DEPARTMENT

of HEALTH

and HUMAN

SERVICES

Fiscal Year

2013

Administration on Aging

Justification of

Estimates for

Appropriations Committee
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FROM THE ADMINISTRATION ON AGING

I am pleased to present the Administration on Aging (AoA) FY 2013 Congressional Justification.

AoA and the national aging services network annually serve nearly 11 million seniors and their 

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

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

admission. From 2010 to 2015, the population age 60 and older will increase by 15 percent, 

from 57 million to 65.7 million. During this period, the number of seniors with severe disabilities 

who are at greatest risk of nursing home admission and Medicaid eligibility will increase by 

more than 13 percent. Further, Census Bureau demographic trends indicate at least 300,000 more

seniors will be living in poverty in FY 2013.

As Assistant Secretary for Aging, my goal is to insure that all older Americans have the 

opportunity to live independently, with dignity, in their homes and communities for as long as 

they are able and choose to do so. My FY 2013 budget request continues the priorities that I 

introduced in my FY 2012 request. This includes a focus on, and funding for, elder rights and 

elder justice programs such as Adult Protective Services and continued funding support for our 

core formula grant programs that support seniors’ health and independence. While the current 

budgetary environment necessitates a shared focus on reducing spending where possible, AoA’s 

programs are critical not only to the seniors whom they serve, but also to reducing the burden 

that could be shifted to other government programs if seniors were forced to rely on living in 

institutional settings before otherwise necessary.

The FY 2013 budget also continues to propose the transfer to AoA of the State Health Insurance 

Assistance Program (SHIPs) from the Centers for Medicare and Medicaid Services (CMS) and 

the transfer of the Senior Community Service Employment Program from the Department of 

Labor (DoL). These transfers recognize that by putting these programs under the national aging 

services network, their participants should be able to benefit immensely from the supports 

currently available through AoA’s existing Aging Services programs.

It is our privilege to continue to help prepare the country for the increasing numbers of older 

Americans and to continue to provide vital support programs for this country’s most vulnerable 

citizens so that they can remain in their homes and communities for as long as possible.

Kathy Greenlee

Assistant Secretary for Aging
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Administration on Aging

Table of Contents

Executive Summary:

Organizational Chart ...................................................................................................................7

Introduction and Mission.............................................................................................................9

Overview of Budget Request.....................................................................................................11

Overview of Performance..........................................................................................................13

All-Purpose Table .....................................................................................................................22

Budget Exhibits:

Appropriations Language .........................................................................................................26

Language Analysis....................................................................................................................28

Amounts Available for Obligation.............................................................................................30

Summary of Changes................................................................................................................31

BA by Activity..........................................................................................................................33

Authorizing Legislation.............................................................................................................36

Appropriations History..............................................................................................................38

Appropriations Not Authorized by Law.....................................................................................40

Narrative by Activity:

Health and Independence ..........................................................................................................42

Summary of Request .....................................................................................................42

Home and Community-Based Supportive Services........................................................44

Nutrition Services..........................................................................................................53

Preventive Health Services ............................................................................................67

Senior Community Service Employment Program.........................................................74

Native American Nutrition and Supportive Services......................................................79

Aging Network Support Activities.................................................................................84

Caregiver Services:

Summary of Request .....................................................................................................91

Family Caregiver Support Services................................................................................94

Native American Caregiver Support Services ..............................................................105

Alzheimer’s Disease Supportive Services Program......................................................110

Lifespan Respite Care..................................................................................................115

Protection of Vulnerable Adults:

Summary of Request ...................................................................................................122

Adult Protective Services Demonstration Program.......................................................125

Long-Term Care Ombudsman Program.......................................................................130

Prevention of Elder Abuse and Neglect........................................................................138

Senior Medicare Patrol Program..................................................................................145

Elder Rights Support Activities....................................................................................150
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Consumer Information, Access, and Outreach

Summary of Request ...................................................................................................155

Aging and Disability Resource Centers........................................................................158

State Health Insurance Assistance Programs................................................................167

Program Administration..........................................................................................................172

Prevention and Public Health Fund:

Chronic Disease Self-Management Programs..........................................................................177

Supplementary Tables:

BA by Object Class.................................................................................................................181

Salaries and Expenses .............................................................................................................182

Detail of FTE..........................................................................................................................184

Detail of Positions...................................................................................................................186

Programs Proposed for Elimination.........................................................................................187

Significant Items:

Significant Items in House and Senate Appropriations Committee Reports.............................188

Enterprise Information Technology and Government-Wide E-Gov Initiatives.........................193
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Administration on Aging

Organizational Chart
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Executive Summary

Introduction and Mission

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

Services (DHHS), is the principal Federal agency charged with helping elderly individuals 

maintain their dignity and independence in their homes and communities. AoA advances the 

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

network to promote the development of comprehensive, coordinated home and community-based 

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

network, led by AoA at the Federal level, is comprised of 56 State and Territorial Units on Aging 

(SUA), 629 Area Agencies on Aging (AAA), 256 Indian Tribal and Native Hawaiian 

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

The mission of AoA is to develop a comprehensive, coordinated and cost-effective system of 

home and community-based services to help elderly individuals maintain their health and 

independence in their homes and communities. 

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

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

possible. These services complement existing medical and health care systems, help to prevent 

hospital readmissions, provide transport to doctors appointments, and support some of life’s most 

basic functions, such as providing assistance in elders’ homes to help them with bathing or 

preparing food. The network also helps consumers learn about and access the services and 

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

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

effective. The most recent data available (FY 2010) show that AoA and its national network 

rendered services, including referrals, to nearly 11 million elderly individuals age 60 and over 

(nearly 20 percent of the country’s elderly population) and their caregivers, including nearly 

three million clients who received intensive in-home services. Critical supports, such as respite 

care and a peer support network, were provided to about 760,000 caregivers.

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

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

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

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

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

people and their family caregivers; and valuing and developing AoA staff.
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11

Overview of Budget Request

The FY 2013 discretionary request for AoA is $1,978,336,000, a net increase of +$7,052,000

from the comparable FY 2012 enacted level. This request builds on the FY 2012 enacted budget, 

proposing level funding for core areas with small increases where the need is greatest and 

making offsetting reductions in others. The request also includes $10,000,000 from the 

Prevention and Public Health Fund (PPHF) for Chronic Disease Self-Management Programs 

discussed in a separate narrative under the PPHF Tab at the end of this document. 

One critical area for which additional funding is sought is the protection of vulnerable older 

adults. As the population of Americans age 60 and older increases, the problem of elder abuse, 

neglect, and exploitation continues to grow. While there is no single set of national elder abuse 

prevalence data, the number of reported cases of elder abuse, neglect, and exploitation are on the 

rise. Together, the data suggest that more than 5 million, or 10% of elders are abused, neglected, 

and/or exploited annually. The negative effects of abuse, neglect, and exploitation on the health 

and independence of seniors are 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.1 Additional adverse health impacts include an increased likelihood of 

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

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

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

ultimately forced to leave their homes and communities prematurely.2

 

To address this growing problem, the FY 2013 budget request includes $8 million in new 

funding for Adult Protective Services demonstrations, including $1,000,000 for grants to Native 

American communities. The budget also requests an additional $5,526,000 to restore funding for 

the Alzheimer’s Disease Supportive Services program, which was reduced in the FY 2012 

appropriation. This partial restoration of funding will allow AoA to continue implementing the 

only program within HHS which provides supportive services to patients suffering from 

Alzheimer’s disease and their caregivers.

The request maintains funding at FY 2012 enacted levels for core AoA service programs, 

including Home and Community Based Supportive Services, Nutrition Services, Preventive 

Health, and programs to support caregivers. Maintaining funding is important because not only 

does the number of seniors (and consequently the need for services for older Americans)

continue to grow, but reports indicate that

3

 1 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. 

making reductions in these core services could lead to 

2 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. 3 Shapiro, Adam and Loh, Chung-Ping. (August 2010). Advanced Performance outcome Measures Project (POMP): 

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

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

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

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

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

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higher government expenditures in areas such as Medicaid. Several State efforts to measure the 

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

signs of potential for savings. This would be because AoA’s services assist seniors in remaining

independent and in their communities, potentially delaying expensive institutionalization in 

settings more expensive to the government. If even a small percentage of OAA service 

recipients are able to delay the institutionalization so many do not want, it could have a 

significant impact on Medicaid expenditures.

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

caregivers provided assistance to adults with limitations in daily activities.4 These unpaid 

caregivers provided an AARP-estimated $450 billion in services, the cost of which, were 

caregivers more limited in their ability to provide this care, could otherwise be borne by 

Medicare and Medicaid.5 The long-term needs of today’s growing numbers of elderly place 

tremendous strain on families, and it is precisely this stress that AoA core programs endeavor to 

make more manageable. These caregivers underscore the critical importance of continuing to 

invest in AoA programs, since if they become overwhelmed by the burdens of caregiving, these 

additional costs (along with those of increased institutionalization) could fall upon already 

overtaxed government resources.

The FY 2013 budget also continues to support the transfer to AoA of the State Health Insurance 

Assistance Program (SHIPs) ($51,902,000) from CMS and the transfer of the Senior Community 

Service Employment Program (SCSEP) ($448,251,000) from the Department of Labor (DoL). 

These programs will benefit from AoA’s connections to the Aging Services Network, and will be 

made more efficient and effective under AoA’s administration. 

In addition, the FY 2013 request Chronic Disease Self-Management Programs (CDSMP), Aging 

and Disability Resource Centers (ADRCs), and Senior Medicare Patrol (SMP) programs by 

continuing to propose dedicated funding lines for these activities. In the case of CDSMP and 

ADRCs, no discretionary funding is requested. Rather, CDSMP funding is proposed from the 

Prevention and Public Health Fund and ADRCs will rely on existing mandatory appropriations. 

AoA will use this mandatory ADRC funding to support states and communities in continuing to 

build the infrastructure needed to support the ongoing integration of the programs into state’s 

Home and Community-Based Supportive Systems and to create greater integration with the 

medical system. 

The FY 2013 request also maintains the FY 2012 realignment of AoA activities that support the 

national aging services network into two groups, one under Aging Network Support Activities 

that the other under Elder Rights Support Activities. 

Finally, the request would provide an additional $196,000 for Program Administration over the 

FY 2012 level for AoA’s planned relocation in FY 2013. 

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

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

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

Institute. July 2011. http://assets.aarp.org/rgcenter/ppi/ltc/i51-caregiving.pdf 5 Id.
13

Overview of Performance

AoA program activities have a fundamental common purpose which reflects the legislative intent 

of the Older Americans Act (OAA) and the AoA Mission: to develop a comprehensive, 

coordinated and cost-effective system of home and community-based services that helps elderly 

individuals maintain their health and independence in their homes and communities. 

The Aging Services Program’s fundamental purpose, in combination with the legislative intent 

that the National Aging Services Network actively participate in supporting community-based 

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

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

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

of several activities across the Aging Services Program budget and progress toward achievement 

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

corresponding indicators are reflective of the Office of Management of Budget (OMB) 

requirements to measure efficiency for all program activities. The client outcome measure 

includes indicators focusing on consumer assessment of service quality and outcome indicators 

focusing on nursing home predictors, successful caregiver program operation and protection of 

the vulnerable elderly. The targeting measure and indicators focus on ensuring that States and 

communities serve the most vulnerable elders. Taken together, the three measures and their 

corresponding performance indicators are designed to reflect AoA’s strategic goals and 

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

Consistent with this Administration’s emphasis on transparency and accountability, AoA has 

taken several steps to improve the analysis and availability of performance information while 

also enhancing the rigor of program evaluations. To this end, AoA has:

• Expanded the availability of performance information via an on-line system that enables 

Aging Network professionals and the public to develop benchmarks and examine trends 

nationally and at the State level.

• Submitted public use data sets to the http://www.data.gov/ system.

• Further analyzed the results from the 2011 National Survey of Older Americans Act 

Participants to help inform decision makers. Results show:

o AoA is effectively reaching those most at risk of institutionalization;

o Service recipients report Title III services enable them to remain in their own 

homes; and

o Comparison of service recipients to the overall US population 60 and older shows 

that Title III serves older people who are less healthy and have more limitations 

than other older adults even after adjusting for demographic and socioeconomic 

differences between the groups.
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• Tested through the Performance Outcomes Measurement Project (POMP) several 

methods for measuring the impact of services. Preliminary analysis for administrative 

data sets from four States, using Cox proportional hazards models, show a consistent 

lowering of the relative risk of nursing home placement with an increase in number of 

services utilized; and there was an increase in mean survival time in the community 

(i.e. months before placement) with increases in the total number of services used.

• Employed more rigorous program evaluation methods such as longitudinal data 

collection and experimental design.

o The Title III-C Elderly Nutrition Services program evaluation employs a complex 

design that includes three major components and several subcomponents. The 

major components include a process study that surveys each level of the Aging 

Network on a large array of topics; a costs study that measures the actual cost of 

providing a meal by cost category (e.g. labor, food, overhead); and an individual 

outcome study. The individual outcome study will measure the program’s success 

at meeting the legislative intent of the program (reduce hunger and social isolation 

while improving health and well-being of consumers). In addition, AoA and 

Centers for Medicare and Medicaid Services (CMS) have entered into an InterAgency Agreement that will enhance this evaluation to include prospective analysis 

of healthcare utilization and cost data of program participants compared to a 

matched group of seniors who do not participate in the program.

o The evaluation of the Title III-E National Family Caregiver Support program will 

be the first for this OAA program. It is designed as a longitudinal study with a 

comparison group so that the effects of the five service categories can be measured 

over time.

o AoA has finalized the design and operational plan for an evaluation of Aging and 

Disability Resource Centers (ADRC). Data collection is scheduled to begin in 

Spring 2012 pending OMB Paperwork Reduction Act clearance. The evaluation is a 

quasi-experimental design that compares consumer experiences and outcomes 

associated with accessing long-term care services and supports through an ADRC to 

those of consumers from non-ADRC communities. AoA is working with the HHS 

Office on Disability and the Department of Education’s Rehabilitation Services 

Administration to include the younger disabled population in the study who access 

services through Centers for Independent Living.

o In May 2011, AoA received a design framework report for the evaluation of the 

Chronic Disease Self-Management Program. The report proposes use of an 

experimental design in which individuals will be randomly assigned to receive the 

intervention or serve as a control group by delaying program participation for a 

minimum of six months. Using the recommendations as a foundation, AoA awarded 

a contract in the fall of 2011 for the conduct of a process evaluation and a more 

detailed outcome evaluation design. The process evaluation, including time for 

OMB PRA clearance, is expected to be completed during the summer of 2013. 
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AoA is coordinating its efforts with CMS to ensure that the data collected measure 

concepts important to both agencies. The results of an evaluation would influence 

future performance measures and indicators of the program. 

Current Performance Information

An analysis of AoA’s performance trends shows that through FY 2010 most outcome indicators 

have steadily improved. While service counts are declining due to flat funding and challenging 

economic times, AoA outcome indicators demonstrate that services are increasingly effective in 

helping older persons remain at home. Some key successes are indicative of the potential of AoA 

and the National Aging Services Network to meet the challenges posed by the growth of the 

vulnerable older adult population, the changing care preferences of aging baby boomers, the 

fiscal difficulties faced by State budgets, and the expanding needs of both the elderly and their 

caregivers. Below are some examples of these successes:

• OAA programs help older Americans who are severely disabled remain 

independent and in the community: Homebound older adults that have three or more 

impairments in Activities of Daily Living (ADL) are at a high risk for nursing home 

placement. Measures of the Aging Network’s success at serving this vulnerable 

population is a proxy for success at nursing home delay and diversion. In FY 2003, the 

Aging Network served home-delivered meals to 280,454 clients with three or more ADL 

impairments and by FY 2010 that number grew by 24% to 348,669 clients. Another 

approach to measuring AoA’s success is the nursing home predictor score. The 

components of this composite score are predictive of nursing home placement based on 

scientific literature and AoA’s POMP which develops and tests performance measures. 

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

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

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

increases. In 2003, the nursing home predictor score was 46.57 and has increased to 60.5 

in FY 2010.

• OAA programs are efficient: The National Aging Services Network is providing high 

quality services to the neediest elders and doing so in a very prudent and cost-effective 

manner. AoA has significantly increased the number of clients served per million dollars 

of AoA Title III funding over the last decade. In FY 2010 The National Aging Services 

Network served 8,438 people per million dollars of OAA Title III funding. Since this 

measure’s introduction in FY 2005, AoA and the National Aging Services Network have

met or exceeded efficiency targets.

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

to “encourage and assist State agencies and Area Agencies on Aging to concentrate 

resources in order to develop greater capacity and foster the development and 

implementation of comprehensive and coordinated systems.” (OAA Section 301). This is 

evident in the leveraging of OAA funds with State/local or other funds (almost $3 in 

other funds for every dollar of OAA funds expended), as well as in the expansion of 
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projects such as the Aging and Disability Resource Center initiative, which has grown to

over 310 sites across 54 States and territories in FY 2010.

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

and they express a high level of satisfaction with these services. In 2010, over 98% of 

transportation clients rated services good to excellent and 94% of caregivers rated services good 

to excellent. To help ensure the continuation of these trends in core programs, AoA uses its 

discretionary funding to test innovative service delivery models for State and local program 

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

example, AoA has worked with CMS and the Department of Veterans Affairs to better integrate 

funding for long-term care service delivery, eliminate duplication and improve access to services 

through Aging and Disability Resource Centers.

Performance for FY 2013

Federal support for OAA programs is not expected to cover the cost of serving every senior. For 

Home and Community-based Services, with the same funding levels in FY 2013 as FY 2011, 

some outcomes are projected to show similar or slightly improved performance; however, 

service counts and other outputs are projected to decline because of rising costs, declining State 

and local program contributions, and staffing constraints at the State and local level. OAA 

programs have strong partnerships with State and local governments, philanthropic 

organizations, and private donations that contribute significant funding. Despite States only 

having to match these programs at 15% or 25% of their Federal allocation, States typically

leverage resources of $2 or $3 per every OAA dollar. Regardless of the historic nature of State 

and local support for these programs, AoA expects declining leveraged funds, as State, local, and 

private budgets face economic hardships. This will adversely impact performance through

FY 2013.

Performance Detail

Taken as a whole, AoA’s performance measures and indicators form an interconnected system of 

performance measurement akin to the three legs of a stool (efficiency, outcomes and targeting) 

holding up AoA’s mission and strategic goals that include:

 

1. Empower older people, their families, and other consumers to make informed decisions 

about, and to be able to easily access, existing health and long-term care options;

2. Enable seniors to remain in their own homes with a high quality of life for as long as

possible through the provision of home and community-based services, including

supports for family caregivers;

3. Empower older people to stay active and healthy through Older Americans Act services 

and the new prevention benefits under Medicare;

4. Ensure the rights of older people and prevent their abuse, neglect and exploitation; and

5. Maintain effective and responsive management.
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Below is a summary of each measure, its indicators and their relationship to AoA’s strategic 

goals.

Measure 1: Improve Efficiency 

Program efficiency is a necessary and important measure of the performance of AoA programs 

for two principal reasons. First, it is important to be a responsible steward of Federal funds. 

Second, the OAA intended Federal funds to act as catalyst in generating capacity for these 

program activities at the State and local levels. It is the expectation of the OAA that States and 

communities increasingly improve their capacity to serve elderly individuals efficiently and 

effectively with both Federal and State funds. 

Improvements in program efficiency support all of AoA’s Strategic Goals. Through optimal

utilization of resources, improvements in program efficiency ensure that affordable and 

accessible community-based long-term care is available to promote the well-being of seniors and 

their family caregivers. 

For FY 2013, there are two efficiency indicators for AoA program activities. Indicator 1.1

addresses performance efficiency at all levels of the National Aging Services Network in the 

provision of home and community-based services, including caregiver services. Indicator 1.3 

demonstrates the efficiency of AoA in providing services to Native Americans.

A summary of program efficiency indicators for FY 2013 follows:

Indicator 1.1: For Home and Community-based Services, including Nutrition Services, 

and Caregiver services, increase the number of clients served per million dollars of Title 

III OAA funding. 

Indicator 1.3: Increase the number of units of service provided to Native Americans per 

thousand dollars of OAA funding. 

Measure 2: Improve Client Outcomes 

While improving efficiency, AoA is committed to maintaining quality and improving client 

outcomes. The FY 2013 performance budget includes nine core performance indicators

supporting AoA’s commitment to improving client outcomes. AoA has multiple quality 

assessment indicators in this plan reflecting separate assessments provided by elders for services 

such as meals, transportation and caregiver assistance. Also, in developing the outcome 

indicators, AoA included measures to assess AoA’s fundamental outcomes: to keep elders at 

home and in the community, and to measure results important to family caregivers. The 

measures for the Ombudsman program focus on the core purposes of this program: advocacy on 

behalf of older adults. 

Although this measure supports all of AoA’s Strategic Goals, it is most strongly tied to Goal 2 to 

enable seniors to remain in their own homes with a high quality of life for as long as possible, 

Goal 3 to empower older adults to stay active and healthy, and Goal 4 to ensure the rights of 

older people and prevent their abuse, neglect and exploitation. 
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A summary of the client outcome indicators for FY 2013 follows: 

Indicator 2.6: Reduce the percent of caregivers who report difficulty in getting services. 

Indicator 2.9a: 90% of home delivered meal clients rate services good to excellent. 

Indicator 2.9b: 90% of transportation clients rate services good to excellent. 

Indicator 2.9c: 90% of National Family Caregiver Support Program clients rate services 

good to excellent. 

Indicator 2.10: Increase the likelihood that the most vulnerable people receiving OAA 

Home and Community-based and Caregiver Support Services will continue to live in 

their homes and communities. This will be tracked by the use of a “nursing home 

predictor index” which measures the prevalence of select characteristics of the service 

population that research has shown to be predictive of nursing home placement. An 

increasing score shows an increased proportion of the client population is high risk with 

respect to institutionalization.

Indicator 2.11: Increase the percentage of transportation clients who live alone.

Indicator 2.12: Decrease the average number of complaints per long-term care facility.

Indicator 2.14: Decrease the number of complaints not resolved to the satisfaction of the 

nursing home resident.

Indicator ALZ.2: Increase number of individuals served with evidence-based 

interventions (Alzheimer Program).

Measure 3: Effectively Target Services to Vulnerable Elderly 

AoA believes that targeting is of equal importance to efficiency and outcomes because it ensures 

that AoA and the National Aging Services Network will focus their services on the neediest, 

especially when resources are scarce. Without targeting, efforts to improve efficiency and 

outcomes could result in unintended consequences whereby entities might attempt to focus their 

efforts toward individuals who are not the most vulnerable. Such an outcome would be 

inconsistent with the intent of the OAA, which specifically requires the network to target 

services to the most vulnerable elders. It would also be inconsistent with the mission of AoA, 

which is to help vulnerable elders maintain their independence in the community. To help 

seniors remain independent, AoA and the National Aging Services Network must focus their 

efforts on those who are at the greatest risk of institutionalization.

Effective targeting of OAA services supports AoA’s Strategic Goal 1 by ensuring access to longterm care options for the economically and socially vulnerable; Goal 2 by enabling the most 

vulnerable seniors to remain in their own homes with a high quality of life; and Goal 4 by 
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ensuring the rights of vulnerable elders. Thus, AoA’s four indicators for effective targeting are 

crucial for ensuring that services are targeted to the most at risk client groups. 

Indicator 3.1: Increase the number of caregivers served. 

Indicator 3.2: Increase the number of older persons with severe disabilities who receive 

home-delivered meals. 

Indicator 3.3: The percentage of OAA clients served who live in rural areas is at least 

10% greater than the percent of all US elders who live in rural areas. 

Indicator 3.4: Increase the number of States that serve more elderly living below the 

poverty level than the prior year. 
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Administration on Aging

Budget by HHS Strategic Plan Goal

(Dollars in Millions)

HHS Strategic Goals FY 2011 FY 2012 FY 2013Request

1.Transform Health Care 60.184 59.988 59.775

1.A Make coverage more secure 52.000 52.115 51.902

1.B Improve health care quality and patient safety 8.184 7.873 7.873

1.C Emphasize primary & preventative care, link to prevention 

1.D Reduce growth of health care costs promoting high-value

1.E Ensure access to quality culturally competent care 

1.F Promote the adoption of health information technology

2. Advance Scientific Knowledge and Innovation 6.802 6.789 6.789

2.A Accelerate scientific discovery to improve patient care

2.B Foster innovation at HHS to create shared solutions

2.C Invest in sciences to improve food & medical product safety

2.D Increase understanding of what works in health & services 6.802 6.789 6.789

3. Advance the Health, Safety and Well-Being of the American 

People 1,915.078 1,895.042 1,902.111

3.A Ensure the children & youth safety, well-being & health

3.B Promote economic & social well-being 1,621.704 1,599.612 1,607.612

3.C Improve services for people with disabilities and elderly 272.495 264.590 263.659

3.D Promote prevention and wellness 20.879 30.840 30.840

3.E Reduce the occurrence of infectious diseases

3.F Protect Americans’ health and safety during emergencies

4. Increase Efficiency, Transparency and Accountability of 

HHS Programs 32.670 43.175 43.371

4.A Ensure program integrity and responsible stewardship 19.793 22.882 23.106

4.B Fight fraud and work to eliminate improper payments 12.731 20.112 20.112

4.C Use HHS data to improve American health & well-being 

4.D Improve HHS environmental performance for sustainability .146

.181 .153

5. Strengthen the Nation’s Health and Human Service 

Infrastructure and Workforce

5.A Invest in HHS workforce to meet needs today & tomorrow

5.B Ensure health care workforce meets increased demands

5.C Enhance ability public health workforce to improve health 

5.D Strengthen the Nation’s human service workforce

5.E Improve national, State & local surveillance capacity

TOTAL 2,014.734 2,004.994 2,012.046

AoA’s Internal Performance Management Plan

AoA core programs provide formula grants to States or tribes and there is a great deal of 

flexibility in program implementation. States, in turn, provide flexibility to the Area Agencies 

on Aging, where the home and community-based programs are actually administered. Since 

AoA is not directly involved in hands-on service provision, for the past ten years the Agency has 

employed a program performance improvement strategy with multiple components that are 
EXECUTIVE SUMMARY

Page 21 of 194

expected to yield performance improvements. Examples of activity supporting the overall 

strategy follow:

1. Collaboration with other Federal agencies.

2. Collaboration with non-governmental organizations.

3. Enhanced partnerships with State and Area Agencies on Aging.

4. Programmatic technical assistance.

5. Improved performance measurement capacity and information collection tools.

6. Rigorous program evaluation.

7. Program Innovations demonstration grants.

8. Senior leadership’s involvement in performance management and reporting.

Some activities cited above are conducted directly by AoA Central and Regional Office staff, but 

most are conducted through discretionary grants and contracts.

AoA senior management is directly engaged in developing these activities through grants and 

procurement planning. There is a rigorous process in which each office within AoA develops 

“concept papers” which detail the proposed discretionary grant and procurement activities for the 

office and justify each proposed activity consistent with AoA strategic goals and overarching 

performance measures. Senior leadership has also implemented programs to better use 

performance data for management decision-making, including a quarterly discretionary 

dashboard, weekly reports for the Assistant Secretary, quarterly reviews of operating budgets, 

and bi-monthly managers meetings.

AoA also monitors senior manager performance by including measurable performance targets in 

performance plans. These performance targets must support AoA’s strategic goals and 

performance measures.

AoA has initiated a Sentinel States Reporting Initiative (SSRI) that will create a consolidated 

data warehouse where detailed program data will be used for analytics to seek new insights about 

the national aging network and its consumers, and to evaluate trends in supporting seniors who 

reside in communities rather than long term care alternatives. AoA is in the early stages of 

building this warehouse, with five States currently participating, and is still exploring its 

potential related to research and performance. SSRI is not a pilot per se, but will continue to 

grow, as additional States are added each fiscal year. SSRI will serve as an "early warning" 

system allowing AoA to monitor data on its consumers and services on a more frequent basis. 

AoA also conducts rigorous program evaluations that demonstrate the efficacy of its programs 

and the results of these evaluations not only improve AoA’s understanding of the effectiveness 

of its core and demonstration programs, but can inform the performance measurement process.

All this and other performance information are used during the year to update AoA’s Executive 

Leadership so that adjustments can be made as needed to AoA programs; it is also discussed and 

used as appropriate in AoA internal discussions as decisions are made each year regarding 

funding levels to propose to the Department and OMB. 
EXECUTIVE SUMMARY

Page 22 of 194

By establishing a culture where performance improvement is expected and by working 

collaboratively with our State and AAA partners toward this end, the Aging Services Network 

has demonstrated very solid performance over the past ten years.

Administration on Aging

All-Purpose Table

(Dollars in Thousands)

FY 2011 FY 2012 

Program Enacted Enacted Total +/- FY 2012

Health and Independence:

Home & Community-Based Supportive Services...................................................................... $ 367,611 $ 366,916 $ 366,916 $ --

Congregate Nutrition Services...................................................................................................... 439,901 439,070 439,070 --

Home-Delivered Nutrition Services.............................................................................................. 217,241 216,831 216,831 --

Nutrition Services Incentive Program 1/...................................................................................... 160,693 160,389 160,389 --

Preventive Health Services............................................................................................................ 20,984 20,945 20,945 --

Chronic Disease Self-Management Programs (Prevention & Public Health Fund) 2/.......... -- 10,000 10,000 --

Senior Community Service Employment Program 3/................................................................. 449,100 448,251 448,251 --

Native American Nutrition & Supportive Services.................................................................... 27,653 27,601 27,601 --

Aging Network Support Activities.............................................................................................. 8,184 7,873 7,873 --

Subtotal, Health and Independence......................................................................................... $ 1,691,367 $ 1,697,876 $ 1,697,876 $ --

Caregiver Services:

Family Caregiver Support Services.............................................................................................. $ 153,912 $ 153,621 $ 153,621 $ --

Native American Caregiver Support Services............................................................................ 6,376 6,364 6,364 --

Alzheimer's Disease Supportive Services Program.................................................................... 11,441 4,011 9,537 5,526

Lifespan Respite Care..................................................................................................................... 2,495 2,490 2,490 --

Subtotal, Caregiver Services..................................................................................................... $ 174,224 $ 166,486 $ 172,012 $ 5,526

Protection of Vulnerable Adults:

Adult Protective Services.............................................................................................................. $ -- $ -- $ 8,000 $ 8,000

Long-Term Care Ombudsman Program........................................................................................ 16,793 16,761 16,761 --

Prevention of Elder Abuse & Neglect......................................................................................... 5,046 5,036 5,036 --

Senior Medicare Patrol Program .................................................................................................. 9,420 9,402 9,402 --

 Health Care Fraud and Abuse Control 4/ (Mandatory) 3,312 10,710 10,710 --

Elder Rights Support Activities 5/................................................................................................ 4,096 4,088 4,088 --

Subtotal, Vulnerable Adults...................................................................................................... $ 38,667 $ 45,997 $ 53,997 $ 8,000

Consumer Information, Access & Outreach

Aging and Disability Resource Centers 6/.................................................................................. $ 16,469 $ 16,457 $ 10,000 $ (6,457)

 ADRCs Mandatory (non-add).................................................................................................... $ 10,000 $ 10,000 $ 10,000 --

State Health Insurance Assistance Program 7/.......................................................................... 52,000 52,115 51,902 (213)

National Clearinghouse for Long-Term Care Information 8/.................................................... 3,000 3,000 3,000 --

Subtotal, Consumer Information, Access & Outreach.......................................................... $ 71,469 $ 71,572 $ 64,902 $ (6,670)

Program Innovations.......................................................................................................................... $ 19,068 $ -- $ -- $ --

Aging Services Programs Administration....................................................................................... $ 19,939 $ 23,063 $ 23,259 $ 196

Subtotal, Program Level............................................................................................................... $ 2,014,734 $ 2,004,994 $ 2,012,046 $ 7,052

Less Funds From Other Sources:

 Health Care Fraud and Abuse Control 4/ (Mandatory) (3,312) (10710) (10710) --

Aging and Disability Resource Centers (Mandatory) ............................................................. (10,000) (10,000) (10,000) --

Long-Term Care Awareness Campaign (Mandatory) 8/........................................................... (3,000) (3,000) (3,000) --

Chronic Disease Self-Management (Prevention & Public Health Fund) 2/........................... -- (10,000) (10,000) --

Total, Discretionary Budget Authority.......................................................................................... $ 1,998,422 $ 1,971,284 $ 1,978,336 $ 7,052

FY 2013 President's Budget
EXECUTIVE SUMMARY

Page 23 of 194

1/ Includes $2,025,445 in FY 2012 budget authority appropriated to AoA and transferred to the Department of Agriculture for commodities

 purchases pursuant to P.L. 110-19 and P.L. 112-74.

