DEPARTMENT 

of HEALTH 

and HUMAN 

SERVICES

Fiscal Year

2011 

Administration on Aging

Justification of 

Estimates for 

Appropriations Committees

BACK COVER INTENTIONALLY LEFT BLANK 
FROM THE ADMINISTRATION ON AGING 

I am pleased to present the Administration on Aging (AoA) FY 2011 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. These services help to keep these individuals from joining the 1.7 million seniors 

who live in nursing homes. 

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 (through the ―spend down‖ 

provisions) will increase by more than 13 percent. Further, demographic trends indicate at least 

100,000 more seniors will be living in poverty in FY 2011. 

As Assistant Secretary for Aging, my goal is to ensure we serve more seniors, particularly now 

when our grant partners at the State, Territory, Tribal, and local levels face very tough economic 

times. This budget request will help us to meet this goal even as we continue to develop and 

maintain a comprehensive, coordinated, cost-effective system of home and community-based 

services that help our seniors maintain their health and independence. Added funding will allow 

us to expand support for AoA‘s core services programs that focus on keeping seniors healthy and 

in their communities, address and support the needs of caregivers, and protect older Americans 

from financial fraud and all forms of abuse and neglect. Overall, the budget requests increases of 

$108.4 million over FY 2010. 

Of this increase, $102.5 million will be directed to a caregiver initiative -- an initiative stemming 

from the work of the White House Task Force on Middle Class Families -- to expand help to 

families to allow them to better care for their aging relatives and to support seniors trying to 

remain independent in their communities. Better support for caregivers is critical since often it is 

their availability -- whether they be 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 homes. As part of this increase, the initiative would double funding for the 

Lifespan Respite Care program, which provides temporary respite services to family caregivers 

of children or adults of any age with special needs. 

With this budget, AoA will help prepare the country for the increasing numbers of older 

Americans and continue to provide effective 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
PAGE INTENTIONALLY LEFT BLANK 
i

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION ON AGING 

TABLE OF CONTENTS 

Executive Summary: 

Organizational Chart .............................................................................................................................................. 1

Executive Summary ............................................................................................................................................... 3

All-Purpose Table .................................................................................................................................................. 7

American Recovery and Reinvestment Act of 2009 ................................................................................................. 9

Budget Exhibits: 

Appropriations Language ..................................................................................................................................... 11

Language Analysis ............................................................................................................................................... 12

Amounts Available for Obligation ........................................................................................................................ 13

Summary of Changes ........................................................................................................................................... 14

Budget Authority by Activity................................................................................................................................ 15

Authorizing Legislation ........................................................................................................................................ 16

Appropriations History Table ............................................................................................................................... 18

Appropriations Not Authorized by Law ................................................................................................................ 19

Narrative by Activity: 

Health and Independence 

Summary of Request ..................................................................................................................................... 21

Home and Community-Based Supportive Services ......................................................................................... 25

Nutrition Services .......................................................................................................................................... 31

Native American Nutrition & Supportive Services ......................................................................................... 43

Preventive Health Services ............................................................................................................................ 47

Caregiver Services 

Summary of Request ..................................................................................................................................... 55

Family Caregiver Support Services ................................................................................................................ 57

Native American Caregiver Support Services ................................................................................................. 66

Alzheimer’s Disease Supportive Services Program......................................................................................... 70

Lifespan Respite Care .................................................................................................................................... 74

Protection of Vulnerable Older Americans ............................................................................................................ 78

Network Support and Demonstrations 

Summary of Request ..................................................................................................................................... 88

Health and Long-Term Care Programs ........................................................................................................... 90

Program Innovations...................................................................................................................................... 96

Aging Network Support Activities ............................................................................................................... 102

Program Administration ..................................................................................................................................... 108

Supplementary Tables: 

Budget Authority by Object ................................................................................................................................ 114

Salaries and Expenses ......................................................................................................................................... 115

Detail of Full Time Equivalent............................................................................................................................ 116

Detail of Positions .............................................................................................................................................. 117

Programs Proposed for Elimination..................................................................................................................... 118

Significant Items: 

Significant Items in House and Senate Appropriations Committee Reports .......................................................... 120
ii
iii

PAGE INTENTIONALLY LEFT BLANK 
1

Administration on Aging Organizational Chart 

Assistant Secretary 

for Aging 

Kathy Greenlee 

Deputy Assistant Secretary 

for Policy and Programs

Cindy Padilla

Assistant Secretary 

for Aging 

Kathy Greenlee 

Deputy Assistant Secretary 

for Policy and Programs

Cindy Padilla

Office of 

Communications

Carol Crecy 

Director

Office of Preparedness 

and Response

Vacant

Director

Executive 

Secretariat

Harry Posman 

Director

Center for Policy and 

 Management

John Wren 

Deputy Assistant Secretary 

Center for Program 

Operations 

Edwin Walker 

Deputy Assistant Secretary 

Office of Management 

Analysis and Resources 

Dan Berger 

Director

Office of 

Evaluation

Saadia Greenberg 

Director

Office of Budget 

and Finance

G. Steven Hagy 

Director

Office of Grants 

Management

Rimas Liogys 

Director

Office of 

Core Programs

Robert Hornyak 

Director

Office of 

Elder Rights

Barbara Dieker 

Director

Office of Administrative 

and Technology Services

Sophia Hurt 

Director

Office of Planning and 

Policy Development

Lori Gerhard 

Director

Office of American Indian, 

Alaskan Native, and Native 

Hawaiian Programs

M. Yvonne Jackson 

Director

Office of Regional 

Operations

Robert Logan 

Director

Region I

Dan Quirk 

Tri-Regional 

Administrator

Region I

Dan Quirk 

Tri-Regional 

Administrator

Region II

Dan Quirk 

Tri-Regional 

Administrator

Region II

Dan Quirk 

Tri-Regional 

Administrator

Region III

Dan Quirk 

Tri-Regional 

Administrator

Region IV 

Costas Miskis 

Regional 

Administrator

Region IV 

Costas Miskis 

Regional 

Administrator

Region V

Jim Varpness 

Bi-Regional 

Administrator

Region V

Bi-Regional 

Administrator

Region VI

Percy Devine 

Bi-Regional 

Administrator

Region VI

Percy Devine 

Bi-Regional 

Administrator

Region VII

Jim Varpness 

Bi-Regional 

Administrator

Region VII

Jim Varpness 

Bi-Regional 

Administrator

Region VIII

Percy Devine 

Bi-Regional 

Administrator

Region VIII

Percy Devine 

Bi-Regional 

Administrator

Region IX

David Ishida 

Bi-Regional 

Administrator

Region IX

David Ishida 

Bi-Regional 

Administrator

Region X

David Ishida 

Bi-Regional 

Administrator

Region X

David Ishida 

Bi-Regional 

Administrator

Region III

Dan Quirk 

Tri-Regional 

Administrator

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
2

PAGE INTENTIONALLY LEFT BLANK 
3

Executive Summary 

Agency Overview 

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/DC and Territorial Units on 

Aging (SUA), 629 Area Agencies on Aging (AAA), 246 Indian Tribal and Native Hawaiian 

organizations, nearly 20,000 direct service providers, and more than 500,000 volunteers. 

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 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 2008) show that AoA and its national 

network of aging service providers rendered direct services to nearly 11 million elderly 

individuals age 60 and over (nearly 20 percent of the 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 nearly 700,000 caregivers. 

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

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

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

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

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

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

Vision 

In order to serve a growing senior population, AoA envisions ensuring the continuation of a 

vibrant aging services network at State, Territory, local and Tribal levels through funding of 

lower-cost, non-medical services and supports that provide the means by which many more 

seniors can maintain their independence. 
EXECUTIVE SUMMARY 

4

Mission 

The mission of AoA is 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. 

Overview of Budget Request 

The FY 2011 President‘s Budget request for AoA is $1,624,733,000, an increase of 

+$108,436,000 over the FY 2010 appropriation. The request provides a 7.7 percent increase in 

funding for AoA‘s core services programs that focus on keeping seniors healthy and 

independent, addressing and supporting the needs of their caregivers, and protecting them from 

financial fraud and all forms of abuse and neglect. 

Of this increase, +$102.5 million will focus additional support on middle class families 

struggling to care for their aging relatives. This caregiver initiative stems from the work of the 

White House Task Force on Middle Class Families. The Task Force heard from many families 

facing difficulties caring for aging parents. The Task Force is concerned about families that 

struggle to hold down a job and care for an aging parent; those juggling caring for their own 

children with the need to drive aging parents to doctor appointments and the grocery store; and 

those who provide extensive hands on care and simply need a break. Caregiving responsibilities 

demand time and money from families who too often are already strapped for both. 

 

In response to these concerns, AoA‘s budget includes a $102.5 million Caregiver Initiative -- an 

effort to expand help to families and seniors so that caregivers can better manage their multiple 

responsibilities and seniors can live in the community for as long as possible. 

 

This initiative does not create new programs, but instead builds on the successful network of 

agencies in local communities across the country -- Area Agencies on Aging and Aging and 

Disability Resource Centers -- that provide critical help to seniors and caregivers already, but 

who need additional resources to meet the needs of more families. The Caregiver Initiative 

provides an additional $52.5 million for caregiver services and temporary respite care -- such as 

several days at a residential facility, when appropriate -- so that caregivers can get a much 

needed break. The Caregiver Services program also helps families retrofit their homes to 

accommodate the special needs of an aging family member, provides a peer support network for 

caregivers, and helps link caregivers and seniors to other supportive services. The Caregiver 

Initiative also provides an additional $50 million for other services that relieve both the time and 

financial stress that caring for an aging parent or family member can bring while improving the 

quality of life for seniors, including: 

 

in-home services to seniors, such as aides that can help seniors bathe, cook meals, clean 

up the house, and buy groceries, 

 

transportation help so that a family member does not have to drive the senior to every 

doctor appointment, and 
EXECUTIVE SUMMARY 

5

 

adult day programs for those who need supervised and engaging activities during the 

day. 

Together, with investments in programs that offer nutritious meals and reduce abuse and neglect, 

this budget seeks to take the next step in helping seniors age in their homes and communities. 

Program Increases 

Health and Independence Programs (+$58,078,000): 

An additional +$50 million for Home and Community-Based Supportive Services 

(including +$2 million for Native Americans) is requested under the Caregiver Initiative 

to expand services including adult day care as a respite service for families, transportation 

assistance, case management, minor modifications of homes to facilitate seniors ability to 

remain at home, and information and referrals; in-home services such as personal care, 

chore, and help eating, dressing and bathing; and community services such as physical 

fitness programs. Health and Independence Programs will support more than 

nine million hours of adult day care, an increase of over a million hours above the 2010 

expected level; 28.5 million rides for critical daily activities such as visiting the doctor, 

the pharmacy, or grocery stores, an increase of three million more trips than expected in 

2010; and an increase in the number of hours of personal care by more than 1.3 million 

hours to 33 million hours of assistance to seniors unable to perform daily activities. They 

will also provide over one million rides for Native American seniors, an increase of about 

250,000 more rides than 2010. 

The request also includes an additional +$8.1 million for AoA nutrition services to ensure 

that millions of older adults continue to have access to a nutritious diet needed to stay 

healthy and decrease their risk of disability. Overall nutrition funding of $828 million 

will support 214 million home-delivered and congregate meals to nearly 

2.3 million elderly individuals in a variety of community settings. In addition, the budget 

supports approximately 4.7 million total meals at home and at congregate meal sites to 

more than 65,000 Native American seniors. 

 

Caregiver Services Programs (+$52,500,000):

As part of the additional +$102.5 million for the Caregiver Initiative, an additional 

+$50 million is requested for the core National Family Caregiver Support Program 

(including +$2 million for Native American caregivers). The initiative also doubles 

funding for the Lifespan Respite Care program, an increase of +$2.5 million. These 

programs support family and informal caregivers by providing information, assistance, 

counseling, training, respite, and other services which help them care for their loved ones 

at home. These funds will increase the number of caregivers receiving support by nearly 

200,000 to 755,000 caregivers. Overall, the $202 million in family caregiver funds will 

provide 12 million hours of respite care or temporary relief from their caregiving 

responsibilities and more than 365,000 sessions of counseling, peer support groups, and 

training to help caregivers better cope with the stresses of caregiving. 
EXECUTIVE SUMMARY 

6

Protection of Vulnerable Older Americans Programs (+$1,407,000): 

Increased funding will allow States to further develop, coordinate, enhance and carry out 

comprehensive statewide systems of elder justice and elder rights protections. These 

systems consist of programs to prevent and treat elder abuse, neglect, and exploitation; to 

provide education, outreach, training and information; and to coordinate services with 

programs providing adult protective services (half of which are directly administered by 

SUAs), law enforcement, protection and advocacy, licensure and certification, and victim 

assistance. The increase will also support regular visits by ombudsmen to long-term care 

facilities to monitor conditions and care, resolve individual resident problems and provide 

a voice for those unable to speak for themselves. Altogether, more than 

12,000 volunteers participate in the Long-Term Care Ombudsman Program. 

Program Administration (+$2,529,000, +4 FTE): 

Eighty-seven percent of the requested funding increase is needed for costs related to the 

renewal of AoA‘s headquarters lease, to pay for increases related to changing billing 

methodologies in external services, and to provide for additional pay costs for AoA staff. 

Remaining dollars will be used to continue to allow AoA to effectively and efficiently 

manage the administration of the Agency and will support four additional FTEs to 

address AoA initiatives and other priorities. 

Program Decreases 

Network Support and Demonstration Programs (-$6,078,000): 

Funding for Program Innovations is reduced since funding is not requested to continue 

FY 2010 Congressional earmarks. Additionally, a reduction in contract costs is proposed 

for Health and Long-Term Care programs. However, no programs are proposed for 

elimination under this request. 
7

All-Purpose Table 

Administration on Aging 

(Dollars in Thousands) 

Program

FY 2009

Appropriation

FY 2009 

Recovery 

Act

FY 2010 

Appropriation

FY 2010 

Recovery 

Act

FY 2011 

President‘s 

Budget 

Request

Health and Independence:

Home & Community-Based Supportive Services........... $ 361,348 $ -- $ 368,348 $ -- $ 416,348 

Congregate Nutrition Services.......................................

Services........................................

 434,269 65,000 440,783 -- 445,644 

Home-Delivered Nutrition Services............................... 214,459 32,000 217,676 -- 220,893 

Native American Nutrition & Supportive Services......... 27,208 3,000 27,708 -- 29,708 

Nutrition Services Incentive Program 1/......................... 161,015 -- 161,015 -- 161,015 

Preventive Health Services............................................ 21,026 -- 21,026 -- 21,026 

Subtotal, Health and Independence ............................ $ 1,219,325 $ 100,000 $ 1,236,556 $ -- $ 1,294,634 

Caregiver Services:

Family Caregiver Support Services................................ $ 154,220 $ -- $ 154,220 $ -- $ 202,220 

Native American Caregiver Support Services................. 6,389 -- 6,389 -- 8,389 

Alzheimer's Disease Supportive Services Program......... 11,464 -- 11,464 -- 11,464 

Lifespan Respite Care 2/................................................ 2,500 -- 2,500 -- 5,000 

Subtotal, Caregiver Services...................................... $ 174,573 $ -- $ 174,573 $ -- $ 227,073 

Protection of Vulnerable Older Americans:

Long-Term Care Ombudsman Program ......................... $ 16,327 $ -- $ 16,827 $ -- $ 17,783 

Prevention of Elder Abuse & Neglect ............................ 5,056 -- 5,056 -- 5,507 

Subtotal, Vulnerable Older Americans....................... $ 21,383 $ -- $ 21,883 $ -- $ 23,290 

Network Support and Demonstrations:

Health and Long-Term Care Programs 3/....................... $ 28,000 $ -- $ 30,589 $ -- $ 30,485 

Program Innovations..................................................... 18,172 -- 19,023 -- 13,049 

Aging Network Support Activities................................ . 13,694 -- 13,694 -- 13,694 

Subtotal, Network Support and Demonstrations ......... $ 59,866 $ -- $ 63,306 $ -- $ 57,228 

Program Administration...................................................... $ 18,696 $ -- $ 19,979 $ -- $ 22,508 

Total, Discretionary Budget Authority......................... $ 1,493,843 $ 100,000 $ 1,516,297 $ -- $ 1,624,733 

Health Care Fraud and Abuse Control 4/ ............................. $ 3,236 $ -- $ 3,289 $ -- $ 3,279 

Chronic Disease Self-Management Programs 5/ .................. $ -- $ -- $ -- $ 32,500 $ -- 

Medicare Enrollment Assistance ......................................... $ 17,500 $ -- $ -- $ -- $ -- 

Total, Program Level.................................................... $ 1,514,579 $ 100,000 $ 1,519,586 $ 32,500 $ 1,628,012 

 

1/ Includes $2,681,000 in FY 2009 budget authority and $2,544,103 in FY 2010 budget authority appropriated to AoA and 

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

2/ Funding for the Lifespan Respite Care Act was appropriated in FY 2009 under the General Departmental Management 

Account in the Office of the Secretary. In FY 2010 the funds were directly appropriated to AoA. This table is comparatively 

adjusted. 

3/ Funding for activities under this program was provided under Aging Network Support Activities in FY 2009 and FY 2010. 

This table is comparatively adjusted. 

4/ FY 2011 is a placeholder. The Secretary and the Attorney General will determine the final amount. 

5/ $32.5 million is funding transferred from the Centers for Disease Control and Prevention through an intra-departmental 

delegation of authority as part of the Recovery Act‘s $650 million ―Prevention and Wellness Fund.‖ 
8

PAGE INTENTIONALLY LEFT BLANK 
9

American Recovery and Reinvestment Act of 2009 

The American Recovery and Reinvestment Act of 2009 (Recovery Act) provided $100 million to 

supplement AoA‘s existing nutrition services programs -- Congregate, Home-Delivered, and 

Nutrition Services for Native Americans. Meals are provided in a variety of community settings 

such as senior centers or delivered to seniors who are homebound due to illness, disability, or 

geographic isolation. These services will help more than 350,000 seniors remain healthy and 

independent in their communities by providing over 14 million meals. 

The Recovery Act funding was awarded using the formula grant methodologies established by 

the Older Americans Act. Formula grants for Congregate Nutrition Services and HomeDelivered Nutrition Services are allocated to States and Territories based on their share of the 

population age 60 and over. Eligible Tribal organizations receive nutrition 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. 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. 

AoA‘s nearly 40 years of experience with these programs shows that these 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. In 

addition, home-delivered meal and congregate meal participants have 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.1

 

Seniors with deficiencies of these nutrients can experience osteoporosis, night blindness, 

decreased resistance to infection, fatigue, vasodilatation, convulsions, psychosis, and coma. 

These nutrition resources came at a particularly critical time as they have augmented existing 

resources, replaced revenue lost from local sources due to the economic downturn, and supported

the continued availability of meals to vulnerable elders to help them maintain their health and 

avoid hospitalization and nursing home admission. In particular, the Recovery Act funding has 

helped 20 percent of the States eliminate waiting lists for seniors requesting home-delivered 

meals.2

AoA obligated the entire $100 million in FY 2009. To date, States have spent over 40 percent of 

these funds, and AoA anticipates that States will spend the remainder by the end of FY 2010. 

 

1

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

2

 The Economic Crisis and Its Impact on State Aging Programs. National Association of State Units on Aging. 

November 2009. 
10

Recovery Act Obligations 

(dollars in millions) 

Program FY 2009 FY 2010 FY 2011 

FY 2009 –

FY 2011 

Congregate Nutrition Services............................................ $ 65.000 $ -- $ -- $ 65.000

Home-Delivered Nutrition Services....................................

Services........................................

 32.000 -- -- 32.000 

Native American Nutrition & Supportive Services.............. 3.000 -- -- 3.000 

Total, Recovery Act Obligations 1/ .............................. $ 100.000 $ -- $ -- $ 100.000

Nutrition Services Outputs 

Indicator FY 2009 

Result

FY 2010 

Target 

FY 2011 

Target 

Number of Congregate meals served

(Output) 3.8 M 4.6 M --

Number of Home-Delivered meals 

served (Output) 2.5 M 2.6 M --

Number of Congregate meals served to 

American Indian, Alaska Native, and 

Native Hawaiian elders (Output)

58,820 323,000 --

Number of Home-Delivered meals 

served to American Indian, Alaska 

Native, and Native Hawaiian elders

(Output)

94,280 585,000 --

 

1/ In FY 2010, AoA will receive $32.5 million to implement chronic disease self-management programs. The funding will be 

transferred from the Centers for Disease Control and Prevention (CDC) through an intra-departmental delegation of authority 

as part of the Recovery Act‘s $650 million ―Prevention and Wellness Fund.‖ AoA expects to obligate all $32.5 million in 

FY 2010. This activity is not recorded on this table to avoid double-counting of the Recovery Act obligations reported by 

CDC. The chronic disease self-management programs are discussed in further detail on page 93. 
11

Appropriations Language 

Administration on Aging 

Aging Services Programs 

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

amended, section 398 and title XXIX of the Public Health Service Act, and section 119 of the 

Medicare Improvements for Patients and Providers Act of 2008, and for necessary 

administrative expenses to carry out title XVII of the Public Health Service Act,

[$1,516,297,000] $1,624,733,000, [, of which $5,500,000 shall be available for activities 

regarding medication management, screening, and education to prevent incorrect medication and 

adverse drug reactions: Provided, That $5,974,000 shall be used for the projects, and in the 

amounts, specified under the heading ―Aging Services Programs‖ in the statement of the 

managers on the conference report accompanying this Act.] of which $202,220,000 shall be for 

sections 371 through 374 of the Older Americans Act of 1965 and $8,389,000 shall be for 

section 631 of such Act.
12

Language Analysis 

Administration on Aging 

Aging Services Programs 

Language Provision Explanation

and for necessary administrative 

expenses to carry out title XVII of the 

Public Health Service Act,

Adds Title XVII of the Public Health 

Service Act to the activities that can be 

supported with the Program 

Administration dollars for the purposes 

of administering funds provided to AoA 

from the Prevention and Wellness Fund

of the American Recovery and 

Reinvestment Act of 2009. Such 

activities include ongoing lifecycle 

management of grants, contracts, and 

other awards that will be obligated in 

FY 2010.

[, of which $5,500,000 shall be 

available for activities regarding 

medication management, screening, 

and education to prevent incorrect 

medication and adverse drug 

reactions:]

Deletes statutory language that 

previously earmarked $5.5 million for 

medication management since Title III-D 

funds may be utilized for those purposes.

[Provided, That $5,974,000 shall be 

used for the projects, and in the 

amounts, specified under the heading 

―Aging Services Programs‖ in the 

statement of the managers on the 

conference report accompanying this 

Act]

Deletes statutory language for one-year, 

one-time Congressional earmarks. No 

funding is requested for these earmarks in 

FY 2011.

of which $202,220,000 shall be for 

sections 371 through 374 of the Older 

Americans Act of 1965 and 

$8,389,000 shall be for section 631 of 

such Act.

