needing medical care and 

residential placements; assist long-term care facilities with medical needs of abandoned, 

incapacitated seniors; and assist abandoned, incapacitated seniors with asset/benefits management 

to see that their finances are being appropriately managed to pay for their care.

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

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

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

voice for those who cannot act for themselves, the program helps ensure that all older Americans 

are able to age with dignity in a safe environment.

National Center on Elder Abuse

To support and enhance the activities of state and local programs to prevent elder abuse, neglect, and 

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

information to professionals and the public and provides technical assistance and training to states and

community-based organizations. The NCEA makes available news and resources, collaborates on 

research, provides consultation, education, and training, identifies and provides information about 

promising practices and interventions, answers inquiries and requests for information, operates a 

listserv forum for professionals, and advises on program and policy development. NCEA also 

facilitates the exchange of promising practices and strategic approaches to for revealing and 

prosecuting fraud in areas such as telemarketing and sweepstakes scams that target the elderly. 

In FY 2016, NCEA accomplishments included:

• The NCEA website is recognized as a viable resource on abuse, neglect, and exploitation 

for its users. A total of 166,979 users have accessed the NCEA website. Many of the users 

are located in the following states: California, Florida, Texas, New York, and Georgia. The 

inquiries trended as follows: 40 percent were about financial abuse, including five percent 

on solicitation scams, nine percent were queries about emotional abuse, and five percent 

were on the topic of discrimination and/or ageism. While 27 percent reported multiple 

forms of alleged abuse, 73 percent were focused on only one type of abuse.
36

• The NCEA facilitated and moderated a total of 172 conversations on its listserv and actively 

engaged 2,139 listserv participants. An average of six topics was discussed each week on the 

listserv.

• In June 2016, the NCEA collaborated with aging partners to learn, understand and disseminate 

an elder abuse communication strategy designed by the Frameworks Institute. The metaphors 

are designed to reframe and educate people and agencies who are in a position to improve 

policies and services relevant to elder abuse. Two metaphors were developed and have been 

introduced to aging network at conference. 

• Developed collaborations with other national organizations and nationally recognized resource 

centers for collaborative purposes. These entities included organizations focused upon the 

needs of Asian and Other Pacific Islanders, Latino, Native American, LGBTQ, African 

American, and Alzheimer’s and related disorders resource centers. 

• The NCEA successfully conducted a four-week World Elder Abuse Awareness Day 

(WEAAD) Campaign that featured national experts posting blogs and being available for 

twitter chats. Among the outcomes: social media tracking indicated that one segment alone 

had over 3 million impressions; and hosted a "Finish this Sentence" campaign. The campaign 

was launched in May 2016 and continued through June 15, 2016. Social media users were 

asked to finish this sentence: “Together we can fight elder abuse by...” The "Finish this 

Sentence" campaign was launched in May 2016 and continued through June 15, 2016 and was 

an enormous success. Social media users were asked to finish this sentence: “Together we can 

fight elder abuse by...”, reaching over 45,000 social media users. Answers were shared in 

English, Russian, Spanish, and several other languages. 

National Legal Assistance and Support Projects

National Legal Resource Center

(FY 2016: $1,032,062)

The National Legal Resource Center (NLRC) is comprised of four national grants that, together, 

provide professionals in aging and legal services networks, including legal assistance providers,

with tools and resources to deliver high-quality legal assistance that addresses substantive legal 

matters designated as priorities in the Older Americans Act, including independence, health, and 

financial security, to older Americans with economic or social need. 

NLRC services underpin the leadership, knowledge, and systems capacity of legal and aging 

services provider organizations and enhance the quality, cost-effectiveness, and accessibility of 

legal assistance and elder rights protections available to older persons with social or economic 

needs. The target audience for the NLRC’s services includes a broad range of legal, elder rights, 

and aging services professionals and advocates. These include legal assistance providers, legal 

assistance developers, long-term care ombudsmen, state unit on aging directors, AAA and ADRC 

personnel, senior legal helplines (SLHs), and others involved in protecting the rights of older 

persons.
37

The NLRC provides core resources through case consultation, training, and technical assistance 

on the Older Americans Act-designated priority legal matters and on associated systems 

development issues. Examples of common legal issues for which the NLRC provides assistance 

include preventing the loss of an older individual’s home through foreclosure or due to elder abuse; 

protecting against consumer scams and creditor harassment; and addressing elder abuse in the 

community and in long-term care facilities. The NLRC also provides technical assistance on the 

efficient, cost-effective, and targeted provision of state-wide legal and elder rights education and 

outreach services.

In FY 2016, older consumers and the legal providers who serve them faced a host of legal 

challenges, including an increasing demand for legal resource support. The NLRC provided legal

training on priority issues to 10,410 aging/legal service professionals nationwide. In addition, the 

NLRC delivered direct case consultation to 475 aging/legal professionals on complex legal issues. 

NLRC partners also provided important technical support to implement Model Approaches 

projects in 27 states, providing expertise to grantees about legal needs and capacity assessments, 

effective targeting and outreach methodologies, statewide reporting systems, and legal service 

delivery standards. 

The combined efforts of the partnering organizations that comprise the NLRC offer subject matter 

expertise that enables the NLRC to achieve its broad resource support objectives. Through 

effective collaborations, interlocking work plans, and the leveraging of organizational resources, 

NLRC partners have been able to achieve national support for local organizations that can provide 

effective legal assistance services on high priority legal issues areas., which positively impact 

older Americans in the most social or economic need.

On September 9, 2016, the newly contracted National Center for Law and Elder Rights (NCLER) 

launched as the National Legal Resource Center (NLRC) concluded operations.

Model Approaches to Statewide Legal Assistance Systems

(FY 2016: $1,472,314)

Thirty-one states have received Model Approaches grants since this initiative began in 2006. 

These grants help states develop and implement statewide systems to deliver cost-effective, 

replicable and comprehensive approaches for legal assistance to older Americans with greatest 

economic and social need who experience the priority legal issues set forth in the Older Americans 

Act. Systems development includes integrating Senior Legal Hotlines (SLHs), which can provide 

brief service, advice and counsel and a portal to representational legal assistance, along with other 

low- and no-cost legal services delivery mechanisms into a broad spectrum comprising a state’s 

legal service delivery network. Legal assistance services, when provided through well-integrated 

and cost-effective service delivery systems, as demonstrated through Model Approaches, enables

older individuals to remain independent, healthy, and financially secure in their homes and 

communities.

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

integration objectives. State legal assistance developers work to incorporate the components of 

the delivery network SLHs into the state’s legal services delivery system. Key project partners 
38

and service delivery components include Title III-B legal services providers, private bar pro-bono 

attorneys, law school clinics, and self-help sites. By promoting the seamless integration of these 

vital legal service delivery components, Model Approaches enables older Americans most in need 

to access quality legal services to receive capable legal assistance to address their priority legal 

issue areas, income security, healthcare financing, housing and foreclosure prevention, and elder 

abuse and defense of guardianship to preserve independence and autonomy. In addition, by 

ensuring strong leadership at the state level, Model Approaches projects have created important 

partnerships and linkages between the existing legal assistance community and the broader 

community-based aging and elder rights networks, including AAAs, ADRC, state long-term care 

ombudsmen, and Adult Protective Services. 

Some illustrative recent examples of success made possible by the systems enhancement efforts 

of Model Approaches grantees in 2016 include:

• A 78-year-old widow in Maine was convinced to sell her home and move in with her 

daughter and her husband. They promised that they would look after her and manage her 

finances and medical issues. Instead, they moved her into a camper in their back yard in 

the heat of summer, where the woman's health declined and she eventually ended up 

needing nursing home care. Over the course of two years they spent her entire nest egg, 

leaving her without a home and disqualified from eligibility for Maine’s Medicaid 

program, called MaineCare. LSE pursued litigation in Superior Court and ultimately came 

to a monetary settlement and also negotiated with the State of Maine to restore her 

MaineCare coverage upon exhaustion of her recovered funds. 

• A 70-year-old military veteran called a SLH because overwhelming storms had flooded his 

apartment causing great hardship during a four month period. The Hotline attorney was 

very concerned about the veteran’s unhealthy living conditions and made a call to the 

manager of the apartment complex to have the issue addressed. The manager apologized 

for the delay, and agreed to replace the client's carpet and take other measures to restore 

the apartment to a habitable condition.

Model Approaches grants are awarded in two phases. Phase I grantees work to develop statewide 

legal service delivery systems that coordinate efforts of senior legal helplines, pro-bono attorneys, 

law school clinics, self-help sites, and Older Americans Act-funded legal services providers to 

ensure maximum impact from limited resources. The target populations are underserved seniors, 

with particular emphasis upon low-income, minority, rural, homebound, Native American, and 

limited-English speaking older adults.

In 2016, two states (Tennessee and Wisconsin) were awarded Phase I grants. During 2016, these 

states convened their stakeholders and undertook a legal needs assessment and an assessment of 

the capacity of the existing network to provide legal assistance to targeted populations on Older 

Americans Act-identified legal priority case types105.

 

105 Older Americans Act, Section 307(a)(11)(e), 42 United States Code Section 3027(a)(11)(e).
39

Phase II Model Approaches grants are primarily focused on enhancing civil legal responses to 

complex issues that emerge from elder abuse, neglect, and financial exploitation. Additionally, 

these grants seek to expand outreach to older adults with greatest social or economic need and 

work to create legal service delivery guidelines or standards that promote quality and consistent 

statewide legal service delivery to older adults facing threats to independence, health, and financial 

security.

In FY 2016, ACL awarded six new Model Approaches Phase II grants (Connecticut, Florida, 

Massachusetts, Pennsylvania, Vermont and Virginia) to continue the evolution of legal service 

delivery systems implemented through previous Model Approaches projects towards higher levels 

of capacity, performance and service delivery impact.

Pension Counseling and Information Program

(FY 2016: $1,602,007)

In 1992, Congress directed AoA to develop demonstration projects specifically designed to help 

individuals with pension problems. These demonstrations were so successful that Congress 

established pension counseling as a permanent program under Title II of the OAA in 2000. 

Today, there are more than 700,000 private (as well as thousands of public) pension and retirement 

plans in the United States. Thousands of Americans reach retirement age each year, only to be 

told that they will not receive the pension benefits they expected. Because individuals have 

generally worked for several employers, which may have merged, sold their plans, or gone 

bankrupt, it is very difficult for most people to know where to get help in finding out whether or 

not they are receiving all of the pension benefits to which they are entitled. 

Benefits from employer-sponsored pensions and retirement savings plans are as critical today to 

the retirement security of Americans as they were when the pension counseling program was first 

established. The pension questions that people face are just as complex, and good help is just as 

hard to find – even more so for those with only modest benefits at stake. The role of the Pension 

Counseling and Information Program is to help ensure that all older Americans have access to the 

help they need in order to secure the employer-sponsored retirement benefits they have earned --

benefits that are critical to their ability to live independently and with dignity after a lifetime of 

productive employment. The Pension Counseling and Information Program provides help that 

would be otherwise unavailable, by assisting individuals in understanding and exercising their 

pension rights. The program promotes the financial security of older individuals by offering them 

the help they need to receive the pension benefits they have earned. The income, in turn, provides 

increased opportunities for choice and independence. 