2/ Provided in FY 2012 and requested in FY 2013 from Prevention and Public Health Funds provided by Sections 311 and 317(k)(2) of the Public 

 Health Service Act, [42 U.S.C. Sections 243 and 247b(k)(2)] as amended, and the Patient Protection and Affordable Care Act (ACA), 

 Section 4002 [42 U.S.C. 300u-11].

3/ Reflects transfer of the SCSEP program from the Department of Labor to AoA in FY 2013. Funding is comparably displayed in FY 2011 and FY 2012. 

4/ AoA received $3,312,080 in FY 2011 and $10,709,503 from the Health Care Fraud and Abuse Control wedge funds recovered from fighting fraud.

 $10,709,503 is a placeholder amount for FY 2013. The Secretary and the Attorney General will determine the final amount.

5/ In FY 2011 activities were previously appropriated and requested in Aging Network Support and Program Innovations.

6/ Includes $10 million in mandatory funds per section 2405 of P.L. 111-148 (Affordable Care Act).

7/ Reflects transfer of the SHIPs program from CMS to AoA in FY 2013. Funding is comparably displayed in FY 2011 and FY 2012. Transfer of 

 discretionary funds from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund.

8/ Funding in FY 2011 was via reimbursable agreement from CMS; funding in FY 2012 and FY 2013 is provided directly to AoA.
24

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EXECUTIVE SUMMARY

Page 25 of 194
26

Administration on Aging

Appropriations Language

For carrying out, to the extent not otherwise provided, the Older Americans Act of 1965 

(``OAA''), section 398 and title XXIX of the PHS Act, section 119 of the Medicare 

Improvements for Patients and Providers Act of 2008, and title XX-B of the Social Security Act,

[$1,473,703,000] $1,926,434,000, together with $51,902,000 to be transferred from the Federal 

Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund to 

carry out section 4360 of the Omnibus Budget Reconciliation Act of 1990: Provided, That 

amounts appropriated under this heading may be used for grants to States under section 361 of 

the OAA only for disease prevention and health promotion programs and activities which have 

been demonstrated through rigorous evaluation to be evidence-based and effective: Provided 

further, That, notwithstanding section 206(g) of the OAA, up to one percent of amounts 

appropriated to carry out programs authorized under title III of such Act shall be available for 

conducting evaluations, training and technical assistance: Provided further, That none of the 

funds provided shall be used to carry out sections 1701 and 1703 of the PHS Act (with respect to 

chronic disease self-management activity grants), except that such funds may be used for 

necessary expenses associated with administering any such grants awarded prior to the date of 

the enactment of this Act: [Provided further, That the total amount available for fiscal year 2012 

under this and any other Act to carry out activities related to Aging and Disability Resource 

Centers under subsections (a)(20)(B)(iii) and (b)(8) of section 202 of the OAA shall not exceed 

the amount obligated for such purposes for fiscal year 2010 from funds available under Public 

Law 111-117:]Provided further, That notwithstanding any other provision of this Act, funds 

made available under this heading to carry out section 311 of the OAA may be transferred to the 

Secretary of Agriculture in accordance with such section: Provided further, That, of the amounts 

provided under this heading, $448,251,000 shall be available for carrying out title V of the OAA: 

Provided further, That, with respect to the previous proviso, such funds shall be available 

through June 30, 2014, and may be recaptured and reobligated in accordance with section 

517(c) of the OAA.

General Provision to transfer Older American Community Service 

Employment Program from Labor to HHS/AoA

SEC. 519 TRANSFER OF OLDER AMERICAN COMMUNITY SERVICE EMPLOYMENT 

PROGRAM TO DEPARTMENT OF HEALTH AND HUMAN SERVICES.

(a) IN GENERAL.—Notwithstanding any other provision of law, the Older American 

Community Service Employment (OACSE) program under title V of the Older Americans Act of 

1965 (42 U.S.C. 3056), and the authority to administer such program, shall be permanently 

transferred from the Secretary of Labor to the Secretary of Health and Human Services, acting 

through the Assistant Secretary for Aging.
Page 27 of 194

(b) TRANSFER OF FUNCTIONS, ASSETS, AND LIABILITIES.—The functions, assets, 

and liabilities of the Secretary of Labor relating to the OACSE program shall be transferred to 

the Secretary of Health and Human Services. 

(c) EFFECTIVE DATE OF TRANSFER.---The transfer under this section shall be 

effective no later than the last day of the second full fiscal quarter following the quarter in which 

this section is enacted.
Page 28 of 194

Administration on Aging

Language Analysis

Aging Services Programs

Language Provision Explanation

and title XX-B of the Social Security Act, Adds title XX-B of the Social Security 

Act to provide AoA the authority to carry 

out provisions of the Elder Justice Act of 

2010. Such activities include activities of 

the Elder Justice Coordinating Council

and Adult Protective Services 

demonstration grants. 
Page 29 of 194

Language Provision Explanation

together with $51,902,000 to be 

transferred from the Federal Hospital 

Insurance Trust Fund and the Federal 

Supplementary Medical Insurance Trust 

Fund to carry out section 4360 of the 

Omnibus Budget Reconciliation Act of 

1990:

Provided further, That amounts 

appropriated under this heading may be 

used for grants to States under section 

361 of the OAA only for disease 

prevention and health promotion 

programs and activities which have been 

demonstrated through rigorous evaluation 

to be evidence-based and effective:

Provided further, That, notwithstanding 

section 206(g) of the OAA, up to onepercent of amounts appropriated to carry 

out programs authorized under Title III of 

such Act shall be available for conducting 

evaluations, training and technical 

assistance:

Provided further, That none of the funds 

provided shall be used to carry out 

sections 1701 and 1703 of the PHS Act 

(with respect to chronic disease selfmanagement activity grants), except that 

such funds may be used for necessary 

expenses associated with administering 

any such grants awarded prior to the date 

of the enactment of this Act

[Provided further, That the total amount 

available for fiscal year 2012 under this 

and any other Act to carry out activities 

related to Aging and Disability Resource 

Centers under subsections (a)(20)(B)(iii) 

and (b)(8) of section 202 of the OAA shall 

not exceed the amount obligated for such 

purposes for fiscal year 2010 from funds 

available under Public Law 111-117:]

Indicates that in addition to the regular 

appropriation, $51,902,000 will be 

transferred to AoA from the Medicare 

Trust Funds to carry out the State Health 

Insurance Assistance Program (SHIPs) 

which is being transferred from the 

Centers for Medicare and Medicare 

Services (CMS) to AoA.

Continues to require that States use the 

amounts that are appropriated for 

Preventive Health Services only for 

evidence-based disease prevention and 

health promotion programs and activities 

that have been demonstrated through 

rigorous evaluation to be effective.

Allows up to 1% of amounts appropriated 

to carry out Home and Community-Based 

Services programs, Nutrition Programs, 

Preventive Health Programs and 

Caregiver Programs under Title III of the 

Older Americans Act to be used for 

conducting evaluations, training and 

technical assistance related to these 

programs.

Allows OAA dollars to be used to provide 

maintenance and closeout of chronic 

disease self-management activity grants 

awarded under the American Recovery 

and Reinvestment Act [FY 2009/2010 

funds] with funds from the Public Health 

Service Prevention and Wellness Fund. 

OAA dollars could not be used for any 

other purposes related to the CDSMP 

program funded with these ARRA dollars. 

Deletes as unnecessary language limiting 

the FY 2012 discretionary appropriation 

for ADRCs to the amount of discretionary 

funding that was obligated for these 

activities in FY 2010; no discretionary 

funding is being requested in FY 2013 for 

this activity. 
Page 30 of 194

Administration on Aging

Amounts Available for Obligation

(Dollars in Thousands)

Discretionary Appropriation:

Appropriation (Annual)............................................................................. 1,500,323 1,473,703 1,478,183

Rescission.................................................................................................... (3,001) (2,785) --

Subtotal, adjusted appropriation........................................................... 1,497,322 1,470,918 1,478,183

Transfer of Funds to: Department of Agriculture ................................. -- (2,025) --

Comparable Transfer from: Department of Labor .................................. 449,100 448,251 448,251

Total, Discretionary Appropriation.................................................... 1,946,422 1,917,144 1,926,434

Mandatory Appropriation:

Appropriation (PPACA) ADRCs.............................................................. 10,000 10,000 10,000

Appropriation (PPACA) National Long-Term Care Clearinghouse.... 3,000 3,000 3,000

Transfer from: (PPACA) Prevention Funds for CDSMP ...................... -- 10,000 10,000

 Subtotal, adjusted mandatory appropriation....................................... 13,000 23,000 23,000

Offsetting collections from:

 Trust Funds: HCFAC.................................................................................. 3,312 10,710 10,710

 Trust Funds: SHIPs HI/SMI Trust Fund Transfer................................. 52,000 52,115 51,902

 Subtotal, Spending Authority from Offsetting Collections................. 55,312 62,825 62,612

Unobligated balance, lapsing....................................................................... (466)

Total obligations......................................................................................... 2,014,268 2,002,969 2,012,046

FY 2011 

Actual FY 2012

FY 2013 

Request
Page 31 of 194

Administration on Aging

Summary of Changes

(Dollars in Thousands)

2012

1,971,284

1,971,284

2013

1,978,336

1,978,336

7,052

FY 2012 

Estimate

FY 2012 

Estimate

FY 2013 

Change 

from Base

FY 2013 

Change 

from 

Base

FTE

Budget 

Authority FTE

Budget 

Authority

Increases:

A. Built-in:

1. Additional Rent Due to HQ Relocation..................................... - 23,063 - 2,363

2. FY 2013 Pay Raise......................................................................... - 23,063 - 55

Subtotal, Built-in Increases........................................................ 2,418

A. Program:

1. Alzheimer's Disease Supportive Services Program................. -- 4,011 -- 5,526

2. Adult Protective Services 1/....................................................... - - - 8,000

Subtotal, Program Increases...................................................... 13,526

Total Increases........................................................................... 15,944

Total estimated budget authority.................................................................................................................

(Obligations)....................................................................................................................................................

Total estimated budget authority.................................................................................................................

(Obligations)....................................................................................................................................................

Net Change...................................................................................................................................................
Page 32 of 194

Decreases:

A. Built-in:

1. RWA to GSA for HQ-Related Moving Costs.......................... 23,063 (2,167)

2. Reduction in Contract Costs to Offset Payraise...................... - 23,063 - (55)

Subtotal, Built-in Decreases....................................................... (2,222)

A. Program:

1. Aging and Disability Resource Centers 2/............................... -- 6,457 -- (6,457)

2. State Health Insurance Assistance Program............................ - 52,115 - (213)

Subtotal, Program Decreases..................................................... (6,670)

Total Decreases.......................................................................... (8,892)

Net Change............................................................................... 7,052

1/ Funding was first authorized for this program in the Elder Justice Act of 2012.

2/ Combined funding from mandatory and discretionary appropriations will be replaced, in FY 2013, by funding 

 from mandatory appropriations only.
Page 33 of 194

Administration on Aging

BA by Activity

(Dollars in Thousands)

Health and Independence:

Home & Community-Based Supportive Services.......................... $ 367,611 $ 366,916 $ 366,916

Nutrition Services ............................................................................. 657,141 655,901 655,901

Nutrition Services Incentive Program 1/......................................... 160,693 160,389 160,389

Preventive Health Services............................................................... 20,984 20,945 20,945

Community Service Employment for Older Americans 3/............. 449,100 448,251 448,251

Native American Nutrition & Supportive Services....................... 27,653 27,601 27,601

Aging Network Support Activities ................................................. 8,184 7,873 7,873

Subtotal, Health and Independence............................................. $ 1,691,366 $ 1,687,876 $ 1,687,876

Caregiver Services:

Family Caregiver Support Services.................................................. $ 153,912 $ 153,621 $ 153,621

Native American Caregiver Support Services................................ 6,376 6,364 6,364

Alzheimer's Disease Supportive Services Program....................... 11,441 4,011 9,537

Lifespan Respite Care........................................................................ 2,495 2,490 2,490

Subtotal, Caregiver Services.......................................................... $ 174,224 $ 166,486 $ 172,012

Protection of Vulnerable Adults:

Adult Protective Services.................................................................. $ -- $ -- $ 8,000

Long-Term Care Ombudsman Program........................................... 16,793 16,761 16,761

Prevention of Elder Abuse & Neglect............................................. 5,046 5,036 5,036

Senior Medicare Patrol Program....................................................... 9,420 9,402 9,402

Elder Rights Support Activities 5/.................................................. 4,096 4,088 4,088

Subtotal, Vulnerable Adults........................................................... $ 35,355 $ 35,287 $ 43,287

Consumer Information, Access & Outreach

Aging and Disability Resource Centers 6/..................................... $ 6,469 $ 6,457 $ --

State Health Insurance Assistance Program 7/............................. 52,000 52,115 51,902

Subtotal, Consumer......................................................................... $ 58,469 $ 58,572 $ 51,902

Program Innovations ........................................................................... $ 19,069 $ -- $ --

Program Administration:

Aging Services Programs Administration...................................... $ 19,939 $ 23,063 $ 23,259

Total, Discretionary Budget Authority.......................................... $ 1,998,422 $ 1,971,284 $ 1,978,336

FY 2011 

Actual

FY 2012 

Enacted

FY 2013 

Request
Page 34 of 194

 Health Care Fraud and Abuse Control 4/....................................... 3,312 10,710 10,710

Aging and Disability Resource Centers (mandatory) ................. $ 10,000 $ 10,000 $ 10,000

Long-Term Care Awareness Campaign 8/...................................... 3,000 3,000 3,000

Chronic Disease Self-Management 2/............................................. -- 10,000 10,000

Total, Program Level........................................................................... $ 2,014,734 $ 2,004,994 $ 2,012,046

Total, FTE.............................................................................................. 121 121 135

1/ Includes $2,025,445 in FY 2012 budget authority appropriated to AoA and transferred to the Department of Agriculture for 

 commodities purchases pursuant to P.L. 110-19 and P.L. 112-74.

2/ Provided in FY 2012 and requested in FY 2013 from Prevention and Public Health Funds provided by Sections 311 and 317(k)(2) 

 of the Public Health Service Act, [42 U.S.C. Sections 243 and 247b(k)(2)] as amended, and the Patient Protection and Affordable 

 Care Act (ACA), Section 4002 [42 U.S.C. 300u-11]

3/ Reflects transfer of the SCSEP program from the Department of Labor to AoA in FY 2013. Funding is compably displayed in

 FY 2011 and FY 2012.

4/ AoA received $3,312,080 in FY 2011 and $10,709,503 from the Health Care Fraud and Abuse Control wedge funds recovered from 

 fighting fraud. $10,709,503 is a placeholder amount for FY 2013. The Secretary and the Attorney General will determine the final

 amount.

5/ In FY 2011 activities were previously appropriated and requested in Aging Network Support and Program Innovations.

6/ Excludes $10 million in mandatory funds per section 2405 of P.L. 111-148 (Affordable Care Act).

7/ Reflects transfer of the SHIPs program from CMS to AoA in FY 2013. Funding is compably displayed in FY 2011 and FY 2012. 

 Transfer of discretionary funds from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance 

 Trust Fund.

8/ Funding in FY 2011 was via reimbursable agreement from CMS; funding in FY 2012 and FY 2013 is provided directly to AoA.
Page 35 of 194

Administration on Aging
Page 36 of 194

Authorizing Legislation

FY 2012 

Amount 

Authorized

FY 2012 

Appropriation

FY 2013 

Amount 

Authorized

FY 2013 

Pres. Budget

1) Home and CommunityBased Supportive Services:

OAA Section 321.................................................................. Expired $366,916,000 Expired $366,916,000

2) Nutrition Services

Services: OAA Sections 331 and 336................................ Expired $655,901,000 Expired $655,901,000

3) Nutrition Services Incentive

Program: OAA Section 311 1/............................................. Expired $160,389,000 Expired $160,389,000

4) Preventive Health Services:

OAA Section 361.................................................................. Expired $20,945,000 Expired $20,945,000

5) National Family Caregiver 

Support Program: OAA 

Section 371............................................................................. Expired $153,621,000 Expired $153,621,000

6) Community Service Employment for Older Americans

Title V OAA 

Section 371............................................................................. Expired $448,251,000 Expired $448,251,000

6) Native American Nutrition

and Supportive Services: 

OAA Sections 613 and 623................................................. Expired $27,601,000 Expired $27,601,000

7) Native American Caregiver

Support Program: OAA

Section 631............................................................................. Expired $6,364,000 Expired $6,364,000

8) Long-Term Care Ombudsman

Program: OAA Section 712 Expired $16,761,000 Expired $16,761,000

9) Prevention of Elder Abuse and

Neglect: OAA Section 721.................................................. Expired $5,036,000 Expired $5,036,000

11) Senior Medicare Patrol Program

 OAA Sections 201 and 202, as amended......................... Expired $9,402,000 Expired $9,402,000

12) Elder Rights Support Activities

 OAA Sections 201, 202, and 411, as amended................ Expired $4,088,000 Expired $4,088,000

14) Aging Network Support 

Activities: OAA Sections 202, 

215 and 411............................................................................ Expired $7,873,000 Expired $7,873,000

15) Alzheimer's Disease 

Demonstration Grants:

PHSA Section 398................................................................. Expired $4,011,000 Expired $9,537,000

16) Lifespan Respite Care

Lifespan Respite Care Act of 2006..................................... Expired $2,490,000 Expired $2,490,000

Title XXIX of the Public Health Service Act....................
Page 37 of 194

17) Program Administration:

OAA Section 205.................................................................. Expired $23,063,000 Expired $23,259,000

18) Aging and Disability Resource Centers

OAA Section 202b................................................................ Expired $6,457,000 Expired $0

18) State Health Insurance Assistance Program:

Omnibus Budget Reconciliation Act of 1990................... Expired $52,115,000 Expired $51,902,000

 Section 4360..........................................................................

19) Adult Protective Services

Section 6703, Patient Protection and Affordable Care.... $129,000,000 $0 $129,000,000 $8,000,000

Act, Subtitle B, Section 2042 ( P.L. 111-148) &.................

OAA Sections 751 and 752................................................. Expired

Total Request Level................................................................... $1,971,284,000 $1,978,336,000

Unfunded Authorizations:

1) Legal Assistance:

OAA Section 731.................................................................. Such Sums $0 Such Sums
Page 38 of 194

Administration on Aging

Appropriations History

Budget 

Estimate to 

Congress

House 

Allowance

Senate 

Allowance Appropriation

FY 2003 1,341,344,000 1,355,844,000 1,369,290,000 1,376,001,000

FY 2003 Rescission -- -- -- -8,944,007

FY 2004 1,343,701,000 1,377,421,000 1,361,193,000 1,382,189,000

FY 2004 Rescission /1 -- -- -- -8,271,225

FY 2005 1,376,527,000 1,403,479,000 1,395,117,000 1,404,634,000

FY 2005 Rescission /2 -- -- -- -11,292,624

FY 2006 1,369,028,000 1,376,217,000 1,391,699,000 1,376,624,000

FY 2006 Rescission -- -- -- -13,766,240

FY 2006 Transfer -- -- -- -936,197

FY 2007 1,334,835,000 1,390,306,000 1,380,516,000 1,383,007,000

FY 2008 /3 1,335,146,000 1,417,189,000 1,451,585,000 1,438,567,000

FY 2008 Rescission -- -- -- -25,131,765

FY 2009 /4 1,381,384,000 1,492,741,000 1,478,156,000 1,491,343,000

FY 2009 ARRA /5 -- -- -- 100,000,000

FY 2010 /6 1,491,343,000 1,530,881,000 1,495,038,000 1,516,297,000

FY 2010 Transfer -224,298

FY 2011 1,624,733,000 1,651,178,000 1,659,383,000 1,500,323,000

FY 2011 Recission -3,000,646

FY 2012 7/ 2,237,944,000 1,471,324,000 1,534,701,000 1,473,703,000

FY 2012 Recission -2,785,299

FY 2013 1,978,336,000
Page 39 of 194

1/ Reflects two separate rescissions of - $8,154,255 and -$117,000.

2/ Reflects two separate rescissions of - $11,236,624 and -$56,000.

3/ Includes $2,659,000 in FY 2008 budget authority appropriated to AoA and transferred to the 

 Department of Agriculture for commodities purchases pursuant to Public Law 110-19.

4/ Includes $2,681,000 in FY 2009 budget authority appropriated to AoA and transferred to the

 Department of Agriculture for commodities purchases pursuant to Public Law 110-19.

5/ American Recovery and Reinvestment Act of 2009, Public Law 111-5.

6/ Includes $2,544,103,000 in FY 2010 budget authority appropriated to AoA and transferred to the

 Department of Agriculture for commodities purchases pursuant to Public Law 110-19.

7/ Includes $2,025,445 in FY 2012 budget authority appropriated to AoA and transferred to the 

 Department of Agriculture for commodities purchases pursant to Public Law 112-74.
Page 40 of 194

Administration on Aging

Appropriations Not Authorized by Law

Program

Last Year of 

Authorization

Authorization 

Level

Appropriations in 

Last Year of 

Authorization

Appropriations 

Requested in FY 

2013

Alzheimer's Disease

 Supportive Services:

 PHSA Section 398 FY 2002 Such Sums $11,483,000 $9,537,000

Older Americans Act 1/ FY 2011 Such Sums $1,927,486,000 $1,906,407,000

Lifespan Respite Care: FY 2011 $94,810,000 $2,495,000 $2,490,000

 Lifespan Respite Care 

 Act of 2006

State Health Insurance FY 1996 $10,000,000 N/A $51,902,000

 Assistance Programs:

 Omnibus Budget

 Reconciliation Act of 1990

1/ Includes $448,251,000 for the Senior Community Service Employment Program (SCSEP) (Title V of the Older 

 Americans Act) which, in FY 2013 is proposed for transfer to AoA from the Department of Labor.
Page 41 of 194

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42

Health and Independence

Summary of Request

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 institutional care. These programs include home and community-based supportive 

services, nutrition services (both meals in congregate settings and those delivered to seniors in 

their homes), preventive health and chronic disease self-management services, and community 

service employment services. 

The U.S. population over age 60 is projected to increase by 15 percent between 2010 and 2015, 

from 57 million to 65.7 million6. In addition, the number of seniors with severe disabilitiesdefined as 3 or more limitations in activities of daily living-who are at greatest risk of nursing 

home admission, is projected to increase by more than 13 percent7 over the same period. AoA’s 

Health and Independence Programs are vital to helping seniors remain in their homes and 

communities for as long as possible. For example, 60 percent of congregate and 92 percent of 

home-delivered meal recipients reported that the meals allowed them to continue living in their 

own homes, while 53 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. 8

The FY 2013 funding request for Health and Independence services is $1,697,876,000; the same 

as the FY 2012 enacted level. For FY 2013, specific program requests include: 

• $366,916,000 for Home and Community-Based Supportive Services (HCBSS); the same 

as the FY 2012 enacted level. HCBSS provides grants to States to fund a broad array of 

services that enable seniors to remain in their homes for as long as possible, including 

adult day care, transportation, case management, personal care services, chore services, 

and physical fitness programs. These services also aid caregivers, who might otherwise 

have to be even more intensively relied upon to provide care for their loved ones, taking 

more time away from their work and other family responsibilities. 

• $816,290,000 for three Nutrition Services programs (Congregate Nutrition Services, 

Home-Delivered Nutrition Services and the Nutrition Services Incentives Program), the 

same as the FY 2012 enacted level. Nutrition Services help over 2.6 million older adults 

receive the meals they need to stay healthy and decrease their risk of disability. In 

FY 2013, these funds will support an estimated 219 million meals. 

 6 U.S. Census Bureau, “2008 National Population Projections,” released August 2008, 

<http://www.census.gov/population/www/projections/2008projections.html>. 7 Data extrapolated by AoA from U.S. Census Bureau, “2008 National Population Projections,” released August

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

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

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

8 2011 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.
HEALTH AND INDEPENDENCE

Page 43 of 194

• $20,945,000 for Preventive Health Services, the same as the FY 2012 enacted level. 

These services support activities that educate older adults about the importance of healthy 

lifestyles and promote healthy behaviors that can help prevent, delay, or enable seniors to 

better cope with and manage chronic disease and disability, thereby reducing the need for 

more costly medical interventions. AoA is continuing to include appropriations language 

that requires States to use their Preventive Health Services funds for proven 

evidence-based prevention activities. 

• $10,000,000 for Chronic Disease Self-Management Programs (CDSMP), which would 

continue funding at the same level as in FY 2012. CDSMP programs have proven 

effective in helping people to better self-manage their chronic conditions and reduce their 

need for more costly medical interventions. This program was funded for 

FY 2010-FY 2011 using funds provided under the American Recovery and Reinvestment 

Act (ARRA). Funding is provided in FY 2012, and requested to continue in FY 2013 

from the Prevention and Public Health Fund appropriated as part of the Affordable Care 

Act. The narrative request, because it involves funding from the Prevention and Public 

Health Fund, is included under a separate tab at the end of this document. 

• $448,251,000 for the Senior Community Service Employment Program (SCSEP); the 

same as the FY 2012 enacted level. SCSEP provides subsidized community-service and 

employment on-the-job training to low-income, unemployed older adults (to allow

participants to enter or re-enter the workforce). Like the FY 2012 budget, the FY 2013 

budget proposes the transfer of this program to AoA from the Department of Labor which 

will allow it to be better integrated with other OAA community-based programs, while 

also enhancing participants’ employment prospects.

• $27,601,000 for Native American Nutrition and Supportive Services, the same as the 

FY 2012 enacted level. These funds will provide approximately 4.5 million meals and 

830,000 rides for Native American seniors to critical daily activities such as meal sites, 

medical appointments, and grocery stores.

• $7,873,000 for Aging Network Support Activities, the same as the FY 2012 enacted 

level. These funds support competitive grants and contracts for ongoing activities which 

help seniors and their families obtain information about their care options and benefits, 

and which assist States, Tribes, and community providers of aging services carry out their 

mission to help older people remain independent and live in their own homes and 

communities.
44

Home and Community-Based Supportive Services

Authorizing Legislation: Section 321 of the Older Americans Act of 1965, as amended

FY 2013 Older Americans Act Authorization................................................................... Expired

Allocation Method .................................................................................................Formula Grant

Program Description and Accomplishments:

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 that enable seniors to remain in their homes for as long as 

possible. AoA programs, like 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 ensures clients can remain in their own homes and communities instead of 

entering nursing homes. 

The services provided to seniors 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 long-term care supports, statistics show 

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

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

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

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

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

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

expensive nursing home care. 

Services provided by the HCBSS program in FY 2010, the most recent available data, include: 

• Transportation Services provided nearly 26 million rides to doctor’s offices, grocery 

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

(Output C). 

FY 2011 

Enacted

FY 2012

Enacted

FY 2013 

Request

FY 2013 +/-

FY 2012

Home and Community-Based 

Supportive Services................................... $367,611,000 $366,916,000 $366,916,000 --
HEALTH AND INDEPENDENCE

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• Personal Care, Homemaker, and Chore Services provided over 35 million hours of 

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

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

(Output D).

• Adult Day Care/Day Health provided over 10 million hours of care for dependent adults in 

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

(Output E). 

• Case Management Services provided over 4 million hours of assistance in assessing 

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

(Output F). 

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

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

they do own a car they do not drive, and are not near public transportation. Many of these 

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

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

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

macular degeneration or cataracts); 

• 9 percent have Alzheimer’s or dementia; 

• 2 percent have Multiple Sclerosis; 

• 19 percent have had a stroke;

• 3 percent have epilepsy; and 

• 3 percent have Parkinson’s disease. 

 

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

20 medications daily.9 Data from AoA’s national surveys of elderly clients show that services 

such as transportation are providing these seniors with the assistance and information they need 

to help them remain at home. For example, over half of seniors using transportation services rely 

on them for the majority of their transportation needs and would otherwise be homebound, while 

80 percent of clients receiving case management reported that as a result of the services arranged 

by the case manager that they were better able to care for themselves.10

 9 2011 National Survey of Older Americans Act Participants. 

 In addition, a study 

published in the Journal of Aging and Health shows that the services provided by the HCBSS

http://www.data.aoa.gov, select AGID.

10 2011 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.
HEALTH AND INDEPENDENCE

Page 46 of 194

program, what the article calls “personal care services,” are the critical services that enable frail 

seniors to remain in their homes and out of nursing home care.11 

Funding History:

Funding for Home and Community-Based Supportive Services during the past ten years is as 

follows:

FY 2003..................................$355,673,000

FY 2004..................................$353,889,000

FY 2005..................................$354,136,000

FY 2006..................................$350,354,000

FY 2007..................................$350,595,000

FY 2008..................................$351,348,000

FY 2009..................................$361,348,000

FY 2010..................................$368,290,000

FY 2011..................................$367,611,000

FY 2012..................................$366,916,000

Budget Request:

The FY 2013 request for Home and Community-Based Supportive Services is $366,916,000, the 

same as the FY 2012 enacted level. HCBSS help to put off the need for much more expensive 

institutional services. In addition, the services funded by this program - particularly adult day 

care, personal care, and chore services – also aid caregivers, who might otherwise have to be 

even more intensively involved with the care of their loved ones, taking time away from work 

and their other family responsibilities and further straining family budgets. The overall budget 

request will support 7.5 million hours of adult day care for older adults; 18 million rides for 

critical daily activities such as visiting the doctor, the pharmacy, or grocery stores; and 30 million 

hours of assistance to seniors who are unable to perform daily activities. 

AoA’s core formula grant programs currently reach one in five seniors, serving over a half 

million seniors in their own communities who meet the disability criteria for nursing home 

admission and helping to keep them from joining the 1.7 million seniors who live in institutional 

settings. Nationally, about 26 percent of individuals 60 and older live alone, and in FY 2013

AoA projects 70 percent of the Older Americans Act transportation users will be individuals who 

live alone (Outcome 2.11). Living alone is a key predictor of nursing home admission, and 

HCBSS services are critical to their ability to remain at home, especially for those who do not 

have an informal caregiver to assist with their care. However, recent research has shown that 

childless seniors who live in a State with higher home and community-based service 

expenditures had significantly lower risk of nursing home admissions.12

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

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

V. 22: 267. Available: 

 

http://jah.sagepub.com/cgi/content/abstract/22/3/267. 12 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.
HEALTH AND INDEPENDENCE

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Federal support for Older Americans Act programs is not expected to cover the cost of serving 

every senior. These programs have strong partnerships with State and local governments, 

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

leveraged resources of $2 or $3 per every Older Americans Act dollar, despite being required to 

meet a far lower (25%) ratio. 