Adds specific appropriations amounts for 

the National Family Caregiver Support 

Services and Native American Caregiver 

Support Services programs because the 

requested appropriation amount exceeds 

the authorization levels in the Older 

Americans Act. This language ensures 

AoA will be able to expend these higher 

sums without violating the 

Antideficiency Act.
13

Amounts Available for Obligation 

Administration on Aging 

FY 2011 Budget Submission 

(Dollars in Thousands) 

FY 2009

Actual 

FY 2010

Estimate 1/

FY 2011

President's

Budget 

General Fund Discretionary Appropriation:

Appropriation (Annual).......................................................................

 

1,493,843 

 

1,516,297 

 

1,624,733 

Across-the-Board Reductions (P.L. 110-161).......................................

 

-- -- -- 

Appropriation (American Recovery and Reinvestment Act).................

 

100,000 -- -- 

Transfers:

Transfer of Funds to: Department of Agriculture 2/..........................

 

(2,681)

 

(2,544) -- 

Subtotal, Adjusted Appropriation.................................................

 

1,591,162 

 

1,513,753 

 

1,624,733 

Offsetting Collections From: 

Trust Funds: HCFAC 3/. .....................................................................

 

3,236 

 

3,289 

 

3,279 

Trust Funds: MIPPA. ..........................................................................

 

17,500 -- -- 

Unobligated Balance: Start of Year .........................................................

 

-- -- -- 

Recoveries of Prior Year Obligations ......................................................

 

-- -- -- 

Unobligated Balance: End of Year ..........................................................

 

-- -- -- 

Unobligated Balance: Lapsing.................................................................

 

(2,522) -- -- 

Total Obligations 4/...............................................................................

 

1,609,376 

 

1,517,042 1,628,012 

 

1/ FY 2010 Appropriation does not include $32,500,000 transferred via Intra-Departmental Delegation of Authority 

(IDDA) from the Centers for Medicare & Medicaid Services. 

2/ Includes FY 2009 and FY 2010 budget authority appropriated to AoA and transferred to the Department of 

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

3/ FY 2009 reflects obligated amount. FY 2010 includes funds carried over from the prior year. 

4/ Excludes the following amounts for reimbursable activities carried out by this account: 

 FY 2009: $977,000 FY 2010: $903,000 FY 2011: $80,000 
14

Summary of Changes 

Administration on Aging 

FY 2011 Budget Submission 

(Dollars in Thousands) 

FY 2010 Enacted .............................................................................................................................................. 1,516,297 

FY 2011 Estimate ............................................................................................................................................. 1,624,733 

Net Change ........................................................................................................................................................ 108,436

Increases/Decreases

FY 2010

Estimate

FTE

FY 2010

Estimate

Budget

Authority

Change

from

Base

FTE

Change

From

Base

Budget

Authority

Increases:

A. Built-in:

1. Provide for January 2011 1.4% Civilian pay raise and related 

pay costs.................................................................................... 108

 

14,139 --

 

233 

2. Increased costs related to GSA rent ............................................ -- 1,710 -- 24 

Subtotal, Built-In Increases................................................. 257

B. Program

1. Additional funding for Home and Community-Based 

Supportive Services................................................................... -- 368,348 -- 48,000 

2. Additional funding for Congregate Nutrition Services ................ -- 440,783 -- 4,861 

3. Additional funding for Home-Delivered Nutrition Services ........ -- 217,676 -- 3,217 

4. Additional funding for Native American Nutrition and 

Supportive Services...................................................................

5.

--

 

27,708 --

 

2,000 

5. Additional funding for Family Caregiver Support Services.........

6.

-- 154,220 -- 48,000 

6. Additional funding for Native American Caregiver Support 

Services..................................................................................... --

 

6,389 --

 

2,000 

7. Additional funding for Lifespan Respite Care.............................

8.

-- 2,500 -- 2,500 

8. Additional funding for Long-Term Care Ombudsman Program...

9.

-- 16,827 -- 956 

9. Additional funding for Prevention of Elder Abuse & Neglect...... -- 5,056 -- 451 

10. Additional FTE and related costs................................................ 108 14,139 4 302 

11. Increased costs related to HQ relocation agreement .................... -- 4,617 -- 1,243 

12. Increased costs for external services........................................... -- 14,075 -- 950 

Subtotal, Program Increases................................................ 114,480

Total, Increases...................................................................................... 114,737

Decreases:

A. Built-in:

1. Reduction in contract costs......................................................... -- 11,652 -- (223)

Subtotal, Built-in Decreases................................................ (223)

B. Program:

1. Elimination of one-time project earmarks................................... -- 5,974 -- (5,974)

2. Reduction in funding for Health and Long-Term Care 

Contracts................................................................................... -- 30,589 -- (104)

Subtotal, Program Decreases............................................... (6,078)

Total, Decreases..................................................................................... (6,301)

Total, Net Change.................................................................................. 108,436
15

Budget Authority by Activity 

Administration on Aging 

FY 2011 Budget Submission 

(Dollars in Thousands) 

 

Activity

FY 2009

Actual

FY 2010 

Estimate

FY 2011 

President‘s 

Budget 

Request

Health and Independence:

Home & Community-Based Supportive Services........... $ 361,348 $ 368,348 $ 416,348 

Congregate Nutrition Services.......................................

Services........................................

 434,269 440,783 445,644 

Home-Delivered Nutrition Services............................... 214,459 217,676 220,893 

Native American Nutrition & Supportive Services......... 27,208 27,708 29,708 

Nutrition Services Incentive Program 1/ ........................ 161,015 161,015 161,015 

Preventive Health Services............................................ 21,026 21,026 21,026 

Subtotal, Health and Independence ............................ $ 1,219,325 $ 1,236,556 $ 1,294,634 

Caregiver Services:

Family Caregiver Support Services................................ $ 154,220 $ 154,220 $ 202,220 

Native American Caregiver Support Services ................ 6,389 6,389 8,389 

Alzheimer's Disease Supportive Services Program......... 11,464 11,464 11,464 

Lifespan Respite Care 2/ ............................................... 2,500 2,500 5,000 

Subtotal, Caregiver Services...................................... $ 174,573 $ 174,573 $ 227,073 

Protection of Vulnerable Older Americans:

Long-Term Care Ombudsman Program......................... $ 16,327 $ 16,827 $ 17,783 

Prevention of Elder Abuse & Neglect ............................ 5,056 5,056 5,507 

Subtotal, Vulnerable Older Americans....................... $ 21,383 $ 21,883 $ 23,290 

Network Support and Demonstrations:

Health and Long-Term Care Programs 3/....................... $ 28,000 $ 30,589 $ 30,485 

Program Innovations..................................................... 18,172 19,023 13,049 

Aging Network Support Activities................................. 13,694 13,694 13,694 

Subtotal, Network Support and Demonstrations......... $ 59,866 $ 63,306 $ 57,228 

Program Administration ..................................................... $ 18,696 $ 19,979 $ 22,508 

Total, Discretionary Budget Authority ........................ $ 1,493,843 $ 1,516,297 $ 1,624,733 

Health Care Fraud and Abuse Control 4/............................. $ 3,236 $ 3,289 $ 3,279 

Medicare Enrollment Assistance......................................... $ 17,500 $ -- $ -- 

Total, Program Level.................................................... $ 1,514,579 $ 1,519,586 $ 1,628,012 

Total, FTE 5/................................................................. 103 108 112

 

1/ Includes $2,681,000 in FY 2009 budget authority and $2,544,103 in FY 2010 budget authority appropriated to AoA and 

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

2/ Funding for the Lifespan Respite Care Act was appropriated in FY 2009 under the General Departmental Management Account 

in the Office of the Secretary. In FY 2010 the funds were directly appropriated to AoA. This table is comparatively adjusted. 

3/ Funding for activities under this program was provided under Aging Network Support Activities in FY 2009 and FY 2010. This 

table is comparatively adjusted. 

4/ FY 2011 is a placeholder. The Secretary and the Attorney General will determine the final amount. 

5/ Includes Commissioned Corps personnel. 
16

Authorizing Legislation 

Administration on Aging 

FY 2011 Budget Submission 

Program

FY 2010 

Amount

Authorized

FY 2010

Appropriations 

Act

FY 2011 

Amount

Authorized

FY 2011

President’s 

Budget

1) Home and Community-Based 

Supportive Services: 

OAA Section 321 ....................... Such Sums $368,348,000 Such Sums $416,348,000

2) Congregate Nutrition Services: 

OAA Section 331 ....................... Such Sums $440,783,000 Such Sums $445,644,000

3) Home-Delivered Nutrition Services: 

OAA Section 336 ....................... Such Sums $217,676,000 Such Sums $220,893,000

4) Native American Nutrition and 

Supportive Services: 

OAA Sections 613 and 623......... Such Sums $27,708,000 Such Sums $29,708,000

5) Nutrition Services Incentive 

Program: OAA Section 311 1/ ... Such Sums $161,015,000 Such Sums $161,015,000 

6) Preventive Health Services: 

OAA Section 361 ....................... Such Sums $21,026,000 Such Sums $21,026,000 

7) National Family Caregiver Support 

Program: OAA Section 371 2/ ... $180,000,000 $154,220,000 $187,000,000 $202,220,000

8) Native American Caregiver Support: 

OAA Section 631 2/ .................. $7,500,000 $6,389,000 $7,900,000 $8,389,000

9) Alzheimer's Disease Supportive 

Services: PHSA Section 398....... Expired $11,464,000 Expired $11,464,000 

10) Lifespan Respite Care Program: 

PHSA Title XXIX ...................... $71,110,000 $2,500,000 $94,810,000 $5,000,000

11) Long-Term Care Ombudsman 

Program: OAA Section 712 ........ Such Sums $16,827,000 Such Sums $17,783,000

 

1/ Includes $2,544,103 in FY 2010 budget authority appropriated to AoA and transferred to the Department of 

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

2/ The budget proposes appropriations language with specific amounts for the National Family Caregiver Support 

Services and Native American Caregiver Support Services programs because the requested appropriation amount 

exceeds the authorization levels in the Older Americans Act. The proposed appropriations language ensures AoA 

will be able to expend these higher sums without violating the Antideficiency Act. 
17

Authorizing Legislation 

Administration on Aging 

FY 2011 Budget Submission 

Program

FY 2010 

Amount

Authorized

FY 2010

Appropriations 

Act

FY 2011 

Amount

Authorized

FY 2011

President’s 

Budget

12) Prevention of Elder Abuse and 

Neglect: OAA Section 721 ......... Such Sums $5,056,000 Such Sums $5,507,000

13) Health and Long-Term Care 

Programs: OAA Section 411 3/.. Such Sums $30,589,000 Such Sums $30,485,000

14) Program Innovations: 

OAA Section 411 ....................... Such Sums $19,023,000 Such Sums $13,049,000

15) Aging Network Support 

Activities: OAA Sections 202, 

215, and 411............................... Such Sums $13,694,000 Such Sums $13,694,000

16) Program Administration: 

OAA Section 205 ....................... Such Sums $19,979,000 Such Sums $22,508,000

Total Request Level............................ $1,516,297,000 $1,624,733,000

Unfunded Authorizations:

1) Legal Assistance: 

OAA Section 731 ....................... Such Sums -- Such Sums -- 

2) Native American Organization and 

Elder Justice Provisions: 

OAA Sections 751 and 752......... Such Sums -- Such Sums --

 

3/ Funding for activities under this program was provided under Aging Network Support Activities in FY 2010. This 

table is comparatively adjusted. 
18

Appropriations History Table 

Administration on Aging 

FY 2011 Budget Submission 

Year

Budget 

Estimate to 

Congress

House 

Allowance

Senate 

Allowance Appropriation

FY 2002

 

1,097,718,000 

 

1,144,832,000 

 

1,209,756,000 

 

1,199,814,000 

FY 2002 Rescission 1/

 

-- 

 

-- 

 

-- -143,000 

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 2 /

 

-- 

 

-- 

 

-- -8,271,225 

FY 2005

 

1,376,527,000 

 

1,403,479,000 

 

1,395,117,000 

 

1,404,634,000 

FY 2005 Rescission 3/

 

-- 

 

-- 

 

-- -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 4/

 

1,335,146,000 

 

1,417,189,000 

 

1,451,585,000 

 

1,438,567,000 

FY 2008 Rescission

 

-- 

 

-- 

 

-- -25,131,765 

FY 2009 5/

 

1,381,384,000 

 

1,492,741,000 

 

1,478,156,000 

 

1,491,343,000 

FY 2009 ARRA 6/

 

-- 

 

-- 

 

-- 

 

100,000,000 

FY 2010 7/

 

1,491,343,000 

 

1,530,881,000 

 

1,495,038,000 

 

1,516,297,000 

FY 2011 1,624,733,000 

 

-- 

 

-- 

 

-- 

 

1/ Reflects three separate rescissions of -$37,000, -$17,000, and -$89,000. 

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

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

4/ 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. 

5/ 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. 

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

7/ Includes $2,544,103 in FY 2010 budget authority appropriated to AoA and transferred to the Department of 

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

Appropriations Not Authorized by Law 

Administration on Aging 

FY 2011 Budget Submission

Program

Last Year of 

Authorization

Authorization Level 

in Last Year of 

Authorization

Appropriations 

in Last Year of 

Authorization

Appropriations 

in FY 2010

Alzheimer's Disease 

Supportive Services: 

PHSA Section 398 .................. FY 2002 Such Sums $11,483,000 $11,464,000

 
20

PAGE INTENTIONALLY LEFT BLANK 
21

Health and Independence 

Summary of Request 

In the face of a growing senior population, AoA programs support the development of a vibrant 

aging services network at the State, Territory, local, and Tribal levels. Through funding of lowcost, non-medical services and supports, these programs provide the means by which many more 

seniors can maintain their health and independence. 

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

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

expensive nursing home care. For example, 58 percent of congregate and 93 percent of homedelivered meal recipients reported that the meals enabled them to continue living in their own 

homes and 48 percent of seniors using transportation services rely on them for the majority of 

their trips to doctors‘ offices, pharmacies, meal sites, and additional sites that help them to 

remain in the community.1

From 2010 to 2015, the population age 60 and older will increase by 15 percent, from 57 million 

to 65.7 million.2 During this period, the number of seniors with severe disabilities (defined as 

3 or more limitations in activities of daily living) who are at greatest risk of nursing home 

admission and Medicaid eligibility (through the ―spend down‖ provisions) will increase by more 

than 13 percent.3 These programs help seniors in need maintain their health and independence. 

The FY 2011 funding request for Health and Independence services is $1,294,634,000, an 

increase of +$58,078,000 above the FY 2010 appropriation. The request includes: 

$416,348,000 for Home and Community-Based Supportive Services (HCBS), an increase 

of +$48,000,000 above the FY 2010 appropriation, as a critical element of the Caregiver 

Initiative. HCBS 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 community 

services such as physical fitness programs. These services also aid caregivers, who might 

otherwise have to be even more intensively involved with the care of their loved ones on 

a more frequent basis -- taking time away from their work and other family 

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

budget supports more than nine million hours of adult day care for older adults, an 

increase of over a million hours above the 2010 expected level; 28.5 million rides for 

critical daily activities such as visiting the doctor, the pharmacy, or grocery stores, an 

increase of three million more trips than expected in 2010; and an increase in the number 

 

1

2008 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.

2 U.S. Census Bureau, ―2008 National Population Projections,‖ released August 2008, 

<http://www.census.gov/population/www/projections/2008projections.html>.

3 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.
HEALTH AND INDEPENDENCE – SUMMARY OF REQUEST 

22

of hours of personal care by more than 1.3 million hours to 33 million hours of assistance 

to seniors unable to perform daily activities. 

$827,552,000 for Nutrition Services, an increase of +$8,078,000 above the FY 2010

appropriation. Nutrition Services help over two million older adults receive the meals 

they need to stay healthy and decrease their risk of disability. The meals provided 

through these programs fulfill the standards of the Dietary Guidelines for Americans and 

provide a minimum of 33 percent of the Dietary Reference Intake. With these funds in 

FY 2011, the Aging Services Network will provide approximately 214 million meals. 

These meals are especially critical for the survival of the 28 percent of meal recipients 

who report these meals as the only or the majority of their food intake for the day. 

$29,708,000 for Native American Nutrition and Supportive Services, an increase of 

+$2,000,000 above the FY 2010 appropriation, as part of the Caregiver Initiative. This 

increase is proportional to the increase for comparable nutrition and home and 

community-based services provided by the States and Territories. These funds will 

provide approximately 4.7 million meals and over one million rides for Native American 

seniors to critical daily activities such as meal sites, medical appointments, and grocery 

stores. 

$21,026,000 for Preventive Health Services, the same amount as the FY 2010 

appropriation. These services support activities that educate older adults about the 

importance of healthy lifestyles and promote healthy behaviors that can help prevent or 

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

interventions. 

In concert with other Older Americans Act (OAA) programs, these services assist nearly 

11 million elderly individuals and caregivers. AoA‘s services are especially critical for the 

nearly three million seniors who receive intensive in-home services, half a million of whom meet 

the disability criteria for nursing home admission. These services help to keep these individuals 

from joining the 1.7 million seniors who live in nursing homes. These increases will also help 

the national aging services network improve its capacity to assist the rapidly growing senior 

population. 

State and Territory Flexibility

Within each program States and Territories have the flexibility to allocate resources to best meet 

local needs through intra-State funding formulas which distribute funds to Area Agencies on 

Aging (AAAs). These formulas vary by State and allow States to take into account their own 

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

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

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

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

The OAA specifically allows the State to transfer up to 40 percent of the funds between 

congregate and home-delivered meals for use as the State considers appropriate to meet the 
HEALTH AND INDEPENDENCE – SUMMARY OF REQUEST 

23

needs of the area served. Additionally, for any fiscal year if the transferred funds are insufficient 

to satisfy the need for nutrition services, then the Assistant Secretary for Aging may grant a 

waiver that permits the State to transfer an additional 10 percent of the funds to meet those 

needs. The OAA provides further flexibility to States by allowing them to transfer up to 

30 percent for any fiscal year between Supportive Services programs and Nutrition Services 

programs, for use as the State considers appropriate. These are options open only to States and 

Territories. A State agency may not delegate to an area agency on aging or any other entity the 

authority to make such transfers. 

As requested by the report of the House of Representatives Appropriations committee, the tables 

below demonstrate the amounts transferred between programs for FY 2008, the most recent year 

of available data. 

Table 1. FY 2008 Pre-transfer allotment of Federal funds for Title III of the OAA

Part B –

Home and CommunityBased ServicesPart C1 –

Congregate Nutrition

Part C2 –

Home-Delivered Meals

Allotment $348,377,459 $406,067,544 $191,809,542

Table 2. FY 2008 Transfers of allotments of Federal funds between Title III programs 

Transfer To Part B To Part C1 To Part C2 

From Part B $418,379 $1,728,365

From Part C1 $39,301,646 $39,188,907

From Part C2 $2,509,501 $250,000

Net Transfer $39,664,403 ($77,822,174) $38,157,771

Net Percent Change 11.39 (19.16) 19.89

Final Allotments after 

Transfers $388,041,862 $328,245,370 $229,967,313
24

PAGE INTENTIONALLY LEFT BLANK 
25

Home and Community-Based Supportive Services 

FY 2009

Appropriation

FY 2009

Recovery Act

FY 2010

Appropriation

FY 2011

President’s

Budget

Request

FY 2011

+/-

FY 2010

Home and Community-Based 

Supportive Services................................ $361,348,000 ............... -- $368,348,000 $416,348,000 +$48,000,000

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

FY 2011 Authorization................................................................................................ Such Sums 

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

Program Description and Accomplishments: 

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

provides grants to States and Territories based on their share of the population age 60 and over to 

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

possible. The services provided to seniors through the HCBS program include transportation, 

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

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

programs. In addition to these services, the HCBS program also funds 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, avoiding the unnecessary, expensive, 

and undesirable alternative of nursing home care. 

Data from AoA‘s national surveys of elderly clients show that the Home and Community-Based 

Supportive Services are providing seniors with the services and information they need to help 

them remain at home. For example, 48 percent of seniors using transportation services rely on 

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

87 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.1

 

1

2008 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID. 
HOME AND COMMUNITY-BASED SUPPORTIVE SERVICES 

26

Services provided by the HCBS program in FY 2008, the most recent available data, include: 

Adult Day Care/Day Health provided nearly nine million hours of care for dependent 

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

day (Output E). 

Transportation Services provided over 28 million rides to doctor‘s offices, grocery stores, 

pharmacies, senior centers, meal sites, and other critical daily activities (Output C). 

Personal Care, Homemaker, and Chore Services provided nearly 33 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). 

Case Management Services provided 4.4 million hours of assistance in assessing needs, 

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

(Output F). 

In continuing with AoA‘s commitment to provide services to those in need, approximately 

80 percent of transportation clients have annual incomes at or below $20,000. This assistance is 

especially critical for seniors who would be homebound with transportation assistance. In 

addition, transportation is a key factor in maintaining the health, safety, and independence of the 

19 percent of riders who take 10 or more daily prescriptions, enabling them to get to the 

pharmacy, doctor, and rehabilitation appointments.2 

Funding History 

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

follows: 

FY 2001 .................................. $325,027,000 

FY 2002 .................................. $356,981,000 

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 .................................. $368,348,000 

 

2

 2008 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID. 
HOME AND COMMUNITY-BASED SUPPORTIVE SERVICES 

27

Budget Request 

The FY 2011 request for Home and Community-Based Supportive Services is $416,348,000, an 

increase of +$48,000,000 above the FY 2010 appropriation. The +$48 million increase is 

requested under the Caregiver Initiative to expand services, including transportation assistance, 

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

and help eating dressing and bathing; and community services such as adult day care and 

physical fitness programs. These services -- particularly adult day care, personal care, and chore 

services -- 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. 

The budget request supports more than nine million hours of adult day care for older adults, an 

increase of over a million hours above the 2010 expected level; 28.5 million rides for critical 

daily activities such as visiting the doctor, the pharmacy, or grocery stores, an increase of three 

million more trips than expected in 2010; and an increase in the number of hours of personal care 

by more than 1.3 million hours to 33 million hours of assistance to seniors unable to perform 

daily activities. 

This +13 percent increase helps the national aging services network address the projected 

demand in coming years for increased elder services. From 2010 to 2015, the population age 60 

and older will increase by 15 percent, from 57 million to 65.7 million.3 During this period, the 

number of seniors with severe disabilities (defined as 3 or more limitations in activities of daily 

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

―spend down‖ provisions) will increase by more than 13 percent.4

 

These services are a cost-effective means of enabling seniors to remain healthy and independent, 

avoiding more expensive nursing home care and medical interventions. AoA core programs 

reach one in five seniors, serving over a half million seniors in their own communities who meet 

the disability criteria for nursing home admission, helping to keep them from joining the 

1.7 million seniors who live in nursing homes. Nationally, about 26 percent of individuals 60 

and older live alone, and in FY 2011 AoA projects 72 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 HCBS 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. 