AoA currently funds six regional counseling projects covering 30 states and a technical assistance 

resource center to assist older Americans in accessing information about their retirement benefits 

and to help them negotiate with former employers or pension plans for due compensation. The six 

regional counseling projects are:

• The Mid-American Pension Rights Project, serving Michigan, Ohio, Indiana, Tennessee, 

Pennsylvania, and Kentucky;
40

• The New England Pension Assistance Project, serving Connecticut, Maine, Massachusetts, 

New Hampshire, Rhode Island and Vermont (and also supporting pensioners in Illinois);

• The South Central Pension Rights Project, serving Arkansas, Louisiana, Missouri, New 

Mexico, Oklahoma and Texas;

• The Upper Midwest Pension Rights Office, serving Iowa, Minnesota, North Dakota, South 

Dakota, and Wisconsin; 

• The Mid-Atlantic Pension Counseling Project, serving New York and New Jersey; and

• The Western States Pension Counseling Project, serving Arizona, California, Hawaii, and 

Nevada.

The projects help with cases that private pension professionals are reluctant to take, where the 

benefits in question are small, as is often the case with low-income workers and those with limited 

English proficiency, but to whom these modest amounts make a huge difference in maintaining 

their financial security and independence.

Data show that since the program’s inception in 1993 through 2016, the Pension Counseling 

projects have recovered $228 million in retirement benefits for more than 57,000 retirees. With a 

relatively small federal investment, the program has brought in a return of more than $9.00 for 

every federal dollar invested in the program. These recoveries demonstrate that pension 

counseling is not only necessary, but that it can be provided efficiently and effectively. 

The impact of the projects’ work is best illustrated through presentation of cases successfully 

resolved during this period:

• The Mid-American Pension Rights Project assisted a widow in Pennsylvania in obtaining 

her survivor pension, which was complicated for the client to access because the pension 

was split between two different companies for which her deceased husband had worked, 

each with unique requirements for the widow to follow in order to obtain the funds. The 

first company had denied the widow her surviving spouse benefits because their marriage 

was common law, and the project required proof that this marriage met the legal criteria of 

a common law marriage before paying her. The project was able to work with the first 

company and secure the survivor benefits for the client after providing the company the 

proper documentation to prove the common law marriage. The second company had 

overpaid pension benefits to the client’s deceased husband, and was refusing to pay the 

client her surviving spouse benefit retroactively to the date of her husband’s death. Once 

the project communicated with the company the applicable federal law and documentation 

that required the retroactive payment of benefits, the client received her full amount of the 

survivor pension. In total, the project secured a monthly payment of $900 for the rest of 

the client’s life from company one and a retroactive payment from company two of more 

than $7,000.

• The New England Pension Assistance Project took the case of a 65-year old woman from 

Massachusetts who was living on less than $20,000 a year to secure her share of her 

deceased ex-husband’s pension and survivor benefits. The client, who had divorced her 

ex-husband in 1991, had filed a Qualified Domestic Relations Order (QDRO) at the time 

of divorce in order to ensure she would receive her share of the husband’s pension. 
41

However, due to the ex-husband’s company changing ownership in the following decades, 

the client was not receiving any pension at all, with the pension payment plan also changing 

hands through the acquisition of the company to a different entity. The project was able to 

track down the current corporate successor and the company’s pension payment plan, 

which had no record of the QDRO designating a share of the ex-husband’s pension to his 

ex-wife (the client); further, the plan had no record of a survivor benefit being owed to the 

client, as the QDRO had given her a right to a lifetime benefit while her ex-husband was 

still alive, and a survivor benefit if he pre-deceased her. The project filed a claim on the 

client’s behalf arguing her right to the portion of the pension and a survivor benefit as laid 

out in the original QDRO, which resulted in the plan paying her a retroactive $9,885 to 

account for the funds paid solely to the ex-husband upon his retirement in 2005 that were 

owed to the client, in addition to her receiving an ongoing monthly share of his pension.

• In California, the Western States Pension Counseling Project assisted a low-income older 

adult with disabilities in accessing her community property portion of her former spouse’s 

pension. The client was struggling to balance expenses for housing, food, and medicine, 

unable to make ends meet with her Supplemental Security Income (SSI) due to high 

medical costs. The project contacted the pension plan on her behalf, and was told by the 

plan that she was not entitled to any benefits, but would not provide written rules or 

documentation to support their denial. Over the course of two years, the project 

investigated the plan’s denying the client access to the pension, coming to an agreement 

with the plan that the client was due $86,106. The project attorney working with the client 

on this case helped the client apply for the pension, as well as explained to the client the 

potential impact of the additional income on her public benefits.

A critical component of the program is the National Pension Assistance Resource Center (the 

Center), which provides support to the counseling projects and facilitates coordination among the 

projects, SUAs, AAAs, legal services providers, and others by providing substantive legal training, 

technical assistance, and programmatic consultation. The Center also assists individuals in states 

not currently served by AoA’s pension counseling projects by providing nationwide referral and 

information services, both by telephone and through the PensionHelp America website, a 

nationwide database of pension assistance and information resources: 

http://www.PensionHelp.org.. 
42

Long-Term Care Ombudsman Program

(FY 2016: $15,837,665)106

State Long-Term Care (LTC) Ombudsman programs work to resolve problems related to the 

health, safety, welfare and rights of individuals who live in long-term care facilities (i.e. nursing 

homes, board and care, assisted living and other residential care communities). LTC Ombudsman 

programs promote policies and consumer protections to improve long-term services and supports 

(LTSS) at facility, local, state and national levels and play an important role in elder justice 

networks. 

Begun in 1972 as a demonstration program, today the LTC Ombudsman program operates in all 

states, the District of Columbia, Puerto Rico and Guam, under the authorization of the OAA. Each 

state has an Office of the State LTC Ombudsman (Office), headed by a full-time State LTC 

Ombudsman (Ombudsman) who directs the program statewide. Across the nation, staff and 

thousands of volunteers designated by their State Ombudsman provide service to residents.

The OAA requires LTC Ombudsman programs to:

• Identify, investigate and resolve complaints made by or on behalf of residents.

• Provide information to residents about long-term services and supports.

• Ensure that residents have regular and timely access to ombudsman services.

• Represent the interests of residents before governmental agencies and seek administrative, 

legal and other remedies to protect residents.

• Analyze, comment on, and recommend changes in laws and regulations pertaining to the 

health, safety, welfare and rights of residents.

Improving and Evaluating Ombudsman Program Services

To improve the quality and effectiveness of LTC Ombudsman program services to residents, ACL 

is undertaking two historic activities: 1) implementation of the LTC Ombudsman program rule,

and 2) implementation of a LTC Ombudsman program evaluation.

1. Promulgation of the State Long-Term Care Ombudsman Programs Rule

ACL published a final rule (45 CFR Part 1324) to guide states in their implementation of the State 

Long-Term Care Ombudsman Program in February 2015 and the rule became effective on July 1, 

2016. Since the rule’s publication, ACL staff and the National Ombudsman Resource Center have 

provided training, technical assistance and support to facilitate its implementation by states. States 

have been reviewing their laws, regulations, and policies to determine if they meet the 

requirements of the new rule. ACL has proactively offered customized technical assistance to 

each state to assist in assuring compliance and anticipates that states’ implementation of this rule 

will strengthen the ability of Ombudsman programs to be effective problem-solvers for older adults 

and people with disabilities who live in our nation’s long-term care facilities.

 

106 This amount reflects Title VII-2 designated as Ombudsman Program Activity funds. States also utilize other 

Older Americans Act and other funding sources to operate the Ombudsman program.
43

2. Evaluation of the Ombudsman Program

ACL is currently evaluating the LTC Ombudsman program to understand service delivery models. 

This process evaluation will help ACL lay the foundation to evaluate program impact and 

efficiency. Not since the Institute of Medicine’s 1995 report,107 has there been a comprehensive, 

national evaluation of the Ombudsman program. ACL completed its evaluation design in 2013108 

and anticipates completion of the process evaluation in 2019. 

Complaint Investigation and Resolution

LTC Ombudsman programs provide a person-centered alternative dispute resolution service, 

working with (or on behalf of) long-term care facility residentsto resolve complaints. Ombudsman 

programs nationwide:

• Completed resolution work on 199,493109 complaints and resolved 73 percent of these 

complaints to the full or partial satisfaction of the resident or complainant.

• 71 percent of complaint resolution work occurred in nursing facility settings; 26 percent 

occurred in board and care, assisted living or other residential care communities; and three 

percent were associated with non-facility settings or services to facility residents by an 

outside provider. 

• Residents were the primary complainant in nursing facilities (42 percent) and in board and 

care, assisted living and other residential care communities (34 percent).110

The five most frequent nursing facility complaints handled by Ombudsman programs were: 

• Improper eviction or inadequate discharge/planning.

• Unanswered requests for assistance.

• Lack of respect for residents, poor staff attitudes.

• Administration and organization of medications and 

• Quality of life, specifically resident/roommate conflict.

The five most frequent complaints in board and care, assisted living, and other residential care 

communities handled by Ombudsman programs were:

• Improper eviction or inadequate discharge planning.

• Administration and organization of medications.

• Quality, quantity, variation and choice of food.

• Lack of respect for residents, poor staff attitudes and

 

107 “Real People, Real Problems: An Evolution of the Long-Term Care Ombudsman Program of the Older 

Americans Act,” IOM (2995)

108 https://www.acl.gov/programs/program-evaluations-and-reports

109 FFY 2016 National Ombudsman Reporting System (NORS) is the source for this and other data in this section. 

States report NORS data annually to ACL.

110 In FY 2016, ombudsmen opened 134,097 new cases (a case contains one or more complaints originating from the 

same person(s)), and completed resolution on 128,750 closed cases, containing, 199,493 complaints.
44

• Building or equipment in disrepair or hazardous. 

Long-Term Care Ombudsman programs devote significant effort to addressing improper discharge 

and eviction. This complaint is the most common among both nursing home and board and care 

residents in FY 2016 and is best illustrated by example of a successful case resolution.

• The Ombudsman program received a complaint from the individual holding a power of 

attorney for a 90-year-old man who was told that he could not return to his residential care 

home after his stay in the hospital and skilled nursing facility. The resident's wife lived at 

the same residential care home and he was sad and distressed about the possibility of being 

separated from her. The residential care home staff stated that the resident had declined 

significantly both medically and cognitively and that they believed they could no longer 

provide for his care. The investigation conducted by Ombudsman representative indicated 

that resident had few medical needs and the skilled nursing facility was ready to send him 

back to his residential care home. The Ombudsman representative met with the 

administrator and residential care director, who explained their reasoning for the denial, 

and declined to discuss the matter further, indicating it was out of their hands. The 

Ombudsman representative then contacted the corporate office and after several calls, the 

administrator did agree to readmit the resident, allowing him to reunite with his wife. 

Ombudsman program strategies to address inappropriate discharges include developing task 

forces, proposing legislation, training both hospital social workers and long-term care facility staff 

on relevant requirements; and training residents and their families on their rights regarding 

discharge and transitioning out of a long-term care facility.