Nonetheless, AoA projects a decline in certain measures of performance for home and 

community-based services in FY 2013 compared to FY 2010, specifically transportation units 

provided and personal care, homemaker, and chore service units provided. Declines in outputs 

are projected to be largely attributable to declining leveraged funds, as State, local, and private 

budgets face economic hardships. 
HEALTH AND INDEPENDENCE

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Outputs and Outcomes Table:

Home and Community-Based Supportive Services Outputs and Outcomes

Measure Most Recent Result FY 2012

Target 

FY 2013

Target 

FY 2013 

+/- FY 2012

2.9b: 90% of transportation clients rate 

services good to excellent. (Outcome)

FY 2010: 98%

Target: 90% 

(Target Exceeded)

90% 90% Maintain

2.11: Increase the percentage of 

transportation clients who live alone.

(Outcome)

FY 2010: 68%

Target: 70% (Target Not Met) 70% 70% Maintain

Indicator Most Recent Result FY 2012

Projection 

FY 2013

Projection 

FY 2013 

+/- FY 2012

Output C: Transportation Services 

units (Output) FY 2010: 25.85 M 20.9 M 18 M -2.9 M

Output D: Personal Care, Homemaker 

and Chore Services units (Output) FY 2010: 35.13 M 30.0 M 30.0 M --

Output E: Adult Day Care/Day Health 

units (Output) FY 2010: 10.27 M 7.5 M 7.5 M --

Output F: Case Management Services 

units (Output) FY 2010: 4.12 M 3.5 M 3.5 M --

Note: For presentation within the budget AoA highlighted specific measures that are most directly related to Home 

and Community-Based Supportive Services; however multiple performance outcomes are impacted by this program 

because AoA’s performance measures (efficiency, effective targeting, and client outcomes) assess network-wide 

performance in achieving current strategic objectives.

Grant Awards Tables:

Home and Community-Based Supportive Services Grant Awards

FY 2011

Actual

FY 2012

Enacted

FY 2013

Budget 

Request

Number of 

Awards 56 56 56

Average 

Award $6,525,038 $6,486,555 $6,486,555

Range of 

Awards

$228,376 -

$36,232,873

$227,029 -

$36,037,733

$227,029 -

$36,037,733
HEALTH AND INDEPENDENCE

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION ON AGING

FY 2013 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM: Home and Community-Based Supportive Services (CFDA 93.044)

State/Territory

FY 2011

Actual

FY 2012

Estimate

FY 2013

Request

Difference

+/-FY 2012

Alabama......................................... 5,610,623 5,536,753 5,536,753 --

Alaska............................................ 1,827,011 1,816,235 1,816,235 --

Arizona .......................................... 7,448,464 7,359,648 7,359,648 --

Arkansas........................................ 3,543,506 3,500,996 3,500,996 --

California....................................... 36,232,873 36,037,733 36,037,733 --

Colorado ........................................ 4,862,516 4,854,891 4,854,891 --

Connecticut.................................... 4,404,337 4,404,337 4,404,337 --

Delaware........................................ 1,827,011 1,816,235 1,816,235 --

District of Columbia....................... 1,827,011 1,816,235 1,816,235 --

Florida ........................................... 26,238,773 26,054,949 26,054,949 --

Georgia .......................................... 9,194,575 9,059,015 9,059,015 --

Hawaii ........................................... 1,827,011 1,816,235 1,816,235 --

Idaho.............................................. 1,827,011 1,816,235 1,816,235 --

Illinois............................................ 14,524,890 14,524,890 14,524,890 --

Indiana........................................... 7,165,491 7,065,226 7,065,226 --

Iowa............................................... 4,260,878 4,260,878 4,260,878 --

Kansas........................................... 3,432,908 3,432,908 3,432,908 --

Kentucky........................................ 4,989,594 4,915,884 4,915,884 --

Louisiana ....................................... 4,838,530 4,795,898 4,795,898 --

Maine............................................. 1,827,011 1,816,235 1,816,235 --

Maryland........................................ 6,149,883 6,079,225 6,079,225 --

Massachusetts ................................ 8,209,095 8,209,095 8,209,095 --

Michigan........................................ 11,646,647 11,444,057 11,444,057 --

Minnesota ...................................... 5,783,935 5,708,544 5,708,544 --

Mississippi..................................... 3,272,711 3,272,711 3,272,711 --

Missouri......................................... 7,118,429 7,118,429 7,118,429 --

Montana......................................... 1,827,011 1,816,235 1,816,235 --

Nebraska........................................ 2,294,938 2,294,938 2,294,938 --

Nevada........................................... 2,755,306 2,817,723 2,817,723 --

New Hampshire.............................. 1,827,011 1,816,235 1,816,235 --
HEALTH AND INDEPENDENCE

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PROGRAM: Home and Community-Based Supportive Services (CFDA 93.044)

State/Territory

FY 2011

Actual

FY 2012

Estimate

FY 2013

Request

Difference

+/-FY 2012

New Jersey.................................... 10,262,972 10,262,972 10,262,972 --

New Mexico.................................. 2,237,028 2,283,731 2,283,731 --

New York ..................................... 24,283,431 24,283,431 24,283,431 --

North Carolina .............................. 10,484,174 10,506,029 10,506,029 --

North Dakota................................. 1,827,011 1,816,235 1,816,235 --

Ohio.............................................. 13,816,810 13,816,810 13,816,810 --

Oklahoma ..................................... 4,278,286 4,278,286 4,278,286 --

Oregon.......................................... 4,576,322 4,563,036 4,563,036 --

Pennsylvania ................................. 17,879,977 17,879,977 17,879,977 --

Rhode Island ................................. 1,827,011 1,816,235 1,816,235 --

South Carolina .............................. 5,479,859 5,409,350 5,409,350 --

South Dakota................................. 1,827,011 1,816,235 1,816,235 --

Tennessee...................................... 7,364,949 7,257,606 7,257,606 --

Texas............................................ 22,440,012 22,389,947 22,389,947 --

Utah.............................................. 2,181,148 2,105,540 2,105,540 --

Vermont........................................ 1,827,011 1,816,235 1,816,235 --

Virginia......................................... 8,499,074 8,414,378 8,414,378 --

Washington................................... 7,221,988 7,172,105 7,172,105 --

West Virginia................................ 2,773,538 2,773,538 2,773,538 --

Wisconsin ..................................... 6,539,594 6,468,835 6,468,835 --

Wyoming...................................... 1,827,011 1,816,235 1,816,235 -- 

Subtotal, States.............................. 358,049,207 356,225,354 356,225,354 --

American Samoa ........................... 472,317 472,317 472,317 --

Guam............................................ 913,505 908,118 908,118 --

Northern Mariana Islands.............. 228,376 227,029 227,029 --

Puerto Rico ................................... 4,825,219 4,506,117 4,506,117 --

Virgin Islands................................ 913,505 908,118 908,118 --

Subtotal, States and Territories ...... 365,402,129 363,247,053 363,247,053 --

Undistributed 13/ .......................... 2,208,871 3,668,947 3,668,947 -- 

TOTAL 367,611,000 366,916,000 366,916,000 --

 13/ Funds held for statutory related requirements are reflected in the undistributed line.
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53

Nutrition Services

FY 2011

Enacted

FY 2012

Enacted

FY 2013 

Budget 

Request

FY 2013 +/-

FY 2012

Congregate Nutrition................... $439,901,000 $439,070,000 $439,070,000 --

Home-Delivered Nutrition........... $217,241,000 $216,831,000 $216,831,000 --

Nutrition Services Incentive 

Program...................................... $160,693,000 $160,389,000 $160,389,000 -- 

 Total BA................................ $817,835,000 $816,290,000 $816,290,000 --

Authorizing Legislation: Sections 311, 331, and 336 of the Older Americans Act of 1965, as 

amended

FY 2013 Older Americans Act Authorization................................................................... Expired

Allocation Method .................................................................................................Formula Grant

Program Description and Accomplishments:

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

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

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

or geographic isolation. Nutrition Services, which help seniors remain healthy and independent 

in their communities, include:

• Congregate Nutrition Services (Title III-C1): Provides funding for the provision of meals 

and related services in a variety of congregate settings, which helps to keep older 

Americans healthy and prevents the need for more costly medical interventions. 

Established in 1972, the program also presents opportunities for social engagement and 

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

• Home-Delivered Nutrition Services (Title III-C2): Provides funding for the delivery of 

meals and related services to frail seniors who are homebound. Established in 1978, 

home-delivered meals are often the first in-home service that an older adult receives and 

serve as a primary access point for other home and community-based services. Homedelivered meals also represent an essential service for many caregivers, helping them to 

maintain their own health and well-being.

• Nutrition Services Incentive Program (Title III-A): Provides additional funding to States, 

Territories, and eligible Tribal Organizations that is used exclusively to provide meals 

and cannot be used to pay for other nutrition-related services or for administrative costs. 

Funds are awarded to States and Tribes based on the number of meals served in the prior 

Federal fiscal year. States and Tribes have the option to purchase commodities directly 
HEALTH AND INDEPENDENCE

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

determine that doing so will enable them to better meet the needs of seniors. Eight States 

and five Tribes elected to spend approximately $2.3 million on commodities, including 

$190,403 assessed by USDA as administrative expenses in FY 2011. 

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

allocated to States and Territories based on their share of the population age 60 and over. 

Nutrition Services Incentive Program grants are provided to States, Territories, and Tribal 

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

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

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

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

Sciences. 

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

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

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

(IADLs), including obtaining and preparing food; these nutrition programs help address their 

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

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

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

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

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

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

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

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

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

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

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

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

recipients say that the meals enabled them to continue living in their own homes.14 In addition, 

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

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

and Zinc intakes compared to matched non-participant group of senior citizens.15 Seniors with 

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

to infection, fatigue, vasodilatation, and other illnesses.

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

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

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

(Outcome 2.9a). Also, the number of home-delivered meal recipients with severe disabilities 

(3+ ADL) totaled nearly 349,000 in 2010 (Outcome 3.2). This level of disability is frequently 

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

 14 2011 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID. 15 Serving Elders at Risk – National Evaluation of the Elderly Nutrition Program, 1993-1995, pp.117-118
HEALTH AND INDEPENDENCE

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number of home-delivered meal clients. The most recent data on how these nutrition programs 

are helping seniors remain healthy and independent in their homes include:

• Home-Delivered Nutrition Services provided over 145 million meals to over 

860,000 individuals in FY 2010 (Output G).

• Congregate Nutrition Services provided over 96.4 million meals to over 1.7 million 

seniors in a variety of community settings in FY 2010 (Output H).

Funding History:

Comparable funding for Nutrition Services during the past ten years is as follows:

FY 2003..................................$714,274,000

FY 2004..................................$714,462,000

FY 2005..................................$718,696,000

FY 2006..................................$714,578,000

FY 2007..................................$735,070,000

FY 2008..................................$758,003,000

FY 2009..................................$809,743,000

FY 2009 (ARRA)......................$97,000,000

FY 2010..................................$819,353,000

FY 2011..................................$817,835,000

FY 2012..................................$816,290,000

Budget Request:

The FY 2013 request for Nutrition Services is $816,290,000, the same as the FY 2012 enacted 

level. At this level, the budget request will support 219 million home-delivered and congregate 

meals to approximately two million elderly individuals in a variety of community settings.

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

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

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

survival of the 28 percent of recipients who report these meals as the sole or majority of their 

food intake for the day and for the 297,000 home-delivered meal recipients with severe 

disabilities who are projected to be served in FY 2013 (Outcome 3.2). This population with 

severe disabilities is particularly important to serve since this level of disability is frequently an 

eligibility requirement for more costly nursing home admission.

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

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

private donations that contribute funding. In FY 2009, State and local funding comprised 

approximately 66 percent of all the funding for home-delivered meals and congregate meals. 

Though all programs funded through OAA rely on State and local funding in some part, 
HEALTH AND INDEPENDENCE

Page 56 of 194

congregate and home-delivered meals have a higher rate of State and local financial support than 

many other OAA services.

In FY 2013 these programs are expected to continue to provide home-delivered meals that clients

rate good to excellent (Outcome 2.9a) ensuring that clients continue to receive high quality 

services. However, as State and local funding tightens, some providers may look at cost cutting 

measures such as reducing menu choices or the frequency of deliveries. This could affect client 

satisfaction with the quality of service.

Outcomes and Outputs Table:

Nutrition Services Outcomes and Outputs

Measure Most Recent Result FY 2012

Target 

FY 2013

Target 

FY 2013 +/-

FY 2012

1.1: For Home and 

Community-based Services 

including Nutrition 

Services, and Caregiver 

services increase the 

number of clients served 

per million dollars of AoA 

funding. (Outcome)

FY 2010: 8,438

Target: 7,742

(Target Exceeded)

8,600 8,600 Maintain

2.9a: 90% of home 

delivered meal clients rate 

services good to excellent.

(Outcome)

FY 2010: 90%16

Target: 90% 

(Target Met)

90% 90% Maintain

3.2: Increase the number of 

older persons with severe 

disabilities who receive 

home-delivered meals.

(Outcome)

FY 2010: 348,669

Target: 325,000

(Target Exceeded)

311,000 297,000 -14,000

Indicator Most Recent Result FY 2012

Projection

FY 2013 

Projection 

FY 2013 +/-

FY 2012

Output G: Number of 

Home-Delivered meals 

served (Output)

FY 2010: 145.5 M 135 M 135 M --

Output H: Number of 

Congregate meals served

(Output)

FY 2010: 96.4 M 84.2 M 84 M -0.4 M

Outputs G& H: Total 

Number of Meals (Outputs) FY 2010: 241.9 M 219.2 M 219 M -0.2 M

Note: For presentation within the budget AoA highlighted specific measures that are most directly related to 

Nutrition Services, however multiple performance outcomes are impacted by this program because AoA’s 

performance measures (efficiency, effective targeting, and client outcomes) assess network-wide performance in 

achieving current strategic objectives.

 16 Based on upper range of survey confidence interval.
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Grant Awards Tables:

Congregate Nutrition Programs Grant Awards

FY 2011

Actual

FY 2012

Enacted

FY 2013

Budget 

Request

Number of 

Awards 56 56 56

Average 

Award $7,808,176 $7,659,943 $7,659,943

Range of 

Awards

$273,286 -

$43,454,221

$268,098 -

$42,353,702

$268,098 -

$42,353,702

Home-Delivered Nutrition Programs Grant Awards

FY 2011

Actual

FY 2012

Enacted

FY 2013

Budget 

Request

Number of 

Awards 56 56 56

Average 

Award $3,855,985 $3,782,782 $3,782,782

Range of 

Awards

$134,959 -

$21,832,514

$132,397 -

$21,582,902

$132,397 -

$21,582,902

Nutrition Services Incentive Program Grant Awards

FY 2011

Actual

FY 2012

Enacted

FY 2013

Budget 

Request

Number of 

Awards 308 308 308

Average 

Award17 $518,595 $515,537 $515,537

Range of 

Awards

$402 -

$15,387,754

$402 -

$15,327,968

$402 -

$15,327,968

 17 If the 253 awards to Tribal organizations are excluded from the “average award” calculation, the average award to 

States, DC, and the territories is $2,845,943 in FY 2011; $2,829,044 in FY 2012 and FY 2013.
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DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION ON AGING

FY 2013 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM: Congregate Nutrition Services (CFDA 93.045)

State/Territory

FY 2011

Actual

FY 2012

Estimate

FY 2013

Request

Difference

+/-FY 2012

Alabama......................................... 6,728,841 6,646,863 6,646,863 --

Alaska............................................ 2,186,289 2,173,394 2,173,394 --

Arizona .......................................... 8,932,970 8,835,245 8,835,245 --

Arkansas........................................ 4,249,740 4,177,866 4,177,866 --

California....................................... 43,454,221 43,263,238 43,263,238 --

Colorado ........................................ 5,831,634 5,828,289 5,828,289 --

Connecticut.................................... 5,241,452 5,241,452 5,241,452 --

Delaware........................................ 2,186,289 2,173,394 2,173,394 --

District of Columbia....................... 2,186,289 2,173,394 2,173,394 --

Florida ........................................... 31,468,259 31,278,922 31,278,922 --

Georgia .......................................... 11,027,088 10,875,332 10,875,332 --

Hawaii ........................................... 2,186,289 2,173,394 2,173,394 --

Idaho.............................................. 2,186,289 2,173,394 2,173,394 --

Illinois............................................ 17,286,541 17,286,541 17,286,541 --

Indiana........................................... 8,593,601 8,481,791 8,481,791 --

Iowa............................................... 5,081,501 5,081,501 5,081,501 --

Kansas........................................... 4,089,903 4,089,903 4,089,903 --

Kentucky........................................ 5,984,038 5,901,510 5,901,510 --

Louisiana ....................................... 5,802,867 5,699,802 5,699,802 --

Maine............................................. 2,186,289 2,173,394 2,173,394 --

Maryland........................................ 7,375,577 7,298,099 7,298,099 --

Massachusetts ................................ 9,780,267 9,780,267 9,780,267 --

Michigan........................................ 13,967,867 13,738,571 13,738,571 --

Minnesota ...................................... 6,936,695 6,853,097 6,853,097 --

Mississippi..................................... 3,897,686 3,891,114 3,891,114 --

Missouri......................................... 8,467,047 8,467,047 8,467,047 --

Montana......................................... 2,186,289 2,173,394 2,173,394 --

Nebraska........................................ 2,738,802 2,738,802 2,738,802 --

Nevada........................................... 3,304,449 3,382,671 3,382,671 --

New Hampshire.............................. 2,186,289 2,173,394 2,173,394 --
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PROGRAM: Congregate Nutrition Services (CFDA 93.045)

State/Territory

FY 2011

Actual

FY 2012

Estimate

FY 2013

Request

Difference

+/-FY 2012

New Jersey.................................... 12,190,488 12,190,488 12,190,488 --

New Mexico.................................. 2,682,876 2,741,615 2,741,615 --

New York ..................................... 28,963,855 28,963,855 28,963,855 --

North Carolina .............................. 12,573,709 12,612,470 12,612,470 --

North Dakota................................. 2,186,289 2,173,394 2,173,394 --

Ohio.............................................. 16,533,997 16,393,785 16,393,785 --

Oklahoma ..................................... 5,104,353 5,080,736 5,080,736 --

Oregon.......................................... 5,488,400 5,477,917 5,477,917 --

Pennsylvania ................................. 21,279,716 21,279,716 21,279,716 --

Rhode Island ................................. 2,186,289 2,173,394 2,173,394 --

South Carolina .............................. 6,572,016 6,493,915 6,493,915 --

South Dakota................................. 2,186,289 2,173,394 2,173,394 --

Tennessee...................................... 8,832,811 8,712,744 8,712,744 --

Texas............................................ 26,912,390 26,879,093 26,879,093 --

Utah.............................................. 2,615,859 2,527,698 2,527,698 --

Vermont........................................ 2,186,289 2,173,394 2,173,394 --

Virginia......................................... 10,192,972 10,101,446 10,101,446 --

Washington................................... 8,661,357 8,610,100 8,610,100 --

West Virginia................................ 3,305,947 3,305,947 3,305,947 --

Wisconsin ..................................... 7,842,960 7,765,825 7,765,825 --

Wyoming...................................... 2,186,289 2,173,394 2,173,394 --

Subtotal, States.............................. 428,416,509 426,229,395 426,229,395 --

American Samoa ........................... 594,843 594,843 594,843 --

Guam............................................ 1,093,145 1,086,697 1,086,697 --

Northern Mariana Islands.............. 273,286 271,674 271,674 --

Puerto Rico ................................... 5,786,903 5,409,585 5,409,585 --

Virgin Islands................................ 1,093,145 1,086,697 1,086,697 --

Subtotal, States and Territories ...... 437,257,831 434,678,891 434,678,891 --

Undistributed 18/ .......................... 2,643,169 4,391,109 4,391,109 --

 

TOTAL.................................. 439,901,000 439,070,000 439,070,000 --

 18/ Funds held for statutory related requirements are reflected in the undistributed line.
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DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION ON AGING

FY 2013 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM: Home-Delivered Nutrition Services (CFDA 93.045)

State/Territory

FY 2011

Actual

FY 2012

Estimate

FY 2013

Request

Difference

+/-FY 2012

Alabama......................................... 3,380,743 3,360,219 3,360,219 --

Alaska............................................ 1,079,676 1,073,311 1,073,311 --

Arizona .......................................... 4,488,153 4,466,521 4,466,521 --

Arkansas........................................ 2,135,178 2,112,056 2,112,056 --

California....................................... 21,832,514 21,871,060 21,871,060 --

Colorado ........................................ 2,929,963 2,946,401 2,946,401 --

Connecticut.................................... 2,533,609 2,554,038 2,554,038 --

Delaware........................................ 1,079,676 1,073,311 1,073,311 --

District of Columbia....................... 1,079,676 1,073,311 1,073,311 --

Florida ........................................... 15,810,460 15,812,575 15,812,575 --

Georgia .......................................... 5,540,292 5,497,856 5,497,856 --

Hawaii ........................................... 1,079,676 1,073,311 1,073,311 --

Idaho.............................................. 1,079,676 1,073,311 1,073,311 --

Illinois............................................ 8,295,464 8,184,109 8,184,109 --

Indiana........................................... 4,317,645 4,287,838 4,287,838 --

Iowa............................................... 2,243,404 2,235,225 2,235,225 --

Kansas........................................... 1,895,162 1,888,402 1,888,402 --

Kentucky........................................ 3,006,534 2,983,417 2,983,417 --

Louisiana ....................................... 2,915,509 2,881,447 2,881,447 --

Maine............................................. 1,079,676 1,082,056 1,082,056 --

Maryland........................................ 3,705,679 3,689,441 3,689,441 --

Massachusetts ................................ 4,663,308 4,581,199 4,581,199 --

Michigan........................................ 7,017,815 6,945,322 6,945,322 --

Minnesota ...................................... 3,485,174 3,464,477 3,464,477 --

Mississippi..................................... 1,958,298 1,947,092 1,947,092 --

Missouri......................................... 4,251,524 4,215,343 4,215,343 --

Montana......................................... 1,079,676 1,073,311 1,073,311 --

Nebraska........................................ 1,227,879 1,231,109 1,231,109 --

Nevada........................................... 1,660,240 1,710,057 1,710,057 --

New Hampshire.............................. 1,079,676 1,073,311 1,073,311 --
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PROGRAM: Home-Delivered Nutrition Services (CFDA 93.045)

State/Territory

FY 2011

Actual

FY 2012

Estimate

FY 2013

Request

Difference

+/-FY 2012

New Jersey.................................... 6,073,137 5,996,154 5,996,154 --

New Mexico.................................. 1,347,946 1,385,981 1,385,981 --

New York ..................................... 13,639,815 13,255,677 13,255,677 --

North Carolina .............................. 6,317,354 6,376,039 6,376,039 --

North Dakota................................. 1,079,676 1,073,311 1,073,311 --

Ohio.............................................. 8,307,104 8,230,098 8,230,098 --

Oklahoma ..................................... 2,564,558 2,558,978 2,558,978 --

Oregon.......................................... 2,757,513 2,769,276 2,769,276 --

Pennsylvania ................................. 9,854,900 9,723,903 9,723,903 --

Rhode Island ................................. 1,079,676 1,073,311 1,073,311 --

South Carolina .............................. 3,301,949 3,282,898 3,282,898 --

South Dakota................................. 1,079,676 1,073,311 1,073,311 --

Tennessee...................................... 4,437,831 4,404,593 4,404,593 --

Texas............................................ 13,521,475 13,588,310 13,588,310 --

Utah.............................................. 1,314,275 1,277,838 1,277,838 --

Vermont........................................ 1,079,676 1,073,311 1,073,311 --

Virginia......................................... 5,121,210 5,106,630 5,106,630 --

Washington................................... 4,351,688 4,352,703 4,352,703 --

West Virginia................................ 1,494,917 1,521,444 1,521,444 --

Wisconsin ..................................... 3,940,504 3,925,893 3,925,893 --

Wyoming...................................... 1,079,676 1,073,311 1,073,311 --

Subtotal, States.............................. 211,676,511 210,583,407 210,583,407 --

American Samoa ........................... 136,498 136,498 136,498 --

Guam............................................ 539,838 536,655 536,655 --

Northern Mariana Islands.............. 134,959 134,164 134,164 --

Puerto Rico ................................... 2,907,489 2,734,732 2,734,732 --

Virgin Islands................................ 539,838 536,655 536,655 --

Subtotal, States and Territories ...... 215,935,133 214,662,111 214,662,111 --

Undistributed 19/ .......................... 1,305,867 2,168,889 2,168,889 --

 

TOTAL................................... 217,241,000 216,831,000 216,831,000 --

 19/ Funds held for statutory related requirements are reflected in the undistributed line.
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DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION ON AGING

FY 2013 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM: Nutrition Services Incentive Program (CFDA 93.053)

State/Territory

FY 2011

Actual

FY 2012

Estimate

FY 2013

Request

Difference

+/-FY 2012

Alabama ........................................ 2,757,851 2,741,475 2,741,475 --

Alaska ........................................... 355,155 353,047 353,047 --

Arizona.......................................... 2,137,183 2,124,493 2,124,493 --

Arkansas........................................ 2,631,552 2,615,926 2,615,926 --

California ...................................... 12,422,425 12,348,663 12,348,663 --

Colorado........................................ 1,412,481 1,404,094 1,404,094 --

Connecticut ................................... 1,504,816 1,495,881 1,495,881 --

Delaware ....................................... 606,130 602,531 602,531 --

District of Columbia ...................... 601,892 598,318 598,318 --

Florida........................................... 7,752,196 7,706,165 7,706,165 --

Georgia.......................................... 2,827,339 2,810,550 2,810,550 --

Hawaii........................................... 474,893 472,073 472,073 --

Idaho............................................. 677,345 673,323 673,323 --

Illinois........................................... 7,020,289 6,978,604 6,978,604 --

Indiana .......................................... 1,900,591 1,889,306 1,889,306 --

Iowa .............................................. 1,960,304 1,948,664 1,948,664 --

Kansas........................................... 2,201,986 2,188,911 2,188,911 --

Kentucky....................................... 1,852,778 1,841,777 1,841,777 --

Louisiana....................................... 3,201,511 3,182,501 3,182,501 --

Maine............................................ 583,674 580,208 580,208 --

Maryland....................................... 1,899,261 1,887,983 1,887,983 --

Massachusetts................................ 5,809,015 5,774,522 5,774,522 --

Michigan ....................................... 7,267,382 7,224,229 7,224,229 --

Minnesota...................................... 1,974,728 1,963,002 1,963,002 --

Mississippi .................................... 1,201,461 1,194,327 1,194,327 --

Missouri ........................................ 4,055,147 4,031,068 4,031,068 --

Montana ........................................ 1,159,925 1,153,038 1,153,038 --

Nebraska ....................................... 1,266,994 1,259,470 1,259,470 --

Nevada .......................................... 1,083,744 1,077,309 1,077,309 --

New Hampshire............................. 1,103,997 1,097,442 1,097,442 --
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PROGRAM: Nutrition Services Incentive Program (CFDA 93.053)

State/Territory

FY 2011

Actual

FY 2012

Estimate

FY 2013

Request

Difference

+/-FY 2012

New Jersey.................................... 3,813,364 3,790,721 3,790,721 --

New Mexico.................................. 1,980,506 1,968,746 1,968,746 --

New York ..................................... 15,419,529 15,327,968 15,327,968 --

North Carolina .............................. 3,361,424 3,341,464 3,341,464 --

North Dakota................................. 806,432 801,643 801,643 --

Ohio.............................................. 5,577,024 5,543,908 5,543,908 --

Oklahoma ..................................... 2,045,615 2,033,469 2,033,469 --

Oregon.......................................... 1,797,863 1,787,187 1,787,187 --

Pennsylvania ................................. 7,162,223 7,119,695 7,119,695 --

Rhode Island ................................. 537,442 534,251 534,251 --

South Carolina .............................. 1,710,911 1,700,751 1,700,751 --

South Dakota................................. 953,291 947,630 947,630 --

Tennessee...................................... 1,647,948 1,638,162 1,638,162 --

Texas............................................ 12,539,020 12,464,565 12,464,565 --

Utah.............................................. 1,332,354 1,324,443 1,324,443 --

Vermont........................................ 755,471 750,985 750,985 --

Virginia......................................... 2,473,229 2,458,543 2,458,543 --

Washington................................... 2,074,062 2,061,747 2,061,747 --

West Virginia................................ 1,619,809 1,610,191 1,610,191 --

Wisconsin ..................................... 2,651,426 2,635,682 2,635,682 --

Wyoming...................................... 788,892 784,207 784,207 --

Subtotal, States.............................. 152,751,880 149,845,819 149,845,819 --

American Samoa ........................... -- -- -- --

Guam............................................ 393,220 390,885 390,885 --

Northern Mariana Islands.............. 62,962 62,589 62,589 --

Puerto Rico ................................... 3,118,596 3,100,079 3,100,079 --

Virgin Islands................................ 200,210 199,021 199,021 --

Subtotal, States and Territories ...... 156,526,868 155,597,432 155,597,432 --

Tribal Organizations....................... 3,200,411 3,187,965 3,187,965 --

Undistributed 20/ ........................... 965,721 1,603,603 1,603,603 --

TOTAL................................. 160,693,000 160,389,000 160,389,000 --

 20/ Funds held for statutory related requirements are reflected in the undistributed line.
65

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67

Preventive Health Services

FY 2011 

Enacted

FY 2012

Enacted

FY 2013 

Request

FY 2013 +/-

FY 2012

Preventive Health Services... $20,984,000 $20,945,000 $20,945,000 --

Authorizing Legislation: Section 361 of the Older Americans Act of 1965, as amended

FY 2013 Older Americans Act Authorization................................................................... Expired

Allocation Method .................................................................................................Formula Grant

Program Description and Accomplishments:

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

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

educate older adults about the importance of healthy lifestyles and promote healthy behaviors 

that can help to prevent or delay chronic disease and disability, thereby reducing the need for 

more costly medical interventions. 

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

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

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

expect to live an additional 18.6 years. The population of older Americans is also growing, 

particularly the population age 85 and over, which is growing very rapidly, totaling 5.5 million in 

2010 and projected to reach 8.7 million by the year 2030. One consequence of this increased 

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

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

quickly limits physical activity. 

Preventive Health Services gives States and Territories flexibility to allocate resources among 

the preventive health activities of their choice to best meet local needs. Priority has been given to 

providing services to those elders living in medically underserved areas of the state or who have 

the greatest economic need. Services currently provided through the Preventive Health Services

program include:

• Information and Outreach, including the distribution of information to seniors through 

Aging and Disability Resource Centers, Area Agencies on Aging, senior centers, 

community parks and recreation programs, housing programs, faith based organizations, 

chronic disease self-management programs, congregate meal sites, and the 

home-delivered meals program about healthy lifestyles and behaviors.

• Health Screenings and Risk Assessments for a variety of conditions, including 

hypertension, diabetes, dental issues, high cholesterol, hearing and vision loss, and 

glaucoma.
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• Evidence-based Prevention Programs, as described below.

Over the last few years, some States have begun to shift their funding to provide greater support 

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

FY 2012, AoA requested, and the Congress included in appropriations language a provision 

which requires States to use all of their title III-D Preventive Health funds to support proven 

evidence-based models that enhance the wellness and fitness of the aging community. Since 

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

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

funding other health services, they still will have the flexibility to continue to use funds provided 

under the Home and Community-Based Services program for this purpose. 