With the FY 2011 request these programs are expected to continue to have a high percentage of 

clients who rate service as good to excellent (Outcome 2.9b) ensuring that clients continue to 

receive high quality services. Efficiency and most service outcome projections remain positive; 

service outputs for transportation are expected to increase by 3 million trips more than the 2010 

projection based on the additional funds requested (Output C). Other in-home services including 

the number of case management service units (Output F) and the number of personal care service 

 

3 U.S. Census Bureau, ―2008 National Population Projections,‖ released August 2008, 

<http://www.census.gov/population/www/projections/2008projections.html >.

4 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.
HOME AND COMMUNITY-BASED SUPPORTIVE SERVICES 

28

units (Output D) are expected to have modest increases consistent with the funding level 

requested and program innovations that affect system-wide performance, including Aging and 

Disability Resource Centers. 

Outcomes and Outputs Table 

Home and Community-Based Supportive Services Outcomes and Outputs 

Measure Most Recent Result FY 2010 

Target 

FY 2011 

Target 

FY 2011 

+/- FY 2010 

2.9b: 90% of transportation clients rate 

services good to excellent. (Outcome) FY 2009: 96.7% 90% 90% Maintain

2.11: Increase the percentage of 

transportation clients who live alone.

(Outcome)

FY 2009: 67.3%

(Target Not In Place) 70% 72% +2%

Indicator Most Recent Result FY 2010 

Projection 

FY 2011 

Projection 

FY 2011 

+/- FY 2010 

Output C: Transportation Services units

(Output) FY 2008: 28.3 M 25.5 M 28.5 M +3 M

Output D: Personal Care, Homemaker and 

Chore Services units (Output) FY 2008: 32.9 M 31.8 M 33.1 M +1.3 M

Output E: Adult Day Care/Day Health 

units (Output) FY 2008: 9 M 8.0 M 9.1 M +1.1 M

Output F: Case Management Services 

units (Output) FY 2008: 4.4 M 4.2 M 4.4 M +0.2 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 Table 

Home and Community-Based Supportive Services Grant Awards 

FY 2009 

Appropriation

FY 2009 

Recovery Act

FY 2010 

Appropriation

FY 2011 

President’s 

Budget

Request

Number of 

Awards 56 -- 56 56

Average 

Award $6,414,079 -- $6,511,866 $7,360,438

Range of 

Awards

$224,493 -

$35,454,106

--

$227,915 -

$36,241,336

$257,615 -

$41,789,087
HOME AND COMMUNITY-BASED SUPPORTIVE SERVICES 

29

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION ON AGING 

FY 2011 DISCRETIONARY STATE FORMULA GRANTS 

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

State/Territory

FY 2009 

Appropriation

FY 2010 

Appropriation

FY 2011 

President's 

Budget Request

Difference 

+/- FY 2010

Alabama......................................... 5,511,235 5,623,904 6,484,799 860,895 

Alaska............................................ 1,795,942 1,823,323 2,060,923 237,600 

Arizona .......................................... 7,186,334 7,494,189 8,641,385 1,147,196 

Arkansas........................................ 3,510,940 3,554,840 4,099,007 544,167 

California....................................... 35,454,106 36,241,336 41,789,087 5,547,751 

Colorado ........................................ 4,564,582 4,735,273 5,460,139 724,866 

Connecticut.................................... 4,416,847 4,414,045 4,841,374 427,329

Delaware........................................ 1,795,942 1,823,323 2,060,923 237,600 

District of Columbia ....................... 1,795,942 1,823,323 2,060,923 237,600 

Florida ........................................... 26,072,475 26,577,730 30,646,195 4,068,465 

Georgia .......................................... 8,752,179 9,068,628 10,456,835 1,388,207 

Hawaii ........................................... 1,795,942 1,823,323 2,060,923 237,600 

Idaho.............................................. 1,795,942 1,823,323 2,060,923 237,600 

Illinois............................................ 14,566,145 14,556,904 15,875,856 1,318,952 

Indiana........................................... 7,018,309 7,138,069 8,230,750 1,092,681 

Iowa............................................... 4,272,980 4,270,269 4,348,953 78,684 

Kansas........................................... 3,442,659 3,440,474 3,657,473 216,999 

Kentucky........................................ 4,892,022 5,010,758 5,777,795 767,037 

Louisiana ....................................... 4,809,520 4,806,469 5,526,280 719,811 

Maine............................................. 1,795,942 1,823,323 2,060,923 237,600 

Maryland........................................ 5,978,676 6,100,006 7,033,783 933,777 

Massachusetts ................................ 8,232,411 8,227,189 8,807,420 580,231 

Michigan........................................ 11,376,983 11,527,993 13,292,675 1,764,682 

Minnesota ...................................... 5,609,504 5,708,774 6,582,662 873,888 

Mississippi..................................... 3,282,007 3,279,924 3,765,447 485,523 

Missouri......................................... 7,138,648 7,134,119 8,100,539 966,420 

Montana......................................... 1,795,942 1,823,323 2,060,923 237,600 

Nebraska........................................ 2,301,456 2,299,996 2,374,017 74,021 

Nevada........................................... 2,657,189 2,733,984 3,152,497 418,513 

New Hampshire.............................. 1,795,942 1,823,323 2,060,923 237,600 
HOME AND COMMUNITY-BASED SUPPORTIVE SERVICES 

30

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

State/Territory

FY 2009 

Appropriation

FY 2010 

Appropriation

FY 2011 

President's 

Budget Request

Difference 

+/- FY 2010

New Jersey.................................... 10,292,122 10,285,593 11,611,269 1,325,676 

New Mexico.................................. 2,169,925 2,236,929 2,579,354 342,425 

New York ..................................... 24,352,403 24,336,954 26,248,230 1,911,276 

North Carolina .............................. 9,988,771 10,271,225 11,843,523 1,572,298 

North Dakota................................. 1,795,942 1,823,323 2,060,923 237,600 

Ohio.............................................. 13,856,054 13,847,264 15,748,264 1,901,000 

Oklahoma ..................................... 4,290,438 4,287,716 4,942,957 655,241 

Oregon.......................................... 4,399,453 4,529,183 5,222,501 693,318

Pennsylvania ................................. 17,930,762 17,919,386 18,798,375 878,989 

Rhode Island ................................. 1,795,942 1,823,323 2,060,923 237,600 

South Carolina .............................. 5,183,532 5,373,309 6,195,844 822,535 

South Dakota................................. 1,795,942 1,823,323 2,060,923 237,600 

Tennessee...................................... 7,115,319 7,313,979 8,433,588 1,119,609 

Texas............................................ 21,600,611 22,242,819 25,647,704 3,404,885 

Utah.............................................. 2,077,089 2,172,568 2,505,140 332,572 

Vermont........................................ 1,795,942 1,823,323 2,060,923 237,600 

Virginia......................................... 8,246,003 8,459,582 9,754,558 1,294,976 

Washington................................... 6,927,144 7,132,007 8,223,761 1,091,754 

West Virginia................................ 2,781,416 2,779,651 2,867,598 87,947 

Wisconsin ..................................... 6,429,923 6,528,884 7,528,312 999,428 

Wyoming ...................................... 1,795,942 1,823,323 2,060,923 237,600 

Subtotal, States.............................. 352,035,418 357,365,121 403,887,945 46,522,824 

American Samoa ........................... 473,659 473,358 472,317 (1,041)

Guam............................................ 897,971 911,661 1,030,461 118,800 

Northern Mariana Islands.............. 224,493 227,915 257,615 29,700 

Puerto Rico ................................... 4,658,903 4,774,804 5,505,721 730,917 

Virgin Islands................................ 897,971 911,661 1,030,461 118,800 

Subtotal, States and Territories ...... 359,188,415 364,664,520 412,184,520 47,520,000 

Undistributed 1/............................. 2,159,585 3,683,480 4,163,480 480,000 

TOTAL 361,348,000 368,348,000 416,348,000 48,000,000 

 

1/ Funds held for statutory related requirements are reflected in the undistributed line. 

 
31

Nutrition Services 

Program

FY 2009

Appropriation

FY 2009

Recovery Act

FY 2010

Appropriation

FY 2011

President’s 

Budget

Request

FY 2011

+/-

FY 2010

Congregate Nutrition Services................................ $434,269,000 $65,000,000 $440,783,000 $445,644,000 +$4,861,000

Home-Delivered Nutrition 

Services................................................................ $214,459,000 . $32,000,000 $217,676,000 $220,893,000 +$3,217,000

Nutrition Services Incentive 

Program................................................................ $161,015,000 . --  ̳ $161,015,000 $161,015,000 --  ̳

 Total BA........................................................... $809,743,000 $97,000,000 $819,474,000 $827,552,000 $8,078,000

Authorizing Legislation: Sections 311, 331, and 336 of the Older Americans Act of 1965, as 

amended 

FY 2011 Authorization................................................................................................ Such Sums 

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

Program Description and Accomplishments: 

Congregate Nutrition Services, established in 1972, and Home-Delivered Nutrition Services, 

established in 1978, provide meals and related services in a variety of settings (including 

congregate facilities such as senior centers) and home-delivery to seniors that 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 help to keep older 

Americans healthy and prevent the need for more costly medical interventions. 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 seniors that are homebound. Home-delivered meals are 

often the first in-home service that an older adult receives, and the program is a primary 

access point for other home and community-based services. Home-delivered meals also 

represent an essential service for many caregivers, by helping them 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 may not be used to pay for other nutrition-related services or for administrative costs. 

Funds are awarded to existing States and Tribes based on the number of meals served in 

the prior period. States and Tribes have the option to receive commodities in lieu of cash 

if they determine that doing so will enable them to better meet the needs of seniors. 
NUTRITION SERVICES 

32

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 millions of older adults receive the meals they need to stay healthy and 

decrease their risk of disability. Studies have found that half of all persons age 85 and over are 

in need of assistance with instrumental activities of daily living, including obtaining and 

preparing food and these nutrition programs help address their needs. Serving Elders at Risk, a 

national evaluation of 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 also 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. 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.1 Seniors with deficiencies of these nutrients can experience 

osteoporosis, night blindness, decreased resistance to infection, fatigue, vasodilatation, 

convulsions, psychosis, and coma. 

Data from AoA‘s national surveys of elderly clients shows that the Nutrition Services are 

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

73 percent of congregate and 85 percent of home-delivered meal recipients say they eat healthier 

meals due to the programs, and 58 percent of congregate and 93 percent of home-delivered meal 

recipients say that the meals enabled them to continue living in their own homes.2

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. Eighty-eight 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 350,000 in 2008 (Outcome 3.2). This level of disability is frequently 

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

number of home-delivered meal clients. Accomplishments that these nutrition programs have 

achieved in helping seniors remain healthy and independent in their homes and communities in 

FY 2008, the most recent available data, include: 

 

1

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

2

 2008 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID. 
NUTRITION SERVICES 

33

Home-Delivered Nutrition Services provided nearly 146 million meals to over 

909,000 individuals (Output G). 

Congregate Nutrition Services provided over 94.2 million meals to more than 1.6 million 

seniors in a variety of community settings (Output H). 

Funding History 

Comparable funding for Nutrition Services during the past ten years is as follows: 

FY 2001 .................................. $680,334,000 

FY 2002 .................................. $716,170,000 

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 2010 .................................. $819,474,000 

* The FY 2009 funding indicated in this table does not include $97 million in Recovery Act funding. 

Note: NSIP funding was appropriated to the Department of Agriculture prior to FY 2003. 

Budget Request 

The FY 2011 request for Nutrition Services is $827,552,000, an increase of +$8,078,000 above 

the FY 2010 appropriation. The budget request will support 214 million home-delivered and 

congregate meals to nearly 2.3 million elderly individuals in a variety of community settings. In 

FY 2011 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. 

These services are a cost-effective means of enabling seniors to remain healthy and independent, 

avoiding more expensive nursing home care and medical interventions. Currently, AoA core 

programs reach one in five seniors, serving over a half million seniors in their own communities 

who meet the disability criteria for nursing home admission, helping to keep them from joining 

the 1.7 million seniors who live in nursing homes. 

In continuing with AoA‘s commitment to provide services to those in need to help maintain their 

health and independence, approximately 72 percent of home-delivered meal recipients have 

annual incomes at or below $20,000. These meals are especially critical for the survival of the 

28 percent of meal recipients who report these meals as the sole or majority of their food intake 

for the day and for the 325,000 home-delivered meal recipients with severe disabilities who are 
NUTRITION SERVICES 

34

projected to be served in FY 2011 (Outcome 3.2). This population with severe disabilities is 

important to serve since this level of disability is frequently an eligibility requirement for nursing 

home admission. 

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

have strong partnerships with State/Tribal and local governments, philanthropic organizations, 

and private donations that contribute funds in greater proportions than other Older Americans 

Act programs. Nutrition Services annual Federal funding has increased by approximately 

20 percent in the past decade and the Recovery Act provided an additional $100 million in the 

FY 2009-2010 period for Nutrition Services. The budget request for an additional $8.1 million, 

or approximately one percent in FY 2011, will help offset the impact of projected inflationary 

increases and the support from partnerships recovering from the economic downturn. 

Considering these factors, in FY 2011 AoA estimates 14.7 million fewer meals will be provided 

to 185,000 fewer seniors than in 2010. AoA expects the same number of home-delivered meal 

recipients with severe disabilities will be served in FY 2010 and FY 2011 (Outcome 3.2). AoA 

projects a decrease of 8.3 million congregate meals (Output H) -- continuing a roughly eight-year 

trend in declining meal counts -- and 6.4 million home-delivered (Output G) meals from 

FY 2010 levels as programs face inflation3

and States spend their remaining Recovery Act funds 

in 2010. Without the stimulus funding, AoA estimates nearly 8.1 million fewer meals would 

have been provided in FY 2010. With this budget request, annual Federal funding for 

congregate meals, excluding Recovery Act funding, will have increased from FY 2004 by over 

$59 million or 15 percent. In contrast, funding from other sources for congregate meals is 

predicted to decline by $24 million during a similar time period. The multi-year decline in 

congregate meal counts are projected to be largely attributable to declining matching funds as 

State, local, and private budgets face economic hardships and States utilize their statutory 

authority to transfer appropriations for congregate meals to home-delivered meals and home and 

community-based supportive services (see page 23). Should State budgets rebound higher than 

projected in FY 2011, States may elect to provide additional support for meals, further offsetting 

inflationary pressure and the ending of Recovery Act support. 

Outcomes and Outputs Table 

Nutrition Services Outcomes and Outputs 

Measure Most Recent Result FY 2010 

Target 

FY 2011 

Target 

FY 2011 

+/- FY 2010 

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 2008: 8,301

(Target Exceeded) 7,742 7,618 -124

 

3

 AoA assumes the inflation factor of 3.2% from FY 2010 to FY 2011 using the Department of Agriculture‘s ―food 

away from home‖ inflation index, consistent with the economic assumptions used in preparation of the President‘s 

budget. 
NUTRITION SERVICES 

35

Measure Most Recent Result FY 2010 

Target 

FY 2011 

Target 

FY 2011 

+/- FY 2010 

2.9a: 90% of home delivered meal 

clients rate services good to excellent.

(Outcome)

91.03%

4

 

(Target Met) 90% 90% Maintain

3.2: Increase the number of older 

persons with severe disabilities who 

receive home-delivered meals.

(Outcome)

FY 2008: 349,934

(Target Not Met) 325,0005

325,000 Maintain

Indicator Most Recent Result FY 2010 

Projection

FY 2011 

Projection 

FY 2011 

+/- FY 2010 

Output G: Number of Home-Delivered 

meals served (Output)

FY 2008: 146 M

(Target Exceeded) 136.5 M5

130.1 M -6.4 M

Output H: Number of Congregate meals 

served (Output)

FY 2008: 94.2 M

(Target Not Met) 92.4 M5

84.1 M -8.3 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. 

Grant Awards Tables 

Congregate Nutrition Services Grant Awards 

FY 2009 

Appropriation

FY 2009 

Recovery Act

FY 2010 

Appropriation

FY 2011

President’s 

Budget

Request

Number of 

Awards 56 56 56 56

Average 

Award $7,708,457 $1,160,714 $7,805,349 $7,883,581

Range of 

Awards

$269,796 -

$42,619,031

$40,625 -

$6,585,441

$273,187 -

$43,489,813

$275,925 -

$44,221,133

 

4

 Based on upper range of survey confidence interval. 

5

 Performance target reflects annual appropriation and Recovery Act funds. 
NUTRITION SERVICES 

36

Home-Delivered Nutrition Services Grant Awards 

FY 2009 

Appropriation

FY 2009 

Recovery Act

FY 2010 

Appropriation

FY 2011

President’s 

Budget

Request

Number of 

Awards 56 56 56 56

Average 

Award $3,806,737 $571,429 $3,848,201 $3,905,073

Range of 

Awards

$133,236 -

$21,597,330

$20,000 -

$3,242,063

$134,687 -

$21,860,186

$136,678 -

$22,183,602

Nutrition Services Incentive Program Grant Awards 

FY 2009 

Appropriation

FY 2009 

Recovery Act

FY 2010 

Appropriation

FY 2011

President’s 

Budget

Request

Number of 

Awards 299 -- 299 299

Average 

Award $535,2936

-- $533,1277$533,1277

Range of 

Awards

$503 -

$16,168,318

--

$503 -

$16,101,637

$503 -

$16,101,637

 

6

 Excluding the 244 awards to Tribal organizations, the average award to states, DC, and territories is $2,856,077. 

7

 Excluding the 244 awards to Tribal organizations, the average award to states, DC, and territories is $2,844,297. 
NUTRITION SERVICES 

37

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION ON AGING 

FY 2011 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM: Congregate Nutrition Services (CFDA 93.045) 

State/Territory

FY 2009

Appropriation

FY 2009

Recovery Act

FY 2010

Appropriation

FY 2011 

President’s 

Budget Request

Difference

+/-FY 2010

Alabama ........................................ 6,625,002 1,023,687 6,748,717 6,862,202 113,485 

Alaska ........................................... 2,158,368 325,000 2,185,498 2,207,403 21,905 

Arizona.......................................... 8,638,621 1,334,829 8,993,070 9,144,296 151,226 

Arkansas........................................ 4,215,426 648,133 4,265,828 4,337,561 71,733 

California....................................... 42,619,031 6,585,441 43,489,813 44,221,133 731,320 

Colorado........................................ 5,487,038 847,851 5,682,355 5,777,908 95,553 

Connecticut.................................... 5,306,740 775,759 5,277,800 5,241,452 (36,348)

Delaware ....................................... 2,158,368 325,000 2,185,498 2,207,403 21,905 

District of Columbia....................... 2,158,368 325,000 2,185,498 2,207,403 21,905 

Florida........................................... 31,341,465 4,842,845 31,893,428 32,429,743 536,315 

Georgia.......................................... 10,520,908 1,625,678 10,882,405 11,065,402 182,997 

Hawaii........................................... 2,158,368 325,000 2,185,498 2,207,403 21,905 

Idaho ............................................. 2,158,368 325,000 2,185,498 2,207,403 21,905 

Illinois........................................... 17,501,863 2,526,641 17,406,419 17,286,541 (119,878)

Indiana........................................... 8,436,640 1,303,619 8,565,723 8,709,763 144,040 

Iowa .............................................. 5,144,796 692,861 5,116,740 5,081,501 (35,239)

Kansas........................................... 4,140,847 579,749 4,118,266 4,089,903 (28,363)

Kentucky ....................................... 5,880,652 908,671 6,012,938 6,114,051 101,113 

Louisiana....................................... 5,716,325 861,168 5,751,188 5,847,899 96,711 

Maine ............................................ 2,158,368 325,000 2,185,498 2,207,403 21,905 

Maryland ....................................... 7,186,907 1,110,512 7,320,042 7,443,135 123,093 

Massachusetts................................ 9,902,090 1,403,578 9,848,091 9,780,267 (67,824)

Michigan ....................................... 13,676,158 2,113,224 13,833,658 14,066,283 232,625 

Minnesota...................................... 6,743,129 1,041,940 6,850,562 6,965,760 115,198 

Mississippi..................................... 3,939,582 596,849 3,918,693 3,984,589 65,896 

Missouri ........................................ 8,572,513 1,284,714 8,525,764 8,571,974 46,210 

Montana ........................................ 2,158,368 325,000 2,185,498 2,207,403 21,905 

Nebraska........................................ 2,772,917 376,813 2,757,795 2,738,802 (18,993)

Nevada .......................................... 3,194,181 493,561 3,280,796 3,335,966 55,170 

New Hampshire ............................. 2,158,368 325,000 2,185,498 2,207,403 21,905 
NUTRITION SERVICES 

38

PROGRAM: Congregate Nutrition Services (CFDA 93.045) 

State/Territory

FY 2009

Appropriation

FY 2009

Recovery Act

FY 2010

Appropriation

FY 2011 

President’s 

Budget Request

Difference

+/-FY 2010

New Jersey .................................... 12,342,333 1,857,089 12,275,026 12,287,022 11,996 

New Mexico .................................. 2,608,445 403,054 2,684,327 2,729,467 45,140 

New York...................................... 29,324,630 4,148,718 29,164,713 28,963,855 (200,858)

North Carolina............................... 12,007,403 1,855,370 12,325,528 12,532,793 207,265 

North Dakota ................................. 2,158,368 325,000 2,185,498 2,207,403 21,905 

Ohio .............................................. 16,597,987 2,502,601 16,507,472 16,664,782 157,310 

Oklahoma...................................... 5,144,022 784,386 5,144,124 5,230,627 86,503 

Oregon .......................................... 5,288,538 817,179 5,435,045 5,526,440 91,395 

Pennsylvania.................................. 21,544,777 3,005,971 21,427,286 21,279,716 (147,570)

Rhode Island.................................. 2,158,368 325,000 2,185,498 2,207,403 21,905 

South Carolina............................... 6,231,073 962,818 6,448,002 6,556,430 108,428 

South Dakota ................................. 2,158,368 325,000 2,185,498 2,207,403 21,905 

Tennessee ...................................... 8,553,255 1,321,639 8,776,816 8,924,406 147,590 

Texas............................................. 25,965,881 4,012,217 26,691,509 27,140,350 448,841 

Utah .............................................. 2,496,848 385,810 2,607,094 2,650,935 43,841 

Vermont ........................................ 2,158,368 325,000 2,185,498 2,207,403 21,905

Virginia ......................................... 9,912,439 1,531,658 10,151,547 10,322,254 170,707 

Washington.................................... 8,327,051 1,286,686 8,558,450 8,702,367 143,917 

West Virginia ................................ 3,347,126 455,732 3,328,873 3,305,947 (22,926)

Wisconsin...................................... 7,729,347 1,194,329 7,834,698 7,966,445 131,747 

Wyoming....................................... 2,158,368 325,000 2,185,498 2,207,403 21,905 