Ombudsman Program Activities

In addition to resolving complaints, LTC Ombudsman programs provide services that prevent 

problems for residents and serve as a resource on rights, quality care and community options. In 

FY 2016, LTC Ombudsman programs provided:

• Routine visits to 68 percent of nursing facilities and 28 percent of board and care, assisted 

living, and other residential care communities at least quarterly. These visits ensure that 

residents have regular access to ombudsman services. 

• Information and assistance to individuals (over 378,500 instances) on topics such as longterm services and supports options; Medicaid eligibility; discharge and eviction rights; and 

other federal and state policies affecting residents. 

• Consultations and information to long-term care facility staff (over 115,700 instances), on 

topics such as residents’ rights, person-centered care practices, and discharge and eviction 

questions.

• Resident and family council support, providing technical assistance, training and 

information to resident councils (22,205 sessions) and family councils (1,974 sessions).

• Training of long-term care facility staff (4,702 sessions).

• Community education (10,690 sessions).

• Coordination with licensing and survey entities, participating in 17,591 facility surveyrelated activities as resident advocates.
45

Systems Advocacy

In addition to individual problem resolution, Ombudsman programs advocate for resident interests 

in public policy arenas. The OAA requires Ombudsman programs to analyze, comment on and 

recommend changes in laws, regulations, and government policies and actions to benefit residents. 

In addition to addressing improper evictions, Ombudsman programs reported on work to address 

systems-level issues, including:

• Mental health supports - Access to sufficient facility-based and/or home and communitybased services to support residents with mental health needs or who exhibit behavioral 

symptoms of dementia. This lack of access to needed services has significant implications 

for providers’ inappropriate use of antipsychotics and involuntary (and often illegal) 

evictions.

• Care requests - LTC Ombudsman programs worked to resolve nearly 9,440 complaints 

related to unanswered requests for assistance with care. Many Ombudsman programs note 

that the failure to respond to requests for assistance is due to the shortage of both direct 

care and nursing staff and facilities often resort to using staff from an agency, which often 

results in a lack of person-centeredness and consistency in care provided. State 

Ombudsmen attribute staffing shortages to the growing demand for long-term services and 

supports coupled with a shrinking labor pool, and generally low wages. They frequently 

observe inadequate training and limited on-the-job support which also impact resident care 

and retention of qualified nursing staff. Not only is turnover high, with median turnover 

estimates of direct care and nursing staff at 50 percent, but it is increasingly difficult to fill 

vacant positions.111 

• Examples of systems-level work to prevent or respond to staffing shortages included: 

o Working in partnership with both the long-term care provider industry, state agencies, 

including workforce commissions, to identify solutions to the workforce shortage;

o Wage increases and/or expanded benefits; additional direct care worker training, 

including training on person-centered care; development of a public awareness 

campaign to elevate the profession; 

o Advocating for improved state laws or regulations to support adequate staffing;

o Training facility staff on topics such as abuse prevention, person-centered care, and 

dementia care. 

• Right to receive visitors - Resident rights to receive visitors, and informing guardians and 

powers of attorney of the limitations in their authority to determine who may visit residents.

• Facility closures and Ombudsman responses - Ombudsman interventions include 

supporting residents as they move to a new setting, frequently upon very short notice. 

 

111 In 2012 approximately 70,000 direct care staff positions were vacant in America’s skilled nursing care centers. 

American Health Care Association 2012 Staffing Report.
46

Ombudsman programs often participate as part of a team that responds to facility closures. 

Teams also generally include case managers, licensing and survey and other community 

partners such as the Aging and Disability Resource Centers.

• Community responses to elder abuse - Service on statewide or local multi-disciplinary 

teams, Financial Abuse Specialist Teams (FAST) and similar community networks to 

address financial exploitation and other forms of abuse. 

• Development of beneficiary support systems for Medicaid managed care recipients across 

states.

• Collaborating to address Healthcare Associated Infections (HAI).

o The Office of the State Long-Term Care Ombudsman sought to raise awareness among 

local long-term care Ombudsman representatives about Catheter Associated Urinary 

Tract Infections (CAUTI) and healthcare-associated infections. The goal was to equip 

Ombudsman representatives with educational tools on these important topics so they 

can share the information with residents and family members. This project was 

accomplished in partnership with non-profit and governmental agencies including the 

Agency for Healthcare Research and Quality at the U.S. Department of Health and 

Human Services, the National Consumer Voice for Quality Long-Term Care, the 

Health Research and Educational Trust and the Health Services Advisory Group (the 

Medicare Quality Improvement Organization). The Office provided multiple training 

sessions for Ombudsman representatives: in various locations throughout the state. In 

total, close to 200 Ombudsman representatives received training to deliver the 

educational resources and messages to residents and their families to empower them to 

speak to staff about healthcare associated infections.

How LTC Ombudsman Programs Operate

There are 53 State LTC Ombudsman programs (in 50 states, plus the District of Columbia, Puerto 

Rico, and Guam). In most states, the Office of the State LTC Ombudsman is housed within the 

state unit on aging or another state agency. In others, the Office is housed in a private non-profit 

agency. Most states have contracts with or through area agencies on aging to provide direct 

ombudsman services to residents. There are 524 designated local Ombudsman entities.

In FY 2016, 1392 full-time equivalent staff and 7,331 volunteers -- all trained and designated to 

investigate and resolve complaints -- provided Ombudsman program services to residents. An 

additional 3,664 volunteers also served residents or assisted in program operations in ways other 

than complaint resolution. 

Total FY 2016 funds expended from all sources nationwide were $101,911,106, an overall increase 

of 7.87 percent from the FY 2015 level. The federal government is the primary entity funding the 

Ombudsman Program, providing 53 percent of total funding in FY 2016. States provided 

41percent of funds, and other non-federal sources funded the remaining six percent. 
47

National Long-Term Care Ombudsman Resource Center Activities

To effectively problem-solve with and for residents, Ombudsman programs must remain up-todate on the latest long-term care developments. Therefore, ACL supports the National 

Ombudsman Resource Center (NORC), which provides training, technical assistance, and 

program management expertise to Ombudsman programs. In FY 2016, the National Consumer 

Voice for Quality Long-Term Care operated the NORC in coordination with the National 

Association of States United for Aging and Disabilities (NASUAD).

In FY 2016, NORC provided training and technical assistance to Ombudsman programs on such 

issues as:

• Implementation of ACL’s final rule for State LTC Ombudsman programs;

• Volunteer management and technical assistance including risk management;

• Ombudsman services in managed long-term services and supports (LTSS); and

• Ombudsman services in home and community-based settings, including assisted living.

Additionally, the NORC provided quarterly orientation training for all new ombudsmen, and 

developed resource materials, the NORC website (www.ltcombudsman.org), and quarterly 

newsletters customized for Ombudsman program staff and volunteers.

Program Results and Challenges

1. Volunteers help the program engage the local community. 

Thousands of volunteers across the county donated their time, talents, and energy to visit residents, 

listen to their concerns and take action to resolve problems. Volunteers frequently provide 

residents with regular access to ombudsman services and provide cost-effective, community-based 

complaint resolution. Volunteers also engage in broader program initiatives as described by a state 

Ombudsman in the following state example.

• Over the course of the reporting period, there was increased scrutiny of the provision of 

memory care services in our state. This was largely due to the failure of a facility and the 

resulting publicity, which in turn led to legislative interest and involvement. In an effort 

to inform both our own office and external stakeholders, the Office of LTC Ombudsman 

opted to conduct a six month Memory Care Initiative. This process included the enhanced 

training, visit expectations, reporting and data collection efforts of roughly 25 volunteers 

who were already designated representatives of the Office. The initiative was divided into 

three two-month segments. The first segment focused on staffing and staff training in 

memory care units. The second focused on mealtime, and the third focused on activities. 

Ombudsman program “Memory Care Specialists” visited during weekends, evenings, all 

three scheduled meal times and times that activities were scheduled to occur. They also 

attended or completed the same training process that memory care staff attended. The data 

resulting from this initiative is currently being compiled and analyzed in order to determine 

barriers and recommendations for improvements.
48

2. Ombudsman programs solve problems at the facility level. 

Ombudsman programs resolve hundreds of thousands of complaints every year on behalf of 

residents. The largest group that requested Ombudsman services to resolve complaints were 

residents themselves, indicating that residents depend on the program to help them resolve their 

concerns. By resolving the vast majority of these complaints to the satisfaction of the resident or 

complainant, the work of Ombudsmen improved the quality of life and quality of care for many 

residents of our nation’s long-term care facilities. Ombudsman complaint resolution is often 

accomplished without outside intervention, which can save on regulatory and legal costs while 

achieving the resident’s desired outcome. 

3. Growth in home and community-based services (HCBS) and Medicaid managed LongTerm Services and Supports (LTSS) increase demands for ombudsman services. 

Federal and state policy changes -- including the promotion of Medicaid HCBS through waivers 

and other statutory options, the rapid growth of Medicaid managed LTSS, and demonstration 

projects to serve persons receiving both Medicare and Medicaid (i.e. Financial Alignment 

Initiative, sometimes called the “duals demonstrations”) are creating opportunities, as well as some 

new challenges, for Ombudsman programs. As these services expand and provide more options 

for residents, Ombudsmen work to represent their interests and concerns and to ensure that strong 

beneficiary support systems are in place.

Increasingly, individuals live in residential settings other than nursing homes, including board and 

care homes, assisted living facilities, and other residential care communities (known by various 

names under state laws). As a result, LTC Ombudsman programs report increasing work, both at 

the individual complaint and the systems levels on behalf of these types of residential settings. 

In additional to complaints about care and dignity, Ombudsman programs report challenges with 

other consumer protections related to the disclosure of fees, and services provided in assisted 

living. 

The following case example illustrates the effectiveness of Ombudsman program complaint 

resolution during this period:

• The Ombudsman program received a note from a resident that stated, "I tried to: Serve My 

Community, My Country, My Schools, My Family, My Church, My God. Now I need 

help. Who will Help Me? I am 97 years old." She had signed an agreement to pay an 

assisted living facility a set amount per month. However, the first bill received from the 

provider caused alarm and anger because the amount charged was nearly double the agreed 

amount. After reviewing the contract, the Ombudsman program confirmed that the assisted 

living facility did not disclose fees and charges prior to the resident signing the contract. 

Fees included a security deposit, “community fee” and additional in-home services. The 

Ombudsman program was able to convince the provider to refund about half the disputed 

amount and because of this advocacy, the provider agreed to change all of their contracts 

to disclose the service fees in one prominent location on the contract. 
49

In addition to service in these residential settings, 15 states have expanded their laws to authorize 

the LTC Ombudsman program to serve individuals receiving HCBS. In four states, LTC 

Ombudsman programs expanded to serve individuals participating in Medicare-Medicaid or in 

Medicare-Medicaid plans offered under the Financial Alignment Initiative, regardless of where 

they reside. 