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

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

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

Some examples of evidence-based interventions are:

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

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

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

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

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

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

a buffer against many illnesses impacted by stress.

• Falls prevention: Falls prevention programs help participants to achieve 

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

reduce fall risk factors; involve medication reviews and modifications; provide referrals 

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

assessments of ways to reduce environmental hazards. Recent studies have shown that in 

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

who fall, 20 to 30 percent will experience serious injuries, such as head trauma, broken 

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

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

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

which may reduce strength, physical fitness, and mobility.21

 21 Even, Jennifer. 2009. Senior Series. The Ohio State University Extension. 20 May 2009.
HEALTH AND INDEPENDENCE

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• Medication management: Medication management programs focus on reviewing the 

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

medications. Medication management programs have been shown to reduce unnecessary 

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

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

adults.

Preventive Health Services have been carried out at multi-purpose senior centers, meal sites, and 

other community-based settings, as well as through individualized counseling and services for 

vulnerable elders. States reported 5.9 million seniors served in these health-related programs 

which received $16 million in additional funding from States and local entities. 

Funding History:

Funding for Preventive Health Services during the past five years is as follows:

FY 2008............................................... $21,026,000

FY 2009............................................... $21,026,000

FY 2010............................................... $21,026,000

FY 2011............................................... $20,984,000

FY 2012............................................... $20,945,000

Budget Request:

The FY 2013 budget request for Preventive Health Services is $20,945,000, the same as the 

FY 2012 enacted level. AoA is continuing a key change in appropriations language that was 

included by the Congress for FY 2012 which requires States to use their Preventive Health 

Services funds to support proven evidence-based models that enhance the wellness and fitness of 

the aging community. Recognizing that the development of evidence-based programs is 

ongoing, AoA will continue to provide guidance regarding what meets the evidence-based 

requirement.

Each of the evidence-based programs that States could use these funds for have been rigorously 

evaluated and found to be effective. By requiring States to use funding for one or more of these 

proven programs, AoA seeks to maximize the impact of this funding on providing benefits to 

individuals and on achieving savings due to reduced medical costs. At the same time, States 

would continue to have the flexibility to use funding provided under the Home and 

Community-Based Services Program to fund related health services, such as health screenings

and physical fitness programs that do not meet these evidence-based requirements.
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Output Table:

Preventive Health Services Output

Indicator Most Recent 

Result 

FY 2012

Projection 

FY 2013

Projection 

FY 2013 

+/- FY 2012

Output AB: The number of people served with 

health and disease prevention programs 

(Output)

N/A Baseline TBD N/A

Grant Awards Tables:

Preventive Health Services Grant Awards

FY 2011

Actual

FY 2012

Enacted

FY 2013

Budget 

Request

Number of 

Awards 56 56 56

Average 

Award $374,713 $374,006 $374,006

Range of 

Awards

$13,115 -

$2,127,762

$13,090 -

$2,123,756

$13,090 -

$2,123,756
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DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION ON AGING

FY 2013 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM: Preventive Health Services (CFDA 93.043)

State/Territory

FY 2011

Actual

FY 2012

Estimate

FY 2013

Request

Difference

+/-FY 2012

Alabama ........................................ 332,502 331,874 331,874 --

Alaska ........................................... 104,920 104,721 104,721 --

Arizona.......................................... 404,463 403,699 403,699 --

Arkansas........................................ 211,162 210,763 210,763 --

California ...................................... 2,127,762 2,123,856 2,123,856 --

Colorado........................................ 255,659 255,177 255,177 --

Connecticut ................................... 260,652 260,160 260,160 --

Delaware ....................................... 104,920 104,721 104,721 --

District of Columbia ...................... 104,920 104,721 104,721 --

Florida........................................... 1,554,456 1,551,622 1,551,622 --

Georgia.......................................... 486,684 485,765 485,765 --

Hawaii........................................... 104,920 104,721 104,721 --

Idaho............................................. 104,920 104,721 104,721 --

Illinois........................................... 839,479 837,894 837,894 --

Indiana .......................................... 426,268 425,464 425,464 --

Iowa .............................................. 231,787 231,350 231,350 --

Kansas........................................... 191,313 190,952 190,952 --

Kentucky....................................... 291,748 291,198 291,198 --

Louisiana....................................... 295,110 294,553 294,553 --

Maine............................................ 105,122 104,924 104,924 --

Maryland....................................... 360,430 359,750 359,750 --

Massachusetts................................ 464,535 463,658 463,658 --

Michigan ....................................... 692,606 691,299 691,299 --

Minnesota...................................... 338,416 337,777 337,777 --

Mississippi .................................... 195,859 195,489 195,489 --

Missouri ........................................ 422,405 421,608 421,608 --

Montana ........................................ 104,920 104,721 104,721 --

Nebraska ....................................... 124,650 124,415 124,415 --

Nevada .......................................... 151,459 151,173 151,173 --

New Hampshire............................. 104,920 104,721 104,721 --
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PROGRAM: Preventive Health Services (CFDA 93.043)

State/Territory

FY 2011

Actual

FY 2012

Estimate

FY 2013

Request

Difference

+/-FY 2012

New Jersey.................................... 619,704 618,534 618,534 --

New Mexico.................................. 127,140 126,899 126,899 --

New York ..................................... 1,373,850 1,371,257 1,371,257 --

North Carolina .............................. 576,505 575,417 575,417 --

North Dakota ................................ 104,920 104,721 104,721 --

Ohio.............................................. 834,207 832,633 832,633 --

Oklahoma ..................................... 256,914 256,429 256,429 --

Oregon.......................................... 254,403 253,923 253,923 --

Pennsylvania................................. 1,016,515 1,014,597 1,014,597 --

Rhode Island................................. 104,920 104,721 104,721 --

South Carolina .............................. 294,842 294,285 294,285 --

South Dakota ................................ 104,920 104,721 104,721 --

Tennessee ..................................... 415,981 415,196 415,196 --

Texas............................................ 1,250,740 1,248,379 1,248,379 --

Utah.............................................. 114,870 114,654 114,654 --

Vermont........................................ 104,920 104,721 104,721 --

Virginia......................................... 483,960 483,047 483,047 --

Washington................................... 396,896 396,147 396,147 --

West Virginia................................ 152,831 152,542 152,542 --

Wisconsin ..................................... 390,666 389,928 389,928 --

Wyoming...................................... 104,920 104,721 104,721 --

Subtotal, States.............................. 20,583,591 20,544,739 20,544,739 --

American Samoa........................... 13,115 13,090 13,090 --

Guam............................................ 52,460 52,361 52,361 --

Northern Mariana Islands.............. 13,115 13,090 13,090 --

Puerto Rico ................................... 269,207 268,699 268,699 --

Virgin Islands................................ 52,460 52,361 52,361 --

Subtotal, States and Territories...... 20,983,948 20,944,540 20,944,540 --

TOTAL................................. 20,983,948 20,945,000 20,945,000 --
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74

Senior Community Service Employment Program

FY 2011

Enacted

FY 2012

Enacted

FY 2013

Request

FY 2013 +/-

FY 2012

Senior Community Service 

Employment Program................. $449,100,000 $448,251,000 $448,251,000 --

FTE22......................................... -- -- 8 +8

Authorizing Legislation: Section 502 of the Older Americans Act of 1965, as amended

FY 2013 Older Americans Act Authorization................................................................... Expired

Allocation Method ....................................................................... Formula & Competitive Grants

Program Description and Accomplishments

The Senior Community Service Employment Program (SCSEP) provides time-limited 

subsidized community service positions and employment training to low-income, unemployed 

older adults to allow them to earn additional income in order to maintain their economic 

independence. Participants must be currently unemployed adults aged 55 and older whose 

income, including pensions and other income, is below 125% of the federal poverty level. The 

program’s emphasis is on assisting those with the greatest social and economic needs and those 

living in rural areas. SCSEP’s goals are to foster economic self-sufficiency through eventual 

unsubsidized employment and to provide opportunities for older individuals to serve their 

communities while gaining the marketable skills needed to obtain unsubsidized employment. 

Community service employment assignments are based at 501(c)(3) non-profits or government 

agencies (also referred to as “host agencies”), and are chosen based on their ability to prepare 

participants to enter or re-enter the workforce. Participants are paid the highest of the Federal, 

state, or local minimum wage. SCSEP is currently administered by the Department of Labor but 

is proposed for transfer to AoA in FY 2013.

In addition to wages and benefits, SCSEP provides the following programmatic services to 

participants: 

• Orientation and assessments; 

• Supportive services; 

• Participant training (e.g., on the job or in a classroom setting); and

 22 Comparable FTE numbers are not available for the level of support provided by the Department of Labor in 

FY 2011 and FY 2012.
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• Placement assistance into unsubsidized employment. 

While enrolled in the program, all participants must be covered by workers’ compensation and 

offered an annual physical examination. Each participant’s skills and interests are assessed at 

least twice a year, leading to the development of an Individual Employment Plan (IEP). SCSEP’s 

focus on assuring that workers are equipped with the skills and knowledge necessary to succeed 

will remain in place while better aligning it with programs that provide other supportive services 

to seniors.

SCSEP is funded by a formula set forth in Title V of the Older Americans Act. In general, the 

formula allocates funds to every state, the District of Columbia (DC) and Puerto Rico (PR) based 

on U.S. Census data on the number of individuals in that jurisdiction who are 55 and older with 

low per-capita income. Currently funds are reserved for the following purposes prior to 

determining the amount available to be allocated to the states, DC, and PR: a) up to 1.5 percent 

of the total authorization for pilots, demonstration and evaluation projects; b) a fixed percentage 

of .75 percent of the total allocation to the Territories of Guam, the U.S. Virgin Islands, 

American Samoa, and the Commonwealth of the Northern Mariana Islands; and c) a portion 

determined by the Secretary for national public or non-profit agencies to serve eligible American 

Indian and Pacific Island /Asian American individuals. 

Prior to the 2006 reauthorization, funds were allocated to and administered through one-year 

grants to States and to national non-profit agencies. Approximately 22 percent of formula funds 

are awarded to States, with 78 percent awarded to national non-profit agencies for services 

across the country. In 2006, DOL conducted a competition for the national grantees. As a result, 

18 organizations received SCSEP funds, including three organizations under the Indian and 

Pacific Islands /Asian Americans set-aside. Under the OAA 2006 amendments, these grants are 

to be renewed annually for four years, with an optional one year extension. In Program Year 

(PY) 200823, the 74 national, state, and territorial SCSEP grantees enrolled over 89,000 

individuals. SCSEP participants provided 48,611,568 hours of service to their local communities. 

The next competition for national grantees will be conducted in 2012. AoA is collaborating with 

DOL on this competition to ensure a smooth transition if Congress authorizes the transfer of the 

program. Through this collaboration, AoA provided input and suggestions related to priorities

and targeting: if the program is transferred to AoA. 

In general, 75 percent of Federal funds must be spent on wages and benefits to participants with 

the remaining funds for other participant costs. There is a cap on administrative expenses of 

13.5 percent. The Federal funds provided to each of the 74 grantees can be no more than 90% of 

the total project amount, with the non-federal matching requirement in either cash or in-kind. 

 23 Funding for SCSEP is appropriated from July 1 – June 30, rather than on the typical fiscal year schedule.
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Funding History

Funding for the Senior Community Service Employment Program during the past five years is as 

follows:

FY 2008..................................$521,625,000

FY 2009..................................$571,925,000

FY 201024

FY 2011 .................................$449,100,000

...............................$825,425,000

FY 2012..................................$448,251,000

Budget Request

The FY 2013 request for SCSEP is $448,251,000; the same as the FY 2012 enacted level. Funds 

will continue to be used to provide formula grants to States and competitive grants to national 

organizations. This funding will also provide necessary administrative support, monitoring, and 

technical assistance; including funding for 8 FTE.

This request again proposes to transfer responsibility for SCSEP from the Department of Labor 

to the Administration on Aging. SCSEP helps older individuals maintain their economic 

independence by providing much-needed employment income and training. The proposed 

transfer to the Administration on Aging will allow for the placement of the program in an agency 

that has as its primary focus the mission of helping older Americans maintain their independence 

(both economic independence and living arrangements) and active participation in communities. 

This shift reflects the recognition that the SCSEP participants can benefit immensely from the 

program’s integration with supports provided by AoA’s existing Aging Services programs.

Demographic analysis indicates that older workers will account for an increasingly large portion 

of the available workforce in the decades ahead. Seniors participation in SCSEP helps employers 

recognize the value of older workers as both needed employees and mentors to younger workers. 

AoA will leverage the experience of the Department of Labor to continue encouraging and 

expanding job opportunities for aging workers, and work with the One-Stop Career Center 

system to place job-ready older workers in unsubsidized employment, helping to break down the 

barriers to fair and diverse workplaces for these senior workers.

 24 Includes a one-time special appropriation of $225,000,000 to serve low-income seniors affected by the recession.
HEALTH AND INDEPENDENCE

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AoA will use the requested funds to continue the vital work done by SCSEP as well as create 

program efficiencies within the context of the aging services network. Millions of hours of 

community service are provided by SCSEP participants each year to non-profit organizations and 

government agencies; more than 45,000,000 hours in each of the last few years. Community 

service is an equally valuable aspect of SCSEP funding that is inextricably linked to the public 

service employment wages and training that seniors receive while in the program. In FY 2013, 

AoA, in partnership with the DOL, the aging services network, and workforce investment 

system, will continue to explore creative ideas that highlight opportunities for seniors to serve 

their communities while accessing employment training options.

Outcome Table

Measure Most Recent 

Result 

PY 2012

Projection 

PY 2013

Projection 

FY 2012 

+/- FY 2012

Output 1.1: Average earnings in the second and 

third quarters after exit (Outcome)

PY 2009: 

$6,900 $7,626 TBD TBD

Output 1.3: Percent of participants employed in 

the first quarter after exit (Outcome)

PY 2009: 

46.2% 36.5% TBD TBD

Output 1.4: Percent of participants employed in 

the first quarter after exit still employed in the 

second and third quarters after exit (Outcome)

PY 2009: 

70.0% 68.4% TBD TBD

These outcomes were developed and the data collected by the Department of Labor. Under the 

proposal to transfer SCSEP, AoA will work with all relevant parties to develop and refine 

performance measures and collect performance data.
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79

Native American Nutrition and Supportive Services

FY 2011 

Enacted

FY 2012

Enacted

FY 2013 

Request

FY 2013 +/-

FY 2012

Native American Nutrition & 

Supportive Services .................... $27,653,000 $27,601,000 $27,601,000 --

Authorizing Legislation: Sections 613 and 623 of the Older Americans Act of 1965, as amended

FY 2013 Older Americans Act Authorization................................................................... Expired

Allocation Method .................................................................................................Formula Grant

Program Description and Accomplishments:

Native American Nutrition and Supportive Services provides grants to eligible Tribal 

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

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

2009 American Community Survey, approximately 301,000 persons age 60 and over identified 

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

over identified themselves as part Native American or Alaskan Native. 

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

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

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

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

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

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

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

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

comprehensive services. 

Services provided by this program in FY 2010, the most recent year for which data are available, 

include: 

• Transportation Services, which provided over 800,000 rides to meal sites, medical 

appointments, pharmacies, grocery stores, and other critical daily activities (Output L).

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

nearly 37,694 homebound Native American elders, as well as critical social contacts that 

help to reduce the risk of depression and isolation experienced by many home-bound 

Native American elders (Output M).

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

59,754 Native American elders in community-based settings, as well as an opportunity 
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for elders to socialize and participate in a variety of activities, including cultural and 

wellness programs (Output N).

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

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

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

care needs (Output O).

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

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

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

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

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

Aging Network Support Activities.

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

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

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

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

age at which a member is considered an elder and thus eligible for services. In FY 2011 grants 

were awarded to 256 Tribal organizations (representing 400 Tribes), including two 

organizations serving Native Hawaiian elders, with an average award of $107,964 and a range 

of grant awards from $73,940 to $1,505,000. 

Funding History:

Funding for Native American Nutrition and Supportive Services during the past five years is as 

follows:

FY 2008............................................... $26,898,000

FY 2009............................................... $27,208,000

FY 2009 (ARRA)................................... $3,000,000

FY 2010............................................... $27,704,000

FY 2011............................................... $27,653,000

FY 2012............................................... $27,601,000

Budget Request:

The FY 2013 request for Native American Nutrition and Supportive Services is $27,601,000; the 

same as the FY 2012 enacted Level. The services provided using these funds, particularly adult 

day care, personal care, chore services, and home-delivered meals, also aid caregivers, who 

might otherwise have to be even more intensively involved with the care of their loved ones, at 

the risk of their own health and careers.

These funds will provide 880,000 rides (Output L), 2.35 million meals at home (Output M), and 

1.8 million meals at congregate sites (Output N) to approximately 65,600 Native American 
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seniors. Services will allow Native American elders, many of whom have limitations in activities

of daily living that make it difficult to care for themselves, to remain at home, in the community, 

or on the reservation, which is what they prefer. 

In FY 2013 the targeted number of units of service, such as home-delivered meals and 

transportation trips, provided to Native Americans per thousand dollars of AoA funding is 

projected at 300, a 36 percent increase over the FY 2002 base of 220 (Outcome 1.3). Over the 

past several years Native American services have met or exceeded their efficiency and output 

targets for meals and trips due in part to increased contributions from tribal organizations. 

Outcome and Outputs Table:

Native American Nutrition & Supportive Services Outcome and Outputs

Measure Most Recent Result FY 2012

Target 

FY 2013

Target 

FY 2012 

+/- FY 2012

Output 1.3: For Title VI Services, increase 

the number of units of service provided to 

Native Americans per thousand dollars of 

AoA funding. (Outcome)

FY 2010: 323

Target: 300

(Target Exceeded)

300 300 Maintain

Indicator Most Recent Result FY 2012

Projection 

FY 2013

Projection 

FY 2013 

+/- FY 2012

Output L: Transportation Services units

(Output) FY 2010: 827,821 830,000 830,000 --

Output M: Home-Delivered Nutrition 

meals (Output) FY 2010: 2.5 M 2.5 M 2.5 M --

Output N: Congregate Nutrition meals

(Output) FY 2010: 2.1 M 2.0 M 2.0 M --

Output O: Information, Referral and 

Outreach units (Output) FY 2010: 903,913 900,000 900,000 --

Grant Awards Table:

Native American Nutrition & Supportive Services Grant Awards

FY 2011

Actual

FY 2012

Enacted

FY 2013

Budget 

Request

Number of 

Awards 256 256 256

Average 

Award $107,964 $107,546 $107,546

Range of 

Awards

$73,940 -

$1,505,000

$73,640 -

$1,505,000

$73,640 -

$1,505,000
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84

Aging Network Support Activities

FY 2011 

Enacted

FY 2012

Enacted

FY 2013 

Request

FY 2013 +/-

FY 2012

Aging Network Support 

Activities..................................... $8,184,000 $7,873,000 $7,873,000 --

Authorizing Legislation: Section 201, 202, 215, and 411 of the Older Americans Act of 1965, as 

amended

FY 2013 Older Americans Act Authorization................................................................... Expired

Allocation Method .......................... Competitive Grants/Co-operative Agreements and Contracts

Program Description and Accomplishments:

Aging Network Support Activities provides competitive grants and contracts to support ongoing 

activities of national significance which help seniors and their families to obtain information about 

their care options and benefits, and which assist States, Tribes, and community providers of aging 

services to carry out their mission to help older people remain independent and live in their own 

homes and communities. These activities provide critical and ongoing support for the national aging 

services network and help support the activities of AoA’s core service delivery programs. 

Competitive grants, cooperative agreements, and contracts for Aging Network Support Activities are 

awarded to eligible public or private agencies and organizations, States and Area Agencies on Aging 

(AAAs), institutions of higher learning, and other organizations representing and/or serving older 

people, including faith-based organizations. Grantees are required to provide a match equal to 

25 percent of the project’s total cost. Project proposals are reviewed by external experts, and project 

awards are made for periods of one to four years. In FY 2011, Aging Network Support Activities 

funded 24 grants with an average award of $279,465.

National Eldercare Locator

Older Americans and their caregivers face a complicated array of choices and decisions about 

health care, pensions, insurance, housing, financial management, and long-term care. The 

Eldercare Locator, created in 1991, helps seniors and their families navigate this complex 

environment by connecting those needing assistance with State and local agencies on aging that 

serve older adults and their caregivers. The Eldercare Locator can be accessed through a toll-free 

nationwide telephone line (800-677-1116) or website (http://www.eldercare.gov). The phone line 

and website both connect those in need to providers in every zip code in the nation. The 

Eldercare Locator website continues to grow as a resource tool for older adults and their 

caregivers, serving over 300,000 individuals a year. 
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National Alzheimer’s Call Center

The National Alzheimer’s Call Center is a national information and counseling service for 

persons with Alzheimer’s disease, their family members, and informal caregivers. In the 

12-month period ending July 31, 2011, the National Alzheimer’s Call Center handled over 

228,000 calls through its national and local partners, and its on-line message board community 

recorded an estimated 13 million page views and over 100,000 individual postings. The National 

Alzheimer’s Call Center is available to people in all States, 24 hours a day, 7 days a week, 

365 days a year to provide expert advice, care consultation, and information and referrals at the 

national and local levels regarding Alzheimer’s disease. Trained professional customer service 

staff and masters degree social workers are available at all times. The Call Center is accessible 

by telephone, website or e-mail at no cost to the caller. Services focus on consumers, not 

professionals. Information provided may include basic information on caregiving; handling legal 

issues; resources for long-distance caregiving; and tips for working with the medical 

community. Local community-based organizations are directly involved to ensure local, on-theground capacity to respond to emergencies and on-going needs of Alzheimer’s patients, their 

families, and informal caregivers. The Call Center has multilingual capacity and responds to 

inquiries in at least 140 languages through its own bilingual staff and with the use of a language 

interpretation service.

Pension Counseling and Information

The Pension Counseling program, first funded in 1993, assists older Americans in accessing 

information about their retirement benefits and helps them negotiate with former employers or 

pension plans for due compensation. Currently, there are more than 700,000 private (as well as 

thousands of public) pension and retirement plans in the United States. Given that an employee 

may have worked for several employers, and these employers may have merged, sold their plans, 

or gone bankrupt, it is very difficult for the average person to know where to go to get help in 

finding out whether he or she is receiving all of their pension benefits. AoA currently funds six 

regional counseling projects covering 27 States. Data for the program shows that:

• Pension Counseling projects have successfully obtained a return of more than $5.50 for 

every Federal dollar invested in the program.

• Projects have directly served over 35,000 individuals by providing hands-on assistance in 

pursuing claims through administrative appeals processes; helping seniors to locate 

pension plans “lost” as a result of mergers and acquisitions; answering queries about 

complex plan provisions; and making targeted referrals to other professionals for 

assistance.

By producing fact sheets and other publications, hosting websites, and conducting outreach, 

education and awareness efforts, Pension Counseling projects also provide indirect services to 

tens of thousands of seniors and their families. 

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 
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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 average-income and low-income women, women of color, women with 

limited English speaking proficiency, rural, and other “underserved” women. Information is 

offered through financial and retirement planning programs, workshops tailored to meet 

women’s special needs, and publications in hard copy and Web based formats. Since its 

establishment, the Center has conducted more than 20,000 workshops on strategies to access 

financial and retirement planning information for women and disseminated financial and 

retirement planning information tailored to the specific needs of hard-to-reach women. 

National Resource Centers on Native American Elders

The National Resource Centers on Native American Elders enhance knowledge about older 

Native Americans and thereby increase and improve the delivery of services to them. Each 

Resource Center addresses at least two areas of primary concern which are specified in the OAA. 

These include health issues, long-term care (including in-home care), elder abuse, mental health, 

and other problems and issues facing Native communities. The Resource Centers are 

administered under cooperative agreements by three institutions of higher education. The 

Resource Centers partner with Native American organizations and communities, educational 

institutions including Tribal Colleges and Universities, and professionals and paraprofessionals 

in the field. Resource centers have specialized areas of interest. The University of North Dakota 

Resource Center has assisted Title VI grantees in assessing needs of tribal elders to determine 

program planning and direction. This process has developed a database of information about 

American Indian, Alaska Native and Native Hawaiian Elders. The University of Hawaii 

Resource Center has focused on long term care needs of Native Hawaiian Elders. The 

University of Alaska Resource Center has focused on elder abuse and neglect issues within 

Native communities.

National Minority Aging Organizations Technical Assistance Centers

The National Minority Aging Organizations (NMAO) Technical Assistance Centers Program 

works to reduce or eliminate health disparities among racial and ethnic minority older 

individuals. These Centers design and disseminate front line health promotion and disease 

prevention information that is culturally and linguistically appropriate for older individuals of 

African American, Hispanic, Asian American and Pacific Islander descent, and American Indian 

and Alaska Native elders. For example, the Center for American Indian and Alaska Native 

elders is developing a culturally appropriate caregiver manual/toolkit for caregivers caring for 

elders with dementia. Each NMAO project pilots a practical, nontraditional, community-based 

intervention for reaching older individuals who experience barriers to accessing home and 

community-based services. Strategies are focusing on barriers due to language and low literacy 

as well as those directly related to cultural diversity. Strategies developed under this program 

incorporate the latest technology and facilitate the generation and dissemination of knowledge in 

forms that can assist racial and ethnic minority older individuals to practice positive health 

behaviors and strengthen their capacity to maintain active, independent life styles. Examples of 

products resulting from these grants include, but are not limited to: 
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• The African American National Minority Aging Technical Assistance Center has 

developed a chronic disease self management curricula and manual tailored for racial and 

ethnic minority seniors; 

• The Hispanic/Latino National Minority Technical Aging Assistance Center developed a 

series of bilingual Influenza Vaccination Promotion materials entitled “Chispa a La Vida; 

and,

• The Asian American Pacific Islander National Minority Aging Technical Assistance 

Center developed a referral database of Chronic Disease Self-Management (CDSMP) 

workshops for use by the National Asian Pacific Center on Aging (NAPCA) Helpline. 

The database includes information about CDSMP workshops or organizations offering 

the program around the country, including availability of workshops in Asian or Pacific 

Islander languages.

National Technical Assistance Resource Center for LGBT Elders 

Older lesbian, gay, bisexual and transgender (LGBT) adults face a number of unique challenges 

as they strive to maintain their independence. The Resource Center, established in 2010, strives 

to meet three primary objectives: educate mainstream aging services organizations about the 

existence and special needs of LGBT elders; sensitize LGBT organizations about the existence 

and special needs of older adults; and educate LGBT individuals about the importance of 

planning ahead for future long-term care needs. The national resource center formally began 

services in September 2010 with the launching of a website including training curricula and 

social networking tools. In 2013, with the groundwork and tools now in place and available, the 

Resource Center will focus on the provision of training and technical assistance for community 

providers across the country.

Multigenerational Civic Engagement

The Multi-Generational Civic Engagement (MGCE) initiative enhances discovery, 

documentation and support for existing, exceptional locally-developed program models and 

volunteer engagement strategies. Eighteen model programs launched in FY 2011 engage older 

adults in civic engagement projects aimed at increasing services to frail elders, families of 

children with special needs, and grandparents raising grandchildren. These model programs also 

partner with the Corporation for National and Community Service.

Program Performance and Technical Assistance

This activity supports cooperative efforts between AoA and selected States and AAAs to develop 

and test outcome measures, various performance measurement instruments, and sampling 

methods that can be used to effectively and efficiently identify the results produced through 

OAA programs on an ongoing basis. It also supports partnerships with National Aging 

Organizations to foster innovation and provide technical assistance to States, AAAs, and Tribal 

organizations in strategic planning, program assessment, and performance measurement.
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Funding History:

Comparable funding for Aging Network Support Activities is as follows:

FY 2008............................................... $10,007,067

FY 2009................................................. $8,200,000

FY 2010................................................. $8,198,000

FY 2011................................................. $8,184,000

FY 2012................................................. $7,873,000

Budget Request:

The FY 2013 request for Aging Network Support Activities is $7,873,000, the same as the 

FY 2012 enacted level. The programs funded by this request provide critical and ongoing 

support for the national aging services network and are needed to support the activities of AoA’s 

core service delivery programs. Not only do they provide a variety of services, some of which 

are not the responsibility of any other government agency, these programs considerably 

strengthen and streamline AoA’s core services, and are critical to AoA’s continuing success.

Aging Network Support Activities outcomes are reflected in performance targets for Health and 

Independence and Caregiver Services. 

Aging Network Support Activities includes funding for the following projects25: 

Activity

FY 2011

Enacted

FY 2012

Enacted

FY 2013

Request

Aging Network Support Activities:

National Eldercare Locator................................................ $ 1,175,644 $ 1,172,779 $ 1,172,779

National Alzheimer's Call Center....................................... 998,000 998,110 998,110

National Education & Resource Center on Women & 

Retirement ........................................................................ 248,502 247,532 247,532

Pension Information and Counseling Program ................... 1,715,562 1,712,757 1,712,757

National Resource Centers on Native Americans............... 691,614 690,692 690,692

National Minority Aging Organizations............................. 932,132 930,238 930,238

National Technical Assistance Resource Center for 

LGBT Elders .................................................................... 300,000 299,433 299,433

Multigenerational Civic Engagement................................. 980,036 978,148 978,148

Program Performance and Technical Assistance ................ 1,142,110 843,403 843,403

Total, Aging Network Support Activities..................... $ 8,183,600 $ 7,873,092 $ 7,873,092

 25 Several projects have been moved to Elder Justice Support Activities and are comparably adjusted. Accordingly, 

actual expenditure amounts are shown for FY 2011 and reflected in FY 2012 and FY 2013
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91

Caregiver Services

Summary of Request

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

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

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

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

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

work while providing critically needed care. 

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

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

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

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

50 years of age and older.26 AARP estimated the economic value of replacing unpaid caregiving 

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

be replaced with paid services).27 

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

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

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

age, and research indicates that caregivers suffer a mortality rate that is 63 percent higher than 

non-caregivers.28 Providing support that makes caregiving easier for family caregivers, such as 

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

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

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

otherwise could.29 

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

every day. By 2015, AoA projects that there will be 12.9 million non-institutionalized seniors 

age 65 and over with 1+ ADL deficits, an increase of almost 2 million seniors (or 18 percent 

since 2008) needing caregiver assistance.30 

To address these caregiver-related needs, AoA requests a total of $172,014,000, an increase of 

$5,528,000 over the FY 2012 enacted level. The request includes:

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

Policy Institute. July 2011. http://assets.aarp.org/rgcenter/ppi/ltc/i51-caregiving.pdf 27 Valuing the Invaluable: 2011 Update, The Growing Contributions and Costs of Family Caregiving. AARP Public 

Policy Institute. July 2011. http://assets.aarp.org/rgcenter/ppi/ltc/i51-caregiving.pdf 28 Schulz R, Beach SR. Caregiving as a risk factor for mortality. The Caregiver Health Effects study. JAMA 

December 15, 1999;282:2215-9.

29 2011 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID. 30 Data extrapolated by AoA from U.S. Census Bureau, “2008 National Population Projections,” released August 

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

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

Medicare beneficiaries, ages 65+: US, 1992-2006.” Accessed 31 August 2009. 
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• $153,621,000 for Family Caregiver Support Services, the same as the FY 2012 enacted 

level. This program makes a range of support services available to family and informal 

caregivers in States, including counseling, respite care, and training, that assist family and 

informal caregivers to care for their loved ones at home for as long as possible. Studies 

have shown that these supports can reduce caregiver depression, anxiety, and stress and 

enable them to provide care longer, thereby avoiding or delaying the need for costly 

nursing home care.