Subtotal, States.............................. 423,042,770 63,728,380 428,312,075 432,576,206 4,264,131 

American Samoa............................ 602,252 40,625 598,968 594,843 (4,125)

Guam............................................. 1,079,184 162,500 1,092,749 1,103,701 10,952 

Northern Mariana Islands............... 269,796 40,625 273,187 275,925 2,738 

Puerto Rico.................................... 5,600,421 865,370 5,729,792 5,826,144 96,352 

Virgin Islands................................ 1,079,184 162,500 1,092,749 1,103,701 10,952 

Subtotal, States and Territories....... 431,673,607 65,000,000 437,099,520 441,480,520 4,381,000 

Undistributed 1/............................. 2,595,393 -- 3,683,480 4,163,480 480,000 

TOTAL 434,269,000 65,000,000 440,783,000 445,644,000 4,861,000 

 

1/ Funds held for statutory related requirements are reflected in the undistributed line. 
NUTRITION SERVICES 

39

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION ON AGING 

FY 2011 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM: Home-Delivered Nutrition Services (CFDA 93.045) 

State/Territory

FY 2009

Appropriation

FY 2009

Recovery Act

FY 2010

Appropriation

FY 2011 

President’s 

Budget Request

Difference

+/-FY 2010

Alabama ........................................ 3,357,241 503,969 3,392,248 3,442,434 50,186 

Alaska ........................................... 1,065,886 160,000 1,077,496 1,093,420 15,924 

Arizona.......................................... 4,377,649 657,147 4,520,374 4,587,251 66,877 

Arkansas........................................ 2,125,590 319,081 2,144,222 2,175,945 31,723 

California ...................................... 21,597,330 3,242,063 21,860,186 22,183,602 323,416 

Colorado........................................ 2,780,574 417,403 2,856,240 2,898,497 42,257 

Connecticut.................................... 2,544,147 381,912 2,532,559 2,570,027 37,468 

Delaware ....................................... 1,065,886 160,000 1,077,496 1,093,420 15,924 

District of Columbia ...................... 1,065,886 160,000 1,077,496 1,093,420 15,924 

Florida........................................... 15,882,387 2,384,170 16,031,256 16,268,432 237,176 

Georgia.......................................... 5,331,504 800,334 5,470,049 5,550,976 80,927 

Hawaii........................................... 1,065,886 160,000 1,077,496 1,093,420 15,924 

Idaho ............................................. 1,065,886 160,000 1,077,496 1,093,420 15,924 

Illinois........................................... 8,286,262 1,243,885 8,304,780 8,427,646 122,866 

Indiana .......................................... 4,275,294 641,782 4,305,567 4,369,266 63,699 

Iowa .............................................. 2,272,276 341,101 2,274,970 2,308,627 33,657 

Kansas........................................... 1,901,319 285,415 1,913,252 1,941,557 28,305 

Kentucky....................................... 2,980,039 447,346 3,022,408 3,067,123 44,715 

Louisiana....................................... 2,824,249 423,960 2,890,839 2,933,608 42,769 

Maine ............................................ 1,065,886 160,000 1,077,496 1,093,420 15,924 

Maryland....................................... 3,641,988 546,714 3,679,425 3,733,860 54,435 

Massachusetts................................ 4,603,113 690,992 4,607,228 4,675,390 68,162 

Michigan ....................................... 6,930,437 1,040,356 6,953,499 7,056,373 102,874 

Minnesota...................................... 3,417,102 512,955 3,443,440 3,494,384 50,944 

Mississippi..................................... 1,957,399 293,833 1,969,734 1,998,875 29,141 

Missouri ........................................ 4,213,292 632,475 4,237,453 4,300,144 62,691 

Montana ........................................ 1,065,886 160,000 1,077,496 1,093,420 15,924 

Nebraska........................................ 1,235,779 185,508 1,241,866 1,260,239 18,373 

Nevada .......................................... 1,618,661 242,984 1,649,095 1,673,492 24,397 

New Hampshire ............................. 1,065,886 160,000 1,077,496 1,093,420 15,924 
NUTRITION SERVICES 

40

PROGRAM: Home-Delivered Nutrition Services (CFDA 93.045) 

State/Territory

FY 2009

Appropriation

FY 2009

Recovery Act

FY 2010

Appropriation

FY 2011 

President’s 

Budget Request

Difference

+/-FY 2010

New Jersey .................................... 6,090,428 914,259 6,073,942 6,163,804 89,862 

New Mexico .................................. 1,321,837 198,426 1,349,279 1,369,242 19,963 

New York...................................... 13,605,956 2,042,446 13,730,647 13,933,787 203,140 

North Carolina............................... 6,084,790 913,413 6,195,436 6,287,095 91,659 

North Dakota ................................. 1,065,886 160,000 1,077,496 1,093,420 15,924 

Ohio .............................................. 8,207,423 1,232,050 8,238,036 8,359,914 121,878 

Oklahoma...................................... 2,572,440 386,159 2,585,698 2,623,952 38,254 

Oregon .......................................... 2,679,984 402,303 2,731,930 2,772,347 40,417 

Pennsylvania.................................. 9,858,253 1,479,863 9,833,572 9,979,055 145,483 

Rhode Island.................................. 1,065,886 160,000 1,077,496 1,093,420 15,924 

South Carolina............................... 3,157,616 474,003 3,241,093 3,289,044 47,951 

South Dakota ................................. 1,065,886 160,000 1,077,496 1,093,420 15,924 

Tennessee ...................................... 4,334,389 650,653 4,411,674 4,476,942 65,268 

Texas............................................. 13,158,293 1,975,245 13,416,508 13,614,999 198,491 

Utah .............................................. 1,265,286 189,937 1,310,458 1,329,845 19,387 

Vermont ........................................ 1,065,886 160,000 1,077,496 1,093,420 15,924 

Virginia ......................................... 5,023,160 754,047 5,102,683 5,178,175 75,492 

Washington.................................... 4,219,760 633,445 4,301,911 4,365,556 63,645 

West Virginia ................................ 1,494,599 224,360 1,500,062 1,522,255 22,193 

Wisconsin...................................... 3,916,871 587,978 3,938,117 3,996,380 58,263 

Wyoming....................................... 1,065,886 160,000 1,077,496 1,093,420 15,924 

Subtotal, States.............................. 209,001,235 31,373,972 211,269,184 214,394,600 3,125,416 

American Samoa............................ 138,905 20,000 137,789 136,678 (1,111)

Guam............................................. 532,943 80,000 538,748 546,710 7,962 

Northern Mariana Islands............... 133,236 20,000 134,687 136,678 1,991 

Puerto Rico.................................... 2,838,031 426,028 2,880,084 2,922,694 42,610 

Virgin Islands................................ 532,943 80,000 538,748 546,710 7,962 

Subtotal, States and Territories....... 213,177,293 32,000,000 215,499,240 218,684,070 3,184,830 

Undistributed 1/............................. 1,281,707 -- 2,176,760 2,208,930 32,170 

TOTAL 214,459,000 32,000,000 217,676,000 220,893,000 3,217,000 

 

1/ Funds held for statutory related requirements are reflected in the undistributed line. 

 
NUTRITION SERVICES 

41

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION ON AGING 

FY 2011 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM: Nutrition Services Incentive Program (CFDA 93.053) 

State/Territory

FY 2009

Appropriation

FY 2010

Appropriation

FY 2011 

President’s 

Budget Request

Difference

+/-FY 2010

Alabama ........................................ 2,892,540 2,880,610 2,880,610 --

Alaska ........................................... 315,215 313,915 313,915 --

Arizona.......................................... 2,173,561 2,164,596 2,164,596 --

Arkansas........................................ 2,738,371 2,727,077 2,727,077 --

California ...................................... 12,400,914 12,349,770 12,349,770 --

Colorado........................................ 1,349,057 1,343,493 1,343,493 --

Connecticut ................................... 1,549,859 1,543,467 1,543,467 --

Delaware ....................................... 663,139 660,404 660,404 --

District of Columbia ...................... 645,836 643,172 643,172 --

Florida........................................... 7,528,758 7,497,708 7,497,708 --

Georgia.......................................... 2,661,160 2,650,185 2,650,185 --

Hawaii........................................... 473,298 471,346 471,346 --

Idaho............................................. 727,215 724,215 724,215 --

Illinois........................................... 7,038,908 7,009,878 7,009,878 --

Indiana .......................................... 1,581,342 1,574,820 1,574,820 --

Iowa .............................................. 1,962,223 1,954,131 1,954,131 --

Kansas........................................... 2,258,687 2,249,371 2,249,371 --

Kentucky....................................... 1,890,964 1,883,165 1,883,165 --

Louisiana....................................... 3,239,049 3,225,691 3,225,691 --

Maine............................................ 580,104 577,712 577,712 --

Maryland....................................... 1,828,155 1,820,615 1,820,615 --

Massachusetts................................ 5,896,317 5,871,999 5,871,999 --

Michigan ....................................... 7,308,594 7,278,452 7,278,452 --

Minnesota...................................... 2,104,664 2,095,984 2,095,984 --

Mississippi .................................... 1,901,968 1,894,123 1,894,123 --

Missouri ........................................ 4,276,556 4,258,919 4,258,919 --

Montana ........................................ 1,147,988 1,143,254 1,143,254 --

Nebraska ....................................... 1,342,273 1,336,738 1,336,738 --

Nevada .......................................... 920,301 916,505 916,505 --

New Hampshire............................. 1,095,668 1,091,149 1,091,149 --
NUTRITION SERVICES 

42

PROGRAM: Nutrition Services Incentive Program (CFDA 93.053) 

State/Territory

FY 2009

Appropriation

FY 2010

Appropriation

FY 2011 

President’s 

Budget Request

Difference

+/-FY 2010

New Jersey .................................... 3,966,134 3,949,777 3,949,777 --

New Mexico .................................. 2,074,623 2,066,067 2,066,067 --

New York...................................... 16,168,318 16,101,637 16,101,637 --

North Carolina............................... 3,412,386 3,398,312 3,398,312 --

North Dakota ................................. 847,273 843,779 843,779 --

Ohio .............................................. 5,749,933 5,726,219 5,726,219 --

Oklahoma...................................... 2,645,114 2,634,205 2,634,205 --

Oregon .......................................... 1,760,732 1,753,471 1,753,471 --

Pennsylvania.................................. 6,313,825 6,287,786 6,287,786 --

Rhode Island.................................. 528,195 526,016 526,016 --

South Carolina............................... 1,624,682 1,617,982 1,617,982 --

South Dakota ................................. 1,021,836 1,017,622 1,017,622 --

Tennessee...................................... 1,718,371 1,711,284 1,711,284 --

Texas............................................. 11,711,830 11,663,528 11,663,528 --

Utah .............................................. 1,390,525 1,384,790 1,384,790 --

Vermont ........................................ 709,225 706,300 706,300 --

Virginia ......................................... 2,344,353 2,334,684 2,334,684 --

Washington ................................... 1,977,265 1,969,111 1,969,111 --

West Virginia ................................ 1,820,272 1,812,765 1,812,765 --

Wisconsin...................................... 2,792,400 2,780,884 2,780,884 --

Wyoming....................................... 799,996 796,696 796,696 --

Subtotal, States.............................. 153,869,972 153,235,379 153,235,379 -

American Samoa............................ -- -- -- --

Guam ............................................ 317,908 316,597 316,597 --

Northern Mariana Islands............... 51,765 51,553 51,553 --

Puerto Rico.................................... 2,673,689 2,662,661 2,662,661 --

Virgin Islands................................ 170,877 170,172 170,172 --

Subtotal, States and Territories....... 157,084,211 156,436,362 156,436,362 --

Tribal Organizations...................... 2,968,488 2,968,488 2,968,488 --

Undistributed 1/............................. 962,301 1,610,150 1,610,150 --

TOTAL 161,015,000 161,015,000 161,015,000 --

 

1/ Funds held for statutory related requirements are reflected in the undistributed line. 
43

Native American Nutrition & Supportive Services 

FY 2009

Appropriation

FY 2009

Recovery Act

FY 2010

Appropriation

FY 2011

President’s 

Budget 

Request 

FY 2011

+/-

FY 2010

Native American Nutrition 

& Supportive Services................................ $27,208,000........... $3,000,000 $27,708,000 $29,708,000 +$2,000,000

Authorizing Legislation: Sections 613 and 623 of the Older Americans Act of 1965, as amended 

FY 2011 Authorization................................................................................................ Such Sums 

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. In the 2000 Census, 

approximately 213,000 persons age 60 and over identified themselves as American Indians or 

Alaskan Natives, and another 182,000 persons age 60 and over identified themselves as part 

American Indians or Alaskan Natives. 

Native American Nutrition and Supportive Services grants provide funding for 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 2008, the most recent available data, include: 

Transportation Services provided approximately one million rides to meal sites, medical 

appointments, pharmacies, grocery stores, and other critical daily activities (Output L). 

Home-Delivered Nutrition Services provided 2.4 million meals to nearly 

20,200 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 elders 

(Output M). 

Congregate Nutrition Services provided 2.2 million meals to more than 45,400 Native 

American elders in community-based settings, as well as an opportunity for elders to 
NATIVE AMERICAN NUTRITION & SUPPORTIVE SERVICES 

44

socialize and participate in a variety of activities, including cultural and wellness 

programs (Output N). 

Information, Referral and Outreach Services provided over one million 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 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 consultation, and through the Native 

American Resource Centers, funded under Program Innovations. 

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 2009 grants 

were awarded to 246 Tribal organizations (representing 400 Tribes), including two 

organizations serving Native Hawaiian elders, with an average award of $107,477 and a range 

of grant awards from $74,650 to $1,505,000. 

Funding History 

Funding for Native American Nutrition and Supportive Services during the past five years is as 

follows: 

FY 2006 ............................................... $26,116,000 

FY 2007 ............................................... $26,134,000 

FY 2008 ............................................... $26,898,000 

FY 2009 ............................................... $27,208,000 

FY 2010 ............................................... $27,708,000 

Budget Request 

The FY 2011 request for Native American Nutrition and Supportive Services is $29,708,000, an 

increase of +$2,000,000 above the FY 2010 appropriation. This increase is requested under the 

Caregiver Initiative to expand services, including adult day care, transportation assistance, case 

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

help eating dressing and bathing; and community services such as physical fitness programs. 

These services -- particularly adult day care, personal care, and chore services -- aid caregivers, 

who might otherwise have to be even more intensively involved with the care of their loved 

ones. 
NATIVE AMERICAN NUTRITION & SUPPORTIVE SERVICES 

45

These funds will provide approximately 1,045,000 rides (Output L), 2.4 million meals at home 

(Output M), and 2.2 million meals at congregate sites (Output N) to approximately 

65,600 Native American seniors. These 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 2011 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 330, a 50 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 contributions from tribal organizations which value 

these programs. At the request level, these programs can continue to provide services that assist 

Native American elders to remain independent and in the community. Tribal representatives 

participating in listening sessions have consistently indicated that the types of home and 

community-based supportive services that AoA is able to provide are important for meeting the 

needs of elderly Native Americans. 

Outcome and Outputs Table 

Native American Nutrition & Supportive Services Outcome and Outputs 

Measure Most Recent 

Result FY 2010 Target FY 2011 Target FY 2011 +/- FY 2010 

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 2008: 332

(Target Exceeded) 3001

330 +30

Indicator Most Recent 

Result 

FY 2010 

Projection 

FY 2011 

Projection 

FY 2011 

+/- FY 2010 

Output L: Transportation Services units

(Output) FY 2008: 1 M 798,000 1,045,000 +247,000

Output M: Home-Delivered Nutrition 

meals (Output) FY 2008: 2.4 M 2,350,0001

2,500,000 +150,000

Output N: Congregate Nutrition meals

(Output) FY 2008: 2.1 M 1,800,0001

2,200,000 +400,000

Output O: Information, Referral and 

Outreach units (Output) FY 2008: 1 M 992,000 1,100,000 +108,000

 

1

 Performance target reflects annual appropriation and Recovery Act funds 
46

PAGE INTENTIONALLY LEFT BLANK 
47

Preventive Health Services 

FY 2009

Appropriation

FY 2009

Recovery Act

FY 2010

Appropriation

FY 2011

President’s 

Budget 

Request 

FY 2011

+/-

FY 2010

Preventive Health Services ................................ $21,026,000.... -- $21,026,000 $21,026,000 --

Authorizing Legislation: Section 361 of the Older Americans Act of 1965, as amended 

FY 2011 Authorization................................................................................................ Such Sums 

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 and is projected to 

total 5.8 million by 2010 and 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, or depression as well as the greater probability of injury from a fall, which quickly 

limits physical activity. 

States and Territories provide funds to Area Agencies on Aging (AAAs), which in turn funds 

local agencies and service providers. States and Territories have in the past, and again in 

FY 2010, been required to use at least the statutorily-mandated level of funding for medication 

management, screening, and education activities, but otherwise have had 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 provided through the Preventive Health Service program include: 

Information and Outreach, including the distribution of information to seniors through 

Aging and Disability Resource Centers, AAAs, senior centers, community parks and 

recreation programs, housing programs, faith based organizations, Chronic Disease 
PREVENTIVE HEALTH SERVICES 

48

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, cholesterol, hearing, vision, and glaucoma. 

Enhanced Fitness evidence-based programs, including physical activity and exercise 

programs that help to maintain both physical and mental well-being. 

Enhanced Wellness evidence-based programs, to help older adults manage their chronic 

diseases through personal health goals and action plans. 

Healthy IDEAS (Identifying Depression, Empowering Activities for Seniors) program that 

integrates depression awareness and management into existing case management services 

provided to older adults. 

In recent years, States have begun to shift the funding to provide greater funding to support 

evidence-based approaches, especially in dealing with chronic diseases. Examples of evidencebased models include enhanced fitness, enhanced wellness, falls prevention, and chronic disease 

self-management programs have been demonstrated to be especially effective and have shown 

the value of focusing dollars on proven interventions. 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. AoA continues to encourage States and 

the Aging Services Network to adopt evidence-based prevention programs and more and more 

States are using these and other resources to do so. Some examples of evidence-based 

interventions are:

Enhanced fitness and enhanced wellness programs 

Enhanced fitness is a multi-component group exercise program designed for communitybased 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 teach participants to improve 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. 
PREVENTIVE HEALTH SERVICES 

49

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.1

Chronic disease self-management programs 

Older Americans are disproportionately affected by a vast array of chronic conditions 

(including diabetes, obesity, heart disease, cancer, arthritis, and depression) that 

collectively account for seven out of every 10 deaths and contribute to more than threequarters of all Medicare expenditures.2

 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. 

Chronic disease self-management programs teach evidence-based disease prevention 

models that utilize state-of-the-art techniques to help people with chronic disease to better 

self-manage their conditions, improve their health status, and reduce their need for more 

costly medical care. Programs often consist of a series of workshops in community 

settings comfortable to seniors such as churches, libraries, YW/MCAs, senior centers, 

public housing programs, community health centers, and cooperative extension programs. 

People with different chronic health problems may attend together, and the workshops 

are facilitated by leaders who are trained and certified. Through these programs, people 

with chronic diseases learn that they can change their health behaviors through action 

plans and goal setting. 

In 2008 at least 400 services were identified by States which were focused on improving seniors‘ 

health. Activities 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. 

 

1

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

2

 Deaths: Leading Causes for 2004. National Vital Statistics Report, V. 56, No. 5. Centers for Disease Control and 

Prevention. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_05.pdf . Accessed December 30, 2009. 

Follow the Money -- Controlling Expenditures by Improving Care for Patients Needing Costly Services. 

 Bodenheimer, T., and Berry-Millett, R. New England Journal of Medicine. 15 October 2009. 
PREVENTIVE HEALTH SERVICES 

50

Funding History 

Funding for Preventive Health Services during the past five years is as follows: 

FY 2006............................................... $21,385,000 

FY 2007............................................... $21,400,000 

FY 2008 ............................................... $21,026,000 

FY 2009 ............................................... $21,026,000 

FY 2010............................................... $21,026,000 

Budget Request 

The FY 2011 budget request for Preventive Health Services is $21,026,000, the same as the 

FY 2010 appropriation. The President‘s budget continues to provide flexibility for States to 

allocate resources among the preventive health activities of their choice to best meet State and 

local needs. States are increasingly supporting evidence-based prevention programs, as 

discussed previously. Their flexibility to support evidence-based programs is further increased 

by this budget‘s request to remove the FY 2010 appropriations requirement to use a minimallymandated level of funding for medication management, screening, and education activities. 

In addition, competitive funding for evidence-based prevention programs, separately funded 

through AoA‘s Health and Long-term Care Programs line, helps States learn about and 

implement evidence-based practices with these preventive health services formula grant 

resources. AoA also plans to issue competitive awards in FY 2010 using Recovery Act 

Prevention and Wellness funds to further support evidence-based chronic disease selfmanagement programs. These Recovery Act awards will further help States implement 

evidence-based best practices. 