4. Ombudsman programs are credible sources of information. 

Ombudsman programs serve as a credible source of information for residents (including through 

resident councils), their families (including through family councils), and facility staff. Based on 

their extensive experience resolving resident problems, ombudsmen represented resident interests 

to policymakers, influencing public policy related to long-term care.

5. Ombudsman programs leverage federal dollars.

Federal funds leveraged resources from other sources for ombudsman programs. During FY 2016, 

47 percent of program expenditures came from non-federal sources. The Ombudsman program’s 

significant use of volunteers, further leverages limited resources. The value of volunteer time 

contributed to the program nationwide in FY 2016 was nearly $15 million.112 

PART IV: SUPPORTING THE NATIONAL

AGING SERVICES NETWORK

Older Americans face a vast array of choices when trying to determine the right services and 

supports to assist them to remain active and independent in their communities. As the number of 

choices available to assist them grows, so too does the complexity of navigating these programs 

and selecting among them to determine which best suit the needs of each individual. 

A key part of AoA’s emphasis on community living is providing consumers with the information

and assistance they need to make decisions about their independence and connecting them with 

the right services. An Aging and Disability Resource Centers (ADRCs) system helps to address 

this need by providing information, outreach, and assistance to older adults and people with 

disabilities so that they can access the services necessary for their independence. ADRCs serve as 

community-level “one stop shop” entry points into long-term care, including cost-effective home 

and community-based services that can enable people to remain in their homes, for people of all 

ages who have chronic conditions and disabilities. 

Aging and Disability Resource Centers/No Wrong Door System

(FY 2016 $6,119,000)

 

112 The Independent Sector places the value of the volunteer time at $24.14 per hour placing the value of 609,843 

hours at $ 14,721,621. http://independentsector.org/resource/the-value-of-volunteer-time/. Accessed March 23, 

2018.
50

The ADRC/No Wrong Door system113 supports state efforts to help individuals and caregivers 

connect to long-term services and supports (LTSS) as well as develop more efficient and costeffective LTSS access systems. The current LTSS system involves numerous funding streams 

administered by federal, state and local agencies using different access processes involving 

screening, intake, needs assessment, service planning, and eligibility determination. Individuals 

seeking LTSS frequently find themselves confronted with a variety of organizations and 

requirements at a time when they are vulnerable or in crisis. This often results in people making 

decisions based on incomplete, and sometimes inaccurate, information about their options. 

Consequently, they may make decisions to purchase and/or use LTSS options that are less than 

optimal for the individual and more expensive than necessary, including decisions to use costly 

options such as nursing facility care that can quickly exhaust an individual’s personal resources 

and result in their spending down to Medicaid eligibility.

In response to this challenge facing our citizens and our nation, AoA and CMS worked 

collaboratively in 2003 to create a joint funding opportunity to support state efforts to make it 

easier for people to access LTSS. This initiative, known as the ADRC program, was designed to 

provide consumers with “visible and trusted” sources of information, one-on-one counseling, and 

streamlined access to services and supports. 

Another major development in the evolution of the ADRC/NWD system model occurred in 2008 

when the Veterans Health Administration (VHA) – the nation’s largest integrated health care 

system - recognized the value of the nationwide aging and disability network and decided to 

purchase an evidence-based self-directed HCBS program from the ADRC/NWD system instead 

of building a separate LTSS access system. VD-HCBS is currently offered at 62 VA Medical 

Centers across the country, and 1,993 Veterans at a nursing home level of care are self-directing 

their HCBS at home in the community. 

In 2012, recognizing the accomplishments of both HHS and the VHA, as well as the lessons 

learned from the experience of states, ACL, CMS and the VHA issued a special funding 

opportunity – known as the 2012 “ADRC Part A Grant Program.” With the 2012 funding 

opportunity announcement, the “No Wrong Door” system framework was adopted across ACL, 

CMS and VHA for the ADRC Part A grants. Lessons learned from these grants demonstrated that 

no one agency or network could successfully implement a LTSS access system for all populations 

and all payers without having multiple agencies and organizations at the state and local level 

formally involved in the system's operations. 

In 2014, 25 states received one-year planning grants to develop plans to transform their multiple 

LTSS access programs and functions into a single statewide ADRC/NWD system for all 

populations and all payers. In 2015, five of the 25 state planning grantees received three-year 

awards to implement their planning grants and the eight states awarded three-year grants in 2012 

received a one-year grant to continue their work in developing their ADRC/NWD system.

 

113 Key Elements of a NWD System of Access to LTSS for All Populations and Payers

(https://nwd.acl.gov/docs/NWD-National-Elements.pdf), Aging and Disability Resource Centers as defined in the 

Older Americans Act 2006
51

Two additional outcomes resulting from this collaboration included NWD system guidance on 1) 

Key Functional Elements of NWD System and 2) Sustaining NWD functions through Medicaid 

Administrative Match. In January 2015, CMS posted the “No Wrong Door System Reference 

Document for Medicaid Administrative Claiming Guidance” to help sustain the infrastructure 

investments that states have made over the years. NWD System Medicaid Administrative 

Guidance was developed to inform states about the appropriate methods for claiming Medicaid 

federal matching funds. 

Also posted on the CMS website is the NWD System Key Elements document that describes the 

vision and functions of the NWD System. The ACL/CMS/VHA vision is that each state will have 

a single statewide NWD System to LTSS for all populations and all payers. The NWD System 

functions include:

• Public outreach and coordination with key referral sources;

• Person-centered counseling;

• Streamlined access to public LTSS programs; and

• State governance and administration.

Public Outreach and Coordination with Key Referral Sources

To be a visible source of individualized counseling and help with accessing LTSS, the NWD 

system must proactively engage in public education to promote broad public awareness of the 

resources that are available. The goal is for residents in each state to know where they can turn to 

for unbiased and trusted help in understanding and accessing the LTSS options that are available 

in their communities. A NWD system’s public education efforts gives special attention to 

underserved and hard-to-reach populations, including people with hearing and visual impairments 

and limited English speaking populations.

A fully operational NWD system has formal linkages between and among all the major pathways 

that people travel while transitioning from one health care setting to another or from one public 

program payer to another. These pathways represent critical junctures where decisions are made 

– usually in a time of crisis - that often determine whether a person is permanently institutionalized 

or transitioned back to the community. The NWD system must have formal linkages with key 

sources of referral including information and referral entities, nursing homes and other institutions, 

acute care systems, and VA Medical Centers.

Person-Centered Counseling

Person-Centered Counseling (PCC) is the NWD system term for person-centered planning, which 

is an approach for working with individuals in the LTSS system. Through the use of PCC, the 

NWD system empowers individuals to make informed choices about their LTSS options that are 

consistent with their personal goals. PCC also helps them to successfully navigate the various 

organizations, agencies and other resources in their communities that provide LTSS. PCC is very 

different from and requires a different skill set compared to traditional case management and other 

commonly used techniques for counseling individuals with LTSS needs. 
52

It will take time for our current LTSS workforce to develop the knowledge and skills required to

fully embrace and effectively use PCC. However, ACL has entered into a public/private 

partnership to develop and deliver the first national training program for Person Centered 

Thinking, Planning and Practice. In 2016, ACL pilot tested the training in 13 NWD System states 

across 1,200 learners including representation from AAAs, ADRCs and CILs. This blended 

learning design, of online and in-person courses, allows learners to obtain key knowledge, skills, 

and abilities of person centered counseling that can be applied across all ADRC/NWD activity. 

As a result of this focus on person-centeredness, ADRC/NWD Systems have accelerated change 

by streamlining resources that put the focus on the needs of the people and their families.

Streamlined Access to Public LTSS Programs

NWD system's streamlined access to public LTSS programs includes all the processes and 

requirements associated with conducting formal assessments and/or determining an individual’s 

eligibility that are required by any of the state-administered programs that provide LTSS to any of 

the NWD system populations. All of these public access processes and requirements must be part 

of, and integrated into, the state’s NWD system's streamlined access function, so states can use 

their NWD system as a vehicle for optimally coordinating and integrating these processes to be 

more efficient, effective, seamless, and responsive for consumers. 

For example, the NWD system person-centered counselors can help ensure applications are 

completely filled out with all the information needed when the applicant applies for public 

assistance, thereby reducing the burden of the application process for both intake staff and 

consumers. Even if the NWD system person-centered counselor is not designated to do the 

preliminary assessment, the data gathered by the NWD system person-centered counselor during 

the PCC process is incorporated into the preliminary assessment and then automatically transferred 

into the final assessment process.

State Governance and Administration

The governance and administration of a NWD system involves a collaborative effort among 

multiple state agencies, since no one state agency has the authority or expertise to carry out all of 

the functions involved in a NWD system as envisioned by ACL, CMS and VHA. Its governing 

body is responsible for coordinating the on-going development, implementation, financing, 

evaluation and continual improvement of the state's NWD system. It includes representatives from 

the State Medicaid Agency, the State Unit on Aging, and the state agencies that serve or represent 

the interests of individuals with physical disabilities, individuals with intellectual and 

developmental disabilities, and the state authorities administering mental health services. NWD 

systems also include a robust Management Information System (MIS) that builds on and leverages 

existing state MIS systems, which is essential for a state to be able to effectively gather and manage 

information from the many entities that will be carrying out NWD system functions, as well as 

from individual consumers who use the NWD system. The NWD system’s Continuous Quality 

Improvement process involves getting input and feedback from the many different customers who 

use or interact with the NWD system, including individuals and their families, system partners, 

advocates, providers and professionals in the health and LTSS systems, on the responsiveness of 

the NWD system to their varying needs. 
53

The result of ADRC/NWD system investments include: 

• Over 1,222 access points have been designated across 56 states, territories, and the District 

of Columbia. This includes: over 620 local Area Agencies on Aging and Aging and 

Disability Resource Centers, 331 Centers for Independent Living, 56 Statewide 

Independent Living Councils, 67 University Centers for Excellence in Developmental 

Disabilities Education, Research, and Service, and 242 Tribal Organizations. Each of these 

organizations and networks have formed proactive partnerships, with support from ACL 

and other federal partners, in order to coordinate and transform existing long-term service 

and support access functions for all populations and all payers.;

• Over 27 million ADRC contacts have been made to help streamline access to LTSS;

• 34 states/territories have ADRC/NWD System legislation or gubernatorial support in 

response to this vision;

• 42 states/territories with ADRC program sites conducted care transitions through formal 

intervention; and

• 303 sites in 43 states/territories reported serving clients with institutional transition from 

nursing facility (both Money Follows the Person (MFP) demonstration funding and nonMFP related) back into the community. 

Aging Network Support Activities

(FY 2016: $9,961,000)

Aging Network Support Activities provide competitive grants and contracts to support ongoing 

activities of national significance that help older adults and their families to obtain information 

about their care options and benefits. These activities provide technical assistance to help states, 

tribes, and community providers of aging services to develop service systems that help older 

people remain independent and able to live in their own homes and communities. They also

provide critical and ongoing support for the national aging services network and help support the 

activities of AoA’s core service delivery programs. 