• $6,364,000 for Native American Caregiver Support Services, the same as the FY 2012 

enacted level. This program makes a range of services available to Native American 

caregivers, including information and outreach, access assistance, individual counseling, 

support groups and training, respite care and other supplemental services. 

• $9,537,000 for Alzheimer’s Disease Supportive Services, an increase of $5,527,000 over 

the FY 2012 enacted level. This program’s funding was significantly reduced in 

FY 2012, and this budget proposes to restore some of that funding in order to continue 

the only program at HHS dedicated to supportive services for those with Alzheimer’s 

Disease and their caregivers. One critical focus of this program is to support the family 

caregivers who provide countless hours of unpaid care, thereby enabling their family 

members with dementia to continue living in the community. Another focus is to expand 

the availability of evidence-based diagnostic and support services to those with 

Alzheimer’s. 

• $2,490,000 for Lifespan Respite Care, the same as the FY 2012 enacted level. This 

program funds grants to improve the quality and access to respite care for family 

caregivers of children or adults of any age with special needs. 

As a group, these programs support caregivers and elders by providing critical respite care and 

other support services for family caregivers, training and recruitment of care workers and 

volunteers, information and outreach, counseling, and other supplemental services.
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94

Family Caregiver Support Services

FY 2011 

Enacted

FY 2012

Enacted

FY 2013 

Request

FY 2013 +/-

FY 2012

Family Caregiver Support 

Services...................................... $153,912,000 $153,621,000 $153,621,000 --

Authorizing Legislation: Section 371 of the Older Americans Act of 1965, as amended

FY 2013 Older Americans Act Authorization................................................................... Expired

Allocation Method .................................................................................................Formula Grant

Program Description and Accomplishments:

Family Caregiver Support Services provides grants to States and Territories, based on their share 

of the population age 70 and over, to fund a range of supports that assist family and informal 

caregivers to care for their loved ones at home for as long as possible. The program includes 

five basic system components: information, access assistance, counseling and training, respite 

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

including transportation services, homemaker services, home-delivered meals, and adult day 

care, to provide a coordinated set of supports for seniors that caregivers can access on their 

behalf.

Family Caregiver Support Services provide a variety of supports to family and informal 

caregivers. Based on FY 2010 data, the most recent available, services provided included: 

• Access Assistance Services provided over one million contacts to caregivers assisting 

them in locating services from a variety of public, private and voluntary agencies (Output 

I).

• Counseling and Training Services provided over 135,000 caregivers with counseling, 

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

(Output J).

• Respite Care Services provided over 67,000 caregivers with 6.4 million hours of

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

caregiving responsibilities (Output K).

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

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

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

administration and wound care. AARP estimated the economic value of replacing unpaid 

caregiving in 2009 to be about $450 billion (the cost if that care had to be replaced with paid 
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services).31 Caregivers often experience conflicts between work and caregiving, with 25 percent 

reporting that they have had to make adjustments such as retiring or taking time away from work 

due to their caregiving responsibilities.

In 2009, at least 43.5 million adult caregivers, or approximately 19 percent of all adults, provided 

uncompensated care to those 50 years of age and older.32 By 2015, AoA projects that there will 

be 12.9 million non-institutionalized seniors age 65 and over with 1+ ADL deficits, an increase 

of almost two million seniors or 18 percent since 2008, needing caregiver assistance.33 

Research has shown that caregiving exacts a heavy emotional, physical, and financial toll. As 

reported in AoA’s 2011 National Survey of OAA Participants, 24 percent of caregivers are 

assisting two or more individuals. Sixty-eight percent of Title III caregivers are 60 or older, 

making them more vulnerable to a decline in their own health, and thirty-four percent describe 

their own health as fair to poor.34 Caregivers also suffer from higher rates of depression than 

non-caregivers of the same age, and research indicates that caregivers suffer a mortality rate that 

is 63 percent higher than non-caregivers.35 The demands of caregiving can lead to a breakdown 

of the caregiver’s health, and the illness, hospitalization, or death of a caregiver increases the risk 

for institutionalization of the care recipient. 

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

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

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

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

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

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

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

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

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

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

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

than otherwise would have been possible.36

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

Policy Institute. July 2011. 

Caregivers receiving services were also asked 

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

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

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

http://assets.aarp.org/rgcenter/ppi/ltc/i51-caregiving.pdf 32 National Alliance for Caregiving and AARP. Caregiving in the U.S.: A Focused Look at Those Caring for the 

50+. 2009. http://www.aarp.org/research/surveys/care/ltc/hc/articles/caregiving_09.html 33 Data extrapolated by AoA from U.S. Census Bureau, “2008 National Population Projections,” released August 

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

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

Medicare beneficiaries, ages 65+: US, 1992-2006.” Accessed 31 August 2009. 34 2011 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID. 35 Schulz R, Beach SR. Caregiving as a risk factor for mortality. The Caregiver Health Effects study. JAMA 

December 15, 1999;282:2215-9. 36 2011 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.
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Those respondents were then asked to identify where the care recipient would be living without 

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

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

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

Funding History:

Funding for Family Caregiver Support Services during the past five years is as follows:

FY 2008............................................. $153,439,000

FY 2009............................................. $154,220,000

FY 2010............................................. $154,197,000

FY 2011............................................. $153,912,000

FY 2012............................................. $153,621,000

Budget Request:

The FY 2013 request for Family Caregiver Support Services levels is $153,621,000, the same as 

the FY 2012 enacted level. With this proposed funding, 796,000 caregivers (Outcome 3.1) will 

be provided with supportive services, including respite care or temporary relief from their 

caregiving responsibilities. This represents 35,000 caregivers more than the levels served in 

FY 2010. Respite care is the service rated by caregivers as the most helpful. Nearly 

128,000 caregivers will also have the opportunity to participate in counseling, peer support 

groups, and training to help them better cope with the stresses of caregiving (Output J). 
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Caregivers state that these programs help keep their loved ones at home, as 83 percent of 

caregivers report these supportive services enable them to provide care longer.

In FY 2013, AoA expects the aging services network to meet or exceed the target of only 

28 percent of caregivers experiencing difficulty obtaining services (Outcome 2.6). This is a 

substantial accomplishment that occurred at the State level as a result of ongoing program 

development, better coordination and integration the Family Caregiver program into the array of 

State home and community-based services. Baseline levels from 2003 showed that 64 percent of 

caregivers had difficulty getting services, and by 2010 that rate had been reduced by more than 

half to 29 percent of caregivers reporting difficulty getting services.

For FY 2013, the performance target for Family Caregiver Support Services Program 

participants who rate services good to excellent is 90 percent (Outcome 2.9c). The substantive 

improvements in program performance can be attributed to the successful implementation of the 

program. Client-reported assessment of service quality and program outcomes is expected to 

remain at high levels, however some service outputs are expected to decline in FY 2013 

compared to FY 2010. Declines are projected to be largely attributable to declining leveraged 

funds, as State, local, and private budgets face economic hardships. 

Outcomes and Outputs Table:

Family Caregiver Support Services Outcomes and Outputs

Measure Most Recent Result FY 2012

Target 

FY 2013 

Target 

FY 2013 

+/- FY 2012

Outcome 2.6: Reduce the percent of 

caregivers who report difficulty in 

getting services. (Outcome)

FY 2010: 29%

Target: 30%

(Target Not Met)

28% 28% Maintain

Outcome 2.9c: 90% of NFCSP clients 

rate services good to excellent.

(Outcome)

FY 2010: 94%

Target: 90%

(Target Exceeded)

90% 90% Maintain

Outcome 3.1: Increase the number of 

caregivers served. (Outcome)

FY 2010: 761,000

Target: 560,000

(Target Exceeded)

792,000 796,000 +4,000

Indicator Most Recent Result FY 2012

Projection 

FY 2013 

Projection

FY 2013 

+/- FY 2012

Output I: Caregivers access assistance 

units of service. (Output) FY 2010: 1.1 M 950,000 950,000 0

Output J: Caregivers receiving 

counseling and training. (Output) FY 2010: 135,217 133,000 128,000 -35,000
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Indicator Most Recent Result FY 2012

Projection 

FY 2013 

Projection

FY 2013 

+/- FY 2012

Output K: Caregivers receiving respite 

care services. (Output) FY 2010: 67,073 67,000 63,500 -3,500

Note: For presentation within the budget AoA highlighted specific measures that are most directly related to Family 

Caregiver Support Services, however multiple performance outcomes are impacted by this program because AoA’s 

performance measures (efficiency, effective targeting, and client outcomes) assess network-wide performance in 

achieving current strategic objectives.
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Grant Awards Table:

Family Caregiver Supportive Services Grant Awards

FY 2011

Actual

FY 2012

Enacted

FY 2013

Budget 

Request

Number of 

Awards 56 56 56

Average 

Award $2,720,937 $2,715,802 $2,715,802

Range of 

Awards

$95,233 -

$15,295,121

$95,053 -

$15,382,313

$95,053 -

$15,382,313
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DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION ON AGING

FY 2013 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM: Family Caregivers Support Services (CFDA 93.052)

State/Territory

FY 2011

Actual

FY 2012

Estimate

FY 2013

Request

Difference

+/-FY 2012

Alabama........................................ 2,386,588 2,342,427 2,342,427 --

Alaska........................................... 764,933 760,424 760,424 --

Arizona ......................................... 3,227,992 3,151,873 3,151,873 --

Arkansas ....................................... 1,518,422 1,498,081 1,498,081 --

California ...................................... 15,356,773 15,382,313 15,382,313 --

Colorado ....................................... 1,902,436 1,918,939 1,918,939 --

Connecticut ................................... 1,821,050 1,867,429 1,867,429 --

Delaware....................................... 764,933 760,424 760,424 --

District of Columbia ...................... 764,933 760,424 760,424 --

Florida........................................... 12,255,674 12,023,622 12,023,622 --

Georgia ......................................... 3,567,093 3,533,479 3,533,479 --

Hawaii........................................... 764,933 760,424 760,424 --

Idaho............................................. 764,933 760,424 760,424 --

Illinois........................................... 5,908,033 5,875,749 5,875,749 --

Indiana .......................................... 3,059,403 3,042,278 3,042,278 --

Iowa .............................................. 1,707,953 1,717,132 1,717,132 --

Kansas........................................... 1,392,604 1,402,676 1,402,676 --

Kentucky....................................... 2,069,945 2,051,857 2,051,857 --

Louisiana....................................... 2,025,081 1,983,538 1,983,538 --

Maine............................................ 764,933 763,461 763,461 --

Maryland....................................... 2,509,470 2,514,342 2,514,342 --

Massachusetts................................ 3,356,283 3,336,098 3,336,098 --

Michigan....................................... 4,908,737 4,928,398 4,928,398 --

Minnesota...................................... 2,496,717 2,511,755 2,511,755 --

Mississippi .................................... 1,387,772 1,358,368 1,358,368 --

Missouri........................................ 3,040,466 3,038,044 3,038,044 --

Montana ........................................ 764,933 760,424 760,424 --

Nebraska ....................................... 919,551 929,554 929,554 --
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State/Territory

FY 2011

Actual

FY 2012

Estimate

FY 2013

Request

Difference

+/-FY 2012

Nevada .......................................... 1,066,391 1,091,664 1,091,664 --

New Hampshire............................. 764,933 760,424 760,424 --

New Jersey................................ 4,364,136 4,364,507 4,364,507 --

New Mexico.............................. 944,416 946,008 946,008 --

New York.................................. 9,759,795 9,642,088 9,642,088 --

North Carolina........................... 4,306,356 4,343,778 4,343,778 --

North Dakota............................. 764,933 760,424 760,424 --

Ohio.......................................... 5,990,792 5,975,048 5,975,048 --

Oklahoma.................................. 1,827,039 1,815,391 1,815,391 --

Oregon ...................................... 1,880,893 1,900,922 1,900,922 --

Pennsylvania ............................. 7,442,187 7,350,508 7,350,508 --

Rhode Island ............................. 764,933 760,424 760,424 --

South Carolina........................... 2,237,296 2,175,994 2,175,994 --

South Dakota............................. 764,933 760,424 760,424 --

Tennessee.................................. 3,033,344 2,994,573 2,994,573 --

Texas......................................... 9,215,393 9,140,595 9,140,595 --

Utah .......................................... 910,038 884,912 884,912 --

Vermont.................................... 764,933 760,424 760,424 --

Virginia..................................... 3,446,280 3,432,115 3,432,115 --

Washington ............................... 2,900,557 2,912,402 2,912,402 --

West Virginia ............................ 1,067,786 1,075,032 1,075,032 --

Wisconsin.................................. 2,853,414 2,876,242 2,876,242 --

Wyoming .................................. 764,933 760,424 760,424 --

Subtotal, States.......................... 150,008,285 149,218,280 149,218,280 --

American Samoa ....................... 95,617 95,053 95,053 --

Guam ........................................ 382,467 380,212 380,212 --

Northern Mariana Islands........... 95,617 95,053 95,053 --

Puerto Rico................................ 2,022,170 1,916,085 1,916,085 --

Virgin Islands............................ 382,467 380,212 380,212 --

Subtotal, States and Territories... 152,986,623 152,084,895 152,084,895 --

Undistributed37 925,377 1,536,105 1,536,105 --

 

37 Funds held for statutory related requirements are reflected in the undistributed line.
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State/Territory

FY 2011

Actual

FY 2012

Estimate

FY 2013

Request

Difference

+/-FY 2012

TOTAL 153,912,000 153,621,000 153,621,000 --
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105

Native American Caregiver Support Services

FY 2011

Enacted

FY 2012

Enacted

FY 2013

Request

FY 2013 +/-

FY 2012

Native American Caregiver 

Support Services......................... $6,376,000 $6,364,000 $6,364,000 --

Authorizing Legislation: Section 631 of the Older Americans Act of 1965, as amended

FY 2013 Authorization..................................................................................................... Expired

Allocation Method .................................................................................................Formula Grant

Program Description and Accomplishments:

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

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

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

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

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

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

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

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

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

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

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

that can be used for services to grandparents caring for grandchildren. In FY 2011 grants for

Caregiver Support Services were awarded to 218 Tribal organizations, including one 

organization serving Native Hawaiian elders, with a range of grant awards from $13,050 to 

$53,406. 

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

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

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

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

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

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

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

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

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

for their elders. Rather, it provides support that strengthens the family caregiver role. 
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Funding History:

Funding for the Native American Caregiver Support Services during the past five years is as 

follows:

FY 2008................................................. $6,316,000

FY 2009................................................. $6,389,000

FY 2010................................................. $6,388,000

FY 2011................................................. $6,376,000

FY 2012................................................. $6,364,000

Budget Request:

The FY 2013 request for Native American Caregiver Support Services is $6,364,000, the same 

as the FY 2012 enacted level. Support for caregivers is critical since often it is their availability, 

whether they are informal family caregivers, paraprofessionals or unrelated friends and 

neighbors who volunteer their time, that determines whether an older person can remain in his or 

her home.

In the 2009 American Community Survey, approximately 301,000 persons age 60 and over 

identified themselves as American Indians or Alaskan Natives, and another 242,000 persons age 

60 and over identified themselves as part American Indian or Alaskan Native. Caregiver support 

services will help Native American elders, many of whom have limitations in activities of daily 

living that make it difficult to care for themselves, to remain at home, in the community, or on 

the reservation, which is what they prefer. Studies have shown that providing assistance to 

caregivers can help them cope with the emotional, physical and financial toll associated with 

caregiving, thereby enabling them to provide care for their loved ones longer and avoid or delay 

the need for costly nursing home care.

Performance data indicates that these programs are an efficient means to help Native American 

Elders remain independent and in the community. It should be noted that some service outputs 

for FY 2011 are expected to decline due to the economic downturn impacting Tribal government 

budgets.

In FY 2013 the Native American Caregiver Support Program will continue to assist family 

caregivers, whose assistance is critical to enabling Native American elders with disabilities to 

remain at home, in the community, and on the reservation. It is estimated that in FY 2011 more 

than 320,000 units of caregiver-related services including respite care, information and referral, 

caregiver training, lending closets, and support groups will be provided by Native American 

Tribal organizations.
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 Outcome Table:

Native American Caregivers Supportive Services Outcome

Measure Most Recent 

Result 

FY 2012

Target 

FY 2013 

Target

FY 2013 

+/- FY 2012

Outcome 3.1: Increase the number of 

caregivers served. (Outcome)

FY 2010: 761,000

Target: 560,000

(Target Exceeded)

792,000 796,000 +4,000
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110

Alzheimer’s Disease Supportive Services Program

FY 2011

Enacted

FY 2012

Enacted

FY 2013

Request

FY 2013 +/-

FY 2012

Alzheimer’s Disease 

Supportive Services Program ...... $11,441,000 $4,011,000 $9,537,000 +$5,526,000

Authorizing Legislation: Section 398 of the Public Health Services Act, as amended

FY 2013 Authorization..................................................................................................... Expired

Allocation Method .......................... Competitive Grants/Co-operative Agreements and Contracts

Program Description and Accomplishments:

The Alzheimer’s Disease Supportive Services Program (ADSSP) funds competitive grants for 

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

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

components of the ADSSP program include delivering evidence-based supportive services; 

translating and replicating evidence-based interventions for persons with dementia and their 

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

innovative projects; and advancing changes to a State’s overall system of home and communitybased care. 

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

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

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

and legal rights of people affected by Alzheimer’s disease throughout a state’s long term services 

and support system.

Funding for ADSSP was reduced in FY 2012 and is sufficient only to issue continuation grants

to the 11 grantees whose grants remain current. As a result of the funding reduction, no new 

grant awards will be made for this program. In FY 2011 the ADSSP program funded 36 grants 

with an average award of $284,503 and a range of grant awards from $108,736 to $700,200. 

Through these grant projects, seven States are in the process of translating four evidence-based 

interventions into practice and nine States are offering innovative programming for caregivers 

and their loved ones with dementia. One example of these promising interventions is the New 

York University Caregiver Intervention, a spousal caregiver support program that in a 

randomized-control trial delayed institutionalization of persons with dementia by an average of 

557 days.38 In 2009, the average nursing home cost was $219 daily ($79,935 annually), which 

would mean an average savings of nearly $122,000 in institutional costs per person with dementia.39

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

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

1731.

 

39 Metlife. (October 2009), “MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and 

Home Care Costs”, p. 4, Accessed August 17, 2010 
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Minnesota is translating this intervention now; early results appear to confirm the original study. 

Other FY 2011 grant projects focus on innovations in areas of great need, such as programs to 

ensure that the states’ long term services and supports system are dementia capable. Overall, 

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

support the continuous quality improvement and evaluation of these services.

Family caregivers remain the major source of support for most people with Alzheimer’s disease. 

The nature of the disease - a slow loss of cognitive and functional/physical independence -

means that most people with Alzheimer’s disease are cared for in the community for years. They 

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

mental health service systems. As the number of people with Alzheimer’s disease grows, it is 

increasingly important that service delivery and health care systems are responsive to persons 

with dementia and are effectively coordinated. It is also important to ensure the availability of 

dementia-capable community-based social and health care services. 

Funding History:

Funding for the ADSSP program during the past five years is as follows:

FY 2008............................................... $11,464,000

FY 2009............................................... $11,464,000

FY 2010............................................... $11,462,000

FY 2011............................................... $11,441,000

FY 2012................................................. $4,010,000

Budget Request:

The FY 2013 request for the Alzheimer’s Disease Supportive Services Program is $9,537,000, an 

increase of $5,526,000 over the FY 2012 enacted level. These additional funds are intended to 

restore much of the funding cut in FY 2012. Without continued funding, communities across the 

nation will lose the ability to implement the translations of the investments made to date in 

proven evidence-based interventions such as the New York University Caregiver Intervention 

referenced above. In addition AoA will unable to undertake subsequent translations of research 

funded by NIA, CDC and other science agencies. The need for cutting edge approaches to 

serving this population continues to grow rapidly. One study estimates that there were 

454,000 new cases of Alzheimer’s disease in 2010; by 2030 the number of new cases is 

projected to be 615,000 and by 2050, 959,000; currently over 5 million individuals have this 

disease40

The FY 2013 funding request will allow AoA to continue to respond to this growing need by 

supporting grants that provide direct services to approximately 3,680 persons with Alzheimer’s 

disease and their family caregivers. Funds will be used to broadly disseminate those translated, 

evidence-based interventions that have proven successful over the past 4 years of funding and to 

. 

 from: http://www.metlife.com/assets/cao/mmi/publications/studies/mmi-market-survey-nursing-home-assistedliving.pdf

40 Alzheimer’s Association, (2011). “Alzheimer’s Disease Facts and Figures”., p. 17 and p. 34. Accessed August 30, 

2011 from: http://www.alz.org/alzheimers_disease_facts_figures.asp
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test new evidence-based interventions as they are identified. In addition funds will be used to 

expand the delivery of dementia-capable home and community-based services, thereby 

potentially impacting the much broader population of families struggling to cope with this 

disease.

Today ADSSP is supporting 16 states in field testing 9 evidence-based caregiver interventions,

with the goal of embedding successful translations in state programs and funding streams. AoA 

is looking at how these interventions can be effectively provided through Aging Network 

programs while attempting to ensure fidelity to the original intervention. Successful translation 

of these research interventions to community settings will have a significant impact on 

supporting and sustaining family caregivers41. 

By the close of FY2013, AoA anticipates the release of evaluation results from a six-state 

translation effort of the New York University Caregiver Intervention (referenced above) which 

aims to significantly delay institutionalization of persons with dementia by providing education, 

support, and counseling to spousal and other family caregivers. In addition, AoA will have 

completed an evaluation of a three state translation of the Savvy Caregiver Intervention. This 

intervention trains caregivers to think about their situation objectively and provides them with 

the knowledge, skills, and attitudes they need to manage stress and carry out the caregiving role 

effectively.

 41 The evidence-based projects have three year project periods to develop, implement and document fidelity of the 

translation to the original model. Actual dissemination/replication of the interventions occurs after the translations 

are shown to have proven fidelity to the original models in the new type of setting. Each of the States funded at the 

end of FY 2008 requested up to a 1-year no-cost extension to finalize their projects. Therefore, baselines to these 

and similar measures will be available starting in FY 2013 for the FY 2008 and subsequent grants after if/when the 

translation projects are proven successful.
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Outcome and Outputs Table:

Alzheimer’s Disease Supportive Services Program Outputs

Note: For presentation within the budget AoA highlighted specific measures that are most directly related to 

Alzheimer’s Disease Supportive Services Programs, however multiple performance outcomes are impacted by this 

program because AoA’s performance measures (efficiency, effective targeting, and client outcomes) assess networkwide performance in achieving current strategic objectives.

 42 Cumulative count began in 2008. 43 Cumulative count began in 2008.

Measure Most Recent Result FY 2012 

Target

FY 2013

Target

FY 2013 

+/- FY 2012

Outcome: ALZ2. Increase number 

of individuals served with 

evidence-based interventions –

cumulative42

FY 2010: 3,322

 (Outcome)

Target: N/A 4,120 4,120 Maintain

Indicator Most Recent Result FY 2012

Projection 

FY 2013

Projection 

FY 2013 

+/- FY 2012

Output AC: Number of 

individuals served – cumulative43 FY 2010: 6,248

(Output)

4,120 7,800 +3,680

Output AD: Percent of 

individuals served that are of a 

racial/ethnic minority (Output)

N/A TBD TBD N/A
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115

Lifespan Respite Care

FY 2011

Enacted

FY 2012

Enacted

FY 2013

Request

FY 2013 +/-

FY 2012

Lifespan Respite Care ................. $2,495,000 $2,490,000 $2,490,000 --

Authorizing Legislation: Lifespan Respite Care Act of 2006, Title XXIX of the Public Health 

Service Act

FY 2013 Authorization..................................................................................................... Expired

Allocation Method ......................................................................................... Competitive Grants

Program Description and Accomplishments:

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

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

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

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

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

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

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

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

needs. 

Caregiving is an activity that is needed across the age spectrum from birth to death. AARP 

estimated, in 2009, that 65.7 million people served as unpaid family caregivers to an adult or 

child with special needs. For many of these caregivers, providing care can take a toll: a majority 

of caregivers (51%) caring for someone over age 18 have medium or high levels of burden and 

31% of all family caregivers indicated they experienced high levels of stress.

44

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

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

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

seek to identify and to fill gaps in services. Select examples of grantee activities include:

• Conducting needs assessments/environmental scans to determine the respite funding 

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

• Broadening stakeholder collaborations to ensure representation of all age and disability 

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

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

50+. 2009. http://www.aarp.org/research/surveys/care/ltc/hc/articles/caregiving_09.html
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• Convening focus groups of respite consumers to inform project activities; and 

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

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

with programs such as the Corporation for National Service (e.g., VISTA, Service 

Learning, Senior Companions, etc.)

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

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

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

education programs on respite care. 

Respite care services are highly valued by caregivers. According to a November 2009 study by 

the National Alliance for Caregiving, of six national policies or programs presented to caregivers 

as potential ways to help them, 26 percent of respondents ranked respite services as either their 

first or second most preferred option.45 By providing opportunities for family caregivers to 

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

family caregiver health and well-being, reduces the likelihood of abuse and neglect, and allows 

care recipients to remain in their own homes for as long as possible.

To illustrate the importance of respite, in a recent National Survey of OAA service recipients a 

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

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

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

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

result of the services they received:

• 77 percent had less stress; 

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

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

• 95 percent reported the care recipient benefited from the service; and 

• 82 percent said that the services enabled them to care longer. 

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

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

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

agency designated by the Governor. Additionally, the eligible State agency must work in 

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

statewide respite care coalition or organization. Priority consideration is given to applicants who 

demonstrate the greatest likelihood of implementing or enhancing lifespan respite care statewide 

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

comprehensive needs of care recipients. 

 45 National Alliance for Caregiving and AARP. Caregiving in the U.S. Bethesda: National Alliance for Caregiving, 

and Washington, DC: AARP, 2009.
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Since 2009, thirty states (twelve states in 2009, twelve more in 2010, and six additional states in 

2011) have been awarded grants of up to $200,000 each for three year projects. Additionally, in 

FY 2011, eight states were awarded expansion grants to focus specifically on providing respite 

services to meet demand and fill gaps in service where identified.

Select examples of FY 2009 and 2010 grantee accomplishments to date include:

• Conducting needs assessments/environmental scans to determine the respite funding 

streams available, programs in existence, data collection, populations served and gaps in 

each area;

• Modification of select modules of the College of Direct Support respite training to adapt 

them for use with special needs respite populations;

• Identification of existing respite models in the state and the creation of a training guide 

entitled: Lifespan Respite: An Information guide for Developing, Recruiting, Training and 

Retaining Volunteers;

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

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

with programs such as the Corporation for National Service (e.g., VISTA, Service 

Learning, Senior Companions, etc.)

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

respite programs.

Funding History:

Funding for the Lifespan Respite Care program during the past five years is as follows:

FY 2008...............................................................$0

FY 2009................................................. $2,500,000 

FY 2010................................................. $2,500,000

FY 2011................................................. $2,495,000

FY 2012................................................. $2,490,000

Note: Funding for the Lifespan Respite Care Act was appropriated in FY 2009 under the General Departmental 

Management Account in the HHS Office of the Secretary. In FY 2010 funding was appropriated directly to the 

Administration on Aging. 

Budget Request:

The FY 2013 request for Lifespan Respite is $2,490,000; the same as the FY 2012 enacted level. 

By continuing to invest resources in this program, AoA seeks to provide resources that will allow 

caregivers to continue to care for their loved ones longer and thereby allow more care recipients 

to remain at home and independent for longer periods at lower cost than could be realized if 

these same individuals had to be institutionalized. 

Lifespan Respite is unique in that no other Federal program mandates respite as its sole focus; 

helps ensure respite quality and choice; or allows funds for respite development, training and
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coordination regardless of age or disability. The Lifespan Respite Care program demonstrates 

AoA’s commitment to include caregivers of children or adults of any age with special needs. 

According to the National Respite Coalition, nearly 90% of family caregivers of care recipients 

age 18 and older, and 81% of family caregivers of children with special needs currently are 

unable to access or use respite services. Caregivers report numerous barriers ranging from cost 

considerations and restrictive eligibility criteria to waiting lists, limited respite options, 

inadequate supply of trained providers or appropriate programs and gaps in service availability.46

The resources requested for FY 2013 will be used to address these issues by:

• Expanding and enhancing respite care services to family members;

• Improving the statewide dissemination and coordination of respite care; and

• Providing, supplementing, or improving access and quality of respite care services to family 

caregivers, thereby reducing family caregiver strain.

The request will also allow AoA to cover new States not funded in previous years, enabling these 

new States to establish and/or strengthen infrastructures that offer targeted Respite Information 

and Referral services. And it will further enable all States funded to date to meet the 

requirements of the Act through continued infrastructure development and better recruitment and 

training of respite providers and volunteers, the provision of emergency and planned respite, 

training of family caregivers, and providing direct respite services, thus reducing the percentages 

of caregivers who do not use respite.

The Lifespan Respite Care Program provides AoA with another vehicle to address the needs of 

caregivers. The program builds upon the existing infrastructure of multi-faceted caregiver 

services AoA’s other caregiver programs now provide to leverage training for caregivers, 

enhance the provision of information about available respite and other supportive services, and to 

further assist caregivers in accessing all services available to them, including respite, from across 

the spectrum of caregiver support. 

 46 National Respite Coalition Written Testimony to the House subcommittee on Labor, Health and Human Services, 

and Education Appropriations. April 12, 2010
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Output Table:

Lifespan Respite Care Output

To date, the 2009 and 2010 grantees have made substantial progress towards building sustainable 

programs capable of meeting the respite care needs of caregivers across the lifespan. It is 

anticipated that the six new states funded in 2011 will achieve similar results with their programs 

while the eight states to receive expansion grants will be able to demonstrate the capacity to 

deliver respite services more efficiently and effectively. 

Indicator Most Recent 

Result 

FY 2012

Projection 

FY 2013 

Projection 

FY 2013 

+/- FY 2012

Output AE: Increase the number 

of people served as a result of 

Lifespan Respite Care (Output)

N/A N/A Baseline --
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122

Protection of Vulnerable Adults

Summary of Request

Protection of Vulnerable Adults consists of several distinct but complementary programs 

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

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

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

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

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

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

identical study conducted in 2000.47 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.48 Together, these data 

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

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

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

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

people.49 Additional adverse health impacts include an increased likelihood of heart attacks, 

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

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

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

forced to leave their homes and communities prematurely.50 Protection of Vulnerable Adults 

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

respond to elder abuse, neglect, and exploitation. 

The total FY 2013 request for Protection of Vulnerable Adults is $43,287,000; an increase of 

$8,000,000 over the FY 2012 enacted level. For FY 2013, specific program requests include:

• $8,000,000 in first-time funding for the Adult Protective Services (APS) program

authorized by the Elder Justice Act of 2010 (included in Subtitle H of the Affordable 

Care Act). APS funding will provide demonstration grants to test innovative approaches 

to reducing and addressing elder abuse in States and in Tribal settings. This funding will 

generate knowledge that can then be used to inform State and local efforts across the 

country to design and implement better approaches to protect our Nation’s older adults 

from abuse. Federal funding will also support evaluation of interventions designed to 

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

Older. http://www.ncea.aoa.gov/NCEAroot/Main_Site/pdf/021406_60PLUS_REPORT.pdf 48 Tatara, Toshio, et al. The National Elder Abuse Incidence Study Final Report. 1998. 

http://www.aoa.gov/AoARoot/AoA_Programs/Elder_Rights/Elder_Abuse/docs/ABuseReport_Full.pdf 49 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. 50 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.
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detect and prevent elder abuse, including financial exploitation; and improvement of the 

knowledge base about how to best implement these important activities.