Performance Measurement 

Since AoA is promoting evidence-based systems, the performance measure developed to address 

this area -- the number of States, the District of Columbia, and territories using Title III funds to 

implement evidence-based disease prevention programs -- is especially appropriate. 
PREVENTIVE HEALTH SERVICES 

51

Outputs Table 

Preventive Health Services Outputs 

Indicator Most Recent 

Result 

FY 2010 

Projection 

FY 2011 

Projection 

FY 2011 

+/- FY 2010 

Output AA: The Number of States that 

implement evidence based disease prevention 

programs using Title III Preventive Health 

funds (Output)

N/A N/A Baseline N/A

Output AB: The Number of people served with 

health and disease prevention programs 

(Output)

N/A N/A Baseline N/A

Grant Awards Table 

Preventive Health Services Grant Awards 

FY 2009 

Appropriation

FY 2009 

Recovery 

Act

FY 2010 

Appropriation

FY 2011

President’s 

Budget

Request

Number of 

Awards 56 -- 56 56

Average Award $375,464 -- $375,464 $375,464

Range of 

Awards

$13,141 -

$2,132,032 --

$13,141 -

$2,132,032

$13,141 -

$2,132,032
PREVENTIVE HEALTH SERVICES 

52

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION ON AGING 

FY 2011 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM: Preventive Health Services (CFDA 93.043) 

State/Territory

FY 2009

Appropriation

FY 2010

Appropriation

FY 2011 

President’s 

Budget Request

Difference

+/-FY 2010

Alabama ........................................ 333,168 333,168 333,168 --

Alaska ........................................... 105,130 105,130 105,130 --

Arizona.......................................... 405,273 405,273 405,273 --

Arkansas........................................ 211,585 211,585 211,585 --

California ...................................... 2,132,032 2,132,032 2,132,032 --

Colorado........................................ 256,172 256,172 256,172 --

Connecticut ................................... 261,174 261,174 261,174 --

Delaware ....................................... 105,130 105,130 105,130 --

District of Columbia ...................... 105,130 105,130 105,130 --

Florida........................................... 1,557,571 1,557,571 1,557,571 --

Georgia.......................................... 487,659 487,659 487,659 --

Hawaii........................................... 105,130 105,130 105,130 --

Idaho............................................. 105,130 105,130 105,130 --

Illinois........................................... 841,161 841,161 841,161 --

Indiana .......................................... 427,123 427,123 427,123 --

Iowa .............................................. 232,252 232,252 232,252 --

Kansas........................................... 191,697 191,697 191,697 --

Kentucky....................................... 292,333 292,333 292,333 --

Louisiana....................................... 295,701 295,701 295,701 --

Maine............................................ 105,333 105,333 105,333 --

Maryland....................................... 361,152 361,152 361,152 --

Massachusetts................................ 465,465 465,465 465,465 --

Michigan ....................................... 693,994 693,994 693,994 --

Minnesota...................................... 339,094 339,094 339,094 --

Mississippi .................................... 196,251 196,251 196,251 --

Missouri ........................................ 423,251 423,251 423,251 --

Montana ........................................ 105,130 105,130 105,130 --

Nebraska ....................................... 124,900 124,900 124,900 --

Nevada .......................................... 151,762 151,762 151,762 --

New Hampshire............................. 105,130 105,130 105,130 --
PREVENTIVE HEALTH SERVICES 

53

PROGRAM: Preventive Health Services (CFDA 93.043) 

State/Territory

FY 2009

Appropriation

FY 2010

Appropriation

FY 2011 

President’s 

Budget Request

Difference

+/-FY 2010

New Jersey .................................... 620,946 620,946 620,946 --

New Mexico .................................. 127,394 127,394 127,394 --

New York...................................... 1,376,603 1,376,603 1,376,603 --

North Carolina............................... 577,661 577,661 577,661 --

North Dakota ................................. 105,130 105,130 105,130 --

Ohio .............................................. 835,879 835,879 835,879 --

Oklahoma...................................... 257,429 257,429 257,429 --

Oregon .......................................... 254,913 254,913 254,913 --

Pennsylvania.................................. 1,018,552 1,018,552 1,018,552 --

Rhode Island.................................. 105,130 105,130 105,130 --

South Carolina............................... 295,433 295,433 295,433 --

South Dakota ................................. 105,130 105,130 105,130 --

Tennessee...................................... 416,815 416,815 416,815 --

Texas............................................. 1,253,246 1,253,246 1,253,246 --

Utah .............................................. 115,100 115,100 115,100 --

Vermont ........................................ 105,130 105,130 105,130 --

Virginia ......................................... 484,930 484,930 484,930 --

Washington ................................... 397,692 397,692 397,692 --

West Virginia ................................ 153,137 153,137 153,137 --

Wisconsin...................................... 391,448 391,448 391,448 --

Wyoming....................................... 105,130 105,130 105,130 --

Subtotal, States.............................. 20,624,841 20,624,841 20,624,841 --

American Samoa............................ 13,141 13,141 13,141 --

Guam ............................................ 52,565 52,565 52,565 --

Northern Mariana Islands............... 13,141 13,141 13,141 --

Puerto Rico.................................... 269,747 269,747 269,747 --

Virgin Islands................................ 52,565 52,565 52,565 --

Subtotal, States and Territories....... 21,026,000 21,026,000 21,026,000 --

TOTAL 21,026,000 21,026,000 21,026,000 --
54

PAGE INTENTIONALLY LEFT BLANK 
55

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. To address this, the request includes an 

additional $102.5 million for the Caregiver Initiative for caregiver and home and 

community-based supportive services programs to expand help to families better care for their 

loved ones and provide additional support to seniors trying to remain independent in their 

communities. 

As part of this Caregiver Initiative, the Budget requests $50 million in additional funding for the 

National Family Caregiver Support program (including $2 million for Native American 

Caregiver Support Services), and doubles funding, from $2.5 million to $5 million, for the 

Lifespan Respite Care program. Together, these programs support family and informal 

caregivers by providing information, assistance, counseling, training, respite, and other services 

which help them care for their loved ones at home. 

AoA is committed to supporting the caregivers of older adults. The availability of a skilled 

caregiver -- whether a family or informal caregiver, a paraprofessional worker, or an unrelated 

volunteer -- all too often determines whether an individual remains independent or moves into a 

nursing home. In 2004, approximately 34 million adult caregivers provided uncompensated care 

to those 50 years of age and older.1

The economic value of replacing unpaid caregiving in 2007 

was estimated to be about $375 billion, an increase from $350 billion in 2006 (cost if that care 

had to be replaced with paid services).2

 

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

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

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

and research indicates that caregivers suffer a mortality rate that is 63 percent higher than noncaregivers.3

 

Providing support that makes it easier for family caregivers, such as information, counseling and 

training, respite care, or supplemental services, is critical to sustaining caregivers‘ ability to 

provide care. Seventy-seven percent of the caregivers served by AoA programs report that AoA 

services allow them to provide care longer than they otherwise could.4

 

 

1

 National Alliance for Caregiving and AARP. Caregiving in the U.S. Bethesda: National Alliance for Caregiving, 

and Washington, DC: AARP, 2004. 

2 Gibson M.J., & Houser, A.N. Valuing the Invaluable: The Economic Value of Family Caregiving, 2008 Update. 

Washington, D.C.: AARP Public Policy Institute: 2008 November, Insight on the Issues #13. 

3

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

December 15, 1999;282:2215-9.

4

 Ibid. 
CAREGIVER SERVICES – SUMMARY OF REQUEST 

56

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.5 

To address all of these caregiver-related needs, AoA requests a total of $227,073,000 in 

FY 2011, an increase of $52,500,000 for caregiver programs. This request includes: 

$202,220,000 for Family Caregiver Support Services, an increase of +$48,000,000 above 

the FY 2010 appropriation. 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. These funds will increase the number of 

caregivers receiving support by nearly 200,000 to 755,000 caregivers. 

$8,389,000 for Native American Caregiver Support Services, an increase of +$2,000,000 

above the FY 2010 appropriation. This program makes a range of services available to 

Native American caregivers, including information and outreach, access assistance, 

individual counseling and outreach, access assistance, individual counseling, support 

groups and training, respite care and other supplemental services. 

$11,464,000 for Alzheimer‘s Disease Supportive Services, the same as the FY 2010 

appropriation. One critical focus of grants under 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 is to expand the 

availability of diagnostic and support services to those with Alzheimer‘s. 

$5,000,000 for Lifespan Respite Care, an increase of +$2,500,000 above the FY 2010 

appropriation. This program funds grants to improve the quality and access of 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. 

 

5 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. 
57

Family Caregiver Support Services 

FY 2009

Appropriation

FY 2009

Recovery Act

FY 2010

Appropriation

FY 2011

President’s 

Budget 

Request 

FY 2011

+/-

FY 2010

Family Caregiver Support 

Services................................................................ $154,220,000 . -- $154,220,000 $202,220,000 +$48,000,000

Authorizing Legislation: Section 371 of the Older Americans Act of 1965, as amended 

FY 2011 Authorization........................................................................................... $187,000,0001

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 Health and 

Independence Services, such as 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 and other informal caregivers have often been called the backbone of America‘s longterm care system. On a daily basis, these individuals assist relatives and other loved ones with 

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

interventions like medication administration and wound care. The economic value of replacing 

unpaid caregiving in 2007 was estimated to be about $375 billion (cost if that care had to be 

replaced with paid services).2

 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. 

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.3

 By 2015, AoA projects that there will 

 

1

 The budget proposes appropriations language with a specific amount for the National Family Caregivers Support 

Services program because the requested appropriation amount exceeds the authorization level in the Older 

Americans Act. The proposed appropriations language ensures AoA will be able to expend the higher sum without 

violating the Antideficiency Act. 

2

 Gibson M.J., & Houser, A.N. Valuing the Invaluable: The Economic Value of Family Caregiving, 2008 Update. 

Washington, D.C.: AARP Public Policy Institute: 2008 November, Insight on the Issues #13. 

3 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>
FAMILY CAREGIVER SUPPORT SERVICES 

58

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.4 

The availability of a skilled caregiver -- whether an informal caregiver, a paraprofessional 

worker or an unrelated volunteer -- all too often determines whether an individual remains 

independent or goes into a nursing home. Research has shown that caregiving exacts a heavy 

emotional, physical and financial toll. Many caregivers who work and provide care at the same 

time experience conflicts between these responsibilities. As reported in AoA‘s 2008 National 

Survey of Older Americans Act (OAA) Participants, twenty-five percent of caregivers are 

assisting two or more individuals. Sixty-five percent of Title III caregivers are 60 or older, 

making them more vulnerable to a decline in their own health, and nearly one-third describe their 

own health as fair to poor.5 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.6

 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. 

Family Caregiver Support Services provide a variety of supports to family and informal 

caregivers. Based on FY 2008 data, the most recent available, services provided included: 

Access Assistance Services provided 1.3 million contacts to caregivers assisting them in 

locating services from a variety of private and voluntary agencies (Output I). 

Counseling and Training Services provided more than 153,000 caregivers with 

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

caregiving (Output J). 

Respite Care Services provided more than 75,000 caregivers with 10 million hours with 

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

caregiving responsibilities (Output K). 

Studies have shown that these types of supports can reduce caregiver depression, anxiety, and 

stress and enable them to provide care longer, thereby avoiding or delaying the need for costly 

institutional care for their loved ones. 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. 

 

4 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. 

5

 2008 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID. 

6

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

December 15, 1999;282:2215-9.
FAMILY CAREGIVER SUPPORT SERVICES 

59

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 to keep their loved ones at home. Approximately 77 percent of 

caregivers of program clients reported in 2008 that services enabled them to provide care longer 

than otherwise would have been possible.7 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. Nearly half the caregivers of nursing home eligible care recipients indicated 

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

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

services. A significant majority of those caregivers, 81 percent, indicated that the care recipient 

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

Clearly, the importance of family and other informal caregivers to keeping those for whom they 

care independent and out of nursing homes and other institutions cannot be overstated nor can 

the need to provide services and supports that allow them to continue providing care. 

Funding History 

Funding for Family Caregiver Support Services during the past five years is as follows: 

FY 2006............................................. $156,060,000 

FY 2007............................................. $156,167,000 

FY 2008 ............................................. $153,439,000 

FY 2009 ............................................. $154,220,000 

FY 2010 ............................................. $154,220,000 

 

7

 2008 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID. 

Where Care Recipients with 3+ ADL Would Live

If Unable to Have Caregiver Supportive Services 

(based on response with care recipients unable to live independently)

8%

70%

8%

1%

11%

2%

Caregivers home Nursing Home Other Fam.memb. Home They'd die Assisted Living Other 
FAMILY CAREGIVER SUPPORT SERVICES 

60

Budget Request 

The FY 2011 request for Family Caregiver Support Services is $202,220,000, a 31 percent 

increase of +$48,000,000 above the FY 2010 appropriation as part of the Caregiver Initiative to 

increase supports to families to assist them in caring for their aging relatives so they may remain 

healthy and independent in their community. Over 50 percent of the caregivers helped by this 

program have incomes from $20,000 to $50,000, so this initiative will assist individuals in the 

middle income bracket, many of whom are caring for a loved one in their prime income earning 

years and are placing their careers, retirement, and own health at risk. 

With this funding increase, nearly 200,000 additional caregivers, for a total of 

755,000 caregivers, (Outcome 3.1) will be provided with supportive services including 

12 million hours of respite care or temporary relief from their caregiving responsibilities. This is 

an increase of 3 million more hours of respite care, the service rated by caregivers as the most 

helpful. They will also provide nearly 186,000 caregivers with counseling, peer support groups, 

and training to help them better cope with the stresses of caregiving, increasing by 49,000 the 

number of people who are better trained in caring for their loved one (Output J). 

In addition, the increases should further reduce the percentage of caregivers reporting difficulty 

in getting services. In FY 2011, the Aging Services Network plans to meet or exceed the target 

of only 30 percent of caregivers experiencing difficulty obtaining services (Outcome 2.6). This 

is a substantial accomplishment since baseline levels from 2003 showed that 64 percent of 

caregivers had difficulty getting services, and by 2008 that rate had been reduced by more than 

half to 24.6 percent of caregivers reporting difficulty getting services. 

For FY 2011, the performance target for National Family Caregiver Support Program 

participants who rate services good to excellent will remain consistently high at 90 percent 

(Outcome 2.9c). The substantive improvements in program performance can be attributed to 

successful implementation of the National Family Caregiver Support Program. While client 

reported assessment of service quality and program outcomes is expected to remain at high 

levels, service outputs are expected to increase reflecting the impact of increased funding. 

Outcomes and Outputs Table 

Family Caregiver Support Services Outcomes and Outputs 

Measure Most Recent Result FY 2010 

Target 

FY 2011 

Target 

FY 2011 

+/- FY 2010 

2.6: Reduce the percent of 

caregivers who report difficulty in 

getting services. (Outcome)

FY 2009: 24.6%

(Target Exceeded) 30% 30% Maintain

2.9c: 90% of NFCSP clients rate 

services good to excellent.

(Outcome)

FY 2009: 95.4%

(Target Exceeded) 90% 90% Maintain

3.1: Increase the number of 

caregivers served. (Outcome)

 FY 2008: 675,243

 (Target Not Met) 560,000 755,000 +195,000
FAMILY CAREGIVER SUPPORT SERVICES 

61
FAMILY CAREGIVER SUPPORT SERVICES 

62

Indicator Most Recent Result FY 2010 

Projection

FY 2011 

Projection 

FY 2011 

+/- FY 2010 

Output I: Caregivers access 

assistance units of service. (Output) FY 2008: 1,300,000 1,200,000 1,600,000 +400,000

Output J: Caregivers receiving 

counseling and training. (Output) FY 2008: 153,148 137,000 186,000 +49,000

Output K: Caregivers receiving 

respite care services. (Output) FY 2008: 75,687 74,000 92,000 +18,000

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. 

Grant Awards Table 

Family Caregiver Support Services Grant Awards 

FY 2009 

Omnibus

FY 2009 

Recovery 

Act

FY 2010 

President's 

Budget

FY 2011 

Request

Number of Awards 56 -- 56 56

Average Award $2,737,470 -- $2,726,389 $3,574,961

Range of Awards $95,811 -

$15,485,835

--

$95,424 -

$15,506,472

$125,124 -

$20,332,763
FAMILY CAREGIVER SUPPORT SERVICES 

63

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION ON AGING 

FY 2011 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM: Family Caregivers Supportive Services (CFDA 93.052) 

State/Territory

FY 2009

Appropriation

FY 2010

Appropriation

FY 2011 

President’s 

Budget Request

Difference

+/-FY 2010

Alabama ........................................ 2,388,721 2,385,024 3,127,348 742,324 

Alaska ........................................... 766,492 763,389 1,000,989 237,600 

Arizona.......................................... 3,197,875 3,275,583 4,295,086 1,019,503 

Arkansas........................................ 1,521,777 1,517,951 1,990,403 472,452 

California ...................................... 15,485,835 15,506,472 20,332,763 4,826,291 

Colorado........................................ 1,847,782 1,856,241 2,433,985 577,744 

Connecticut ................................... 1,867,650 1,821,153 2,387,976 566,823 

Delaware ....................................... 766,492 763,389 1,000,989 237,600 

District of Columbia ...................... 766,492 763,389 1,000,989 237,600 

Florida........................................... 12,409,192 12,419,421 16,284,888 3,865,467 

Georgia.......................................... 3,474,146 3,494,535 4,582,187 1,087,652 

Hawaii........................................... 766,492 763,389 1,000,989 237,600 

Idaho............................................. 766,492 763,389 1,000,989 237,600 

Illinois........................................... 6,001,247 5,925,733 7,770,080 1,844,347 

Indiana .......................................... 3,066,134 3,043,099 3,990,244 947,145 

Iowa .............................................. 1,760,734 1,733,866 2,273,521 539,655 

Kansas........................................... 1,430,357 1,413,037 1,852,836 439,799 

Kentucky....................................... 2,070,600 2,074,910 2,720,712 645,802 

Louisiana....................................... 1,987,302 2,001,064 2,623,882 622,818 

Maine............................................ 766,492 763,389 1,000,989 237,600 

Maryland....................................... 2,508,352 2,492,457 3,268,219 775,762 

Massachusetts................................ 3,412,029 3,341,332 4,381,300 1,039,968 

Michigan ....................................... 4,936,669 4,859,982 6,372,621 1,512,639 

Minnesota...................................... 2,478,709 2,451,906 3,215,046 763,140 

Mississippi .................................... 1,390,319 1,383,291 1,813,832 430,541 

Missouri ........................................ 3,053,274 3,023,691 3,964,795 941,104 

Montana ........................................ 766,492 763,389 1,000,989 237,600 

Nebraska ....................................... 945,715 935,875 1,227,161 291,286 

Nevada .......................................... 1,035,492 1,044,422 1,369,492 325,070 

New Hampshire............................. 766,492 763,389 1,000,989 237,600 
FAMILY CAREGIVER SUPPORT SERVICES 

64

PROGRAM: Family Caregivers Supportive Services (CFDA 93.052) 

State/Territory

FY 2009

Appropriation

FY 2010

Appropriation

FY 2011 

President’s 

Budget Request

Difference

+/-FY 2010

New Jersey .................................... 4,425,545 4,349,022 5,702,627 1,353,605 

New Mexico .................................. 942,470 955,657 1,253,100 297,443 

New York...................................... 9,932,045 9,869,763 12,941,664 3,071,901 

North Carolina............................... 4,171,739 4,172,612 5,471,311 1,298,699 

North Dakota ................................. 766,492 763,389 1,000,989 237,600 

Ohio .............................................. 6,013,361 5,935,403 7,782,759 1,847,356 

Oklahoma...................................... 1,846,777 1,834,451 2,405,413 570,962 

Oregon .......................................... 1,879,727 1,874,573 2,458,022 583,449 

Pennsylvania.................................. 7,582,087 7,421,172 9,730,965 2,309,793 

Rhode Island.................................. 766,492 763,389 1,000,989 237,600 

South Carolina............................... 2,153,600 2,172,509 2,848,688 676,179 

South Dakota ................................. 766,492 763,389 1,000,989 237,600 

Tennessee...................................... 2,980,312 2,993,934 3,925,777 931,843 

Texas............................................. 9,079,495 9,115,012 11,952,003 2,836,991 

Utah .............................................. 889,240 908,506 1,191,273 282,767 

Vermont ........................................ 766,492 763,389 1,000,989 237,600 

Virginia ......................................... 3,417,589 3,424,476 4,490,323 1,065,847 

Washington ................................... 2,883,863 2,883,684 3,781,213 897,529 

West Virginia ................................ 1,082,333 1,069,824 1,402,800 332,976 

Wisconsin...................................... 2,887,829 2,850,761 3,738,042 887,281 

Wyoming....................................... 766,492 763,389 1,000,989 237,600 

Subtotal, States.............................. 150,402,319 149,756,461 196,367,214 46,610,753 

American Samoa............................ 95,811 95,424 125,124 29,700 

Guam ............................................ 383,246 381,695 500,495 118,800 

Northern Mariana Islands............... 95,811 95,424 125,124 29,700 

Puerto Rico.................................... 1,937,877 1,967,101 2,579,348 612,247 

Virgin Islands................................ 383,246 381,695 500,495 118,800 

Subtotal, States and Territories....... 153,298,310 152,677,800 200,197,800 47,520,000 

Undistributed 1/............................. 921,690 1,542,200 2,022,200 480,000 

TOTAL 154,220,000 154,220,000 202,220,000 48,000,000 

 

1/ Funds held for statutory related requirements are reflected in the undistributed line. 

 
65

PAGE INTENTIONALLY LEFT BLANK 
66

Native American Caregiver Support Services 

FY 2009

Appropriation

FY 2009

Recovery Act

FY 2010

Appropriation

FY 2011

President’s 

Budget 

Request 

FY 2011

+/-

FY 2010

Native American Caregiver 

Supportive Services ................................ $6,389,000 ............... -- $6,389,000 $8,389,000 +$2,000,000

Authorizing Legislation: Section 631 of the Older Americans Act of 1965, as amended 

FY 2011 Authorization............................................................................................... $7,900,0001

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

Program Description and Accomplishments: 

Native American Caregiver Supportive Services provide grants to eligible Tribal organizations to 

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

Native Hawaiian elders. 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. 

Formula grants for the Native Americans Caregiver Supportive Services programs are 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 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 2009 grants for Caregiver Support 

Services were awarded to 205 Tribal organizations, including one organization serving Native 

Hawaiian elders, with an average award of $31,088 and a range of grant awards from $14,360 to 

$58,666. 

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 

 

1

 The budget proposes appropriations language with a specific amount for the Native American Caregiver Support 

Services program because the requested appropriation amount exceeds the authorization level in the Older 

Americans Act. The proposed appropriations language ensures AoA will be able to expend the higher sum 

without violating the Antideficiency Act. 
NATIVE AMERICAN CAREGIVER SUPPORT SERVICES 

67

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. 

Funding History 

Funding for the Services for Native Americans programs during the past five years is as follows: 

FY 2006 ................................................. $6,237,000 

FY 2007 ................................................. $6,241,000 

FY 2008 ................................................. $6,316,000 

FY 2009 ................................................. $6,389,000 

FY 2010 ................................................ $6,389,000 

Budget Request 

The FY 2011 request for Services for Native Americans is $8,389,000, an increase of 

+$2,000,000 above the FY 2010 appropriation. These additional funds are requested as part of 

the Caregiver Initiative to increase supports to families to assist them in caring for their aging 

relatives, and to insure that additional resources also are available for the supportive services that 

allow seniors to remain healthy, independent and in their community. In the 2000 Census, 

approximately 213,000 persons age 60 and over identified themselves as American Indians or 

Alaskan Natives, and another 182,000 persons age 60 and over identified themselves as part 

American Indians or Alaskan Natives. 

The increase for caregiver supportive services will allow more 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 performance for 

FY 2010 is expected to decline due to the economic downturn impacting Tribal government 

budgets. For FY 2011 the efficiency measure shows performance trending upward again, 

consistent with the budget level requested and the anticipated positive impact of management 

improvements and targeted investments. 

In FY 2011 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, or 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. 
NATIVE AMERICAN CAREGIVER SUPPORT SERVICES 

68

Outcome Table 

Native American Caregivers Supportive Services Outcome and Outputs 

Measure Most Recent 

Result 

FY 2010 

Projection 

FY 2011 

Projection 

FY 2011 

+/- FY 2010 

3.1: Increase the number of caregivers 

served. (Outcome)

FY 2008: 675,243

(Target Not Met) 560,000 755,000 +195,000
69

PAGE INTENTIONALLY LEFT BLANK 
70

Alzheimer’s Disease Supportive Services Program

FY 2009

Appropriation

FY 2009

Recovery Act

FY 2010

Appropriation

FY 2011

President’s 

Budget 

Request 

FY 2011

+/-

FY 2010

Alzheimer‘s Disease 

Supportive Services Program................................ $11,464,000 . -- $11,464,000 $11,464,000 --

Authorizing Legislation: Section 398 of the Public Health Services Act, as amended 

FY 2011 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 diagnostic and support services that help persons with 

dementia and as well as the family members who care for them. A critical focus of these grants 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. In order to maintain 

the quality of life of the caregiver and their family members with dementia, the ADSSP: 

1) provides respite care, personal care, counseling, and informational assistance, using proven 

and innovative direct care practices; and 2) enhances the responsiveness and readiness of the 

home and community-based care system by improving service coordination and educating 

service providers about proven dementia care strategies. 