ACL awards competitive grants, cooperative agreements, and contracts for Aging Network Support 

Activities to eligible public or private agencies and organizations, states and area agencies on aging, 

institutions of higher learning, and other organizations representing and/or serving older people, 

including faith-based organizations. Grantees are required to provide a match equal to 25 percent of 

the project’s total cost. External experts review project proposals, and project awards are made for 

periods of one to four years. 

To ensure that older Americans have access to the highest quality home and community-based 

services (HCBS) system, the national aging services network must continually enhance program 

design and delivery in key priority areas. To address this critical need, ACL supports a cooperative 

agreement that is documenting and reporting on Area Agency on Aging and Tribal organizations’ 

activities and expertise in the delivery of community-based services through surveys and the 

highlighting of best practices. In FY 2016, the project conducted data collection for the biannual 

National Survey of Area Agencies on Aging which was released in 2017. Additionally, in 2016, 

the project released a report examining the state of IT in AAAs across the country. The report, 
54

“Information Technology in Area Agencies on Aging,” identified issues and barriers AAAs face 

in addressing IT needs. 

National Eldercare Locator

In FY 2016, ACL awarded a cooperative agreement in the amount of $1,577,451 to continue 

operation of the Eldercare Locator. The Eldercare Locator is the only national information and 

referral resource to provide support to older adults and family caregivers seeking assistance on a 

wide array of needs related to aging. Through its call center (800.677.1116), which operates five 

days a week from 9:00 a.m. to 8:00 p.m. Eastern Time, and website (www.eldercare.gov), the 

Locator helps consumers navigate the maze of federal, state and local resources to find the 

assistance they need. Older adults and caregivers contact the Locator to find local resources 

involving a broad range of services including transportation and in-home services and supports. 

The Eldercare Locator served over 308,637 callers and 559 website users in FY 2016.

National Alzheimer’s Call Center

In FY 2016, ACL awarded a cooperative agreement in the amount of $933,571 to continue 

operation of the Alzheimer’s Call Center. The National Alzheimer’s Call Center is a national 

information and counseling service for persons with Alzheimer’s disease, their family members, 

and informal caregivers. In the 12-month period ending January 31, 2017, the National 

Alzheimer’s Call Center handled over 300,000 calls through its national and local partners, and its 

on-line message board community recorded over 5.7 million page views and over 260,000 active 

participants.

The National Alzheimer’s Call Center is available to people in all states, 24 hours a day, seven

days a week, 365 days a year to provide expert advice, care consultation, and information and 

referrals at the national and local levels regarding Alzheimer’s disease. Trained professional 

customer service staff and master’s level social workers are available at all times. Services focus 

on consumers, not professionals. Information provided may include basic information on 

caregiving; handling legal issues; resources for long-distance caregiving; and tips for working with 

the medical community. In FY 2016, the top reasons callers contacted the Call Center included: 

assistance with handling challenging behaviors; tips for handling caregiver stress; caregivers 

seeking emotional support; and information on local care options.

National Education and Resource Center on Women and Retirement Planning

The National Education and Resource Center on Women and Retirement Planning, established in 

1998, provides women with access to a one-stop gateway that integrates financial information and 

resources on retirement, health, and planning for long-term care. This project has made userfriendly financial education and retirement planning tools available to traditionally hard-to-reach 

women, including low-income women, women of color, women with limited English speaking 

proficiency, rural, and other underserved women. Information is offered through financial and 

retirement planning programs, workshops tailored to meet women’s special needs, and 

publications in hard copy and web-based formats, including materials designed to identify and 
55

prevent fraud and financial exploitation of older persons. In 2016, the Center presented more than 

20 trainings and workshops to underserved older women and professionals who serve them, in 

partnership with organizations such as the American Bar Association Commission on Law and 

Aging, the National Council on Aging, and the American Association of Service Coordinators. 

The Center is funded through a 5-year cooperative agreement between ACL and the Women’s 

Institute for a Secure Retirement (WISER). In FY 2016, ACL awarded WISER $231,526 

(representing funds for year 3 of 5).

National Minority Aging Organizations Technical Assistance Centers

The National Minority Aging Organizations (NMAO) Technical Assistance Centers Program 

works to reduce or eliminate health disparities among racial and ethnic minority older individuals. 

In FY 2016, five national non-profit organizations received a total of approximately $1,150,000 

for the second year of five-year cooperative agreements to continue providing training and 

technical assistance to professionals serving African American, Hispanic, Asian, Native Hawaiian 

or other Pacific Islander descent, American Indian and Alaska Native elders, and older lesbian, 

gay, bisexual, and transgender (LGBT) adults, as well as to older consumers and their families. 

Each NMAO project develops and pilots practical, community-based interventions for reaching 

older individuals who experience barriers to accessing home and community-based services. 

Interventions focus on barriers due to language and low literacy, as well as those directly related 

to cultural diversity. Strategies developed under this program incorporate the latest technology 

and facilitate the generation and dissemination of knowledge in forms that can assist racial and 

ethnic minority older individuals to practice positive health behaviors and strengthen their capacity 

to maintain active, independent life styles. Select examples of technical assistance, training and 

related activities conducted by several of the grantees include:

• The National Indian Council on Aging (NICOA) developed and delivered Money Smart 

for Older Adults training to 47 Title VI program directors who will take the financial 

literacy training back to their elders. Additionally, NICOA has actively promoted 

intergenerational programming throughout Indian Country to emphasize and strengthen 

cultural bonds and traditions between generations;

• Services and Advocacy for GLBT Elders (SAGE) conducted virtual and in-person trainings 

reaching more than four thousand professionals nationwide to more competently and 

sensitively address the service and support needs of older LGBT individuals and their 

family caregivers and the development of over 60 new educational materials and resources;

• The Asociacion Nacional Pro Personas Mayores delivered a webinar to area agencies on 

aging on ensuring cultural diversity in service delivery. The webinar was targeted to more 

than 1800 aging network professionals; and

• The National Caucus on Black Aging (NCBA) collaborated with CMS’ Office of 

Communications, Partner Relations, and the SHIP counselors to train existing and 

upcoming beneficiaries, their families and caregivers on how to maximize the benefits of 

Medicare, Medicaid, prescription drug and Medigap Plans. Over 4000 beneficiaries were 

trained this year.
56

In addition to the individual activities of each organization on behalf of the groups they represent, 

the NMAO Technical Assistance Centers conduct joint presentations at national, regional and local 

aging network events to educate and advocate for their specific member populations. These 

presentations reaffirm and expand knowledge about the provision and acceptance of services to 

racial and ethnic minority older persons, and allow for direct discussions and responses with the 

aging network. Professionals and consumers across the country report that they use the products 

to improve program design and implementation, refine service delivery approaches, and enable 

families to provide care to their elder loved ones for longer periods.

Advancing Person-Centered, Trauma-Informed Supportive Services for Holocaust Survivors

There are an estimated 100,000 to 130,000 survivors of the Holocaust living in the United States. 

The youngest survivors are in their early 70’s; however, many are much older and nearly 25 

percent of them live in poverty.114 In FY 2015, Congress appropriated funds “to help provide 

supportive services for aging Holocaust survivors living in the United States.” That same year, 

AoA issued a funding opportunity intended to build capacity for providing person-centered, 

trauma-informed (PCTI) supportive services for Holocaust survivors and to expand the use of these 

practices by the broader aging services network with any older adult population who has a history 

of trauma. 

In FY 2016, AoA funded the second year of a five-year cooperative agreement in the amount of 

$2,500,000 in which the grantee is focusing on two priority areas: 1) advancing innovations in the 

delivery of PCTI supportive services to Holocaust survivors living in the U.S., while 2) improving 

the nation’s overall capacity to delivery PCTI health and human services for older adults. AoA’s 

grantee worked closely with their first cohort of 23 sub-grantees to develop and administer a range 

of programs and interventions in the areas of physical and mental health, accessibility and family 

caregiver support. In FY 2016, the first full year for which data was available from the grantee, 

nearly 8,500 Holocaust survivors and over 300 family caregivers received direct services while 

more than 2,000 professionals were trained in the use of PCTI supportive services. Preliminary 

outcome reporting suggests that the interventions being developed and deployed are leading to 

decreases in isolation, loneliness, depression and increases in feelings of safety, security and 

independence among survivors while the family caregivers who are served are reporting reductions 

in stress. 

 

114 Kover, E. (2014). Testimony before the U.S. Senate Special Committee on Aging, January 15, 2014.
57

Appendix

Formula Grant Funding Allocations by State, Territory and Tribal

Organizations

U.S. Administration on Aging 

Department of Health and Human Services
58

THIS PAGE INTENTIONALLY LEFT BLANK
59

State

Supportive 

Services

Congregate 

Meals

Home 

Meals

Preventive 

Services NFCSP Total Title III

Alabama $5,340,110 $6,658,222 $3,446,917 $312,046 $2,279,069 $18,036,364 

Alaska $1,725,835 $2,225,239 $1,123,369 $98,465 $747,367 $5,920,275 

Arizona $6,495,849 $9,360,431 $4,845,833 $379,579 $3,346,118 $24,427,810 

Arkansas $3,459,887 $4,163,564 $2,128,668 $198,170 $1,446,132 $11,396,421 

California $34,172,853 $45,269,354 $23,435,646 $1,996,859 $15,390,530 $120,265,242 

Colorado $4,106,001 $6,361,144 $3,293,123 $239,931 $2,005,562 $16,005,761 

Connecticut $4,352,620 $5,241,452 $2,571,861 $244,616 $1,751,433 $14,161,982 

Delaware $1,725,835 $2,225,239 $1,123,369 $98,465 $747,367 $5,920,275 

District of Columbia $1,725,835 $2,225,239 $1,123,369 $98,465 $747,367 $5,920,275 