• $16,761,000 for the Long-Term Care Ombudsman Program, the same as the FY 2012 

enacted level. This consumer advocacy program improves the quality of care for the 

residents of long-term care facilities in all States.

• $5,036,000 for Prevention of Elder Abuse and Neglect, the same as the FY 2012 enacted 

level. This program provides state formula grants for training, education, and campaigns 

promoting public awareness of elder abuse and prevention efforts. 

• $9,402,000 for the Senior Medicare Patrol Program, the same as the FY 2012 enacted 

level. SMP funds competitive grants to support the volunteer-based network that helps to 

prevent and combat healthcare fraud and abuse and helps to preserve the financial 

integrity of Medicare and Medicaid.

• $4,088,000 for Elder Rights Support Activities, the same as the FY 2012 enacted level. 

This program provides funding for four resource centers and programs that provide 

information, training, and technical assistance on Elder Rights issues to the national 

Aging Services Network.

This enhanced focus on elder rights and elder justice will build a foundation and establish best 

practices for States to develop programs to expand and improve the protection of individuals 

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

assistance available to the public, States, and localities in preventing and addressing abuse; 

protect the rights of older adults and prevent their exploitation; reduce health-care fraud and 

abuse; and provide assistance to Tribes in developing elder justice systems. This multifaceted 

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

essential to successfully fulfilling the shared mission of the Older Americans Act and the Elder 

Justice Act to maintain the health and independence of older Americans and adults with 

disabilities.
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125

Adult Protective Services Demonstration Program

FY 2011

Enacted

FY 2012

Enacted

FY 2013

Request

FY 2013 +/-

FY 2012

Adult Protective Services Programs....... -- -- $8,000,000 +$8,000,000

FTE.......................................... -- -- 1 +1

Authorizing Legislation: Title XX of the Social Security Act, Subtitle B, Section 2042, as 

amended by the Affordable Care Act, Subtitle H – Elder Justice Act, Sections 6701-6703;

Section 751 of the Older Americans Act, as amended

FY 2013 Social Security Act Authorization............................................................... $25,000,000

Allocation Method ................................................................... Competitive Grants and Contracts

Program Description:

The Adult Protective Services (APS) Demonstration Program, as established in the Elder Justice 

Act, provides competitive grants to States to test and evaluate innovative approaches to 

preventing, detecting, and responding to elder abuse, neglect, and exploitation. 

Current State and local APS programs provide a range of services designed to ensure the safety 

and well-being of elders who are in danger of being mistreated or neglected, are unable to take 

care of themselves or to protect themselves from harm, and who have no one to assist them. 

These services include:

• receiving and investigating reports of elder abuse, neglect, or exploitation;

• case planning, monitoring, evaluation, and other case work and services; and

• providing, arranging for, or facilitating the provisions of medical, social service, 

economic, legal, housing, law enforcement, or other protective, emergency, or support 

services.

The increasing complexity of elder and adult abuse cases, coupled with a rising older population

and different State and local budget conditions have presented challenges to State, local, and 

Tribal APS programs. 51

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

Older. 

The FY 2012 budget request cannot fill the service holes, but the 

funding can be used to test new approaches, rigorously evaluate them, and then use the findings 

to inform and improve State, local and Tribal APS efforts. States, localities and tribes lack the 

http://www.ncea.aoa.gov/NCEAroot/Main_Site/pdf/021406_60PLUS_REPORT.pdf
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resources to conduct these pilots, evaluate them and share lessons learned with others. That is 

the gap this request seeks to fill.

A number of obstacles have prevented APS programs from evaluating their services, including a 

lack of resources, the increasing number and complexity of abuse cases, and the absence or 

inadequacy of consistent data systems and uniform reporting requirements needed to conduct 

meaningful program evaluations. Many of these same challenges have limited efforts to develop 

new and innovative approaches to preventing, detecting, and responding to abuse, neglect, and 

exploitation. Demonstration funds will provide competitive grant funding to test new or 

previously unevaluated approaches and evaluate their effectiveness.

Funding History:

No prior funding has been appropriated to this program.

Budget Request:

The FY 2013 request for Adult Protective Services Program is $8,000,000 in new funding. The 

request includes funding for demonstration grants and associated evaluations and the piloting and 

assessment of an APS resource center. It also includes the funds to support one FTE to carry out

these activities.

The budget request is consistent with the findings of the recent GAO report on Federal elder 

justice efforts, as well as an earlier HHS report to Congress assessing the feasibility of 

establishing uniform standards for data collection, reporting, and dissemination of best practices 

regarding Elder Abuse. This report to Congress included a detailed analysis of the significant 

level of effort required to address the data collection and reporting requirements for APS. Taken 

together, these activities will complement each other, and will advance efforts to develop 

innovative approaches and best practices that can then be disseminated to APS programs 

nationwide.

The FY 2013 request for $8 million includes approximately $5.5 million to fund competitive 

grants to test promising approaches to meeting the growing challenges that State and local APS 

programs face. Elder abuse, neglect, and exploitation present complex problems requiring 

multidisciplinary solutions that employ the most effective and efficient interventions available. 

These competitive grants will allow State and local APS programs to develop and evaluate 

innovative approaches and identify best practices that can then be disseminated to APS programs 

nationwide.

The ability of APS programs to employ tested, proven techniques is essential to ensuring that 

elders are able to receive protection and relief from abuse, neglect, and exploitation. Using the 

results of the APS State demonstrations, AoA will develop a compendium of best practices and 

lessons learned that APS programs across the nation can use to improve their programs. 

Additionally, AoA will present findings at conferences, conduct trainings and webinars to 

disseminate the results, and seek out ways to coordinate with other national, State and local 
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entities to distribute the information. The cumulative results of these projects will allow AoA to 

establish a strong evidence-base for current and future projects.

Critical to the success of these efforts, AoA will provide APS State demonstration grantees with 

uniform definitions and reporting requirements to be used to track APS program results and 

compare them with other programs throughout the nation. Currently, APS programs have wide 

ranging definitions of elder abuse, neglect, and exploitation that make the combination of output 

data unreliable and comparative evaluations impossible to conduct. 

Additionally, in FY 2013 AoA will provide $1 million to support research and demonstration 

programs to test approaches to addressing the unique challenge of preventing, identifying, and 

responding to elder abuse, neglect, and exploitation within Tribal nations. At listening sessions

with Tribal grantees, elder abuse has been repeatedly raised as an issue of concern in these 

communities. In an effort to respond to these concerns, funds will provide competitive grants to 

eligible Tribal organizations, public agencies, and nonprofit organizations to support Tribes in 

the development of informational, legal, and supportive services to assist in the prevention, 

detection, and resolution of elder abuse, neglect, and exploitation. Funding will support 

coalition-building, training, and technical assistance; the development of statutes and codes; 

elder rights program development; and research for effectively preventing and addressing elder 

abuse within Tribal nations.

Most of the balance of $1.5 million will fund contracts to evaluate these activities and support 

the continued development of data collection and reporting requirements associated with the 

state-level demonstration grants. These funds will also be used for the funding of an APS 

resource center, in keeping with a March 2011 GAO report on Elder Justice at the Federal level 

which indicated the need for additional resources that could provide more easily accessible and 

centrally available information on APS best practices. Lastly, a portion of the budget allocated 

for the evaluation and administration of APS State Demonstrations will be used to provide staff 

resources to support the grants management, technical assistance, coordination, and the 

development and dissemination of best practices that are essential to the success of the these 

demonstration projects.

Output Table:

Adult Protective Services Output

Indicator Most Recent Result FY 2012

Projection 

FY 2013

Projection 

FY 2013 

+/- FY 2012

Output AP.1: Design Adult Protective 

Service evaluation to develop and test 

appropriate methods of addressing elder 

abuse, neglect and exploitation.

N/A Evaluation 

Design Baseline N/A
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130

Long-Term Care Ombudsman Program

FY 2011

Enacted

FY 2012

Enacted

FY 2013

Request

FY 2013 +/-

FY 2012

Long-Term Care Ombudsman 

Program................................................ $16,793,000 $16,761,000 $16,761,000 --

Authorizing Legislation: Section 712 of the Older Americans Act of 1965, as amended

FY 2013 Older Americans Act Authorization................................................................... Expired

Allocation Method ............................................................................................... Formula Grants

Program Description and Accomplishments:

The Long-Term Care Ombudsman program is a consumer advocacy program that improves the 

quality of care for the estimated 2.9 million individuals who reside in 69,320 long-term care 

facilities.52 Formula grants to States and Territories based on the number of individuals age 60 

and older provide funding for the training, travel, and other operating costs of nearly 

10,000 ombudsmen (both staff and certified volunteers) who resolve complaints on behalf of 

these residents and routinely monitor the condition of long-term care facilities. 

A primary Ombudsman duty is to identify, investigate and resolve complaints that are made by, 

or on behalf of residents. These complaints relate to action, inaction, or decisions of providers, 

public agencies, and others that may adversely affect residents’ health, safety, welfare or rights. 

Ombudsmen advocate on behalf of residents by representing their interests before government 

and administrative entities, providing information to residents and families about the long-term 

care system, and educating the general public about issues related to long-term care policies and 

regulations. 

Much of the efficiency of the Ombudsman Program is due to the strong reliance on volunteers 

who make up the bulk of those who resolve resident issues.

53 All but five states have volunteer 

ombudsman programs. These certified volunteer ombudsmen donated over 811,440 hours in 

FY 2010, a five percent increase over FY 2009. FY 2010 output data for the Long-Term Care 

Ombudsman Program highlights the accomplishments achieved by this program and the 

important role that ombudsmen play in ensuring that the rights of long-term care facility 

residents are respected: 

• 1,167 FTE and 8,800 certified volunteer ombudsmen regularly visited residents in

33,391 facilities, more than 74 percent of all nursing home facilities and nearly

 52 National Ombudsman Reporting System (NORS) – Federal Fiscal 2010

53 Shaughnessy, Carol V. The Role of Ombudsmen in Assuring Quality for Residents of Long-Term Care Facilities: 

Straining to Make Ends Meet. National Health Policy Forum. December 9, 2009. 
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39 percent of all licensed board and care facilities (Output S). At least another 

2200 volunteers support these paid staff and certified volunteer ombudsmen.

• Ombudsmen investigated and worked to resolve 211,937 complaints (Output Q). 

• Ombudsmen provided over 381,299 consultations to individuals and facility managers 

and staff on such topics as residents’ rights, staffing levels, malnutrition, dementia care, 

depression, discharge procedures, financial exploitation and strategies to reduce the use 

of restraints and prevent the abuse and neglect of residents (Output R).

Funding History:

Funding for the Long-term Care Ombudsman Program during the past five years is as follows:

FY 2008............................................... $15,577,000

FY 2009............................................... $16,328,000

FY 2010............................................... $16,825,000

FY 2011............................................... $16,793,000

FY 2012............................................... $16,761,000

Budget Request:

The FY 2013 request for the Long-Term Care Ombudsman program is $16,761,000, the same as 

the FY 2012 enacted level. 

The number of older Americans is increasing rapidly. This is particularly true among the 

population age 85 and older. As a percentage of the population, the number of older Americans 

age 85 and older is growing faster than any other age cohort and is projected to reach nearly 

20 million by the year 2030. As this population grows, the need for safe, high-quality long-term 

care services (including non-nursing home alternatives) will increase, even as we seek to help 

more people remain in the community for longer periods. 

Outcome data (displayed in the summary tables at the end of this section) demonstrate the 

success of this program in protecting older Americans in an efficient and effective manner. The 

percentage of the complaints processed by ombudsmen that were fully or partially resolved to the 

satisfaction of the resident has consistently remained near 75 percent,54 demonstrating both the 

efficiency of the program and its ability to produce positive outcomes for residents. The average 

number of complaints per facility at 3.05 is on track to meet the projected 2012 target. A new 

outcome measure was added to further evaluate the level of success in resolving resident 

problems. Outcome 2.14 will target a decrease in complaints that are not resolved to the 

satisfaction of the resident. 

The FY 2013 request represents an important element of AoA’s enhanced focus on elder rights, 

which expands and improves upon AoA’s successful elder rights programs to create a full array 

 54 NORS 2010 – Complaint resolution: 9% needing no further action; 4% withdrawn; 6% not resolved to the 

satisfaction of the resident; 6% referred to other agency for resolution.
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of services to prevent, detect, and resolve elder abuse, neglect, and exploitation. This request 

also supports Federal policy for quality alternatives to nursing home care. LTC Ombudsmen 

advocate for quality care and individual rights and well-being in other congregate long-term care 

settings, such as board and care and assisted living. In addition, LTC Ombudsmen serve 

individuals in these settings regardless of the individuals’ eligibility for Medicaid or other public 

benefits. Ombudsmen are the only Federally-funded entity providing services to all of these 

residents. Outreach, access, complaint investigation and advocacy in board and care require 

Ombudsmen to employ new strategies compared to the work done in nursing home settings. 

Supporting volunteers to work in these often more intimate environments requires additional 

support and training. 

Outcomes and Outputs Table:

Long-Term Care Ombudsman Program Outcomes and Outputs

Measure Most Recent Result FY 2012

Target 

FY 2013

Target 

FY 2013 

+/- FY 2012

Outcome 2.12: Decrease the average 

number of complaints per LTC facility

(Outcome)

FY 2010: 3.05

Target: 4.06

(Target Not Met)

3.0 3.0 --

Outcome 2.14 : Decrease the number of 

complaints not resolved to the satisfaction 

of the resident (Outcome)

FY 2010: 11,809

Target: N/A

11,293 10,778 -515

Indicator Most Recent Result FY 2012

Projection 

FY 2013

Projection 

FY 2013 

+/- FY 2012

Output Q: Decrease the Number of 

Complaints (Output) FY 2010: 211,937 204,000 200,000 -4,000

Output R: Number of Ombudsman 

Consultations (Output) FY 2010: 381,299 400,000 425,000 +25,000

Output S: Facilities regularly visited not in 

response to a complaint (Output) FY 2010: 33,391 35,000 35,000 --

Grant Awards Table:
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Long-Term Care Ombudsman Program Grant Awards

FY 2011

Enacted

FY 2012

Enacted

FY 2013

Request

Number of 

Awards 56 56 56

Average Award $299,093 $296,315 $296,315

Range of 

Awards

$10,468 -

$1,693,475

$10,371 -

$1,690,679

$10,371 -

$1,690,679

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION ON AGING

FY 2013 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM: Long-Term Care Ombudsman Program (CFDA 93.042)

State/Territory

FY 2011

Actual

FY 2012

Estimate

FY 2013

Request

Difference

+/-FY 2012

Alabama......................................... 262,233 259,752 259,752 --

Alaska............................................ 83,746 82,968 82,968 --

Arizona.......................................... 348,130 345,272 345,272 --

Arkansas........................................ 165,619 163,266 163,266 --

California....................................... 1,693,475 1,690,679 1,690,679 --

Colorado.................................. 227,267 227,763 227,763 --

Connecticut .............................. 196,524 197,433 197,433 --

Delaware.................................. 83,746 82,968 82,968 --

District of Columbia ................... 83,746 82,968 82,968 --

Florida..................................... 1,226,365 1,222,346 1,222,346 --

Georgia.................................... 429,742 424,996 424,996 --

Hawaii..................................... 83,746 82,968 82,968 --

Idaho....................................... 83,746 82,968 82,968 --

Illinois..................................... 643,452 632,649 632,649 --

Indiana .................................... 334,905 331,459 331,459 --

Iowa ....................................... 174,013 172,788 172,788 --

Kansas..................................... 147,001 145,978 145,978 --

Kentucky ................................. 233,207 230,625 230,625 --

Louisiana ................................. 226,146 222,742 222,742 --

Maine...................................... 83,746 83,645 83,645 --

Maryland ................................. 287,437 285,202 285,202 --

Massachusetts ........................... 361,717 354,137 354,137 --

Michigan.................................. 544,348 536,888 536,888 --

Minnesota ................................ 270,333 267,812 267,812 --

Mississippi ............................... 151,899 150,514 150,514 --
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State/Territory

FY 2011

Actual

FY 2012

Estimate

FY 2013

Request

Difference

+/-FY 2012

Missouri .................................. 329,777 325,855 325,855 --

Montana .................................. 83,746 82,968 82,968 --

Nebraska.................................. 95,242 95,167 95,167 --

Nevada .................................... 128,779 132,191 132,191 --

New Hampshire......................... 83,746 82,968 82,968 --
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PROGRAM: Long-Term Care Ombudsman Program (CFDA 93.042)

State/Territory

FY 2011

Actual

FY 2012

Estimate

FY 2013

Request

Difference

+/-FY 2012

New Jersey............................... 471,073 463,516 463,516 --

New Mexico............................. 104,556 107,140 107,140 --

New York ................................ 1,057,995 1,024,692 1,024,692 --

North Carolina .......................... 490,016 492,882 492,882 --

North Dakota............................ 83,746 82,968 82,968 --

Ohio ....................................... 644,354 636,204 636,204 --

Oklahoma ................................ 198,924 197,815 197,815 --

Oregon.................................... 213,891 214,071 214,071 --

Pennsylvania ............................ 764,412 751,679 751,679 --

Rhode Island ............................ 83,746 82,968 82,968 --

South Carolina .......................... 256,121 253,775 253,775 --

South Dakota............................ 83,746 82,968 82,968 --

Tennessee ................................ 344,228 340,485 340,485 --

Texas...................................... 1,048,816 1,050,406 1,050,406 --

Utah ....................................... 101,944 98,779 98,779 --

Vermont .................................. 83,746 82,968 82,968 --

Virginia................................... 397,235 394,754 394,754 --

Washington .............................. 337,546 336,473 336,473 --

West Virginia ........................... 115,956 117,611 117,611 --

Wisconsin................................ 305,652 303,480 303,480 --

Wyoming................................. 83,746 82,968 82,968 --

 

Subtotal, States.............................. 16,419,028 16,278,537 16,278,537 --

American Samoa ....................... 10,468 10,371 10,371 --

Guam...................................... 41,873 41,484 41,484 --

Northern Mariana Islands............. 10,468 10,371 10,371 --

Puerto Rico .............................. 225,524 211,401 211,401 --

Virgin Islands........................... 41,873 41,484 41,484 --

 

Subtotal, States and Territories ...... 16,749,234 16,593,648 16,593,648 --

 

Undistributed 55/ .......................... 43,766 167,352 167,352 --

TOTAL 16,793,000 16,761,000 16,761,000 --

 55/ Funds held for statutory related requirements are reflected in the undistributed line.
136

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138

Prevention of Elder Abuse and Neglect

FY 2011

Enacted

FY 2012

Enacted

FY 2013

Request

FY 2013 +/-

FY 2012

Prevention of Elder Abuse and 

Neglect ....................................... $5,046,000 $5,036,000 $5,036,000 --

Authorizing Legislation: Section 721 of the Older Americans Act of 1965, as amended

FY 2013 Authorization..................................................................................................... Expired

Allocation Method .................................................................................................Formula Grant

Program Description and Accomplishments:

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

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

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

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

of AoA’s enhanced focus on elder justice. The program coordinates activities with State and 

local adult protective services programs (over half of which are directly administered by State 

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

justice. The importance of these services at the State and local level is demonstrated by the fact 

that States significantly leverage Older Americans Act (OAA) funds to obtain other funding for 

these activities. In FY 2009 over $35 million of the Elder Abuse Prevention services 

expenditures was leveraged from non-OAA funds, a ratio of approximately $7 of non-OAA 

funds for every $1 investment of AoA funds.

Examples of State elder abuse prevention activities in 2010 include:

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

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

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

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

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

produced a prevention tool called the Kentucky Fraud Fighter Form.

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

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

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

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

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

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

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

Funding History:

Funding for Prevention of Elder Abuse and Neglect during the past five years is as follows:

FY 2008................................................. $5,056,000

FY 2009................................................. $5,056,000

FY 2010................................................. $5,055,000

FY 2011................................................. $5,046,000

FY 2012................................................. $5,036,000

Budget Request and Anticipated Accomplishments:

The FY 2013 request for the Prevention of Elder Abuse and Neglect program is $5,036,000, the 

same as the FY 2012 enacted level. The FY 2013 request will maintain the ability of States and 

Territories to train law enforcement officials, develop and distribute educational materials, 

conduct public awareness campaigns, and create community coalitions and multidisciplinary 

teams to investigate and respond to elder abuse and neglect. States and AAAs also use this 

funding to coordinate their activities with fraud and crime prevention partnerships organized by 

sheriffs, police chiefs, and community organizations. 

These activities are important elements of AoA’s continued focus in FY 2013 on elder justice, 

which seeks to improve upon AoA’s successful elder rights programs, including the Prevention 

of Elder Abuse and Neglect program. This enhanced focus will allow the creation of a full array 

of services to protect elder rights and prevent, detect, and resolve elder abuse, neglect, and 

exploitation. Prevention of Elder Abuse and Neglect programs complement Adult Protective 

Services by funding the infrastructure on which best practices may be developed and evaluated.
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Output Table:

Prevention of Elder Abuse and Neglect Output

Indicator Most Recent Result FY 2012

Projection 

FY 2013

Projection 

FY 2013 

+/- FY 2012

Output U: Elder Abuse prevention nonOAA service expenditures (Output, 

results in thousands)

 FY 2010: $29,072 $20,000 $20,000 --

Grant Awards Table:

Prevention of Elder Abuse, Neglect, and Exploitation Grant Awards

FY 2011

Enacted

FY 2012

Enacted

FY 2013 

Request

Number of 

Awards 56 56 56

Average Award $89,868 $89,037 $89,037

Range of 

Awards

$3,145 -

$503,223

$3,116 -

$497,037

$3,116 -

$497,037
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DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION ON AGING

FY 2013 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM: Prevention of Elder Abuse & Neglect (CFDA 93.041)

State/Territory

FY 2011

Actual

FY 2012

Estimate

FY 2012

Estimate

Difference

+/-FY 2012

Alabama......................................... 77,924 76,364 76,364 --

Alaska............................................ 25,163 24,930 24,930 --

Arizona .......................................... 103,449 101,506 101,506 --

Arkansas........................................ 49,214 48,157 48,157 --

California....................................... 503,223 497,037 497,037 --

Colorado ........................................ 67,534 66,959 66,959 --

Connecticut.................................... 59,907 59,907 59,907 --

Delaware........................................ 25,163 24,930 24,930 --

District of Columbia....................... 25,163 24,930 24,930 --

Florida ........................................... 364,420 359,354 359,354 --

Georgia .......................................... 127,700 124,943 124,943 --

Hawaii ........................................... 25,163 24,930 24,930 --

Idaho.............................................. 25,163 24,930 24,930 --

Illinois............................................ 197,384 197,384 197,384 --

Indiana........................................... 99,519 98,224 98,224 --

Iowa............................................... 55,927 55,927 55,927 --

Kansas........................................... 45,843 45,843 45,843 --

Kentucky........................................ 69,299 67,801 67,801 --

Louisiana ....................................... 68,518 68,518 68,518 --

Maine............................................. 25,163 24,930 24,930 --

Maryland........................................ 85,413 83,846 83,846 --

Massachusetts ................................ 109,606 109,606 109,606 --

Michigan........................................ 161,756 160,862 160,862 --

Minnesota ...................................... 80,331 78,733 78,733 --

Mississippi..................................... 45,198 45,198 45,198 --

Missouri......................................... 97,995 97,643 97,643 --

Montana......................................... 25,163 24,930 24,930 --

Nebraska........................................ 29,770 29,770 29,770 --

Nevada........................................... 38,267 38,862 38,862 --

New Hampshire.............................. 25,163 24,930 24,930 --
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PROGRAM: Prevention of Elder Abuse & Neglect (CFDA 93.041)

State/Territory

FY 2011

Actual

FY 2012

Estimate

FY 2013

Request

Difference

+/-FY 2012

New Jersey.................................... 143,950 143,950 143,950 --

New Mexico.................................. 31,069 31,498 31,498 --

New York ..................................... 318,066 318,066 318,066 --

North Carolina .............................. 145,611 144,901 144,901 --

North Dakota................................. 25,163 24,930 24,930 --

Ohio.............................................. 197,185 197,185 197,185 --

Oklahoma ..................................... 60,208 60,208 60,208 --

Oregon.......................................... 63,559 62,934 62,934 --

Pennsylvania ................................. 242,944 242,944 242,944 --

Rhode Island ................................. 25,163 24,930 24,930 --

South Carolina .............................. 76,108 74,607 74,607 --

South Dakota................................. 25,163 24,930 24,930 --

Tennessee...................................... 102,289 100,098 100,098 --

Texas............................................ 311,661 308,806 308,806 --

Utah.............................................. 30,293 29,040 29,040 --

Vermont........................................ 25,163 24,930 24,930 --

Virginia......................................... 118,040 116,052 116,052 --

Washington................................... 100,303 98,919 98,919 --

West Virginia................................ 36,736 36,736 36,736 --

Wisconsin ..................................... 90,826 90,309 90,309 --

Wyoming...................................... 25,163 24,930 24,930 --

Subtotal, States.............................. 4,934,164 4,892,787 4,892,787 --

American Samoa ........................... 3,145 3,116 3,116 --

Guam............................................ 12,582 12,465 12,465 --

Northern Mariana Islands.............. 3,145 3,116 3,116 --

Puerto Rico ................................... 67,016 62,149 62,149 --

Virgin Islands................................ 12,582 12,465 12,465 --

Subtotal, States and Territories ...... 5,032,634 4,986,098 4,986,098 --

Undistributed 56/ .......................... 13,366 49,902 49,902 --

TOTAL 5,046,000 5,036,000 5,036,000 --

 56/ Funds held for statutory related requirements are reflected in the undistributed line.
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145

Senior Medicare Patrol Program

FY 2011

Enacted

FY 2012

Enacted

FY 2013

Request

FY 2013 +/-

FY 2012

Senior Medicare Patrol Program............ $9,420,000 $9,402,000 $9,402,000 --

Authorizing Legislation: Sections 201 and 202 of the Older Americans Act of 1965, as amended

FY 2013 Authorization..................................................................................................... Expired

Allocation Method ...........................................................................................Competitive Grant

Program Description and Accomplishments:

The Senior Medicare Patrol (SMP) program provides competitive grants to 54 States and 

Territories to support a national volunteer-based network of retired seniors whose purpose is to 

educate older adults on preventing and identifying healthcare fraud and abuse. Projects use the 

skills of retired professionals as volunteers to conduct community outreach and education and 

provide information that empowers beneficiaries of Medicare and Medicaid and their families to 

prevent, identify and report fraud. Activities are carried out in partnership with the Centers for 

Medicare & Medicaid Services, the Office of Inspector General (OIG), healthcare providers, and 

other aging and elder rights professionals from around the country.

The HHS OIG collects performance data from the SMP projects for the annual performance 

report. The most recent report, dated May 6, 2011, documented the following program outputs 

and outcomes for the calendar year 2010. Data shows that compared to FY 2009, SMP projects:

• Maintained 4,964 active volunteers (12% increase) who worked over 129,662 hours

(6% increase) to educate beneficiaries about how to prevent Medicare and Medicaid fraud;

• Educated 298,097 beneficiaries (37% increase) in 8,300 group education sessions

(16% increase) and held 70,789 one-on-one counseling sessions with or on behalf of 

beneficiaries (109% increase); 

• Conducted 6,231 community outreach education events (10% increase); and

• Resolved 89,612 inquiries for information or assistance from beneficiaries

(50% increase).

• Documented $39,031 in actual savings and $248,064 in costs awarded for Medicare, 

Medicaid, beneficiaries and others. This does not include potential savings resulting 

from the sentinel effect, fraud deterrence, or calls to the fraud hotline or other non-SMP 

contracts. 
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In addition, the OIG reports that since the program’s inception 14 years ago, SMP projects have:

• Educated over 4.2 million beneficiaries in 84,968 group education sessions and 

1,112,887 one-on-one counseling sessions; 

• Conducted 75,062 community outreach education events; and 

• Documented over $105.976 million in savings, including Medicare and Medicaid funds 

recovered, beneficiary savings, and other savings as directly attributable to the project as 

a result of beneficiary complaints. This does not attempt to quantify the total savings 

that occur as a result of SMP program’s impact on fraud deterrence.

The SMP program historically has been supported by approximately $3.2 million in Health Care

Fraud and Abuse Control (HCFAC) funding authorized by the Health Insurance Portability and 

Accountability Act of 1996 (HIPAA) for infrastructure, technical assistance, and other SMP 

program support and capacity-building activities designed to enhance program effectiveness. 

Activities funded by HCFAC resources include support for project training and technical 

assistance provided by AoA’s National Consumer Technical Resource Center (Center). 

In the past two years, the critically important role of the SMP program continued to be

recognized by partners in Medicare fraud prevention in the private and public sectors. In 2010, 

and again in 2011, the Centers for Medicare & Medicaid Services (CMS) provided funding for

the award of an additional $9 million in grants from its Program Integrity funding, administered 

by AoA, targeted to help more than 50 Senior Medicare Patrol (SMP) programs fight Medicare 

fraud in high fraud states and expand the capacity of the program to reach more beneficiaries. In 

FY 2012, SMP will receive an additional $7.3 million from HCFAC funds to again fight 

Medicare fraud in high-fraud States.

In November 2010, AoA received a national level commendation for the SMP program from the 

National Health Care Anti-Fraud Association (NHCAA), considered the leading national 

organization focused exclusively on the fight against health care fraud. The NHCAA’s members 

comprise more than 100 private health insurers and those public sector law enforcement and 

regulatory agencies having jurisdiction over health care fraud committed against both private 

payers and public programs. The award, given annually by the NHCAA, recognizes an 

organization or individuals “who have done the most in the past year to raise public awareness 

about the problem of health care fraud in our nation’s health care system.” This organization’s 

decision to award the Administration on Aging’s (AoA) Senior Medicare Patrol (SMP) program 

the NHCAA 2010 Excellence in Public Awareness Award is a major achievement, and a notable 

acknowledgement of the value of the SMP program.
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Funding History:

Funding for the SMP discretionary appropriations is as follows:

FY 2008................................................. $9,274,000

FY 2009................................................. $9,439,000

FY 2010................................................. $9,438,000

FY 2011................................................. $9,420,000

FY 2012................................................. $9,402,000

Budget Request:

The FY 2013 request for the Senior Medicare Patrol (SMP) program is $9,402,000; the same as 

the FY 2012 enacted level. This amount will enable AoA to continue the proven fraud prevention 

activities of the SMP program.