 

ADSSP grants enable States to develop service and outreach programs that are specific to State 

needs and resources. The primary components of the ADSSP program include: 

Delivering supportive services including respite care, home health care, personal care, 

adult day care, and companion services to assist caregivers, families, and persons with 

Alzheimer‘s disease.

Translating and replicating evidence-based interventions for dementia caregivers at the 

community level. 

Incorporating evidence-based research in the formulation of innovative projects and 

advancing changes to a State‘s overall system of home and community-based care. 

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.
ALZHEIMER’S DISEASE SUPPORTIVE SERVICES PROGRAM

71

Linking public and non-profit agencies that develop and operate respite care and other 

community-based supports, educational, and diagnostic services within the State to 

people who need services. 

In FY 2009 the ADSSP funded 16 grants with an average award of $646,764 and a range of 

grant awards from $203,155 to $1,000,000. In 2008, a programmatic review was performed to 

determine the future direction of the program and how to enhance the program‘s operation and 

results. As a result of this review, AoA issued two grant funding opportunities in FY 2009 

reflecting the new directions of the ADSSP that encourage States to: 1) translate and replicate 

evidence-based interventions for people with dementia and their caregivers; and, 2) develop or 

expand innovative service models for people with dementia and their caregivers, including a 

focus to expand services available to people in the early stages of dementia and to provide 

chronic care management. 

Through two FY 2009 funding opportunities, 7 States are in the process of translating 

4 evidence-based interventions into practice and 9 States are offering innovative programming 

for caregivers and their loved ones with dementia. One of the more promising interventions is a 

caregiver support program in New York City that, in a randomized-controlled trial, has 

significantly delayed institutionalization of persons with dementia by providing education, 

support, and counseling to the persons‘ caregivers.1 Minnesota is translating this intervention 

now, but no outcomes data are yet available. Overall, these grants offer both direct services and 

other additional services to thousands of families. The program also supports the provision of 

assistance for evaluation and continual quality improvement to grantees. 

Funding History 

Funding for the ADSSP program during the past five years is as follows: 

FY 2006............................................... $11,660,000 

FY 2007............................................... $11,668,000 

FY 2008 ............................................... $11,464,000 

FY 2009 ............................................... $11,464,000 

FY 2010............................................... $11,464,000 

Budget Request 

The FY 2011 request for the ADSSP is $11,464,000, the same as the FY 2010 appropriation. 

Funds will be used to address the needs of a growing population: One study estimates that there 

were 411,000 new cases of Alzheimer‘s disease in 2000; by 2029 the number of new cases is 

projected to be 615,000.2

 Consistent with a decision in spring 2008 to incorporate evidencebased approaches into the ADSSP, this request will fund grants to States to pilot test and 

implement evidence-based and other innovative approaches that help individuals with 

 

1 Mittleman M, et al., ―A Family Intervention to Delay Nursing Home Placement of Patients with Alzheimer‘s 

Disease: a randomized, controlled trial,‖ Journal of the American Medical Association 1996;276;1725-1731. 

2 Hebert et al., ―Annual incidence of Alzheimer disease in the United States projected to the years 2000 through 

2050.‖ Alzheimer Disease and Associated disorders 2001;15;169-173. 
ALZHEIMER’S DISEASE SUPPORTIVE SERVICES PROGRAM

72

Alzheimer‘s disease and their caregivers while also providing funding to demonstrate and 

expand the service delivery of home and community-based services. 

While more than $148 billion is spent each year in Alzheimer‘s disease-related costs,3family 

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-competent community-based social and health care services. 

Outcome and Outputs Table 

Alzheimer‘s Disease Supportive Services Program Outcome and Outputs

Measure Most Recent 

Result

FY 2010 

Target

FY 2011 

Target

FY 2011 

+/- FY 2010

ALZ.1: Percent of ADSSP grant funds 

dedicated to implementing evidence-based 

programs (Outcome)

59% 60% 60% --

Indicator Most Recent 

Result

FY 2010 

Projection

FY 2011 

Projection

FY 2011 

+/- FY 2010

Output AC: Number of individuals served 

(Output) N/A N/A Baseline --

Output AD: Percent of individuals served 

that are of a racial/ethnic minority (Output) N/A N/A Baseline --

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. 

 

3 Alzheimer‘s Association, 2009 Alzheimer‘s Disease Facts and Figures.
73

PAGE INTENTIONALLY LEFT BLANK 
74

Lifespan Respite Care 

FY 2009

Appropriation

FY 2009

Recovery Act

FY 2010

Appropriation

FY 2011

President’s 

Budget 

Request 

FY 2011

+/-

FY 2010

Lifespan Respite Care................................ $2,500,000 ............ -- $2,500,000 $5,000,000 +$2,500,000

Funding for the Lifespan Respite Care Act was appropriated in FY 2009 under the General Departmental 

Management Account in the Office of the Secretary. Beginning in FY 2010 these funds are being directly 

appropriated to the Administration on Aging. 

Authorizing Legislation: Lifespan Respite Care Act of 2006, Title XXIX of the Public Health 

Service Act 

FY 2011 Authorization.............................................................................................. $94,810,000 

Allocation Method ......................................................................................... Discretionary Grant 

Program Description and Accomplishments: 

The Lifespan Respite Care program provides grants to eligible State organizations to improve the 

quality and access of 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. 

Respite care services are highly valued by caregivers. In the most recent National Survey of 

Older Americans Act (OAA) service recipients a random sample of 1,629 caregivers (which 

represented over 229,000 active caregivers) answered questions about the impact of the caregiver 

program. Eighty-four percent of caregivers received respite care 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 

59 percent reported they now know more about caring for their loved one‘s condition 

77 percent reported that it was the most helpful service they received 

95 percent reported the care recipient benefited from the service 

82 percent said that the services enabled them to care longer 

 

The activities funded by the Lifespan Respite Care program include providing respite care 

services for family caregivers, training and recruitment of respite care workers and volunteers, 

information and outreach, access assistance, and program development. 

In addition to these activities, a grant has been awarded to establish a National Lifespan Respite 

Resource Center to maintain a national database on lifespan respite care; provide training and 
LIFESPAN RESPITE CARE 

75

technical assistance to State, community, and nonprofit respite care programs; and provide 

information, referral, and education programs to the public on lifespan respite care. 

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 under Title XIX of the 

Social Security Act; or any other State-level agency designated by the Governor. Additionally, 

the eligible State agency must be an Aging and Disability Resource Center and work in 

collaboration with 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. 

The first grants for the program were awarded in FY 2009 to twelve recipients for up to 

$200,000 for three-year project periods. 

Funding History 

FY 2006 ...............................................................$0

FY 2007...............................................................$0

FY 2008...............................................................$0

FY 2009................................................. $2,500,000 

FY 2010 ................................................. $2,500,000 

Note: Funding for the Lifespan Respite Care Act was appropriated in FY 2009 under the General Departmental 

Management Account in the Office of the Secretary. In FY 2010 funding was appropriated directly to the 

Administration on Aging. 

Budget Request 

The FY 2011 request for the Lifespan Respite Care program is $5,000,000, double the level of 

funding provided in the FY 2010 appropriation. This +$2.5 million increase is requested as part 

of the $102.5 million Caregivers Initiative, intended to assist families to have better support and 

assistance in caring for their relatives and loved ones with special needs. 

The Lifespan Respite Care program demonstrates AoA‘s commitment to providing caregivers 

and their families with the support they need to continue caring for their loved ones by 

expanding support to include caregivers of children or adults of any age with special needs. 

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.1

 

 

1 National Alliance for Caregiving and AARP. Caregiving in the U.S. Bethesda: National Alliance for Caregiving, 

and Washington, DC: AARP, 2009.
LIFESPAN RESPITE CARE 

76

By providing opportunities for family caregivers to receive the much needed short-term relief 

from caring for their loved ones, 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. 

States providing Lifespan Respite Care will, at a minimum: 

Expand and enhance respite care services to family members; 

Improve the statewide dissemination and coordination of respite care; and 

Provide, supplement, or improve access and quality of respite care services to family 

caregivers, thereby reducing family caregiver strain. 

The Lifespan Respite Care Program provides AoA, together with the National Family Caregiver 

Support program and the Alzheimer‘s Disease Supportive Services Program, with another 

vehicle to address the needs of caregivers. The Lifespan Respite Care program will build upon 

the existing infrastructure of multi-faceted caregiver services that these two earlier 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. With the 

addition of the Lifespan Respite Care Program, AoA will have new opportunities to further 

elevate the importance of caregiving by supporting the central role of caregivers in the health and 

long-term care delivery system with coordinated, accessible and high quality respite services. 

Output Table 

Lifespan Respite Care Output 

Indicator Most Recent 

Result 

FY 2010 

Projection 

FY 2011 

Projection

FY 2011 

+/- FY 2010 

Output AE: Increase the number of people 

served as a result of Lifespan Respite Care 

(Output)

N/A N/A Baseline N/A
77

PAGE INTENTIONALLY LEFT BLANK 
78

Protection of Vulnerable Older Americans 

Program

FY 2009

Appropriation

FY 2009

Recovery Act

FY 2010

Appropriation

FY 2011

President’s 

Budget 

Request 

FY 2011

+/-

FY 2010

Long-Term Care Ombudsman 

Program................................................................ $16,327,000 -- $16,827,000 $17,783,000 + $956,000

Prevention of Elder Abuse and 

Neglect ................................................................ 5,056,000 . --  ̳ 5,056,000 5,507,000 +451,000

 Total................................................................ $21,383,000 . -- $21,883,000 $23,290,000 +$1,407,000

Authorizing Legislation: Sections 712 and 721 of the Older Americans Act of 1965, as amended 

FY 2011 Authorization................................................................................................ Such Sums 

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

Program Description and Accomplishments: 

Protection of Vulnerable Older Americans programs provide a combination of training, outreach, 

and information dissemination activities that promote the rights of older people, help improve the 

quality of care for residents of long-term care facilities, and increase public and professional 

awareness of the problem of elder abuse. According to the best available estimates, between one 

and two million Americans age 65 or older have been injured, exploited, or otherwise mistreated 

by someone on whom they depended for care or protection. These funds address this problem by 

supporting a national Long-Term Care Ombudsmen Program, as well as State and local efforts to 

develop and enhance comprehensive systems of elder justice. 

Long-Term Care Ombudsmen are advocates for residents of nursing homes and a variety of 

similar adult residential care facilities. Ombudsmen regularly visit long-term care facilities, 

monitor conditions and care, resolve problems of individual residents and provide a voice for 

those unable to speak for themselves. Over twelve thousand volunteer ombudsmen participate in 

this program. These funds also allow States to develop, coordinate, enhance and carry out 

comprehensive statewide systems of elder justice and elder rights protections, consisting of 

programs for the prevention and treatment of elder abuse, neglect, and exploitation; provide 

public education, outreach, training and information; and coordinate services with adult 

protective services programs (half of which are directly administered by State Units on 

Aging (SUAs)), law enforcement, protection and advocacy programs, licensure and 

certifications programs, and victim assistance programs. 

Separate formula grant awards are made for the Long-Term Care Ombudsman Program and for 

the Prevention of Elder Abuse, Neglect and Exploitation, but for each of these programs, grants 

are allocated by formula to the 56 States and Territories based on their share of the population 

aged 60 and over. States and Territories then have discretion to further allocate funding among 

the various activities authorized under each program and may choose to provide funding to Area 
PROTECTION OF VULNERABLE OLDER AMERICANS 

79

Agencies on Aging (AAAs) and local service providers. These two programs follow different 

paths in protecting vulnerable elder rights, with one focused primarily on residents of long-term 

care facilities and the other on those residing at home. 

Long-Term Care Ombudsman Program (Title VII-A2) 

Grants provide funding for the training, travel, and other operating costs of more than 

10,000 paid and certified volunteer ombudsmen, who routinely monitor the condition of longterm care facilities. Ombudsmen advocate on behalf of residents to ensure their welfare 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. The program also enables States and 

communities to investigate and resolve complaints from residents and their caregivers related to 

improper action, inaction, or decisions which may have an adverse affect on the health, safety, 

welfare, or rights of long-term care facility residents. 

Outcome data (as 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. In 

FY 2008, ombudsmen resolved or partially resolved 10,089 complaints per million dollars of 

AoA funding (Outcome 1.2). Much of the efficiency in the Ombudsman Program is due to the 

strong reliance on volunteers who make up the bulk of those who resolve these issues - there was 

a ratio of nearly seven volunteers to one paid staff (FTE) in FY 2008 for this program. While the 

total number of complaints investigated decreased in FY 2008 (Output Q), the percentage of 

complaints that are fully or partially resolved has consistently remained above 75 percent, 

demonstrating both the efficiency of the program and its ability to produce positive outcomes for 

seniors. 

FY 2008 output data for the Long-Term Care Ombudsman Program highlights the 

accomplishments achieved by these programs and the important role that ombudsmen play in 

ensuring that the rights of long-term care facility residents are respected: 

Over 1,300 professional ombudsmen and 8,700 certified volunteer ombudsmen regularly 

visited 37,700 facilities, more than 80 percent of all nursing home facilities and nearly 

50 percent of all licensed board and care facilities (Output S). At least another 

2,000 volunteers support these paid and certified volunteer ombudsmen. 

Ombudsmen handled 271,650 complaints (Output Q). 

Ombudsmen provided nearly 327,000 consultations to individuals and 

128,000 consultations to 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). 

Prevention of Elder Abuse, Neglect and Exploitation (Title VII-A3) 

Grants provide funding for training and education, promoting public awareness of elder abuse, 

and supporting State and local elder abuse prevention coalitions and multi-disciplinary teams. 
PROTECTION OF VULNERABLE OLDER AMERICANS 

80

The program coordinates activities with adult protective services programs (over half of which 

are directly administered by SUAs) 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 for 

other sources of support for these activities, such as Social Services Block Grant and State 

General Funds. In FY 2008 over $19 million of the Elder Abuse Prevention services 

expenditures came from non-OAA funds (Output U), a ratio of approximately $4 of non-OAA 

funds for every $1 investment of Title VII-A3 funds. 

Examples of State elder abuse prevention activities include: 

In Kentucky, the statewide network of Local Coordinating Councils on Elder Abuse has 

developed ―Visor Cards‖ for law enforcement officers which contain contact information 

for, and resource information to assist, victims of elder abuse, and produced ―Fraud 

Fighter‖ forms that were distributed to thousands of seniors to help in the prevention of 

exploitation and scam artists. Other public awareness activities included renting 

billboards with elder abuse awareness messages and the State reporting number, hosting 

community trainings on the various forms of elder abuse, as well as other events and 

items to raise awareness in communities. 

Lifespan, out of Rochester, New York, used OAA funding to support training of 

non-traditional reporters, such as hairdressers, store clerks, and others who have frequent 

contact with the elderly, on what to look for and how to report suspected cases of elder 

abuse. Additionally, a series of television ads were developed and aired, which have 

resulted in an increased awareness of the problem of elder abuse. 

The Wisconsin Bureau of Aging and Disability Resources developed, in collaboration 

with the National Clearinghouse on Later Life, information designed to raise awareness 

of caregivers who have experienced abuse in the family, as well as of the risks and signs 

of abuse in later life, or ―domestic violence grown old.‖ The information was distributed 

statewide and is available at http://dhfs.wisconsin.gov/aps/Publications/publications.htm. 

Protection of Vulnerable Older Americans programs demonstrate 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, these programs help ensure that all older 

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

To support these important programs, AoA also provides funding to two national resource 

centers through the Aging Network Support Activities request. The Long-Term Care 

Ombudsman Resource Center supports the efforts of professional and volunteer ombudsmen by 

providing training and technical assistance to State and local ombudsman programs. The 

National Center on Elder Abuse supports the Prevention of Elder Abuse, Neglect, and 

Exploitation program by providing information and technical assistance on elder abuse issues to 

States and community-based organizations. 
PROTECTION OF VULNERABLE OLDER AMERICANS 

81

Funding History 

Funding for Protection of Vulnerable Older Americans during the past five years is as follows: 

FY 2006............................................... $20,142,000 

FY 2007 ............................................... $20,156,000 

FY 2008 ............................................... $20,633,000 

FY 2009............................................... $21,383,000 

FY 2010 ............................................... $21,883,000 

Budget Request 

The FY 2011 request for Protection of Vulnerable Older Americans programs is $23,290,000, an 

increase of +$1,407,000 above the FY 2010 appropriation. The request includes $17,783,000 for 

the Long-Term Care Ombudsman Program and $5,507,000 for the Prevention of Elder Abuse 

and Neglect program. 

The number of older Americans is increasing, particularly the population age 85 and older, 

which is growing faster in percentage terms than any other age cohort and is projected to reach 

nearly 20 million by the year 2030. As this population grows, the need for effective long-term 

care services will increase greatly. Many of these seniors will rely on the support of family and 

other informal caregivers to remain at home and in the community, while for others a nursing 

home may represent the best option for receiving the care they need. Regardless of the setting in 

which these vulnerable elders reside, one of the consequences of this growing population of frail 

elders is the likelihood of an increase in the instances of elder abuse. Research has found that 

between one and two million Americans age 65 or older have been injured, exploited, or 

otherwise mistreated by someone on whom they depend for care or protection. Perpetrators of 

elder abuse may be paid attendants, family members, or employees of long-term care facilities. 

This budget request will support the Ombudsman program‘s increased prevention efforts by 

maintaining the current level of consultations (Outputs R) and regular facility visits (Output S). 

These methods are an efficient means to protect vulnerable adults by increasing facilities‘ staff 

skills and enhancing residents‘ knowledge of their rights. Title VII Protection of Vulnerable 

Adults is part of the AoA‘s Aging Services Program which successfully underwent a program 

assessment in 2007. 

Long-Term Care Ombudsman Program 

The Ombudsman program has been engaged in adopting a more proactive approach to address 

the needs of residents, placing greater emphasis on training, consultation, and regular facility 

visits to lessen the need for complaint investigation and resolution. Therefore, new performance 

indicators have been introduced to reflect the new program focus. In FY 2011, the average 

number of complaints per LTC facility will decrease to 3.9 (Outcome 2.12). In FY 2011, the 

Ombudsman program will also focus on reducing the percentage of complaints of the most 

serious abuse including complaints about gross neglect, exploitation and physical or sexual abuse 

(Outcome 2.13). This new outcome measure captures some of the most important work that the 

Ombudsman program performs in protecting frail elders living in institutional facilities. 
PROTECTION OF VULNERABLE OLDER AMERICANS 

82

Complaint investigation is a large part of the Long-Term Care Ombudsman Program‘s activities. 

It is estimated that in FY 2011 ombudsmen will handle approximately 265,000 complaints on 

issues ranging from residents‘ rights violations, involuntary transfer or discharge, inadequate 

assessment and care planning, unresponsiveness of staff, lack of dignity, and other issues 

(Output Q). The purpose of an ombudsman investigation is to work with, or on behalf of the 

resident to address the individual‘s specific concerns. Outcomes are projected to remain constant 

for FY 2010 and begin to show improvement in FY 2011. Outputs are projected to show 

declines in 2009 and 2010, with improvement back to 2008 levels by 2011. 

Prevention of Elder Abuse, Neglect & Exploitation 

In FY 2011, the Prevention of Elder Abuse, Neglect and Exploitation program will continue 

support to State and local efforts to train law enforcement officials, develop and distribute 

educational materials, conduct public awareness campaigns, and create community coalitions. 

State and AAAs also use this funding to coordinate their activities with fraud and crime 

prevention partnerships organized by sheriffs, police chiefs, and community organizations. 