Florida $24,965,219 $32,179,591 $16,659,162 $1,458,822 $12,175,645 $87,438,439 

Georgia $7,816,357 $11,497,595 $5,952,229 $456,742 $3,691,256 $29,414,179 

Hawaii $1,725,835 $2,225,239 $1,123,369 $98,465 $747,367 $5,920,275 

Idaho $1,725,835 $2,225,239 $1,123,369 $98,465 $747,367 $5,920,275 

Illinois $14,354,336 $17,286,541 $8,395,795 $787,832 $5,579,518 $46,404,022 

Indiana $6,846,052 $8,534,666 $4,418,340 $400,043 $2,913,777 $23,112,878 

Iowa $4,210,846 $5,081,501 $2,266,934 $217,527 $1,579,568 $13,356,376 

Kansas $3,392,598 $4,089,903 $1,937,158 $179,543 $1,313,589 $10,912,791 

Kentucky $4,685,598 $5,932,483 $3,071,207 $273,799 $1,989,094 $15,952,181 

Louisiana $4,739,584 $5,798,475 $3,001,832 $276,954 $1,925,518 $15,742,363 

Maine $1,725,835 $2,225,239 $1,134,584 $98,655 $747,367 $5,931,680 

Maryland $5,788,659 $7,497,316 $3,881,311 $338,256 $2,503,548 $20,009,090 

Massachusetts $8,112,702 $9,780,267 $4,720,820 $435,955 $3,168,410 $26,218,154 

Michigan $11,123,548 $13,877,388 $7,184,232 $649,995 $4,738,888 $37,574,051 

Minnesota $5,435,089 $7,101,910 $3,676,612 $317,595 $2,448,987 $18,980,193 

Mississippi $3,234,282 $3,891,114 $1,998,933 $183,809 $1,314,791 $10,622,929 

Missouri $7,034,843 $8,467,047 $4,309,755 $396,418 $2,922,404 $23,130,467 

Montana $1,725,835 $2,225,239 $1,123,369 $98,465 $747,367 $5,920,275 

Nebraska $2,267,990 $2,738,802 $1,264,078 $116,982 $862,082 $7,249,934 

Nevada $2,432,485 $3,627,769 $1,878,072 $142,140 $1,185,340 $9,265,806 

New Hampshire $1,725,835 $2,225,239 $1,123,369 $98,465 $747,367 $5,920,275 

New Jersey $10,142,462 $12,190,488 $6,078,857 $581,578 $4,121,143 $33,114,528 

New Mexico $2,041,926 $2,818,273 $1,459,002 $119,318 $952,990 $7,391,509 

New York $23,998,290 $28,963,855 $13,431,294 $1,289,327 $9,085,852 $76,768,618 

North Carolina $9,258,914 $13,132,620 $6,798,671 $541,037 $4,428,714 $34,159,956 

North Dakota $1,725,835 $2,225,239 $1,123,369 $98,465 $747,367 $5,920,275 

Ohio $13,654,570 $16,393,785 $8,391,051 $782,885 $5,613,283 $44,835,574 

Oklahoma $4,228,050 $5,080,736 $2,601,402 $241,108 $1,748,862 $13,900,158 

Oregon $4,085,823 $5,771,973 $2,988,113 $238,752 $1,912,618 $14,997,279 

Pennsylvania $17,670,027 $21,279,716 $9,807,313 $953,977 $6,797,425 $56,508,458 

Rhode Island $1,725,835 $2,225,239 $1,123,369 $98,465 $747,367 $5,920,275 

South Carolina $4,735,280 $6,833,310 $3,537,560 $276,703 $2,270,483 $17,653,336 

South Dakota $1,725,835 $2,225,239 $1,123,369 $98,465 $747,367 $5,920,275 

Tennessee $6,680,839 $8,857,622 $4,585,533 $390,389 $2,984,205 $23,498,588 

Texas $20,087,400 $28,490,410 $14,749,298 $1,173,791 $9,354,202 $73,855,101 

Utah $1,844,852 $2,699,962 $1,397,753 $107,803 $900,695 $6,951,065 

Vermont $1,725,835 $2,225,239 $1,123,369 $98,465 $747,367 $5,920,275 

Virginia $7,772,608 $10,410,071 $5,389,225 $454,186 $3,467,798 $27,493,888 

Washington $6,374,314 $9,122,298 $4,722,553 $372,478 $2,972,693 $23,564,336 

West Virginia $2,740,971 $3,305,947 $1,527,374 $143,428 $1,004,589 $8,722,309 

Wisconsin $6,315,353 $7,933,770 $4,107,261 $366,631 $2,746,803 $21,469,818 

Wyoming $1,725,835 $2,225,239 $1,123,369 $98,465 $747,367 $5,920,275 

American Samoa $466,771 $594,843 $140,421 $12,308 $93,421 $1,307,764 

Guam $862,917 $1,112,620 $561,685 $49,232 $373,684 $2,960,138 

Northern Mariana 

Islands

$215,730 $278,155 $140,421 $12,308 $93,421 $740,035 

Puerto Rico $4,323,579 $5,300,084 $2,743,818 $252,645 $1,929,864 $14,549,990 

Virgin Islands $862,917 $1,112,620 $561,685 $49,232 $373,684 $2,960,138 

TOTAL $345,166,956 $445,047,800 $224,673,820 $19,692,964 $149,473,459 $1,184,054,999 
60

State Ombudsman Elder Abuse Total Title VII

Alabama $242,979 $76,215 $319,194 

Alaska $79,188 $23,759 $102,947 

Arizona $341,592 $86,912 $428,504 

Arkansas $150,054 $48,157 $198,211 

California $1,652,022 $471,073 $2,123,095 

Colorado $232,138 $59,061 $291,199 

Connecticut $181,295 $59,907 $241,202 

Delaware $79,188 $23,759 $102,947 

District of Columbia $79,188 $23,759 $102,947 

Florida $1,174,335 $344,252 $1,518,587 

Georgia $419,583 $106,751 $526,334 

Hawaii $79,188 $23,759 $102,947 

Idaho $79,188 $23,759 $102,947 

Illinois $591,835 $197,384 $789,219 

Indiana $311,457 $98,224 $409,681 

Iowa $159,800 $55,927 $215,727 

Kansas $136,554 $45,843 $182,397

Kentucky $216,495 $66,595 $283,090 

Louisiana $211,605 $68,518 $280,123 

Maine $79,979 $23,759 $103,738 

Maryland $273,601 $78,087 $351,688 

Massachusetts $332,779 $109,606 $442,385 

Michigan $506,430 $160,862 $667,292 

Minnesota $259,171 $76,347 $335,518 

Mississippi $140,908 $45,198 $186,106 

Missouri $303,802 $97,643 $401,445 

Montana $79,188 $23,759 $102,947 

Nebraska $89,107 $29,770 $118,877 

Nevada $132,389 $33,682 $166,071 

New Hampshire $79,188 $23,759 $102,947 

New Jersey $428,510 $143,950 $572,460 

New Mexico $102,848 $26,393 $129,241 

New York $946,796 $318,066 $1,264,862 

North Carolina $479,251 $126,782 $606,033 

North Dakota $79,188 $23,759 $102,947 

Ohio $591,501 $197,185 $788,686 

Oklahoma $183,378 $60,208 $243,586 

Oregon $210,638 $56,795 $267,433 

Pennsylvania $691,335 $242,944 $934,279 

Rhode Island $79,188 $23,759 $102,947 

South Carolina $249,369 $63,445 $312,814 

South Dakota $79,188 $23,759 $102,947 

Tennessee $323,243 $91,810 $415,053 

Texas $1,039,705 $274,281 $1,313,986 

Utah $98,530 $25,068 $123,598 

Vermont $79,188 $23,759 $102,947 

Virginia $379,896 $102,820 $482,716 

Washington $332,901 $86,291 $419,192 

West Virginia $107,667 $36,736 $144,403 

Wisconsin $289,528 $90,309 $379,837 

Wyoming $79,188 $23,759 $102,947 

American Samoa $9,899 $2,970 $12,869 

Guam $39,594 $11,880 $51,474 

Northern Mariana Islands $9,899 $2,970 $12,869 

Puerto Rico $193,417 $54,217 $247,634 

Virgin Islands $39,594 $11,880 $51,474 

TOTAL $15,837,665 $4,751,881 $20,589,546 
61

State/Territory

Nutrition Services 

Incentive Program

Alabama $3,343,062 

Alaska $482,319 

Arizona $1,850,582 

Arkansas $2,547,704 

California $13,100,197 

Colorado $1,381,206 

Connecticut $1,538,793 

Delaware $500,490 

District of Columbia $795,581 

Florida $6,300,064 

Georgia $2,758,744 

Hawaii $409,291 

Idaho $737,226 

Illinois $6,134,768 

Indiana $1,467,482 

Iowa $1,758,186 

Kansas $2,036,030 

Kentucky $1,670,281 

Louisiana $3,472,592 

Maine $596,374 

Maryland $1,617,398 

Massachusetts $5,123,191 

Michigan $7,535,532 

Minnesota $1,813,004 

Mississippi $1,544,079 

Missouri $4,000,525 

Montana $952,920 

Nebraska $1,121,363 

Nevada $1,262,846

New Hampshire $1,183,758 

New Jersey $3,697,546 

New Mexico $2,322,927 

New York $16,626,262 

North Carolina $3,271,673 

North Dakota $808,445 

Ohio $5,511,975 

Oklahoma $2,079,523 

Oregon $1,904,526 

Pennsylvania $6,322,179 

Rhode Island $399,849 

South Carolina $1,690,316 

South Dakota $877,494 

Tennessee $1,544,863 

Texas $11,187,189 

Utah $1,366,184 

Vermont $840,508 

Virginia $2,140,665 

Washington $2,263,353 

West Virginia $1,580,090 

Wisconsin $2,796,955 

Wyoming $860,761 

American Samoa $120,587 

Guam $406,456 

Northern Mariana Islands $53,085 

Puerto Rico $2,998,875 

Virgin Islands $184,443 

TOTAL $152,892,317 
62

State Tribe No. Grantee Name TITLE6 A/B TITLE6 C NSIP

AK 01 Aleutian Pribilof Islands Association, Inc. $97,340 $28,550 $8,031

AK 02 Association of Village Council Presidents $140,520 - $21,936

AK 03 Bristol Bay Native Association $140,520 $49,980 $4,623

AK 04 Central Council Tlingit & Haida Indian Tribes of AK $184,510 $57,120 $1,477

AK 06 Copper River Native Association $85,720 $21,410 $2,028

AK 07 Hoonah Indian Association $85,720 $21,410 $1,647

AK 08 Kodiak Area Native Association - Northern Region $75,540 $14,270 $2,218

AK 09 Kodiak Area Native Association - Southern Region $75,540 $14,270 $1,477

AK 10 Metlakatla Indian Community $109,690 $35,700 $2,874

AK 11 Native Village of Barrow $121,310 $42,850 $23,354

AK 12 Tanana Chiefs Conference for Kuskokwim subregion $75,540 $14,270 $730

AK 13 Tanana Chiefs Conference for Lower Yukon Subregion $75,540 $14,270 $3,175

AK 14 Tanana Chiefs Conference for Yukon Flats Subregion $75,540 $14,270 $454

AK 15 Tanana Chiefs Conference for Yukon Koyukuk Subregion $85,720 $21,410 $4,445

AK 16 Tanana Chiefs Conference for Yukon Tanana Subregion $75,540 $14,270 $1,093

AK 17 Fairbanks Native Association $140,520 $49,980 $2,597

AK 19 Maniilaq Association $140,520 $49,980 $12,841

AK 20 Native Villiage of Unalakleet $85,720 $21,410 $6,427

AK 21 Chugachmiut $85,720 $21,410 $776

AK 22 Arctic Slope Native Association, Limited $85,720 $21,410 $23,354

AK 23 Denakkanaaga, Inc. $97,340 $28,550 -

AK 24 Klawock Cooperative Association $75,540 $14,270 $834

AK 25 Kootznoowoo Inc. $75,540 $14,270 $1,008

AK 26 Gwichyaa Zhee Gwich'in Tribal Government $75,540 $14,270 $8,145

AK 27 Native Village of Point Hope $75,540 $14,270 $1,861

AK 28 Seldovia Village Tribe $75,540 - $616

AK 30 Sitka Tribes of Alaska $109,690 $35,700 $1,225

AK 32 Ketchikan Indian Community $140,520 $49,980 $5,422

AK 35 Southcentral Foundation $184,510 $57,120 $11,627

AK 36 Kenaitze Indian Tribe $140,520 $49,980 $5,757

AK 37 Wrangell Cooperative Association $97,340 $28,550 $1,808

AK 38 Native Village of Savoonga $75,540 $14,270 $10,354

AK 39 Native Village of Gambell $75,540 $14,270 $3,577

AK 40 Native Village of Eyak Traditional Council $75,540 $14,270 $2,219

AK 41 Organized Village of Kake $75,540 $14,270 $1,759

AK 42 Chickaloon Native Village $97,340 - $2,699

AK 44 Galena Village (aka Louden Village Council) $75,540 $14,270 $11,723

AK 45 Asa'carsarmiut Tribal Council $75,540 - $3,475

AK 46 Orutsararmuit Native Council $109,690 $35,700 $10,201

AK 47 Chilkoot Indian Association $75,540 $14,270 $673

AK 48 Knik Tribal Council $109,690 - $1,528

AK 49 Yakutat Tlingit Tribe $75,540 $14,270 $922

AK 50 Craig Tribal Association (Skagway Traditional Council) $75,540 $14,270 $853