Since the program’s inception, SMP projects have educated over 4.2 million beneficiaries and 

received over 170,000 complex issues (complaints) from beneficiaries who have detected billing 

or other discrepancies based on that information. While SMPs make numerous referrals of 

potential fraud to CMS program integrity contractors, there is no mechanism for tracking the 

actions (investigation, prosecution, collection) required to realize actual savings to the 

government as a result of these referrals. Therefore, it is not possible to directly track the 

outcome of most of the cases reported and dollars recovered as a result of SMP program 

activities. Moreover, the impact of the SMP program’s primary activities – deterrence resulting 

from the education of beneficiaries to prevent health care fraud - is difficult to measure and 

nearly impossible to quantify in dollars and cents. As the OIG indicated in the May 2011 report:

We continue to emphasize that the number of beneficiaries who have learned 

from the Senior Medicare Patrol Projects to detect fraud, waste, and abuse and 

who subsequently call the OIG fraud hotline or other contacts cannot be 

tracked....In addition, the projects are unable to track substantial savings 

derived from a sentinel effect, whereby fraud and errors are reduced in light of 

Medicare beneficiaries scrutiny of their bills. 57 

Despite these evaluation challenges, the SMP program has documented nearly $106 million in 

savings to Medicare, Medicaid, program beneficiaries, and others since its inception in 1997, 

excluding any deterrent effect. During that same period, the program has educated over 

4.2 million beneficiaries through the work of 24,431 volunteers who contributed a combined 

673,466 hours of their time to preventing, detecting and reporting suspected incidents of fraud 

and educating and training community members about fraud prevention.58

 57 Performance Data for the Senior Medicare Patrol Projects: May 2011 Performance Report, OEI-02-11-00110. 

http://www.oig.hhs.gov/oei/reports/oei-02-11-00110.pdf 58 The OIG has only begun collecting information on number of volunteers and volunteer hours since 2007.
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Outcomes and Outputs Table:

Senior Medicare Patrol Program Outcomes and Outputs

Indicator Most Recent Result FY 2012

Projection 

FY 2013

Projection 

FY 2013 

+/- FY 2012

Output W: Beneficiaries Educated and 

Served (Output) FY 2010: 397,842 420,000 450,000 +30,000
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150

Elder Rights Support Activities

FY 2011

Enacted

FY 2012

Enacted

FY 2013

Request

FY 2013 +/-

FY 2012

Elder Rights Support Activities............. $4,096,000 $4,088,000 $4,088,000 --

Authorizing Legislation: Sections 201, 202, and 411 of the Older Americans Act of 1965, as 

amended

FY 2013 Older Americans Act Authorization................................................................... Expired

Allocation Method ............................Competitive Grants/Cooperative Agreements and Contracts

Program Description and Accomplishments:

Elder Rights Support Activities consists of four programs and resource centers that provide the 

necessary information, training, and technical assistance that AoA and States need to fulfill their 

shared mission to prevent, detect, and respond to elder abuse, neglect, and exploitation. The 

combination of legal systems development and assistance programs, the National Center on 

Elder Abuse, and the National Long-Term Care Ombudsman Resource Center create a 

supportive framework for AoA’s Protection of Vulnerable Adults programs. The Elder Rights 

Support Activities described below are essential components of AoA’s ongoing elder rights 

programs:

Model Approaches to Statewide Legal Assistance Systems 

Model Approaches to Statewide Legal Assistance Systems helps States develop and implement 

cost-effective, replicable approaches for integrating senior legal helplines into the broader 

tapestry of state legal service delivery networks. The cornerstone of these projects is legal 

helplines, which assist seniors in accessing quality legal services. By ensuring strong leadership 

at the State level, Model Approaches projects create linkages within the existing legal assistance 

community and services providers and professionals in the broader community-based aging and 

elder rights networks, including AAAs, Aging and Disability Resource Centers, State LongTerm Care Ombudsmen, and Adult Protective Services. These linkages leverage the strengths of 

both elder rights and aging service networks for the provision of quality service to seniors most 

in need.

National Legal Assistance and Support Projects

National Legal Assistance and Support grants fund a comprehensive national legal assistance 

support system serving professionals and advocates working in legal and aging services 

networks. These grants provide funding for the National Legal Resource Centers, which support

the leadership, knowledge, and systems capacity of legal and aging provider organizations. 

These centers work to enhance the quality, cost effectiveness, and accessibility of legal 

assistance and elder rights protections available to older persons with social or economic needs. 

AoA is funding four projects which provide core support functions for aging and legal networks 
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including case consultation, training, technical assistance/legal and aging systems development, 

and information development and dissemination.

National Center on Elder Abuse

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

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

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

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

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

policy development. NCEA also facilitates the exchange of strategies for uncovering and 

prosecuting fraud in areas such as telemarketing and sweepstakes scams. In 2010, the NCEA:

• Continued its outreach by serving over 1,700 subscribers to its newsletter and over

1,600 members to the Elder Abuse Listserv.

• Responded to over 1,000 individual public inquiries and requests for information.

• Effectively utilized technology to provide cost-effective trainings to over 1,100 professionals 

though live Webcast forums on issues relevant to elder justice, and maintained the NCEA 

training library with over 230 resources.

• Supported systems change in 22 local communities by providing funding, training, and 

technical assistance to new elder justice community coalitions to leverage local resources and 

expertise to prevent and combat elder abuse, neglect, and exploitation.

National Long-Term Care Ombudsman Resource Center

The National Long-Term Care Ombudsman Resource Center (NORC) provides training and 

technical assistance to support the activities of State and local long-term care ombudsmen. The 

Center works to enhance the skills, knowledge and management capacity of the statewide 

ombudsman programs to enable them to handle resident complaints and represent resident 

interests. The Center also provides information to consumers and links them to ombudsmen, who 

can help consumers navigate the long-term care system and resolve problems in nursing, board 

and care, and assisted living homes. 

In FY 2010, the NORC engaged in numerous projects and activities in support of long-term care 

ombudsman programs. Highlights included supporting the success of CMS’s Money Follows 

the Person (MFP) demonstration project by working with CMS, AoA, and National Association 

of State Long-Term Care Ombudsman Programs (NASOP) to promote ombudsman coordination 

with MFP grantees, Aging and Disability Resource Centers (ADRCs), Centers for Independent 

Living, and other single points of entry programs; and furthering Federal efforts to support 

consumer choice and access to alternatives to nursing home care. NORC also provided 

ombudsmen with training from national experts on such issues as: The Changing Long-Term 

Care System; Managing Program Goals and Priorities During Fiscal Crises; Minimum Data Set 

(MDS) 3.0 Section Q, Money Follows the Person, and Nursing Home Transition; Advocacy in 

Assisted Living. State and local ombudsman training was provided at two national conferences 
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and via web-based teleconferences. The Center’s website continued high utilization (over 40,000 

monthly visits) by ombudsmen, consumers, and agencies.

Funding History:

Comparable funding for Elder Rights Support Activities is as follows:

FY 2008................................................. $3,498,790

FY 2009................................................. $4,104,000

FY 2010................................................. $4,103,000

FY 2011................................................. $4,096,000

FY 2012................................................. $4,088,000

Budget Request:

The FY 2013 request for Elder Rights Support Activities is $4,088,000, the same as the FY 2012 

enacted level. This request reflects continuation of the current level of support services for elder 

rights and elder justice. These activities are a critical component of AoA’s successful elder rights 

programs and help to create a full array of services to prevent, detect, and resolve elder abuse, 

neglect, and exploitation. 

The National Center on Elder Abuse, the National Long-Term Care Ombudsman Resource 

Center, and the Statewide Model Approaches and Legal Assistance programs provide the 

technical assistance, information, resources, referrals, and legal systems development and 

assistance activities that support the efforts of the entire spectrum of Protection of Vulnerable 

Adults programs. Continued support for these programs and resource centers will provide the 

best and most efficient services and supports possible to support AoA’s efforts to promote elder 

rights and elder justice.

Elder Rights Support Activities includes funding for the following projects59:

Activity

FY 2011

Enacted

FY 2012

Enacted

FY 2013

Request 

Elder Rights Support Activities:

Model Approaches to Statewide Legal Assistance..................... $ 1,996,000 $ 1,992,228 $ 1,992,228

National Legal Assistance and Support Projects........................ 744,508 743,592 743,592

National Center on Elder Abuse................................................ 809,378 807,471 807,471

National Long-Term Care Ombudsman Resource Center........... 545,906 544,968 544,968

Total, Elder Rights Support Activities............................... $ 4,095,792 $ 4,088,259 $ 4,088,259

 59 Several projects have been relocated from Aging Network Support Activities and are comparably adjusted. 

Accordingly, actual expenditure amounts are shown for FY 2011 and reflected in FY 2012 and FY 2013
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PROTECTION OF VULNERABLE ADULTS

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155

Consumer Information, Access, and Outreach

Summary of Request

Older Americans and Americans with disabilities face a vast array of choices when trying to 

determine the right services and supports to assist them to remain active and independent in their 

communities. As the number of choices available to assist them grows, so too does the 

complexity of navigating these programs and selecting among them so as to determine which 

best suit the needs of individuals. 

A key part of AoA’s emphasis on community living is providing consumers with the information 

they need to make decisions about their independence and connecting them with the right 

services. Aging and Disability Resource Centers (ADRCs) and the State Health Insurance 

Assistance Programs (SHIPs) help to address this need by providing information, outreach, and 

assistance to seniors and those with disabilities, so that they can access the services necessary for 

their independence. ADRCs serve as community-level “one stop shop” entry points into longterm care – including home and community-based services that can enable people to remain in 

their homes - for people of all ages who have chronic conditions and disabilities. SHIPs provide 

one-on-one counseling to help aging and disabled beneficiaries and coming-of-agers navigate 

complex health and long-term care-related topics. 

The FY 2013 request for these programs is $64,902,000; a reduction of -$6,457,000 from the 

FY 2012 enacted level. This request would provide:

• $10,000,000 for ADRCs (mandatory funds provided by the Affordable Care Act). 

ADRCs support State efforts to develop more efficient, cost-effective, and consumerresponsive systems of information and integrated access by creating “one-stop shop” 

entry points into long-term care at the community-level. Under the request, $6,457,000 in 

ADRC funds would be eliminated;

• $51,902,000 for State Health Insurance Assistance Programs (SHIPs), which provide 

free, one-on-one counseling and assistance to help aging and disabled beneficiaries 

navigate the complexities of health and long-term care systems. The SHIPs, two-thirds of 

which are currently administered by State Units on Aging, fit naturally within AoA’s 

mission of promoting community living, and will benefit from deeper connection to the 

aging services network from within AoA; and

• $3,000,000 for the National Clearinghouse for Long-Term Care Information (mandatory 

funds provided by the Deficit Reduction Act).
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158

Aging and Disability Resource Centers

FY 2011

Enacted

FY 2012

Enacted

FY 2013

Request

FY 2013 +/-

FY 2012

BA (Discretionary) ..................... $6,469,000 $6,457,000 -- -$6,457,000

BA (Mandatory) ......................... $10,000,000 $10,000,000 $10,000,000 --

Total, Program Level........... $16,469,000 $16,457,000 $10,000,000 -$6,457,000

Total, FTE........................... 3 3 3 --

Authorizing Legislation: Section 202b of the Older Americans Act of 1965, as amended

Mandatory Appropriation: Section 2405 of the Affordable Care Act of 2010

FY 2013 Older Americans Act Authorization................................................................... Expired

Allocation Method .......................... Competitive Grants/Co-operative Agreements and Contracts

Program Description and Accomplishments:

Aging and Disability Resource Centers (ADRCs) support State efforts to develop more efficient, 

cost-effective, and consumer-responsive systems of information and integrated access by 

creating “one-stop shop” entry points into long-term care at the community-level. ADRCs help 

States make better use of taxpayer dollars by streamlining access to community services and 

supports and diverting individuals from more costly forms of care, including institutional care 

and unnecessary hospital re-admissions.

ADRCs are a key component in transforming States’ long-term supports and services programs. 

Since 2003, AoA and CMS have provided grants to States to develop a foundational 

infrastructure for delivering person-centered systems of information, counseling, and access that 

make it easier for individuals to learn about and access their health and long-term services and 

support options. ADRCs grew out of best practice innovations known as “No Wrong Door”60

and “Single Points of Entry” programs, where people of all ages may turn for objective 

information on their long-term services and support options.

ADRCs provide services including:

• “one-on-one” options counseling and advice to help consumers, including private pay 

individuals, and their caregivers fully understand the options available to them.

 60 In a “No Wrong Door” entry system, multiple agencies retain responsibility for their respective services while 

coordinating with each other to integrate access to those services through a single, standardized entry process that is 

administered and overseen by a coordinating entity (Allison Armor-Garb, Point of Entry Systems for Long-Term Care: 

State Case Studies, prepared for the New York City Department of Aging, 2004).
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• streamlined access to all publicly supported long-term care services and support 

programs;

• targeted discharge planning, care transition and diversion support that integrates the 

medical and social service systems on behalf of older adults and individuals with 

disabilities to help them remain in their own homes and communities after a 

hospitalization, rehabilitation or skilled nursing facility visit; 

• outreach and assistance to Medicare beneficiaries on their Medicare benefits including 

prevention and low-income subsidies; and,

• integrated access-point to care transition and diversion support for Veterans served 

through the AoA/Department of Veterans Affairs (VA) Veteran-Directed Home and 

Community Based Services Program partnership.

Effective ADRCs perform five key operational functions:

 

• Information, Referral and Awareness: ADRCs serve as a highly visible and trusted place 

that people know they can turn to for objective information on the full range of long term 

service and support options. ADRCs promote awareness of the various options, including 

Medicare benefits, that are available in the community, especially among underserved, 

hard-to-reach and private paying populations, as well as options individuals can use to 

“plan ahead” for their long-term care. ADRCs have the capacity to link consumers with 

needed services and supports – both public and private – through appropriate referrals to 

other agencies and organizations.

• Options Counseling and Assistance: ADRCs provide counseling and decision support to 

consumers and their family members and/or caregivers by identifying and understanding 

the needs of the clients and assisting them in making informed decisions about 

appropriate long term service and support choices – including their Medicare options – in 

the context of their personal needs, preferences, values and individual circumstances.

 

• Streamlined Eligibility Determinations for Public Programs: ADRCs serve as a single 

point of entry to publicly-funded long-term services and supports, including those funded 

by Medicaid, the Older Americans Act (OAA), and other State and Federal programs and 

services. ADRCs must have the necessary protocols and procedures in place to facilitate 

integrated and/or fully coordinated access (i.e., consumer intake, needs assessment, 

service or care planning, eligibility determination, and ensuring that people get the 

services they need) to publicly supported long-term services and supports – both 

community-based and institutional. The goal is to create a process that is seamless for 

consumers regardless of which service they choose. 

• Person-Centered Care Transitions: ADRCs create formal collaborations between and 

among the major pathways that are used in health care and long-term services and 

supports, including preadmission screening programs for nursing home services, hospital 

discharge planning, care transition services, physician services, and various community 
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agencies and organizations. These linkages ensure that people with chronic conditions 

and disabilities have the information they need to make informed decisions about their 

service and support options as they pass through critical transition points in the health and 

long-term services and support systems that cut across all payers and settings. These 

critical activities can help individuals break the cycle of readmission to the hospital and 

live longer in the community with enhanced quality of life.

• Quality Assurance and Continuous Improvement: ADRCs must ensure that they are 

person centered and adhere to the highest standard of service in all areas. ADRCs should 

continually monitor the quality of their services and evaluate their own impact on 

consumers’ lives, system efficiencies and public costs. 

AoA and the Centers for Medicare & Medicaid Services (CMS) have invested over $100 million 

in the ADRC program since 2003. As a result of these investments: 

• Over 310 ADRC sites have been established across 50 states, 3 territories, and 

Washington, DC, often by expanding existing infrastructure in the aging services network 

such as Area Agencies on Aging, etc. Together these ADRC sites can reach roughly 

51 percent of the U.S. population.

• 21 States and Territories have achieved statewide coverage, and an additional 12 States 

have achieved 50 percent or more statewide coverage. 

• 35 states with ADRC programs sites currently conduct care transitions through formal 

intervention with an additional 10 states currently planning to conduct activities also 

through formal interventions

• 25 States have developed statewide web-based directories available to consumers and 

service providers which improve the quality and consistency of the aging services 

network information and assistance provided across the state. 

• As a result of these investments, in 2012 it is estimated that ADRCs will respond to over 

three million contacts to help individuals make better informed decisions about their 

health and long-term care options, with the vast majority of these decisions resulting in 

referrals for community-based services.
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Funding History:

Comparable discretionary funding for Aging and Disability Resource Centers is as follows:

FY 2008................................................. $2,250,000 0 FTE

FY 2009............................................... $13,577,000 0 FTE

FY 2010............................................... $13,684,000 3 FTE

FY 2011................................................. $6,469,147 3 FTE

FY 2012................................................. $6,457,000 3 FTE

Note: Discretionary funding for ADRC activities was provided under Aging Network Support Activities in FY 2009 and 

FY 2010 and requested under Health and Long-term Care Programs in FY 2011.

Comparable mandatory funding for Aging and Disability Resource Centers is as follows:

FY 2008...............................................................$0 

FY 2009...............................................................$0 

FY 2010............................................... $10,000,000 

FY 2011............................................... $10,000,000 

FY 2012............................................... $10,000,000

Note: Mandatory appropriations of $10 million for FY 2010 through FY 2014 for ADRCs are made under Section 

2405 of P.L. 111-148, the Affordable Care Act of 2010. 

Budget Request:

No discretionary funding is requested for Aging and Disability Resource Centers. This represents

a reduction of -$6,457,000 from the FY 2012 Enacted Level. Instead, ADRCs will continue to 

receive funding using the $10,000,000 in mandatory funding that was appropriated to AoA under

the Affordable Care Act (section 2405 of P.L. 111-148) for each year from FY 2010 to 2014 for 

ADRC activities. 

AoA intends to use this funding for ADRCs to support states and communities to continue to 

build the infrastructure needed to support the ongoing integration of the programs efforts into 

state’s HCBS systems and create greater integration with the health care system. Special 

emphasis will be given to strengthening the capacity of existing ADRCs to carry-out options 

counseling, nursing home diversion, and care transitions that help reduce unnecessary hospital 

readmissions. As many ADRCs are increasingly integrated into their state’s Home and 

Community-Based Supportive Services system, a reduction in funding is acceptable for 

FY 2013, however, its impact on ADRC performance will vary from state to state.

Continued funding for ADRCs, using mandatory funds, will provide an important means for 

ensuring the continued development and integration of these programs as part of States’ overall 

long-term care reform efforts. This is illustrated by the fact that currently, 28 of the original 

31 States awarded Money Follows the Person (MFP) program funds report direct involvement 
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with their ADRCs. This involvement has increased since October 2010, when CMS published 

new MDS 3.0 Section Q provisions. These provisions require State Medicaid agencies to 

designate Local Contact Agencies (LCAs) to provide information and referral to persons residing 

in nursing facilities who indicate a desire to return to community living. Nationally, 70% of 

States have designated ADRCs as Local Contact Agencies. In 12 States, ADRCs are the only

Local Contact Agencies. Every effort will be made to capitalize on other funding sources such 

as MFP to support ADRC activities, but for some states that do not have access to these 

opportunities a discontinuation or reduction in ADRC funding could negatively impact their 

efforts to carry out their Olmstead and other rebalancing efforts which seek to insure that 

individuals can remain independently in their communities rather than in institutions.

Continued ADRC funding could also have an impact on Medicare spending. States use ADRCs 

to assist individuals in “critical pathways,” defined as the times or places when people make 

important decisions about long-term care. This work includes several innovative interventions to 

facilitate the hospital discharge process to help reduce unnecessary readmissions to hospitals, as 

well as to help divert individuals from nursing home placement, and to help individuals already 

in nursing homes to return to the community. 

In the 2010 ADRC grant program announcement, a special emphasis was placed on increasing 

the capacity of ADRCs to adopt evidence-based care transitions programs specifically designed 

to reduce hospital readmission. These formal interventions include the use of evidence based 

care transition models such as:

• Better Outcomes for Older Adults through Safe Transitions (BOOST)

• Bridge Program

• Care Transition Intervention

• Geriatric Resources for Assessment and Care of Elders (GRACE) 

• Guided Care® 

• Transitional Care Model 

Currently, 97 ADRCs are actively partnering with 122 hospitals across 35 states. Between April 

2011 and September 2011, 66 ADRC sites served 8,553 consumers with care transition services

following an acute care episode. 

In FY 2013, AoA plans to make available competitive grants to States and Territories to further 

develop programs under existing ADRCs to reach statewide coverage and ensure the five key 

operational functions of programs are at a fully-functional level. All States and Territories will 

have the opportunity to compete for funding to further bolster their capacity in the areas of 

Options Counseling and Assistance, Streamlined Eligibility Determinations for Public Programs, 

and Person Centered Care Transitions.

AoA will also partner with CMS to ensure these efforts assist states in reducing the growth in 

long-term care spending through effective and efficient increases in non-institutional services 

and supports. In particular, the implementation of ADRCs has and will continue to assist states 

to institute administrative changes that will aid states in meeting the requirements of the CMS 

State Balancing and Incentive Payment Program, including establishing a single entry point 
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system, conflict-free case management services, and the use of a statewide standardized 

assessment instrument for determining eligibility for HCBS.

ADRCs will also continue, with VA funding, to serve clients under the current AoA/Department 

of Veterans Affairs (VA) partnership. In FY 2008, the VA and AoA began working together to 

develop the Veterans Directed - Home and Community Based Services Program (VD-HCBS), 

which is designed to serve Veterans of any age who are at risk of admission to a nursing home 

by providing them the opportunity to self-direct their care and access services to help them 

remain in the community. Rather than build a separate infrastructure to serve Veterans, the VA

made a strategic decision to use the aging services network infrastructure – including using the 

ADRC as the integrated access point to empower the veterans to set-up their own service plan for 

long-term supports and services – as a delivery vehicle for VD-HCBS. Since inception of the 

program the VA has invested $40.8 million to help expand this program nationwide. HHS and 

the VA have worked together to develop Program Guidelines/National Standards, web based 

tools to track and scale program and implemented a National Training program for the VDHCBS. Currently, 19 states and the District of Columbia are operating VDHCBS programs with 

33 operational VAMCs, 82 operational AAA/ADRCs and 775+ Veterans served (132 or 17% 

under age 60). In FY12, it is projected that additional 38 VAMCs will be added.

With ADRCs in place for nearly a decade, AoA believes it is appropriate to gather new 

information about the impact of ADRCs. AoA is partnering with the Agency for Healthcare 

Research and Quality and the Assistant Secretary for Planning and Evaluation to rigorously 

evaluate the effectiveness of ADRCs. In FY 2009, AoA initiated a design contract for the 

evaluation. In FY 2010, AoA invested $2.1 million to conduct an evaluation of the ADRC 

program based on recommendations from the design contract. This evaluation will look at both 

outcomes and process. Data collection is slated to start in the spring of 2012 and the final report 

is expected to be completed in late 2013 or early 2014. The results of this evaluation will 

influence future performance measures and indicators. 
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Outcome and Outputs Table:

Aging and Disability Resource Centers Outcome and Outputs

Note: For presentation within the budget AoA highlighted specific measures that are most directly related to Aging 

and Disability Resource Centers; however multiple performance outcomes are impacted by this program because 

AoA’s performance measures (efficiency, effective targeting, and client outcomes) assess network-wide 

performance in achieving current strategic objectives.

Measure Most Recent Result FY 2012 

Target

FY 2013

Target 

FY 2013 

+/- FY 2012

LTC.2: Percent of individuals 

who indicate ADRC information 

and counseling contribute to 

informed decision making 

(Outcome)

N/A TBD TBD N/A

Indicator Most Recent Result FY 2012 

Projection

FY 2013

Projection 

FY 2013 

+/- FY 2012

Output AF: Total number of 

ADRC contacts (Output) FY 2010: 3,253,200 3.75 M 3.75 M --

Output AG: Increase in the 

number of ADRC pilot programs 

(Output)

FY 2010: 310 310 310 --
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167

State Health Insurance Assistance Programs

FY 2011

Enacted

FY 2012

Enacted

FY 2013

Request

FY 2013 +/-

FY 2012

BA.............................................. $52,000,000 $52,115,000 $51,902,000 - $213,000

FTE61 ......................................... -- -- 5 +5

Authorizing Legislation: Section 4360 of the Omnibus Budget Reconciliation Act of 1990 

(42 U.S.C. 1395b-4).

FY 2013 Authorization..................................................................................................... Expired

Allocation Method ..................................................... Formula and Competitive Grants/Contracts

Program Description and Accomplishments:

State Health Insurance Assistance Program (SHIP) grants to States provide infrastructure, 

training, and outreach support to over 12,000 (mostly volunteer) counselors in over 

1,300 community-based organizations in all 50 States, the District of Columbia, Guam, Puerto 

Rico, and the Virgin Islands. Under the direction and support of State program directors and 

trainers, SHIP counselors receive extensive training and continuous ongoing information updates 

about health plan options, Medicare entitlement and enrollment, Medigap, long-term care 

insurance, Medicare Part D prescription drug benefits, preventive benefits, and programs for 

beneficiaries with limited income and resources such as the Medicare Part D Extra Help/LowIncome Subsidy, the Medicare Savings Programs, and Medicaid.

SHIPs provide free, one-on-one counseling and assistance to help aging and disabled Medicare 

and Medicaid beneficiaries as well as coming-of-agers navigate the complexities of health and 

long-term care systems. Services are provided via telephone and face-to-face interactive 

sessions, public education presentations and programs, and media activities. In FY 2010 SHIPs 

served 4.7 million clients. SHIP activities align with AoA’s mission of developing a 

comprehensive, coordinated and cost-effective system of home and community-based services 

that helps elderly individuals and people with disabilities maintain their health and independence 

in their homes and communities. 

The budget request would transfer the SHIP program from the Centers for Medicare and

Medicaid Services to the Administration on Aging. This transfer reflects the natural synergies 

between the SHIP programs and the aging services network. About two-thirds of the 54 State 

SHIP programs are already administered by State Units on Aging, with most of the remaining 

programs administered by State Insurance Commissions. At the community level, many SHIPs 

are either housed in or create local partnerships with Area Agencies on Aging. Similarly, almost 

50 percent of the SHIPs are co-located with the Senior Medicare Patrol program, which is also 

administered by AoA. 

 61 Onboard staffing in FY 2013 is 10; FTE usage is half that amount reflecting the fact that staff will be brought onboard throughout the fiscal year.
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SHIP activities complement programs authorized through the Older Americans Act, including 

but not limited to Information and Referral/Assistance (I&R/A), Aging and Disability Resource 

Centers (ADRCs), and Benefits Counseling. SHIPs also have a long history of outreach and 

assistance to underserved populations, including people with limited incomes, under-65 

Medicare beneficiaries with disabilities, dual eligibles, and people with cognitive and/or mental 

disabilities. 

Funding History:

Comparable funding for the State Health Insurance Assistance Program is as follows:

FY 2008............................................... $54,300,000

FY 2009............................................... $52,500,000

FY 2010............................................... $46,960,000

FY 2011............................................... $52,000,000

FY 2012................................................$51,902,000

In addition, the following legislative action has taken place since FY 2008 which provided 

additional mandatory funding for the SHIPs:

• The Medicare, Medicaid, and SCHIP Extension Act of FY 2007 (MMSEA) provided the 

SHIPs with an additional $15.0 million in FY 2008.

• The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) provided 

the SHIPs with an additional $7.5 million in FY 2009.

• The Affordable Care Act provides a total of $15 million to be distributed to states via 

formula grants in FY 2010 – FY 2012.

Budget Request and Anticipated Accomplishments:

The SHIP budget request for FY 2013 is $51,902,000, the same as the comparable FY 2012 

enacted level. This includes funding for 10 staff (5 FTE) and related administrative expenses to 

administer the program. 

Funds will be used to continue SHIP grants at current levels. This funding will allow States to 

continue the personalized counseling that they have been providing and to make further 

improvements to better streamline the program. Funds will also be used to provide administrative 

support for the SHIPs program.

The needs of the over 46 million Americans who depend on Medicare for their health care are 

multifaceted and diverse. More than one-quarter of beneficiaries have cognitive impairments; 

almost one-third have limitations in activities of daily living such as eating and dressing; almost 

one-third have not graduated from high school; and more than 1 in 10 are over 85 years of age. 

Yet these beneficiaries can face difficulties trying to navigate the health care system. Recent and 

upcoming changes in the system as a result of the Affordable Care Act (ACA) will provide 
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opportunities to beneficiaries for improved care, including increased Medicare preventive 

services. These opportunities will increase the responsibilities of the SHIP counselors in terms 

of training, outreach and one-on-one counseling. The counselor knowledge base will need to 

include the inter-relationship of Medicare, Early Retiree Insurance Program, Pre-Existing

Condition Insurance Plan (PCIP), Medicare covered preventive benefits, state Medicaid 

programs, and planning for the State based Exchanges in addition to other long-term care support 

options that beneficiaries need to remain in the community. 

Research has consistently found that Medicare beneficiaries prefer to receive information about 

Medicare and other supports through one-on-one assistance rather than through other means, 

such as written materials, mass media, and the internet. Given the large number and variety of 

private plan options available in the Medicare program and the new opportunities for 

beneficiaries through the ACA, the type of one-on-one beneficiary counseling and decisions 

support provided by SHIPs is an essential component to the information provided more generally 

through http://www.Medicare.gov and 1-800-MEDICARE. Due to AoA’s unique connections to 

the aging services network as well as the greater efficiencies leveraged by a single point of 

management of these activities which are often co-located with ADRCs. Transferring the SHIPs 

program to AoA is a logical way to meet the needs of beneficiaries.

Outcomes and Outputs:

In grant year 2007, the total number of clients reached by SHIPs was 4.2 million. In grant year 

2010, the number was 4.7 million. In FY 2009, the last year for which complete data is available, 

SHIPs reached over 4.7 million individuals through 54,656 public information and outreach 

events. 

Funds will be used to make SHIP grants to States to continue the personalized counseling that 

they provide and to make further improvements, which are anticipated to include:

• Continuing the number of community outreach in public forums to include elderly, and 

pre-retirees to raise awareness of long-term care related topics including prevention and 

relevant ACA opportunities.

• Continuing the number of community outreach in public forums to include disabled to 

raise awareness of long-term care options.

• Continuing the number of individual client contacts to individuals on Medicare under the 

age of 65.

• Tracking the number of individual client contacts of pre-retirees.

• Continuing the number of local and field counselors (paid and unpaid).

• Continuing the number of individual personalized counseling sessions.
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172

Program Administration

FY 2011

Enacted

FY 2012

Enacted

FY 2013

Request

FY 2013 +/-

FY 2012

Program Administration.............. $19,939,000 $23,063,000 $23,259,000 +$196,000

Total, FTE 1/ .............................. 112 107 107 --

1/ Overall FTE for AoA as a whole total 121 in FY 2011, 121 in FY 2012 and 135 in FY 2013. FTE numbers for 

Program Administration only reflect those FTE funded from the Program Administration budget line and FTE 

related to funding provided via Intra-Departmental Delegations of Authority (IDDA) and Interagency Agreements 

(IAA). Not included are reimbursable FTE supported with HCFAC funds (6.5 in FY 2011 and 8 in FY 2012 and 

FY 2013), FTE supported with mandatory funds (ADRCs and the National Clearinghouse on Long-Term Care 

Information (3 in FY 2011, 7 in FY 2012 and FY 2013), or FTE related to transferred or new programs (14 in FY 

2013). These FTE are included in the appropriate narrative tables in other sections of this document. 

Authorizing Legislation: Section 205 of the Older Americans Act of 1965, as amended

FY 2013 Older Americans Act Authorization................................................................... Expired

Allocation Method ................................................................................... Direct Federal/Contract

Program Description and Accomplishments:

Program Administration funds the direction of AoA programs established under the Older 

Americans Act (OAA), as well as the Alzheimer’s Disease Supportive Services program and the 

Lifespan Respite Care program authorized respectively by Section 398 and Title XIX of the 

Public Health Services Act (PHSA). In addition, a very small portion of these funds will be used 

to oversee and to close-out activities originally funded under the American Recovery and 

Reinvestment Act (ARRA) of 2009. 

Program Administration funding does not include resources necessary to carry out new programs 

that are proposed to come to AoA in FY 2013. Funding to support the 14 FTE and related 

administrative expenses for these programs is requested separately as part of each program’s 

respective request. These new programs include the State Health Insurance Assistance Program

(5 FTE), proposed for transfer to AoA from the Centers for Medicare and Medicaid Services; the 

Senior Community Service Employment Program (8 FTE), proposed for transfer from the 

Department of Labor; and the Adult Protective Services Demonstration program (1 FTE). 