Outcomes and Outputs Table 

Protection of Vulnerable Older Americans Outcomes and Outputs 

Measure Most Recent 

Result FY 2010 Target FY 2011 Target FY 2011 +/- FY 2010 

1.2: For Title VII Services, increase the 

number of Ombudsman complaints 

resolved or partially resolved per million 

dollars of AoA funding. (Outcome)

FY 2008: 10,089

(Target Not Met) Discontinued Discontinued N/A

2.7: Improve the Ombudsman complaint 

resolution rates. (Outcome)

FY 2008: 24

(Target Not Met) Discontinued Discontinued N/A

2.12: Decrease the average number of 

complaints per LTC facility. (Outcome) FY 2008: 4.06 4.06 3.9 -0.16

2.13: Decrease the percentage of 

complaints for abuse, gross neglect, and 

exploitation in nursing homes. (Outcome)

FY 2008: 20.18 20 19.5 -0.5

Indicator Most Recent 

Result 

FY 2010 

Projection 

FY 2011 

Projection 

FY 2011 

+/- FY 2010 

Output Q: Number of Complaints (Output) FY 2008:

271,650 270,000 265,000 -5,000

Output R: Number of Ombudsman 

consultations (Output)

FY 2008:

455,423 411,000 455,000 +44,000

Output S: Facilities regularly visited not in 

response to a complaint (Output)

FY 2008:

37,706 35,000 37,000 +2,000

Output U: Elder Abuse prevention nonOAA service expenditures ($ Thousand)

(Output)

FY 2008:

$19,936 $17,992 $19,950 +$1,958
PROTECTION OF VULNERABLE OLDER AMERICANS 

83

Indicator Most Recent 

Result

FY 2010 

Projection

FY 2011 

Projection

FY 2011 

+/- FY 2010

Output AH: Increase the number of 

Ombudsman FTE per bed (Output) FY 2008: 1,305 1,178 1,311 +133

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

Protection of Vulnerable Older Americans, 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 

Long-Term Care Ombudsman Program Grant Awards 

FY 2009 

Omnibus

FY 2009 

Recovery 

Act

FY 2010 

President's 

Budget

FY 2011 

Request

Number of 

Awards 56 -- 56 56

Average Award $288,638 -- $288,638 $314,378

Range of 

Awards

$10,102 -

$1,637,618 --

$10,102 -

$1,639,669

$11,003 -

$1,785,889

Prevention of Elder Abuse, Neglect, and Exploitation Grant Awards 

FY 2009 

Omnibus

FY 2009 

Recovery 

Act

FY 2010 

President's 

Budget

FY 2011 

Request

Number of 

Awards 56 -- 56 56

Average Award $89,383 -- $89,383 $97,356

Range of 

Awards

$3,128 -

$502,534 --

$3,128 -

$501,013

$3,407 -

$553,052
PROTECTION OF VULNERABLE OLDER AMERICANS 

84

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION ON AGING 

FY 2011 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM: Long-Term Care Ombudsman Program (CFDA 93.042) 

State/Territory

FY 2009

Appropriation

FY 2010

Appropriation

FY 2011 

President’s 

Budget Request

Difference

+/-FY 2010

Alabama ........................................ 256,575 262,235 277,133 14,898 

Alaska ........................................... 81,457 83,294 88,026 4,732 

Arizona.......................................... 334,558 349,443 369,297 19,854 

Arkansas........................................ 162,447 165,757 175,174 9,417 

California ...................................... 1,650,561 1,689,883 1,785,889 96,006 

Colorado........................................ 212,503 220,799 233,344 12,545 

Connecticut ................................... 194,435 195,777 206,900 11,123 

Delaware ....................................... 81,457 83,294 88,026 4,732 

District of Columbia ...................... 81,457 83,294 88,026 4,732 

Florida........................................... 1,213,801 1,239,282 1,309,691 70,409 

Georgia.......................................... 407,457 422,857 446,882 24,025 

Hawaii........................................... 81,457 83,294 88,026 4,732 

Idaho............................................. 81,457 83,294 88,026 4,732 

Illinois........................................... 633,272 641,994 678,468 36,474 

Indiana .......................................... 326,737 332,838 351,748 18,910 

Iowa .............................................. 173,657 175,865 185,856 9,991 

Kansas........................................... 145,307 147,902 156,305 8,403 

Kentucky....................................... 227,748 233,645 246,919 13,274 

Louisiana....................................... 215,841 223,474 236,170 12,696 

Maine............................................ 81,457 83,294 88,026 4,732 

Maryland....................................... 278,337 284,435 300,595 16,160 

Massachusetts................................ 351,790 356,158 376,392 20,234 

Michigan ....................................... 529,654 537,534 568,074 30,540 

Minnesota...................................... 261,150 266,192 281,316 15,124 

Mississippi .................................... 149,593 152,269 160,920 8,651 

Missouri ........................................ 321,998 327,573 346,183 18,610 

Montana ........................................ 81,457 83,294 88,026 4,732 

Nebraska ....................................... 94,444 96,001 101,456 5,455 

Nevada .......................................... 123,705 127,482 134,725 7,243 

New Hampshire............................. 81,457 83,294 88,026 4,732 
PROTECTION OF VULNERABLE OLDER AMERICANS 

85

PROGRAM: Long-Term Care Ombudsman Program (CFDA 93.042) 

State/Territory

FY 2009

Appropriation

FY 2010

Appropriation

FY 2011 

President’s 

Budget Request

Difference

+/-FY 2010

New Jersey .................................... 465,457 469,541 496,217 26,676 

New Mexico .................................. 101,021 104,305 110,231 5,926 

New York...................................... 1,039,826 1,061,436 1,121,740 60,304 

North Carolina............................... 465,026 478,933 506,143 27,210 

North Dakota ................................. 81,457 83,294 88,026 4,732 

Ohio .............................................. 627,247 636,834 673,015 36,181 

Oklahoma...................................... 196,597 199,885 211,241 11,356 

Oregon .......................................... 204,816 211,189 223,188 11,999 

Pennsylvania.................................. 753,411 760,176 803,364 43,188 

Rhode Island.................................. 81,457 83,294 88,026 4,732 

South Carolina............................... 241,319 250,550 264,785 14,235 

South Dakota ................................. 81,457 83,294 88,026 4,732 

Tennessee...................................... 331,253 341,041 360,416 19,375 

Texas............................................. 1,005,614 1,037,151 1,096,076 58,925 

Utah .............................................. 96,699 101,304 107,059 5,755 

Vermont ........................................ 81,457 83,294 88,026 4,732 

Virginia ......................................... 383,892 394,458 416,869 22,411 

Washington ................................... 322,492 332,556 351,449 18,893 

West Virginia ................................ 114,224 115,961 122,549 6,588 

Wisconsin...................................... 299,344 304,433 321,729 17,296 

Wyoming....................................... 81,457 83,294 88,026 4,732 

Subtotal, States.............................. 15,972,749 16,331,970 17,259,846 927,876 

American Samoa............................ 10,182 10,412 11,003 591 

Guam ............................................ 40,729 41,647 44,013 2,366 

Northern Mariana Islands............... 10,182 10,412 11,003 591 

Puerto Rico.................................... 216,895 222,642 235,292 12,650 

Virgin Islands................................ 40,729 41,647 44,013 2,366 

Subtotal, States and Territories....... 16,291,466 16,658,730 17,605,170 946,440 

Undistributed 1/............................. 35,534 168,270 177,830 9,560 

TOTAL 16,327,000 16,827,000 17,783,000 956,000 

 

1/ Funds held for statutory related requirements are reflected in the undistributed line. 

 
PROTECTION OF VULNERABLE OLDER AMERICANS 

86

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION ON AGING 

FY 2011 DISCRETIONARY STATE FORMULA GRANTS 

PROGRAM: Prevention of Elder Abuse, Neglect, and Exploitation (CFDA 93.041) 

State/Territory

FY 2009

Appropriation

FY 2010

Appropriation

FY 2011 

President’s 

Budget Request

Difference

+/-FY 2010

Alabama ........................................ 78,989 77,747 85,822 8,075 

Alaska ........................................... 25,225 25,027 27,260 2,233 

Arizona.......................................... 102,997 103,602 114,362 10,760 

Arkansas........................................ 50,011 49,143 54,248 5,105 

California ...................................... 508,140 501,013 553,052 52,039 

Colorado........................................ 65,421 65,462 72,261 6,799 

Connecticut ................................... 59,907 59,907 64,072 4,165 

Delaware ....................................... 25,225 25,027 27,260 2,233 

District of Columbia ...................... 25,225 25,027 27,260 2,233 

Florida........................................... 373,679 367,419 405,582 38,163 

Georgia.......................................... 125,439 125,368 138,389 13,021 

Hawaii........................................... 25,225 25,027 27,260 2,233 

Idaho............................................. 25,225 25,027 27,260 2,233 

Illinois........................................... 197,384 197,384 210,106 12,722 

Indiana .......................................... 100,589 98,679 108,928 10,249 

Iowa .............................................. 55,927 55,927 57,555 1,628 

Kansas........................................... 45,843 45,843 48,404 2,561 

Kentucky....................................... 70,114 69,270 76,465 7,195 

Louisiana....................................... 68,518 68,518 73,137 4,619 

Maine............................................ 25,225 25,027 27,260 2,233 

Maryland....................................... 85,688 84,329 93,087 8,758 

Massachusetts................................ 109,606 109,606 116,560 6,954 

Michigan ....................................... 163,059 160,862 175,920 15,058 

Minnesota...................................... 80,397 78,920 87,117 8,197 

Mississippi .................................... 46,053 45,198 49,833 4,635 

Missouri ........................................ 99,130 97,643 107,205 9,562 

Montana ........................................ 25,225 25,027 27,260 2,233 

Nebraska ....................................... 29,770 29,770 31,419 1,649 

Nevada .......................................... 38,084 37,796 41,721 3,925 

New Hampshire............................. 25,225 25,027 27,260 2,233 
PROTECTION OF VULNERABLE OLDER AMERICANS 

87

PROGRAM: Prevention of Elder Abuse, Neglect, and Exploitation (CFDA 93.041) 

State/Territory

FY 2009

Appropriation

FY 2010

Appropriation

FY 2011 

President’s 

Budget Request

Difference

+/-FY 2010

New Jersey .................................... 143,950 143,950 153,667 9,717 

New Mexico .................................. 31,100 30,925 34,136 3,211 

New York...................................... 320,120 318,066 347,378 29,312 

North Carolina............................... 143,162 141,993 156,741 14,748 

North Dakota ................................. 25,225 25,027 27,260 2,233 

Ohio .............................................. 197,185 197,185 208,418 11,233 

Oklahoma...................................... 60,524 60,208 65,417 5,209 

Oregon .......................................... 63,054 62,613 69,116 6,503 

Pennsylvania.................................. 242,944 242,944 248,784 5,840 

Rhode Island.................................. 25,225 25,027 27,260 2,233 

South Carolina............................... 74,292 74,282 81,998 7,716 

South Dakota ................................. 25,225 25,027 27,260 2,233 

Tennessee...................................... 101,979 101,111 111,613 10,502 

Texas............................................. 309,587 307,492 339,430 31,938 

Utah .............................................. 29,769 30,034 33,154 3,120 

Vermont ........................................ 25,225 25,027 27,260 2,233 

Virginia ......................................... 118,184 116,948 129,095 12,147 

Washington ................................... 99,282 98,595 108,836 10,241 

West Virginia ................................ 36,736 36,736 37,951 1,215 

Wisconsin...................................... 92,156 90,309 99,632 9,323 

Wyoming....................................... 25,225 25,027 27,260 2,233 

Subtotal, States.............................. 4,946,694 4,908,148 5,344,991 436,843 

American Samoa............................ 3,153 3,128 3,407 279 

Guam ............................................ 12,612 12,514 13,630 1,116 

Northern Mariana Islands............... 3,153 3,128 3,407 279 

Puerto Rico.................................... 66,773 66,008 72,865 6,857 

Virgin Islands................................ 12,612 12,514 13,630 1,116 

Subtotal, States and Territories....... 5,044,997 5,005,440 5,451,930 446,490 

Undistributed 1/............................. 11,003 50,560 55,070 4,510 

TOTAL 5,056,000 5,056,000 5,507,000 451,000 

 

1/ Funds held for statutory related requirements are reflected in the undistributed line. 

 
88

Network Support and Demonstrations 

Summary of Request 

AoA‘s innovation and demonstration programs provide a means to identify, evaluate, and 

replicate the best models and practices nationwide as part of the overall strategy for 

strengthening AoA‘s core formula-grant programs. To do this, AoA draws on best practices and 

evaluations of its core programs at the State and local level to identify cutting edge, state-of-theart approaches for further testing and replication. AoA-supported Aging and Disability Resource 

Centers (ADRCs) are models of best practices that were identified through this process and are 

now being replicated across the country. 

The budget requests $57,228,000 in FY 2011, a decrease of -$6,078,000 below the FY 2010 

appropriation for three discretionary grant programs -- Health and Long-term Care Programs, 

Program Innovations, and Aging Network Support Activities. This request includes: 

$30,485,000 for Health and Long-Term Care programs -- ADRCs and evidence-based 

disease prevention (EBDP) programs, a reduction of -$104,000 below the FY 2010 

appropriation. This reduction will be applied to achieve savings in contractual costs. 

This program provides a key vehicle for strengthening and transforming the core services 

programs and for reforming the nation‘s long-term care system to help individuals break 

the cycle of nursing home care and hospital admissions. Activities supported with these 

funds include: 

o Aging and Disability Resource Centers, which provide one-stop assistance to help 

individuals in need of short and long-term services and facilitate streamlined 

access to community-based long-term services and supports; and 

 

o Evidence-based Disease Prevention Programs, which support community-level 

deployment of low-cost, science-based disease prevention programs that have 

been proven effective in reducing the risk of disease, disability, and the utilization 

of emergency room and hospital services. 

$13,049,000 for Program Innovations activities, a decrease of -$5,974,000 below the 

FY 2010 appropriation to eliminate one-time, Congressionally-mandated earmarks. The 

request maintains funding for all ongoing projects of national significance at the FY 2010 

appropriation level. Program Innovations provides funding that is used as a catalyst for 

developing new approaches, translating cutting-edge research findings into practice, 

demonstrating new techniques that States and communities can use to help seniors stay 

healthy and independent in their own homes and communities, and for addressing 

emerging aging issues. 

$13,694,000 is requested for Aging Network Support Activities, the same level as the 

FY 2010 appropriation, to provide competitive grants and contracts to support five 

ongoing activities -- Pension Information and Counseling, the National Eldercare 

Locator, the National Long-Term Care Ombudsman Resource Center, the National 
NETWORK SUPPORT AND DEMONSTRATIONS – SUMMARY OF REQUEST 

89

Center on Elder Abuse and the Senior Medicare Patrol program -- each of which provides 

critical and ongoing support for the national aging services network and AoA‘s core 

services delivery programs. 

These funds help AoA innovate with cost-effective services and supports in an increasingly 

expensive area -- long-term care. These innovations frequently enhance service delivery and 

coordination in the long-term care system with partners such as the Department of Veterans 

Affairs, State Medicaid programs, State Health Departments, the private sector, and 

philanthropic organizations. 
90

Health and Long-Term Care Programs 

FY 2009

Appropriation

FY 2009

Recovery Act

FY 2010

Appropriation

FY 2011

President’s 

Budget

Request

FY 2011

+/-

FY 2010

Health and Long-Term Care 

Programs............................................................... $28,000,000 -- $30,589,000 $30,485,000 -$104,000

Authorizing Legislation: Section 411 of the Older Americans Act of 1965, as amended 

FY 2011 Authorization................................................................................................ Such Sums 

Allocation Method .......................... Competitive Grants/Co-operative Agreements and Contracts 

Program Description and Accomplishments: 

Health and Long-Term Care funding allows AoA to identify and evaluate the best models and 

practices nationwide, as part of its overall strategy for strengthening its core programs and the 

national aging services network. To this end, AoA draws on the latest research and the results of 

evaluations of its core programs at the State and local level to identify cutting edge, state-of-theart approaches for further testing and replication. 

Since 2003, funding has been targeted to programs designed specifically to enable older 

individuals and their caregivers to manage their health, develop strategies to plan for their longterm care, and avoid the need to enroll in Medicaid -- all through the use of low-cost, 

community-based service alternatives and preventive services. These programs, which are 

described in more detail below, focused on empowering older individuals to remain healthy and 

independent for as long as possible and on breaking the cycle of unnecessary admissions and 

readmissions for costly nursing home care and hospital services. 

Aging and Disability Resource Centers 

Aging and Disability Resource Centers (ADRCs) support state efforts to develop more efficient, 

cost-effective, and consumer-responsive systems of consumer information and access by creating 

―one-stop shop‖ entry points into long-term care at the community-level, ranging from in-home 

services to institutional care. ADRCs help States make better use of taxpayer dollars to 

streamline access to public services to overcome duplication and fragmentation in the long-term 

care system. 

AoA and the Centers for Medicare & Medicaid Services (CMS) have invested over $65 million 

in the ADRC program since 2003. As a result of these investments: 

Currently, over 200 ADRCs have been established across the country with 12 States 

and territories achieving statewide coverage and an additional 8 states achieving 

50 percent or more statewide coverage. 
HEALTH AND LONG-TERM CARE PROGRAMS 

91

In 2011, it is estimated that ADRCs will respond to over two 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 including homemaker services, personal care assistance, 

transportation, legal assistance, and caregiver support. 

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. 

80 percent of the ADRC states have streamlined their Medicaid application process 

for consumers. For example, some states are making their applications available on 

the internet and allowing consumers to complete their application online and submit it 

electronically. 

Standards have been established to provide guidance to states on the desired end 

result of how an ADRC should perform. For example, the standards require that each 

ADRC has a plan for reducing the average time from initial contact to determination 

of their eligibility for public services. 

Evidence-based Disease Prevention 

In partnership with the Centers for Disease Control and Prevention (CDC), the Agency for 

Healthcare Research and Quality (AHRQ), the Health Resources and Services Administration 

(HRSA), CMS, and over 30 private foundations, AoA supports community-level deployment of 

low-cost, science-based disease prevention programs that have proven effective in reducing the 

risk of disease, disability, and injury among the elderly and reduce the utilization of emergency 

rooms and hospital services. Evidence-based programs have been tested through randomized 

controlled experiments. 

Since 2003, AoA and its partners have invested over $42 million to-date in Evidence-based 

Disease Prevention (EBDP) discretionary grant programs. These grants focus on providing 

low-cost interventions at the community level that include areas such as chronic disease 

self-management, diabetes self-management education, falls prevention, depression awareness 

and enhanced fitness and enhanced wellness programs. Some examples of these programs may 

be found beginning on page 48 in the discussion of preventive health services.

Of these evidence-based models, AoA has provided particular support for chronic disease selfmanagement programs (CDSMP) in partnership with AHRQ, CDC, CMS, HRSA, and over 

30 private foundations. To date about 1,200 community-based delivery sites have held 

programs. Supporting these sites, and the rest of the State and local infrastructure, is a national 

technical assistance center on evidence-based prevention programs for the elderly, a national 

chronic disease self-management training and certification center, local program training 

materials and guides, marketing materials, quality assurance mechanisms and fidelity protocols, 

and a variety of technologies, including an AHRQ-sponsored Knowledge Transfer Program to 

support rapid diffusion. Over 12,000 individuals have participated in the chronic disease 
HEALTH AND LONG-TERM CARE PROGRAMS 

92

self-management programs offered through this infrastructure. Under the American Recovery 

and Reinvestment Act (Recovery Act), AoA has received $32.5 million in separate funding to 

continue the development of CDSMPs in fiscal years 2010 and 2011. 

Nursing Home Diversion/Community Living Programs 

These programs help States target individuals who are at high risk of nursing home placement 

and spend-down to Medicaid and provide them with information and access to community-based 

long-term care services that enable them to continue to live at home. Nursing Home 

Diversion/Community Living Programs (CLPs) strategically use ADRCs to identify these 

individuals and work with them and their family caregivers to develop care plans and link them 

to needed services, especially consumer-directed and community-based services and supports. 

Currently, 20 states are developing CLPs. The states enrolled 243 participants in FY 2008. CLP 

projects will continue to receive funding through the end of FY 2010.

Funding for all of these health and long-term care programs is awarded as competitive grants to 

states. Grantees are generally required to provide a 25 percent match for EBDP programs and a 

5 percent match for ADRCs. ADRC grants do not pay for on-going costs of operating ADRC 

services and thus AoA‘s grants for ADRCs account for only 14 percent of their total program 

budget, on average. As a result, ADRC funds are helping transform state operations. External 

experts review project proposals, and project awards are made for periods of one to four years. 

Competitive contracts are also funded to support evaluation and technical assistance activities. 

Funding History 

Comparable funding for Health and Long-Term Care Programs is as follows: 

FY 2008 ............................................... $16,212,000 

FY 2009 ............................................... $28,000,000 

FY 2010 ............................................... $30,589,000 

Note: Funding for activities under this program was provided under Aging Network Support Activities in FY 2009 and FY 2010. 

Budget Request 

The FY 2011 budget request for Health and Long-Term Care Programs is $30,485,000, a 

reduction of -$104,000 from the FY 2010 appropriation. The -$104,000 is the result of reducing 

contractual support for this activity consistent with the Administration‘s effort to improve 

efficiencies government-wide by reducing contracting expenses. 

Beginning in FY 2011, funding under this activity will be realigned. Funding for ADRCs and 

for Evidence-Based Disease Prevention Programs other than Chronic Disease Self-Management 

Programs will continue, as described below. Funding for CDSMPs will come predominantly, if 

not entirely, instead from $32.5 million in Recovery Act funding provided for fiscal years 2010 

and 2011, as discussed below. Finally, AoA plans to refocus funds currently being used to 
HEALTH AND LONG-TERM CARE PROGRAMS 

93

support CLPs on new approaches that will complement the aging services network‘s role in 

health and long-term care reform, such as discharge planning. 

AoA expects that many of the goals of the CLPs, such as keeping individuals in their own homes 

by helping divert individuals from costly institutional care, can be accomplished by ADRCs and 

the ongoing availability of home and community-based services such as adult day care, 

homemaker services, personal care assistance, transportation, legal assistance, and caregiver 

support and that this shift will provide a better use of its available resources. AoA will redirect 

additional resources in FY 2011 as FY 2010 CLP grants conclude. 

Aging and Disability Resource Centers 

Funding under the request will help ADRCs continue to mature and develop, particularly since 

grants do not pay for the on-going cost of operating ADRC services, and expand the number of 

States with statewide coverage. In FY 2011, AoA‘s goal is to award competitive ADRC grants 

to at least 50 States and Territories. With this funding, AoA intends, in coordination with CMS 

and the Department of Veterans Affairs, to further improve ADRC efforts to break the cycle of 

unnecessary admissions and readmissions for costly nursing home and hospital services. 

In FY 2008, the Veterans Administration and AoA began working together to develop the 

Veterans Directed Home and Community Based Services Program (VDHCBS), 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 Veterans 

Administration made a strategic decision to use the aging services network infrastructure as a 

delivery vehicle for VDHCBS. In FY 2009 the Veterans Administration invested an additional 

$10 million in the implementation of VDHCBS and plans for continued funding in FY 2010. 

Between FY 2009 and FY 2010, the implementation of VDHCBS is expected to expand to at 

least another 10 states, bringing the total number of states implementing VDHCBS to at least 20. 

AoA and the VA envision further expansion of the VDHCBS program in FY 2011. 

Evidence-Based Disease Prevention 

In addition, AoA also expects to issue new grants for evidence-based disease prevention 

programs in FY 2011. The size and number of grants will be determined after AoA issues 

awards from its FY 2010 Recovery Act program announcement for chronic disease selfmanagement programs. If Recovery Act grantees are generally able to support evidence-based 

chronic disease self-management programs through FY 2011, AoA may focus its FY 2011 

resources on sustaining and expanding other evidence-based disease prevention programs, such 

as falls prevention and enhanced physical fitness. 

Evaluation 

AoA will continue to partner with AHRQ and the Assistance Secretary for Planning and 

Evaluation to rigorously evaluate the health and long-term care programs, particularly ADRCs. 

In FY 2009, AoA initiated a design contract for the evaluation. In mid-2010, AoA expects to 

begin a $2.5 million evaluation based on recommendations from the design contract. The 

evaluation is expected to continue in FY 2011 at a similar funding level. 
HEALTH AND LONG-TERM CARE PROGRAMS 

94

CDSMPs under the Recovery Act 

In FY 2010, AoA will receive $32.5 million of the $650 million in Recovery Act prevention 

funding that was delegated to the Centers for Disease Control and Prevention by the Secretary of 

Health and Human Services. These funds will support activities across fiscal years 2010 and 

2011. This investment will allow AoA, in coordination with its existing HHS partners and 

private philanthropies, to put the results of HHS‘ research investments into practice at more than 

1,200 community-based sites across the country. AoA estimates that 50,000 individuals across 

the country will complete the expanded chronic disease self-management programs in the first 

year. 

Older Americans are disproportionately affected by a vast array of chronic conditions (including 

diabetes, obesity, heart disease, cancer, arthritis, and depression) that collectively account for 

seven out of every 10 deaths and contribute to more than three-quarters of all Medicare 

expenditures.1

 Nearly half of older adults have hypertension and roughly one in five has heart 

disease, with a similar proportion having some type of cancer.1 The average 75-year old has 

three chronic conditions and takes 4.5 medications.2 More than 65 percent of Americans aged 65 

and over have some form of cardiovascular disease. 