AK Total Total $4,186,690 $985,060 $213,843

AL 01 Poarch Band of Creek Indians $140,520 $49,980 $26,510

AL Total Total $140,520 $49,980 $26,510

AZ 02 Colorado River Indian Tribes $121,310 $42,850 $9,067

AZ 03 Gila River Indian Community $184,510 $57,120 $20,774

AZ 04 Hopi Tribe $140,520 $49,980 $12,818

AZ 05 Hualapai Elderly Services Program $85,720 $21,410 $20,968

AZ 06 Navajo Nation $184,510 $57,120 $35,947

AZ 07 Pascua Yaqui Tribe $184,510 $57,120 $31,758

AZ 09 Salt River Pima-Maricopa Indian Community $109,690 $35,700 $14,170

AZ 10 San Carlos Apache Tribe $140,520 $49,980 $7,592

AZ 11 Tohono O'odham Nation $184,510 $57,120 $2,432

AZ 12 White Mountain Apache Tribe $140,520 $49,980 $21,636

AZ 13 Ak-Chin Indian Community $75,540 $14,270 $9,475

AZ 14 Yavapai Apache Tribe $85,720 - $3,389

AZ 15 Havasupai Tribe $75,540 $14,270 $6,604

AZ 16 Inter-Tribal Council of Arizona, Inc. $85,720 $21,410 $1,769

AZ 17 Cocopah Indian Tribe $75,540 - $14,844
63

State Tribe No. Grantee Name TITLE6 A/B TITLE6 C NSIP

AZ 18 Quechan Indian Tribe $85,720 $21,410 $12,632

AZ Total Total $1,960,100 $549,740 $225,875

CA 01 Bishop Paiute Tribe $97,340 $28,550 $15,950

CA 02 Blue Lake Rancheria $75,540 $14,270 $23,103

CA 06 Karuk Tribe $97,340 $28,550 $5,057

CA 07 Pit River Health Service, Inc. $75,540 - $3,541

CA 09 Riverside-San Bernardino Co. Indian Health-Morongo $85,720 $21,410 $3,024

CA 10 Riverside-San Bernardino Co. Indian Health-Pechanga $75,540 $14,270 $2,062

CA 11 Riverside-San Bernardino Co. Indian Health-Soboba/ $75,540 $14,270 $2,468

CA 12 Sonoma County Indian Health Project - Sonoma $75,540 - $8,556

CA 13 Southern Indian Health Council, Inc. - Area I $75,540 $14,270 $13,040

CA 14 Southern Indian Health Council, Inc. - Area II $75,540 $14,270 $13,134

CA 15 Toiyabe Indian Health Project, Inc. - Northern $75,540 $14,270 $10,958

CA 16 Tule River Indian Health Center, Inc. $85,720 $21,410 $20,253

CA 17 Coast Indian Community of Resighini Rancheria $85,720 $21,410 $8,792

CA 18 United Indian Health Services for Smith River $140,520 $49,980 $12,548

CA 20 Indian Senior Center, Inc. $85,720 $21,410 $9,199

CA 21 Sonoma County Indian Health Project - Manchester $75,540 - $3,565

CA 25 Pala Band of Mission Indians $85,720 - $10,404

CA 26 Redding Rancheria $140,520 $49,980 $5,128

CA 28 Toiyabe Indian Health Project, Inc. - Southern $75,540 $14,270 $6,212

CA 29 Hoopa Valley Tribe / K'ima:w Medical Center $85,720 - $8,303

CA 30 Round Valley Indian Tribes $85,720 - $6,829

CA 31 Fort Mojave Indian Tribe $85,720 $21,410 $7,856

CA 33 CA Indian Manpower Consortium, Inc. - Chico, $75,540 $14,270 $3,935

CA 34 CA Indian Manpower Consortium, Inc. - Big Sandy, $85,720 $21,410 $7,657

CA 35 CA Indian Manpower Consortium, Inc. - Berry Creek, $85,720 $21,410 $4,966

CA 36 CA Indian Manpower Consortium, Inc. - Coyote Valley, $85,720 $21,410 $6,493

CA 37 CA Indian Manpower Consortium, Inc. - Enterprise, $97,340 $28,550 $8,375

CA 38 Santa Ynez Tribal Health Clinic $75,540 - $2,592

CA 39 CA Indian Manpower Consortium, Inc. - North Fork, $75,540 $14,270 $3,813

CA Total Total $2,498,000 $485,320 $237,813

CO 01 Southern Ute Indian Tribe $85,720 $21,410 $4,503

CO 02 Ute Mountain Ute Tribe $97,340 - $15,818

CO Total Total $183,060 $21,410 $20,321

CT 01 Mohegan Tribe of Indians of Connecticut $85,720 - $3,505

CT Total Total $85,720 - $3,505

HI 01 Alu Like, Inc. $1,505,000 $57,120 $32,566

HI Total Total $1,505,000 $57,120 $32,566

IA 01 Sac & Fox Tribe of the Mississippi in Iowa $97,340 $28,550 $12,721

IA Total Total $97,340 $28,550 $12,721

ID 01 Coeur d'Alene Tribe $85,720 $21,410 $19,101

ID 02 Nez Perce Tribe $97,340 $28,550 $21,958

ID 03 Shoshone-Bannock Tribes $121,310 $42,850 $18,257

ID Total Total $304,370 $92,810 $59,316

KS 01 Kickapoo Tribe in Kansas $75,540 $14,270 $11,014

KS 02 Prairie Band of Potawatomi Nation $97,340 $28,550 $27,859

KS 03 Iowa Tribe of Kansas and Nebraska $75,540 $14,270 $6,354

KS Total Total $248,420 $57,090 $45,227

LA 01 Institute for Indian Development, Inc. $97,340 - $16,723

LA Total Total $97,340 - $16,723

MA 01 Wampanoag Tribe of Gay Head (Aquinnah) $85,720 $21,410 $916

MA 02 Mashpee Wampanoag Tribe $97,340 $28,550 $1,496

MA Total Total $183,060 $49,960 $2,412

ME 01 Pleasant Point Passamaquoddy $97,340 $28,550 $26,280

ME 02 Penobscot Indian Nation $85,720 - $4,424

ME 04 Aroostook Band of Micmacs $75,540 $14,270 $1,691

ME Total Total $258,600 $42,820 $32,395

MI 01 Grand Traverse Band of Ottawa & Chippewa Indians $97,340 $28,550 $13,437

MI 02 Inter-Tribal Council of Michigan, Inc. $85,720 $21,410 $3,445

MI 03 Keweenaw Bay Indian Community $85,720 $21,410 $22,087
64

State Tribe No. Grantee Name TITLE6 A/B TITLE6 C NSIP

MI 04 Sault Ste. Marie Tribe of Chippewa Indians $184,510 - $19,172

MI 05 Little Traverse Bay Bands of Odawa Indians $85,720 $21,410 $3,952

MI 07 Bay Mills Indian Community $85,720 $21,410 $5,633

MI 08 Pokagon Band of Potawatomi Indians $85,720 - $3,655

MI 09 Little River Band of Ottawa Indians $109,690 - $6,107

MI 10 Nottawaseppi Huron Band of the Potawatomi $75,540 $14,270 $4,704

MI Total Total $895,680 $128,460 $82,192

MN 01 Bois Forte Reservation Tribal Government $85,720 $21,410 $11,146

MN 02 Fond du Lac Band of Lake Superior Chippewa $140,520 $49,980 $42,493

MN 03 Leech Lake Band of Ojibwe $184,510 $57,120 $20,363

MN 07 Red Lake Band of Chippewa Indians $140,520 - $61,649

MN 08 White Earth Reservation Tribal Council $97,340 $28,550 $15,291

MN 09 Grand Portage Band of Lake Superior Chippewa $75,540 - $4,405

MN 10 Mille Lacs Band of Ojibwe $85,720 $21,410 $22,815

MN 11 Lower Sioux Indian Community $75,540 $14,270 $3,122

MN Total Total $885,410 $192,740 $181,284

MO 99 Eastern Shawnee Tribe of Oklahoma $109,690 $35,700 $20,821

MO Total Total $109,690 $35,700 $20,821

MS 01 Mississippi Band of Choctaw Indians $140,520 $49,980 $24,656

MS Total Total $140,520 $49,980 $24,656

MT 01 Assiniboine and Sioux Tribes $140,520 $49,980 $43,184

MT 02 Blackfeet Tribe - Eagle Shield Center $140,520 $49,980 $26,040

MT 03 Chippewa Cree Tribe Senior Citizens Department $121,310 $42,850 $48,484

MT 04 Confederated Salish and Kootenai Tribes $140,520 $49,980 $7,863

MT 05 Fort Belknap Indian Community $97,340 $28,550 $18,462

MT 06 Northern Cheyenne Elderly Program $121,310 $42,850 $34,656

MT 07 Crow Tribal Elders Program $140,520 $49,980 $49,863

MT Total Total $902,040 $314,170 $228,552

NC 01 Eastern Band of Cherokee Indians $184,510 $57,120 $34,462

NC Total Total $184,510 $57,120 $34,462

ND 01 Spirit Lake Senior Services $97,340 $28,550 $38,539

ND 02 Standing Rock Sioux Tribe $140,520 $49,980 $106,476

ND 03 Three Affiliated Tribes $140,520 $49,980 $29,719

ND 04 Trenton Indian Service Area $97,340 $28,550 $1,099

ND 05 Turtle Mountain Band of Chippewa Indians $140,520 $49,980 $18,640

ND Total Total $616,240 $207,040 $194,473

NE 01 Omaha Tribe of Nebraska $85,720 $5,860 $10,782

NE 02 Santee Sioux Nation $75,540 - $4,912

NE 03 Winnebago Tribe of Nebraska $85,720 $21,410 $18,475

NE Total Total $246,980 $27,270 $34,169

NM 01 Eight Northern Indian Pueblos Council (Picuris, etc.) $140,520 $49,980 $29,388

NM 02 Eight N. Indian Pueblos Council (San Ildefonso, etc.) $75,540 $14,270 $8,700