Funding also does not include resources for 14 additional FTE that will continue to be charged to 

three existing mandatory programs: Aging and Disability Resource Centers (ADRC) funding (4 

FTE), Health Care Fraud and Abuse (HCFAC) funding (8 FTE) and National Clearinghouse for 

Long-Term Care Information funding (2 FTE). 
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Funding History:

Comparable funding for Program Administration during the past five years, is as follows:

FY 2008 .............................................. $18,064,000 99 FTE

FY 2009 .............................................. $18,696,000 96 FTE

FY 2010 .............................................. $19,976,000 93 FTE

FY 2011 .............................................. $19,939,000 112 FTE

FY 2012 .............................................. $23,063,000 107 FTE

FTE numbers exclude FTE paid for with HCFAC funds and with direct mandatory 

appropriations. 

Budget Request:

The FY 2013 request for Program Administration is $23,259,000, a net increase of $196,000. 

This request will support the same level of FTE as were supported with these funds in FY 2012. 

Additional funds will be used to address costs related to AoA’s Headquarters move as a result of 

the expiration of its current lease. None of these additional funds will be used for additional 

staffing needs or to meet the proposed 0.5% pay raise, which will be absorbed through offsetting 

reductions in contracts and related areas. 

AoA Headquarters Lease Renewal Process

The ten year lease on AoA’s Central Office space ends on September 30, 2012 and AoA has been 

working with the HHS Office for Facilities Management and Policy (OFMP) to determine how to 

move forward. Because the Department of Health and Human Services had a surplus of leased space 

relative to its needs, AoA worked with OFMP on assuming space under an existing HHS lease that 

would be available after October 2012. 

The proposed space is currently being leased by the Office of the Assistant Secretary for 

Preparedness and Response (ASPR) which is scheduled to vacate in the fall of 2012. After ASPR 

completes its relocation, AoA would begin its renovation of the space to meet its own needs. 

Renovations would probably continue into 2013, with AoA able to assume occupancy no earlier than 

the spring of 2013, with the summer or fall of 2013 a more likely scenario. 

Because the new space is not expected to be available until at least the Spring of 2013, AoA will 

need to extend its current lease. GSA recently negotiated the necessary lease extension, which 

due to changes in the real estate market is significantly higher for the period of the extension 

than the rent that AoA has been paying for the last 10 years. AoA expects to incur additional 

rental costs of approximately $85,677 more per month for each month that we remain in our 

current location after September 2012. In addition, AoA must also pay rent on two locations

concurrently during the period that the new space is being renovated but AoA is unable to 

occupy. This rent on the new facility is estimated at $141,605 monthly, plus tax escalation. 
CONSUMER INFORMATION, ACCESS, AND OUTREACH

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Together, these rent increases are projected to total $2,331,000 in FY 2013. The FY 2012 

appropriation included an increase of $2,167,500 to cover the estimated costs of payments to 

GSA related to AoA’s planned Headquarters’s relocation. This amount, which remains in the 

Program Administration base request for FY 2013, will be combined in FY 2013 with the 

$196,000 net increase over FY 2012, for a total of $2,363,500, and used in FY 2013 to pay 

projected rent over and above the rent that is currently budgeted for in the base. The remaining 

balance of $32,500 will be retained and used to offset tax escalation costs on the current facility. 

Remaining relocation costs are currently estimated to total approximately $3,000,000 to cover 

procurement of systems furniture and IT, the physical move and to surplus outdated furniture at 

the current location have been included in a consolidated FY 2013 Departmental request for the 

Public Health and Social Services Emergency Fund associated with procuring new long term 

leases centrally. This estimate may be updated. AoA will continue to work closely with OFMP 

staff to refine our schedule and milestones and ensure that cost estimates are sufficient to cover all 

costs associated with the lease renewal, including build-out, moving, and rent. 

Performance Measures

Improving program efficiency, improving client outcomes, and effective targeting of services to 

vulnerable elders are the three performance measures used to assess the performance of the 

AoA’s Aging Services programs as a whole. Program Administration is not directly measured 

by AoA’s performance indicators, nor by specific outcomes, and it does not have specific output 

measures. Rather, the program provides the administrative resources that enable AoA to carry 

out its programmatic activities and achieve its performance goals.
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CONSUMER INFORMATION, ACCESS, AND OUTREACH

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177

Prevention and Public Health Fund

Chronic Disease Self-Management Programs

FY 2011 

Enacted

FY 2012

Enacted

FY 2013 

Request

FY 2013 +/-

FY 2012

Chronic Disease SelfManagement Programs from 

Prevention and Public Health 

Fund .......................................... 1/ $10,000,000 $10,000,000 +$10,000,000

1/ Funding totaling $32.5 million was provided under the American Recovery and Reinvestment Act (ARRA) to cover 

FY 2010 - FY 2011. No funding was provided from AoA’s base funding for these years.

Authorizing Legislation: Sections 311 and 317(k)(2) of the Public Health Service Act, [42 

U.S.C. Sections 243 and 247b(k)(2)] as amended, and the Patient Protection and Affordable Care 

Act (ACA), Section 4002 [42 U.S.C. 300u-11]

FY 2013 Public Health Service Act Authorization............................................................ Expired

Allocation Method .......................... Competitive Grants/Co-operative Agreements and Contracts

Intended Recipients.....................................................................................States

Program Description and Accomplishments

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

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

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

and reduce their need for more costly medical care. 

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

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

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

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

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

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

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

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

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

services62, and reduces health care costs. 

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

Dissemination. Permanente Journal; Spring 2002.
PREVENTION AND PUBLIC HEALTH FUND

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CDSMP emphasizes an individual’s role in managing his/her illness. The program consists of a 

series of workshops that are conducted once a week for two and a half hours over six weeks in 

community settings such as churches, libraries, YW/MCAs, senior centers, public housing 

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

chronic health problems attend together, and the workshops are facilitated by two leaders who 

are certified trainers. One or both of the leaders are non-health professionals or lay people with 

chronic diseases themselves. Topics covered include: 1) techniques to deal with problems such 

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

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

effectively with health professionals; and 5) nutrition. 

Funding for CDSMP is awarded in the form of competitive grants to states. 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 three years. In FY 2010 AoA 

funded 47 State grants for CDSMPs, with an average award of $574,468, using funding provided 

under the Recovery Act. AoA also funded a Technical Assistance Resource Center through a 

grant to the National Council on Aging. Competitive grants and contracts are also used to 

support evaluation and technical assistance activities. 

Through these grants, as of January 31, 2012, 61,902 people had completed CDSMP courses 

across the country, well ahead of the programmatic goal to reach 50,000 completers within two 

years from the award date.

Funding History

Stand-alone funding for the nationwide deployment of CDSMP through the aging services 

network was requested for the first time in FY 2012 and provided from the Prevention and Public 

Health Fund.

63 Since FY 2011 no funding has been provided from AoA’s base budget for this 

activity. In FY 2010, $30 million in Recovery Act funding was provided in coordination with

the Centers for Disease Control and Prevention as part of its Recovery Act funding. An 

additional $2.5 million was also transferred from CDC to CMS for related evaluation and quality 

improvement purposes.

Budget Request

AoA requests FY 2013 funding totaling $10,000,000 for CDSMP from the Prevention and Public 

Health Fund, the same as the FY 2012 enacted level. The Prevention and Public Health Fund 

(Section 4002) is designed to target resources to activities that invest in prevention and public 

health programs to improve our nation’s health while also restraining the rate of growth in public 

and private sector health care costs. CDSMP, by emphasizing an individual’s role in managing 

his/her illness, helps participants to adopt healthy behaviors, improve their health status and 

reduce their use of hospital stays and emergency room visits. Studies noted above (footnote 65) 

indicate that the program significantly improves participant health status, reduces the use of 

 63 Evidence-Based Programs including the Chronic Disease Self Management Program, together with Long-Term 

Care Programs (ADRCs and Community Living Programs) were funded in earlier years as subactivities that were 

part at one time or another of Aging Network Support and of Program Innovations. 
PREVENTION AND PUBLIC HEALTH FUND

Page 179 of 194

hospital care and physician services, and reduces health care costs. This continued investment of 

resources will allow AoA, in coordination with its existing HHS partners and private 

philanthropy, to continue to build on past investments in CDSMP and on AoA’s existing service 

delivery infrastructure as it pursues its goal of taking CDSMP to scale nationwide.

Older Americans are disproportionately affected by a vast array of chronic diseases and 

conditions. Over 80 percent of adults 65 and over have at least one chronic condition, and 

roughly half suffer from two.64 Nearly half of older adults have hypertension and roughly one in 

five has heart disease, with a similar proportion having some type of cancer.65 The average 

75-year old has three chronic conditions and takes 4.5 medications.66 More than 65 percent of 

Americans aged 65 and over have some form of cardiovascular disease. One million adults age 

75+ have diabetes, a number that is expected to grow to 4 million by 2050 if nothing changes

current growth rates.67 Minority elders – the fastest growing segment of the elderly population –

are especially at risk of chronic illnesses and conditions. For example, among adults age 65+, 

65% of African-Americans had hypertension, compared to 47% of Whites; and 25% of 

Hispanics have diabetes, compared to 14% of Whites.

CDSMP serves this population and is especially well suited for delivery through AoA’s network 

of community based organizations, including senior centers, congregate meal programs, faithbased organizations and senior housing projects. At the community level, aging services provider 

organizations work in collaboration with public health agencies and health care providers. 

Participant referrals to the CDSMP program come from both clinical and community-based 

organizations. Clinical referrals come from community-health centers, physicians, hospitals, 

managed care organizations, and other health system components. Community referrals come 

from a variety of sources, including the Aging and Disability Resources Centers. ADRCs serve 

as community-level “one stop shop” entry points into long-term care for people of all ages who 

have chronic conditions. Funds will support competitive grants to States, as well as related 

technical assistance and evaluation activities such as:

• A proposed interagency agreement with the CMS Center for Strategic Planning to 

evaluate the impact of CDSMP on participant health care utilization and cost by linking 

Medicare claims data to CDSMP Medicare participants (both elderly and younger people 

with disabilities);

• A survey of participants (pre- and post) to evaluate the impact of CDSMP on behaviors, 

health status, and quality of life; and

• Continued funding for a National Technical Assistance Center on Evidence-Based 

Prevention Programs.

 64 NCCDPHP. Healthy Aging: Preventing Disease and Improving Quality of Life Among Older Americans. 

Available at http://www.cdc.gov/nccdphp/aag/aag_aging.htm. Accessed September 14, 2004. 65 Centers for Disease Control and Prevention (CDC), National Center for Health Statistics, National Health 

Interview Survey, 2000-2001. 66 Alliance for Aging Research. Ten Reasons Why America Is Not Ready for the Coming Aging Boom. 2002. 67 NCCDPHP. Available at http://www.cdc.gov/nccdphp/bb_aging/index.htm. Accessed September 14, 2004.
PREVENTION AND PUBLIC HEALTH FUND

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Accountability and quality assurance will include tracking a combination of inputs and outputs. 

AoA will track via State reports the number of programs being conducted and the number of 

participants completing the program. Participant surveys (pre and post) will be used to track 

self-reported behavioral change and health status. AoA and CMS will establish protocols and 

mechanisms to track CDSMP participants’ Medicare claims data to assess the impact of CDSMP 

on health care utilization. 

AoA will continue to monitor the performance of the CDSMP with the output measure that was 

provided in both the FY 2009 and FY 2010 budget submissions 

Outputs and Outcomes Table

Evaluation

In its initial evaluation design work, AoA partnered with the Agency for Healthcare Research 

and Quality and the Assistant Secretary for Planning and Evaluation to determine the most 

promising approach for rigorously evaluating the effectiveness of employing CDSMPs in the 

Aging Services Network. In FY 2010, AoA initiated a design contract for recommendations on 

how to best carry-out an evaluation. The evaluation design recommendations were completed in 

the Spring of 2011. Using the recommendations as a foundation, AoA awarded a contract in Fall 

of 2011 for the conduct of a process evaluation and a more detailed outcome evaluation design. 

It is anticipated that the outcome evaluation would use a randomized control trial design. The 

process evaluation, including time for OMB Paperwork Reduction Act clearance, is expected to 

be completed during the summer of 2013. AoA is coordinating its efforts with CMS to ensure 

that the data collected measure concepts important to both agencies. The results of an evaluation 

would influence future performance measures and indicators of the program.

Indicator Most Recent 

Result 

FY 2012

Projection 

FY 2013

Projection 

FY 2013 

+/- FY 2011 

Output CD1: Total number of 

individuals with chronic 

conditions completing the 

CDSMP program (Output)

FY 2009: 

8,426 20,000 20,000 Maintain

Output CD2: Percentage of 

individuals that report 1 or more 

health benefits (e.g. improved 

health status, increased physical 

activity, less fatigue, greater 

mobility, etc.) after completing the 

CDSMP program (Outcome) 

N/A Baseline TBD TBD
SUPPLEMENTARY TABLES

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Administration on Aging

BA by Object Class

2012 Enacted

2013 President's 

Budget

Increase or 

Decrease

Personnel compensation:

Full-time permanent (11.1)................................................... 13,729 13,887 158

Other than full-time permanent (11.3)................................ 325 328 3

Other personnel compensation (11.5)................................ 141 142 2

Military personnel (11.7)...................................................... - - -

Special personnel services payments (11.8)..................... - - -

Subtotal personnel compensation.................................. 14,195 14,357 163

Civilian benefits (12.1)............................................................. 3,727 3,770 43

Military benefits (12.2)............................................................ - - -

Benefits to former personnel (13.0)...................................... - - -

Total Pay Costs........................................................................ 17,922 18,128 206

Travel and transportation of persons (21.0)........................ 750 750 -

Transportation of things (22.0).............................................. 11 11 -

Rental payments to GSA (23.1).............................................. 1,501 3,893 2,392

Communication, utilities, and misc. charges (23.3)............. 670 641 (29)

Printing and reproduction (24.0)............................................ 29 33 4

Other Contractual Services:

Advisory and assistance services (25.1).......................... 9,839 9,574 (265)

Other services (25.2)............................................................. 57 57 -

Purchase of goods and services from -

government accounts (25.3)............................................. 8,372 5,602 (2,769)

Operation and maintenance of facilities (25.4)................. 1 1 -

Research and Development Contracts (25.5)................... - - -

Medical care (25.6)................................................................ - - -

Operation and maintenance of equipment (25.7)............. 67 67 -

Subsistence and support of persons (25.8)...................... - - -

Subtotal Other Contractual Services............................ 18,336 15,301 (3,034)

Supplies and materials (26.0).................................................. 78 75 (3)

Equipment (31.0)...................................................................... 80 82 2

Land and Structures (32.0) .................................................... - - -

Investments and Loans (33.0)................................................ - - -

Grants, subsidies, and contributions (41.0)......................... 1,931,908 1,939,422 7,514

Interest and dividends (43.0)................................................. - - -

Refunds (44.0).......................................................................... - - -

Total Non-Pay Costs............................................................... 1,953,362 1,960,208 6,846

Total Budget Authority by Object Class............................. 1,971,284 1,978,336 7,052
SUPPLEMENTARY TABLES

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Administration on Aging

Salaries and Expenses

2012 Enacted

2013 President's 

Budget

Increase or 

Decrease

Personnel compensation:

Full-time permanent (11.1)................................................... 13,729 13,887 158

Other than full-time permanent (11.3)................................ 325 328 3

Other personnel compensation (11.5)................................ 141 142 2

Military personnel (11.7)...................................................... - - -

Special personnel services payments (11.8)..................... - - -

Subtotal personnel compensation.................................. 14,195 14,357 163

Civilian benefits (12.1)............................................................. 3,727 3,770 43

Military benefits (12.2)............................................................ - - -

Benefits to former personnel (13.0)...................................... - - -

Total Pay Costs........................................................................ 17,922 18,128 206

Travel and transportation of persons (21.0)........................ 750 750 -

Transportation of things (22.0).............................................. 11 11 -

Rental Payments to Others (23.2).......................................... - - -

Communication, utilities, and misc. charges (23.3)............. 670 641 (29)

Printing and reproduction (24.0)............................................ 29 33 4

 - - -

Other Contractual Services: - - -

Advisory and assistance services (25.1).......................... 9,839 9,574 (265)

Other services (25.2)............................................................. 57 57 -

Purchase of goods and services from -

government accounts (25.3)............................................. 8,372 5,602 (2,769)

Operation and maintenance of facilities (25.4)................. 1 1 -

Research and Development Contracts (25.5)................... - - -

Medical care (25.6)................................................................ - - -

Operation and maintenance of equipment (25.7)............. 67 67 -

Subsistence and support of persons (25.8)...................... - - -

Subtotal Other Contractual Services............................ 18,336 15,301 (3,034)

Supplies and materials (26.0).................................................. 78 75 (3)

Total Non-Pay Costs............................................................... 19,874 16,811 (3,062)

Total Salary and Expense....................................................... 37,796 34,939 (2,857)

Direct FTE (Discretionary) 1/.............................................. 119 120 1

1/ Total FTE for AoA equal 121 in FY 2012 and 135 in FY 2013. The table above excludes 8 

 reimbursable FTE for HCFAC and 7 mandatory FTE for ADRCs and the National Clearinghouse

 on Long-Term Care in each of FY 2012 and FY 2013. Exact FTE usage for SHIPs and SCSEP by

 CMS and the Department of Labor are not known for FY 2012; therefore, the projected usage of 5 

 and 8 FTE respectively has been added to the totals in FY 2012 for purposes of comparability.
SUPPLEMENTARY TABLES

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Administration on Aging

Detail of FTE

2011 

Actual 

Civilian

2011 

Actual 

Military

2011 

Actual 

Total

2012 

Est. 

Civilian

2012 

Est. 

Military

2012 

Est. 

Total

2013 

Est. 

Civilian

2013 

Est. 

Military

2013 

Est. 

Total

1/ 1/ 2/

Immediate Office of the ...................

Assistant Secretary..........................

 Direct:............................................... 25 25 14 14 13 13

 Reimbursable:.................................. 0 0 0

 Total:............................................. 25 0 25 14 0 14 13 0 13

Center for Management and ..........

Budget................................................

 Direct:............................................... 20 20 25 25 27 27

 Reimbursable:.................................. 0 0 0

 Total:............................................. 20 0 20 25 0 25 27 0 27

Center for Policy, Planning ............

and Evaluation 4/..............................

 Direct:............................................... 23 23 24 24 26 26

 Reimbursable:.................................. 0 0 0

 Total:............................................. 23 0 23 24 0 24 26 0 26

Center for Program Operations.......

 Direct:............................................... 20 20 22 22 26 26

 Reimbursable 3/:............................. 2 2 3 3 3 3

 Total:............................................. 22 0 22 25 0 25 29 0 29

Office of Regional Operations........

 Direct:............................................... 26 26 28 28 35 35

 Reimbursable 3/:............................. 5 5 5 5 5 5

 Total:............................................. 31 0 31 33 0 33 40 0 40

OPDIV FTE Total............................. 121 0 121 121 0 121 135 0 135
SUPPLEMENTARY TABLES

Page 185 of 194

Average GS Grade

FY 2008............................................... 12.9

FY 2009............................................... 13.0

FY 2010............................................... 12.8

FY 2011............................................... 12.8

FY 2012............................................... 12.8

1/ FY 2011 and FY 2012 do not include FTE for either the State Health Insurance Assistance Program

 (SHIPs) or the Senior Community Service Employment Program (SCSEP) which are proposed for 

 transfer to AoA. These figures are not currently available as regional staff work on these and 

 multiple other programs. 

 

 2/ In FY 2013, FTE for SHIPs and for SCSEP have been annualized, to reflect the fact that not all of 

 these staff will be on board at the beginning of the year. As a result, while AoA anticipates filling

 10 positions for SHIPs and 16 positions for SCSEP in FY 2012, only 5 FTE and 8 FTE 

 respectively are included in the FTE breakdown above.

 3/ Reimbursable funding reflects FTE paid for with HCFAC funds.

 4/ Includes FTE paid for with Mandatory funding.
SUPPLEMENTARY TABLES

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Administration on Aging

Detail of Positions

2011

 Actual 1/ 2012 1/

2013 

Estimate

Executive level I ...........................................

Executive level II..........................................

Executive level III ........................................

Executive level IV......................................... 1 1 1

Executive level V..........................................

Subtotal ..................................................... 1 1 1

Total - Exec. Level Salaries 2/ $196,136 $190,360 $191,074

ES-0 ............................................................... 3 3 3

Subtotal ..................................................... 3 3 3

 Total - ES Salary 2/ $609,600 $596,700 $596,700

GS-15.............................................................. 19 22 22

GS-14.............................................................. 19 20 22

GS-13.............................................................. 42 46 67

GS-12.............................................................. 8 7 9

GS-11.............................................................. 8 7 9

GS-10.............................................................. 2 2 2

GS-9................................................................ 9 9 9

GS-8................................................................ 0 0 0

GS-7................................................................ 2 2 2

GS-6................................................................ 1 1 1

GS-5................................................................ 0 0 0

GS-4................................................................ 0 0 0

GS-3................................................................ 0 0 0

GS-2................................................................ 0 0 0

GS-1................................................................ 0 0 0

Subtotal 2/.................................................. 110 116 143

 Total - GS Salary

Average ES level ......................................... 0 0 0

Average ES salary/benefits........................ $203,200 $198,900 $198,900

Average GS grade........................................ 12.8 12.8 12.8

Average GS salary/benefits........................ 131,804 129,300 130,200

1/ Comparable numbers are not available in FY 2011 and FY 2012 for the 

 two programs proposed for transfer to AoA in FY 2013, the State

 Health Insurance Assistance Program (SHIPs) or the Senior Community

 Service Employment Program (SCSEP).

2/ Excludes 17 positions related to the CLASS Program in FY 2011.
SUPPLEMENTARY TABLES

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Administration on Aging

Programs Proposed for Elimination

No programs are proposed for elimination in FY 2013.
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SIGNIFICANT ITEMS

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Significant Items in House and Senate Appropriations Committee Reports

FY 2012 Senate Appropriations Committee Report Language (Senate Report 112-84)

Item

Elder Falls Prevention - The Committee recommends that $7,000,000 in mandatory funding be 

transferred from the PPH Fund for elder falls prevention activities at AoA, in coordination with 

CDC. This is a new activity that was not funded in fiscal year 2011. The administration did not 

request funding. The Committee notes that falls are the leading cause of fatal and nonfatal 

injuries for those 65 and older. Among older adults who sustain hip fractures in falls, 25 percent 

remain institutionalized for at least 1 year and 50 percent cannot return home or live 

independently. The Committee intends that funds provided to AoA should be used for public 

education about the risk of these falls, as well as implementation and dissemination of 

community-based strategies that have been proven to reduce the incidence of falls among 

seniors.

Action taken or to be taken

No funding was provided by the Congress for this activity. However, AoA has recognized for 

some time that Elder Falls Prevention is one of many evidence-based approaches with the 

potential to make positive differences in outcomes for seniors. AoA will continue to encourage 

States to look at this approach in conjunction with available Preventive Health funds which 

beginning in FY 2012 must be spent on evidence-based activities similar to a discretionary 

funding opportunity AoA made available in 2006.

During 2006-2007, AoA initiated its state-based Evidence-Based Disease and Disability 

Prevention Program. Through both public and private partnerships, 27 states have deployed 

evidence-based interventions whose primary focus is to help enable adults to maintain their 

health, wellness, and independence. AoA required each state to implement the Stanford 

University Chronic Disease Self-Management Program (CDSMP). In addition, each state 

participating in this grant program was required to select and implement one or more other 

evidence-based programs, including Falls Management programs such as Matter of Balance, 

which addresses fear of falling, and Stepping On and Tai Chi, which build muscle strength and 

improve balance to prevent falls. 

Since 2004 AoA and CDC have partnered on three activities related to older adult falls: 

• Supporting a collaborative initiative by the National Council on Aging (NCOA), the 

Archstone Foundation, the Home Safety Council, and other partners to address the 

growing problem of falls and fall-related injuries among adults aged 65 years and older.

The Falls Free Coalition, formed in 2004 as a result of this initiative, includes more than 

55 organizations and employs a collective approach to promoting a national fall 

prevention action plan. 
SIGNIFICANT ITEMS

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• Assessing the long-term impact of Matter of Balance, a program designed to reduce fear 

of falling, increase self efficacy and a sense of control in relation to fall risk, and increase 

physical and social activity. 

• Estimating the average program implementation and maintenance costs and comparing 

these costs across three AoA-funded fall prevention programs: Matter of Balance, Tai 

Chi: Moving for Better Balance, and Stepping On.

Finally, AoA will continue to coordinate with the Centers for Disease Control and Prevention 

around efforts like CDC’s Unintentional Injury Program.

Item

Older Adults and Mental Health - The Committee urges AoA to expand its efforts to address the 

mental and behavioral health needs of older adults, including an emphasis on mental health 

screening, treatment services for older individuals and programs to increase public awareness 

and reduce the stigma associated with mental disorders in older individuals. The Committee is 

pleased with AoA efforts to implement the mental and behavioral health aspects of the Older 

American Act Amendments of 2006 and continues to urge AoA to designate an officer to focus 

on the mental health needs of older Americans. Within funding for Program Innovations, the 

Committee has provided $1,000,000 to continue the 24-hour call center that provides Alzheimer 

family caregivers with professional care consultation and crisis intervention.

Action taken or to be taken

The Administration on Aging (AoA) is an active partner with the Substance Abuse and Mental 

Health Services Administration (SAMHSA) on a variety of initiatives. AoA and SAMHSA 

entered into a Memorandum of Understanding in FY 2011 to formally collaborate on the Older 

Adult Targeted Capacity Expansion (TCE) Grant Program. Five grants were awarded to 

community organizations to provide services for older adults through aging-mental health 

partnerships. An Older Adults Technical Assistance Center was also established to provide 

assistance to the TCE grantees, State Units on Aging, Area Agencies on Aging, and other 

community aging and mental health providers to assist them in developing, implementing and 

sustaining effective mental health programs for older adults. Mental health screening, treatment 

services for older individuals and increasing public awareness and reducing the stigma associated 

with mental disorders in older individuals will be key components of the work of the grantees 

and the Center. AoA and SAMHSA will continue to collaborate on technical assistance 

activities for this program. In addition, AoA and SAMHSA have made two joint presentations at 

national conferences regarding older adults mental health programs. 

AoA also participates in mental-health related workgroups and committees both inside and 

outside the Department of Health and Human Services (DHHS), including: the Federal 

Workgroup on Suicide Prevention; the Federal Mental Health Coalition; the Action Alliance for 

Suicide Prevention and its Clinical Care Workgroup; and the HHS Behavioral Health 

Coordinating Council and its Prescription Drug Abuse sub-committee. An Aging Services 

Program Specialist, with extensive knowledge in the prevention and treatment of mental health 

issues among older adults, has been designated to provide guidance both within and outside 

AoA, on behavioral health program and policy development. AoA also commissioned a study in 

FY2011 through the National Council on Aging’s Center for Health Aging entitled “Advancing 
SIGNIFICANT ITEMS

Page 191 of 194

Older Adult Mental Health: Lessons Learned from Partnerships between State Units on Aging 

and State Mental health Authorities”. The purpose of this study was to learn from the 

experiences of five strong state partnerships that have increased or improved access to evidencebased or evidence-informed (EB/EI) interventions shown to improve the health of older adults 

and adults with/or at risk of mental health or substance use disorders. The results of this study 

will help inform AoA program and policy development in the area of mental health. 

Through its health programs, AoA has also encouraged States and Area Agencies on Aging to 

use evidence-based programs designed to reduce reduce/prevent depression and improve quality 

of life in older adults including Healthy IDEAS (Identifying Depression, Empowering Activities 

for Seniors) and PEARLS (Program to Encourage Rewarding Lives for Seniors. State plan 

guidance developed by AoA for FY 2012, similar to past guidance, will direct States and Area 

Agencies on Aging to implement the provisions related to mental and behavioral health that were 

signed into law as part of the Older Americans Act Amendments of 2006.
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SIGNIFICANT ITEMS

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FY 2013 HHS Enterprise Information Technology and 

Government-Wide E-Gov Initiatives 

OPDIV Allocation Statement:

The AoA will use $152,377.00 of its FY 2013 budget to support Department-wide enterprise 

information technology and government-wide E-Government initiatives. Operating Divisions 

help to finance specific HHS enterprise information technology programs and initiatives, 

identified through the HHS Information Technology Capital Planning and Investment Control

process, and the government-wide E-Government initiatives. The HHS enterprise initiatives 

meet cross-functional criteria and are approved by the HHS IT Investment Review Board based 

on funding availability and business case benefits. Development is collaborative in nature and 

achieves HHS enterprise-wide goals that produce common technology, promote common 

standards, and enable data and system interoperability. 

Of the amount specified above, $38,618.00 is allocated to developmental government-wide EGovernment initiatives for FY 2013. This amount supports these government-wide EGovernment initiatives as follows:

FY 2013 Developmental E-Gov Initiatives*

 Line of Business - Human Resources $207.00

 Line of Business - Grants Management $1,374.00

 Line of Business - Financial $6,021.00

 Line of Business - Budget Formulation and Execution $4,421.00

 Disaster Assistance Improvement Plan $1,356.00

 Federal Health Architecture (FHA) $0.00

 Integrated Acquisition Environment- Grants and Loans $25,239.00

 Line of Business - Geospatial $0.00

FY 2013 Developmental E-Gov Initiatives Total $38,618.00

* Specific levels presented here are subject to change, as redistributions to meet changes in resource demands are 

assessed.

Prospective benefits from these initiatives are:

Lines of Business-Human Resources Management: Provides standardized and interoperable 

HR solutions utilizing common core functionality to support the strategic management of Human 

Capital.

Lines of Business-Grants Management: Supports end-to-end grants management activities 

promoting improved customer service; decision making; financial management processes; 

efficiency of reporting procedure; and, post-award closeout actions. The Administration for 

Children and Families (ACF), is a GMLOB consortia lead, which has allowed ACF to take on 

customers external to HHS. These additional agency users have allowed HHS to reduce overhead 
SIGNIFICANT ITEMS

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costs for internal HHS users. Additionally, NIH is an internally HHS-designated Center of 

Excellence. This effort has allowed HHS agencies using the NIH system to reduce grants 

management costs. Both efforts have allowed HHS to achieve economies of scale and 

efficiencies, as well as streamlining and standardization of grants processes, thus reducing 

overall HHS costs for grants management systems and processes. 

Lines of Business –Financial Management: Supports efficient and improved business 

performance while ensuring integrity in accountability, financial controls and mission 

effectiveness by enhancing process improvements; achieving cost savings; standardizing 

business processes and data models; promoting seamless data exchanges between Federal 

agencies; and, strengthening internal controls.

Lines of Business-Budget Formulation and Execution: Allows sharing across the Federal 

government of common budget formulation and execution practices and processes resulting in 

improved practices within HHS.

In addition, $113,759.00 is allocated to ongoing government-wide E-Government initiatives for 

FY 2013. This amount supports these government-wide E-Government initiatives as follows:

FY 2013 Ongoing E-Gov Initiatives*

 E-Rule Making $2,978.00

 Integrated Acquisition Environment $4,105.00

 GovBenefits $4,149.00

 Grants.gov $102,527.00

FY 2013 Ongoing E-Gov Initiatives Total $113,759.00

* Specific levels presented here are subject to change, as redistributions to meet changes in resource demands are 

assessed.