NM 03 Five Sandoval Indian Pueblos, Inc. $97,340 $28,550 $12,174

NM 04 Jicarilla Apache Nation $109,690 $35,700 $22,374

NM 05 Laguna Rainbow Corporation $140,520 $49,980 $18,189

NM 06 Mescalero Apache Tribe $109,690 - $7,762

NM 07 Pueblo de Cochiti Elder Program $85,720 $21,410 $7,544

NM 09 Pueblo of Isleta Elder Center $140,520 $49,980 $26,053

NM 10 Pueblo of Jemez $140,520 $49,980 $9,043

NM 11 Pueblo of San Felipe Elderly Services Program $109,690 $35,700 $32,067

NM 12 Taos Pueblo Senior Citizens Program $121,310 $42,850 $9,936

NM 13 Pueblo of Zuni $140,520 $49,980 $20,722

NM 14 Ohkay Owingeh Senior Citizens Program $140,520 $49,980 $14,045

NM 15 Santa Clara Pueblo $140,520 $49,980 $19,044

NM 16 Santo Domingo Pueblo $140,520 $49,980 $20,762

NM 17 Pueblo of Tesuque $75,540 $14,270 $7,687

NM 18 Acoma Elderly & Assistance Program $97,340 $28,550 $15,548

NM Total Total $2,006,020 $621,140 $281,038

NV 01 Fallon Paiute Shoshone Tribes $85,720 $21,410 $19,834

NV 02 Inter-Tribal Council of Nevada, Inc. (McDermitt, etc.) $85,720 $21,410 $6,019

NV 03 Inter-Tribal Council of Nevada, Inc. (Duckwater, etc.) $85,720 $21,410 $5,501
65

State Tribe No. Grantee Name TITLE6 A/B TITLE6 C NSIP

NV 04 Inter-Tribal Council of Nevada, Inc. (Ely, etc.) $85,720 $21,410 $6,620

NV 05 Shoshone-Paiute Tribes $85,720 $21,410 $8,629

NV 06 Walker River Paiute Tribe $85,720 - $10,507

NV 07 Washoe Tribe of Nevada and California $85,720 $21,410 $31,190

NV 08 Yerington Paiute Tribe $75,540 $14,270 $6,340

NV 09 Pyramid Lake Paiute Tribe $85,720 $21,410 $6,609

NV 10 Elko Band Council $85,720 $21,410 $8,799

NV 11 Reno-Sparks Indian Colony $75,540 $14,270 $16,938

NV Total Total $922,560 $199,820 $126,986

NY 01 St. Regis Mohawk Tribe $184,510 $57,120 $10,633

NY 02 Seneca Nation of Indians $140,520 $49,980 $18,861

NY 04 Oneida Indian Nation $85,720 $21,410 $4,737

NY 05 Shinnecock Indian Nation $85,720 $21,410 $5,171

NY Total Total $496,470 $149,920 $39,402

OK 01 Apache Tribe of Oklahoma $85,720 $21,410 $17,963

OK 02 Caddo Nation of Oklahoma $85,720 $21,410 $739

OK 03 Cherokee Nation $186,042 $58,547 $55,936

OK 04 Cheyenne and Arapaho Tribes $184,510 $57,120 $7,486

OK 06 Choctaw Nation of Oklahoma $184,510 $57,120 $43,963

OK 07 Citizen Potawatomi Nation $184,510 $57,120 $11,766

OK 08 Comanche Nation $140,520 $49,980 $19,768

OK 09 Delaware Nation $78,960 $14,270 $8,421

OK 10 Iowa Tribe of Oklahoma $140,520 $49,980 $8,709

OK 12 Kickapoo Tribe of Oklahoma $100,000 $21,410 $11,023

OK 13 Kiowa Tribe of Oklahoma $184,510 $57,120 $9,018

OK 14 Miami Tribe of Oklahoma $140,520 $49,980 $38,207

OK 15 Muscogee (Creek) Nation/Elderly Nutrition Program $184,510 $57,120 $149,649

OK 17 Otoe-Missouria Tribe of Indians $97,340 $28,550 $14,367

OK 18 Ottawa Tribe of Oklahoma $140,520 $49,980 $33,370

OK 19 Pawnee Nation of Oklahoma $85,720 $21,410 $12,425

OK 20 Peoria Tribe of Indians of Oklahoma $121,310 $42,850 $21,891

OK 21 Ponca Tribe of Oklahoma $109,690 $35,700 $9,710

OK 22 Quapaw Tribe of Oklahoma $140,520 $49,980 $26,174

OK 23 Sac and Fox Nation of Oklahoma $140,520 $49,980 $18,456

OK 24 Seminole Nation of Oklahoma $140,520 $49,980 $15,415

OK 25 Seneca-Cayuga Tribe of Oklahoma $140,520 $49,980 $15,593

OK 26 Wichita and Affiliated Tribes $140,520 $49,980 $8,469

OK 27 Wyandotte Nation $140,520 $49,980 $20,350

OK 28 Absentee Shawnee Tribe of Oklahoma $184,510 $57,120 $28,618

OK 29 Fort Sill Apache Tribe $109,690 $35,700 $8,245

OK 31 United Keetoowah Band of Cherokee Indians $184,510 $57,120 $21,319

OK 32 Chickasaw Nation $184,510 $57,120 $130,473

OK 33 Kaw Nation $85,720 - $20,730

OK 34 Osage Nation of Oklahoma $184,510 $57,120 $60,165

OK 35 Delaware Tribes of Indians $140,520 $49,980 $8,557

OK 36 Alabama-Quassarte Tribal Town $75,540 $14,270 $821

OK Total Total $4,427,762 $1,379,387 $857,796

OR 01 Confederated Tribes of Siletz Indians of Oregon $97,340 $28,550 $4,059

OR 02 Yellowhawk Tribal Health Center $121,310 $42,850 $11,524

OR 03 Confederated Tribes of Warm Springs $121,310 $42,850 $8,996

OR 04 Confederated Tribes of Grand Ronde $109,690 $35,700 $13,004

OR 05 The Klamath Tribes $140,520 $49,980 $4,391

OR 06 Confed. Tribes of Coos, Lower Umpqua & $85,720 $21,410 $9,781

OR 07 Cow Creek Band of Umpqua Tribe of Indians $75,540 $14,270 $467

OR Total Total $751,430 $235,610 $52,222

RI 01 Narragansett Indian Tribe $109,690 $35,700 $3,048

RI Total Total $109,690 $35,700 $3,048

SC 01 Catawba Indian Nation Eldercare Program $97,340 $28,550 $8,611

SC Total Total $97,340 $28,550 $8,611

SD 01 Cheyenne River Elderly Nutrition Services $140,520 $49,980 $7,879

SD 02 Crow Creek Sioux Tribe $85,720 - $14,382
66

State Tribe No. Grantee Name TITLE6 A/B TITLE6 C NSIP

SD 03 Lower Brule Sioux Tribe $85,720 $21,410 $16,135

SD 04 Oglala Sioux Tribe $184,510 $57,120 $31,497

SD 05 Rosebud Sioux Tribe $184,510 $57,120 $30,833

SD 06 Sisseton Wahpeton Oyate $140,520 $49,980 $31,212

SD 08 Yankton Sioux Tribe $121,310 $42,850 $21,185

SD Total Total $942,810 $278,460 $153,123

TX 01 Alabama-Coushatta Tribe of Texas $85,720 $21,410 $6,693

TX 02 Kickapoo Traditional Tribe of Texas $75,540 - $84,756

TX Total Total $161,260 $21,410 $91,449

UT 01 Ute Indian Tribe, Unitah & Ouray $97,340 $28,550 $5,616

UT Total Total $97,340 $28,550 $5,616

WA 01 Confederated Tribes of the Colville Reservation $140,520 $49,980 $16,143

WA 02 Lower Elwha Klallam Tribe $75,540 $14,270 $4,703

WA 03 Lummi Tribe $109,690 $35,700 $21,107

WA 04 Makah Tribe Senior Program $85,720 $21,410 $10,423

WA 05 Muckleshoot Indian Tribe $140,520 $49,980 $44,133

WA 09 Puyallup Tribe of Indians $140,520 - $11,918

WA 10 Quinault Tribe of the Quinault Indian Reservation $109,690 $35,700 $34,342

WA 13 Swinomish Indian Tribal Community $85,720 $21,410 $3,381

WA 14 Spokane Tribes Senior Program $97,340 $28,550 $12,527

WA 16 The Tulalip Tribes of Washington $140,520 $49,980 $10,783

WA 17 Jamestown S'Klallam Tribe $85,720 $21,410 $10,696

WA 19 Quileute Tribal Council $75,540 $14,270 $4,877

WA 20 S. Puget Intertribal Planning Agency - Shoalwater Bay $97,340 $28,550 $7,947

WA 21 Stillaguamish Tribe of Indians $109,690 $35,700 $3,401

WA 22 Upper Skagit Indian Tribe $75,540 $14,270 $2,704

WA 24 The Suquamish Tribe $97,340 $28,550 $8,139

WA 25 Port Gamble S'Klallam Tribe $85,720 $21,410 $12,991

WA 26 Samish Indian Nation $97,340 $28,550 $4,095

WA 27 Cowlitz Indian Tribe $184,510 $57,120 $4,051

WA 28 Skokomish Indian Tribe $97,340 $28,550 $3,233

WA 29 Confederated Tribes of the Chehalis Reservation $140,520 $49,980 $10,021

WA 30 Nooksack Indian Tribe $97,340 $28,550 $8,767

WA 31 Yakama Indian Nation $75,540 $14,270 $2,449

WA 32 Snoqualmie Tribe $75,540 $14,270 $3,695

WA 33 S. Puget Intertribal Planning Agency - Nisqually $140,520 $49,980 $3,414

WA 34 Squaxin Island Tribe $85,720 $21,410 $4,404

WA Total Total $2,747,040 $763,820 $264,344

WI 01 Bad River Elderly Nutrition Program $85,720 $21,410 $13,704

WI 02 Forest County Potawatomi Community $85,720 $21,410 $8,786

WI 03 Lac Courte Oreilles Band of Lake Superior Chippewa $97,340 $28,550 $8,482

WI 04 Lac du Flambeau Band of Lake Superior Chippewa $97,340 $28,550 $18,176

WI 05 Menominee Indian Tribe of Wisconsin $140,520 $49,980 $4,164

WI 06 Oneida Tribe of Indians of Wisconsin $140,520 $49,980 $8,632

WI 07 Red Cliff Band of Lake Superior Chippewa $85,720 $21,410 $12,953

WI 08 St. Croix Chippewa Indians of Wisconsin $85,720 $21,410 $7,274

WI 09 Stockbridge-Munsee Community $85,720 $21,410 $1,548

WI 10 Ho-Chunk Nation $109,690 $35,700 $11,008

WI 11 Sokaogon Chippewa Community $75,540 - $3,295

WI Total Total $1,089,550 $299,810 $98,022

WY 01 Northern Arapaho Tribe $97,340 - $10,888

WY 03 Eastern Shoshone Tribe $97,340 - $11,904

WY Total Total $194,680 - $22,792

Total Total Total $29,773,242 $7,474,517 $3,734,285