There are a variety of chronic disease self-management programs. Chronic disease selfmanagement programs eligible for funding must be evidence-based; shown to be effective in 

reducing the risk of disease, disability, and injury among the elderly; have results published in 

peer-reviewed journals; and be suitable for delivery through AoA‘s network of community-based 

organizations, including senior centers, congregate meal programs, faith-based organizations, 

and senior housing projects. Recognizing that the development of evidence-based 

self-management programs is ongoing, AoA provided a list of programs that meet the above 

criteria and allow for potential grantees to propose implementing programs not on the list, 

provided the programs meet the necessary criteria. 

Grantees must demonstrate that implementation will be accomplished at the community level by 

aging services provider organizations working in collaboration with public health agencies and 

health care providers. Participant referrals to the chronic disease self-management programs will 

come from both clinical and community-based organizations. Clinical referrals will come from 

community-health centers, physicians, hospitals, managed care organizations, and other health 

system components. Community referrals will come from a variety of sources, including 

ADRCs. 

 

 

 

1

 Deaths: Leading Causes for 2004. National Vital Statistics Report, V. 56, No. 5. Centers for Disease Control and 

Prevention. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_05.pdf . Accessed December 30, 2009. 

Follow the Money -- Controlling Expenditures by Improving Care for Patients Needing Costly Services. 

 Bodenheimer, T., and Berry-Millett, R. New England Journal of Medicine. 15 October 2009. 

2

 Centers for Disease Control and Prevention (CDC), National Center for Health Statistics, National Health 

Interview Survey, 2000-2001. 
HEALTH AND LONG-TERM CARE PROGRAMS 

95

Out of the $32.5 million total investment: 

$27 million will be allocated to the states, based on the distribution of Medicare 

beneficiaries by state, via competitive grants; 

$2.5 million will be used for an interagency agreement with CMS develop a quality 

assurance program in one state on participant health care utilization and cost by linking 

Medicare claims data to program participants; and 

$3.0 million will be used to continue funding a National Technical Assistance Center on 

Evidence-Based Prevention Programs and program administration. 

Outcome and Outputs Table 

Health and Long-term Care Programs Outcome and Outputs 

 

Measure Most Recent 

Result 

FY 2010 

Target 

FY 2011 

Target 

FY 2011 

+/- FY 2010 

LTC.2: Percent of individuals 

who indicate ADRC information 

and counseling contribute to 

informed decision making 

(Outcome)

N/A -- Baseline --

Indicator Most Recent 

Result 

FY 2010 

Projection 

FY 2011 

Projection 

FY 2011 

+/- FY 2010 

Output AF: Total number of 

ADRC contacts (Output)

FY 2008: 

1.3 M 1,750,000 2,000,000 +250,000

Output AG: Increase in the 

number of ADRC programs 

(Output)

FY 2008: 197 207 220 +13

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

and Long-Term Care Programs; 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. 
96

Program Innovations

FY 2009

Appropriation

FY 2009

Recovery Act

FY 2010

Appropriation

FY 2011

President’s 

Budget 

Request

FY 2011

+/-

FY 2010

Program Innovations................................ $18,172,000 .............. -- $19,023,000 $13,049,000 --

Authorizing Legislation: Section 411 of the Older Americans Act of 1965, as amended 

FY 2011 Authorization................................................................................................ Such Sums 

Allocation Method .......................... Competitive Grants/Co-operative Agreements and Contracts 

Program Description and Accomplishments: 

Program Innovations is intended as a source of funding for AoA to use as a catalyst for tapping 

existing Aging Services Network practices that represent new approaches, translating 

cutting-edge research and evaluation results into practice, and demonstrating techniques and best 

practices that can be replicated across the States and communities in the network to help seniors 

stay healthy, active, and independent in their own homes and communities. It also provides 

funds to address key AoA priorities. 

These funds can provide AoA with the flexibility to innovate in a way that directly strengthens 

the core programs. These innovations demonstrate practical methods that can then be more 

widely replicated by States and local communities to help strengthen and transform Older 

Americans Act (OAA) core programs. Generally, these innovations are modeled after novel 

activities or best practices developed within the aging services network that need further support, 

modeling, and evaluation before enabling widespread replication and adoption. 

In some cases, Program Innovation grants may be awarded to explore emerging opportunities or 

risks facing seniors and caregivers but where the Aging Services Network has limited expertise. 

In these cases, universities, consumer-focused organizations, and other entities may be brought 

collaboratively into the aging network as technical assistance partners to lend expertise in 

helping address these emerging challenges. 

Currently, all Program Innovations funding goes to support ongoing projects of national 

significance, including resource centers and other projects that are national in scope that have 

provided demonstrated benefits to elderly Americans. 

All funding is awarded in the form of competitive grants, cooperative agreements, and contracts 

to eligible public and nonprofit agencies, State Units on Aging, Area Agencies on Aging 

(AAAs), institutions of higher learning, and other organizations representing or serving older 

people, including community and faith-based organizations. Grantees are generally required to 

provide a match equal to 25 percent of the project‘s total cost. External experts review project 
PROGRAM INNOVATIONS 

97

proposals, and project awards are made for periods of one to four years. In FY 2009, Program 

Innovations funded 82 grants and grant supplements with an average award of $216,226 and a 

range of grant awards from $20,000 to $969,234. 

Activity

FY 2009

Appropriation

FY 2010

Appropriation

FY 2011

President‘s

Budget 

Request

Program Innovations:

Model Approaches to Statewide Legal Assistance Systems................. 2,000,000 2,000,000 2,000,000

National Legal Assistance & Support Projects .................................... 746,000 746,000 746,000

National Education & Resource Center on Women & Retirement ....... 249,000 249,000 249,000

Multigenerational Civic Engagement................................................... 982,000 982,000 982,000

National Resource Centers on Native Americans................................ 693,000 693,000 693,000

National Minority Aging Organizations: Asian-Pacific Americans...... 357,000 357,000 357,000

National Minority Aging Organizations: Native Americans................. 129,000 129,000 129,000

National Minority Aging Organizations: Hispanic & AfricanAmericans.......................................................................................... 448,000 448,000 448,000

Program Performance, Evaluation, and Technical Assistance .............. 1,445,000 1,445,000 1,445,000

National Alzheimer's Call Center........................................................ 1,000,000 1,000,000 1,000,000

Community Innovations for Aging in Place ........................................ 5,000,000 5,000,000 5,000,000

One-Time Project Earmarks ............................................................... 5,123,000 5,974,000 --

Total, Program Innovations......................................................... 18,172,000 19,023,000 13,049,000

Projects of national significance currently receiving Program Innovations funding are reflected in 

the previous table and discussed in more detail in the narrative below: 

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 to ensure their rights and 

financial security, and to enhance their choice and independence. 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 

Long-Term 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 form the National Legal Resource Center which supports the leadership, 

knowledge, and systems capacity of legal and aging provider organizations in order to enhance 

the quality, cost effectiveness, and accessibility of legal assistance and elder rights protections 

available to older persons with social or economic needs. AoA is funding four projects which 
PROGRAM INNOVATIONS 

98

provide core support functions for aging and legal networks including case consultation, training, 

technical assistance/legal and aging systems development, and information development and 

dissemination. 

National Education and Resource Center on Women and Retirement Planning 

The National Education and Resource Center on Women and Retirement (WISER) Planning 

provides women with access to a one-stop gateway that integrates financial information and 

resources on retirement, health, and planning for long-term care. This project has made user 

friendly financial education and retirement planning tools available to traditionally hard-to-reach 

women, including average and low-income women, women of color and 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 over 10,000 pieces of financial and retirement 

planning information tailored to the specific needs of hard-to-reach women. 

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. Nineteen model programs in FY 2009 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 are also supported 

by the Corporation of National and Community Service. 

National Resource Centers on Native American Elders 

The National Resource Centers on Native American Elders (Resource Centers) 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 are: 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. 

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. Each NMAO project pilots a practical, nontraditional, communitybased 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 
PROGRAM INNOVATIONS 

99

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. 

Program Performance, Evaluation, and Technical Assistance 

This program 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. 

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. 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. In the 12-month period ending 

July 31, 2009, the National Alzheimer‘s Call Center handled over 250,000 calls through its 

national and local partners, and its on-line message board community recorded over 4.8 million 

page views, with nearly 75,000 individual postings. 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.

Community Innovations for Aging in Place

The Community Innovations for Aging in Place program (CIAIP), established and defined in the 

2006 reauthorization of the OAA, is intended to provide grants to eligible entities such as nonprofit health or social service organizations, community-based organizations, AAAs, local 

government organizations or tribal organizations to carry out aging in place projects. Projects 

are designed to promote independence for older individuals, including individuals who reside in 

Naturally Occurring Retirement Communities. AoA is currently funding fourteen local CIAIP 

grants and a technical assistance resource center to support their efforts. The fourteen grants, in 

line with Congressional intent, represent a diverse array of initiatives including the creative 

delivery of services to elders living in naturally occurring retirement communities. Funded 

projects indicate a clear understanding of the importance of program coordination with AAAs, 

Aging and Disability Resource Centers, and Evidence-Based Prevention programs. 
PROGRAM INNOVATIONS 

100

One-Time Congressional Project Earmarks

This line funded one-time projects in FY 2010 whose selection was incorporated into law by 

reference. 

Funding History 

Comparable funding for Program Innovations during the past five years is as follows: 

FY 2006 ............................................... $24,595,000 

FY 2007 ............................................... $24,058,000 

FY 2008 ............................................... $14,655,000 

FY 2009 ............................................... $18,172,000 

FY 2010 ............................................... $19,023,000 

Budget Request 

The FY 2011 budget request for Program Innovations is $13,049,000, a decrease of -$5,974,000 

from the FY 2010 appropriation level to eliminate funding for one-time Congressional project 

earmarks. 

The request maintains funding for all ongoing projects of national significance at the FY 2010 

appropriation level of $13,049,000 to provide support for activities that improve AoA‘s core 

service delivery programs. These investments will help generate knowledge that can be used to 

improve AoA‘s performance in program efficiency and outcomes for OAA services, maintain 

the current high level of consumer satisfaction with services, and ensure that services are 

targeted to the most vulnerable elderly individuals. 

Program Innovations outcomes are reflected in performance targets for Health and Long-term 

Care, Caregivers, Home and Community-Based Services, and Protection of Vulnerable Older 

Americans. 
101

PAGE INTENTIONALLY LEFT BLANK 
102

Aging Network Support Activities 

FY 2009

Appropriation

FY 2009

Recovery Act

FY 2010

Appropriation

FY 2011

President’s 

Budget 

Request

FY 2011

+/-

FY 2010

Aging Network Support 

Activities .............................................................. $13,694,000 -- $13,694,000 $13,694,000 --

Authorizing Legislation: Section 201, 202, and 215 of the Older Americans Act of 1965, as amended 

FY 2011 Authorization .......................................................................................................... Such Sums 

Allocation Method ..................................... Competitive Grant/Co-operative Agreement and Contracts 

Program Description and Accomplishments: 

Aging Network Support Activities provides competitive grants and contracts to support five 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. 

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 2009, Aging Network Support Activities 

funded 68 grants and grant supplements with an average award of $190,828 and a range of grant 

awards from $15,000 to $812,176. 

Aging Network Support Activities includes funding for the following projects1: 

Activity

FY 2009

Appropriation

FY 2010

Appropriation

FY 2011 

President‘s 

Budget

Request

Aging Network Support Activities:

Pension Information and Counseling Program................ 1,719,000 1,719,000 1,719,000

National Eldercare Locator............................................. 1,178,000 1,178,000 1,178,000

National Long Term-Care Ombudsman Resource Center 547,000 547,000 547,000

National Center on Elder Abuse ..................................... 811,000 811,000 811,000

Senior Medicare Patrol (SMP) Program.......................... 9,439,000 9,439,000 9,439,000

Total, Aging Network Support Activities ................ 13,694,000 13,694,000 13,694,000

 

1

 The National Center on Senior Benefits Outreach was awarded $5,000,000 from the Medicare Improvements for 

Patients and Providers Act of 2008 (P.L. 110-275) through FY 2011. 
AGING NETWORK SUPPORT ACTIVITIES 

103

Pension Counseling and Information 

The Pension Counseling program 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 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 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 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. 

National Long-Term Care Ombudsmen Resource Center 

The National Long-Term Care Ombudsman Resource Center provides training and technical 

assistance to support the activities of State and local long-term care ombudsmen, which are 

carried out under the Protection of Vulnerable Older Americans Program. The Center works to 

enhance the skills, knowledge and management capacity of the State-wide ombudsman programs 

to enable them to handle residents‘ complaints and represent residents‘ 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. 
AGING NETWORK SUPPORT ACTIVITIES 

104

Among other accomplishments, the Center‘s FY 2009 outcomes included publication and 

distribution of Equipping Long-Term Care Ombudsmen for Effective Advocacy: A Basic 

Curriculum; Self-Evaluation and Continuous Quality Improvement Tools for both State and local 

ombudsman programs; State and local ombudsman training at two national conferences and via 

web-based teleconferences; and continued high utilization (over 40,000 monthly visits) to the 

Center‘s website by ombudsmen, consumers, and agencies. 

National Center on Elder Abuse 

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

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

information to professionals and the public and provides technical assistance and training to States 

and community-based organizations. The NCEA makes available news and resources; collaborates 

on research; provides consultation, education, and training; identifies and provides information about 

promising practices and interventions; answers inquiries and requests for information; operates a 

listserv forum for professionals; and advises on program and policy development. NCEA also 

facilitates the exchange of strategies for uncovering and prosecuting fraud in areas such as 

telemarketing and sweepstakes scams. In FY 2008, the NCEA: 

Continued its outreach by serving over 1,700 subscribers to its newsletter and over 

1,750 members to the Elder Abuse Listserv (an increase of approximately 16 percent over 

FY 2007). 

Launched the first-ever national elder abuse public awareness campaign, broadcasting an 

elder abuse information piece May 22, 2009 through June 18, 2009 in over 700 U.S. movie 

theaters with a potential viewership of over 2 million people. NCEA distributed materials to 

over 650 AAAs and State Units on Aging to help local communities sponsor their own public 

awareness activities in coordination with the national event. 

Responded to over 1,200 individual public inquiries and requests for information. 

Effectively utilized technology to provide cost-effective trainings to over 600 professionals 

though live Webcast forums on issues relevant to elder rights and consumer protection, and 

expanded the NCEA training library to over 230 resources. 

Supported systems change in 20 local elder justice community collaborations with funding, 

training, and technical assistance to leverage local resources and expertise to prevent and 

combat elder abuse, neglect, and exploitation. 

Senior Medicare Patrol (SMP) Program 

The SMP program serves a unique role in the Department‘s fight to identify and prevent health 

care fraud in the Medicare and Medicaid programs. Projects utilize the skills of retired 

professionals as volunteers to conduct community outreach and education and provide toolkits 

that empower beneficiaries and their families to recognize and report suspected cases of 

Medicare and Medicaid 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. 
AGING NETWORK SUPPORT ACTIVITIES 

105

Project training and technical assistance is provided by AoA‘s National Consumer Technical 

Resource Center (Center). The website http://www.smpresource.org is maintained by the Center 

as a gateway to ―one stop‖ current fraud alerts and consumer information, the SMP locator, and 

best practices. A total of 54 SMP projects operate in all States, the District of Columbia, Guam, 

Puerto Rico, and the Virgin Islands. 

OIG collects performance data from the SMP projects semiannually. The most recent report, 

dated May 18, 2009, documented the following program outputs and outcomes for the calendar 

year 2008. Data show SMP projects: 

Maintained 4,685 active volunteers who worked almost 113,000 hours to educate 

beneficiaries about how to prevent Medicare and Medicaid fraud; 

Educated 308,724 beneficiaries in 6,869 group education sessions and held 

24,505 one-on-one counseling sessions; 

Conducted 5,742 community outreach education events and over 785,000 media 

activities; 

Received 40,734 inquiries for information or assistance from beneficiaries and resolved 

over 99 percent; 

Resolved or referred for further investigation over 4,000 complaints of potential fraud, 

error, or abuse from beneficiaries, their families, or caregivers as a result of educational 

efforts; and 

Referred over 10 percent of the complaints of potential fraud, worth over $2,343,000 to 

the Centers for Medicare & Medicaid Services or other entities for further investigation. 

In addition, the OIG reports that since the program‘s inception 12 years ago, SMP projects have:

Educated 2.6 million beneficiaries in 67,491 group education sessions and 

1,008,243 one-on-one sessions; 

Conducted 957,960 media outreach events and 63,147 community outreach education 

events; and 

Documented over $105.72 million in savings, including Medicare and Medicaid funds 

recovered, beneficiary savings, and other savings as attributable to the project as a result 

of beneficiary complaints, which does not attempt to quantify the savings that may occur 

from the SMP program deterring fraud. 
AGING NETWORK SUPPORT ACTIVITIES 

106

Funding History 

Funding for Aging Network Support Activities during the past five years is as follows: 

FY 2006 .................................................... $13,124,000 

FY 2007 .................................................... $13,133,000 

FY 2008 .................................................... $13,694,000 

FY 2009 .................................................... $13,694,000 

FY 2010 .................................................... $13,694,000 

Budget Request 

The FY 2011 budget request for Aging Network Support Activities is $13,694,000, the same as 

the FY 2010 appropriation. 

The FY 2011 request for Aging Network Support Activities focuses on maintaining performance at 

FY 2010 levels for the activities funded with this appropriation. These programs provide critical and 

ongoing support for the national aging services network and continue to be needed to support the 

activities of AoA‘s core service delivery programs. At the current request level AoA‘s commitment 

to maintain FY 2010 service levels is ambitious and will take advantage of management initiatives to 

maximize performance. 

In FY 2011, AoA anticipates that SMP projects will refer $2,750,000 for further action 

(e.g. investigation), an increase of $250,000 over the FY 2010 target (Outcome 1.5). 

In FY 2011, AoA estimates increasing the number of beneficiaries educated to 333,000 over 

FY 2010 projection of 320,000 beneficiaries educated through the Senior Medicare Patrol 

(Output W). 

In addition to the SMP program, the National Eldercare Locator and the Pension Counseling and 

information program will continue to help thousands of seniors and families obtain information and 

assistance in accessing services and benefits. 

In FY 2011, AoA plans to increase the number of Eldercare Locator web contacts to 303,000 nearly 

12 percent over the 2007 performance (Output Y), and 61 percent over the 2005 performance level. 

This projection is expected to be achieved through more efficient use of technology and expanded 

familiarity of the potential service population in seeking assistance through the web. 

Both the National Long-Term Care Ombudsman and the National Elder Abuse Resource Centers 

will continue to provide training and technical assistance for programs that protect the rights of 

vulnerable elders in institutional settings and at home. 
AGING NETWORK SUPPORT ACTIVITIES 

107

Outcome and Outputs Table 

Aging Network Support Activities Outcome and Outputs 

Measure Most Recent 

Result FY 2010 Target FY 2011 Target FY 2011 +/- FY 2010 

1.5: SMP projects will increase the total 

dollar amount referred for further action.

(Outcome)

FY 2008: 

$2,345,299 $2,500,000 $2,750,000 +$250,000

Indicator Most Recent 

Result 

FY 2010 

Projection 

FY 2011 

Projection

FY 2011 

+/- FY 2010 

Output W: Beneficiaries Educated (Output) FY 2008: 

333,229 320,000 333,000 +12,000

Output X: Eldercare Locator calls (Output) FY 2008: 

118,571 121,940 125,000 +3,060

Output Y: Eldercare Locator web contacts

(Output)

FY 2008: 

300,899 298,000 303,000 +5,000

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

Network Support Activities, 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.
108

Program Administration 

FY 2009

Appropriation

FY 2009

Recovery Act

FY 2010

Appropriation

FY 2011

President’s 

Budget 

Request 

FY 2011

+/-

FY 2010

Program Administration ................................ $18,696,000........ -- $19, 979,000 $22,508,000 +$2,529,000

FTE................................................................ 103 ....... -- 108 112 +4

Authorizing Legislation: Section 205 of the Older Americans Act of 1965, as amended 

FY 2011 Authorization................................................................................................ Such Sums 

Allocation Method ................................................................................... Direct Federal/Contract 

Program Description and Accomplishments: 

Program Administration dollars pay for the staffing and administrative costs related to AoA‘s 

programs, including those established under the Older Americans Act (OAA), and section 398 

and Title XXIX of the Public Health Services Act (Alzheimer‘s Disease Supportive Services and 

Lifespan Respite Care). These funds are also used to carry out and support oversight and 

implementation of activities under the Medicare Improvements for Patients and Providers Act 

of 2008 (MIPPA) and the American Recovery and Reinvestment Act (Recovery Act) of 2009. 

AoA‘s mission, as embodied in the OAA, is to develop a comprehensive and cost-effective 

system of services that helps elderly individuals to maintain their independence and dignity in 

their homes and communities. AoA does this by overseeing the development of coordinated 

systems of community-based care in States and localities that are responsive to the needs and 

preferences of older people and their family caregivers. 

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, or 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. 

AoA‘s responsibilities are expanding at the same time that the demand for services under its core 

programs is increasing, reflecting the sharp increases nationally in the numbers of seniors. AoA 

is actively involved in prevention through its Chronic Disease Self-Management program and 

other Evidence-Based Disease Prevention programs; is taking on greater responsibility for 

addressing caregiver and workforce issues through activities such as those under the Lifespan 

Respite Care act; is helping States to transform systems through the expansion of Aging and 

Disability Resource Centers, and is actively establishing new partnerships with a range of 

agencies like the Department of Veterans Affairs and the Department of Housing and Urban 

Development to better address issues related to seniors. In FY 2009 alone, AoA received 
PROGRAM ADMINISTRATION 

109

funding for new programs under the Medicare Improvements for Patients and Provider‘s 

Act (MIPPA) and the Lifespan Respite Care Act, and appropriations for a new Community 

Innovations for Aging in Place program, in addition to increased funding for nutrition programs 

provided by the Recovery Act. 

Over the last decade, however, AoA‘s resources have been stretched to meet growing 

responsibilities. AoA appropriations for Program Administration were relatively flat and lagged 

increases in pay and other expenses. Fixed costs have grown to comprise 93 percent of AoA‘s 

FY 2009 operating budget, leaving AoA little room to make adjustments in the short run to 

address new demands and responsibilities. As a result, to cover steadily increasing fixed costs 

while remaining within its budget, AoA staffing has had to be reduced from 120 FTE in FY 2002 

to 103 FTE in FY 2009. 

The FY 2010 appropriation for AoA took a key first step to address the imbalance between 

resources and responsibilities for Program Administration. This additional funding allows AoA 

to begin to make needed investments in human capital development, information technology 

modernization, and other activities that are critically needed to effectively reach out to citizens, 

promote efficiency and innovation, and provide transparency and accountability. 

Funding History 

Comparable funding for Program Administration during the past five years is as follows: 

FY 2006 ............................................... $17,688,000 113 FTE 

FY 2007 ............................................... $18,379,000 112 FTE 

FY 2008 .............................................. $18,064,000 106 FTE 

FY 2009 .............................................. $18,696,000 103 FTE 

FY 2010 .............................................. $19,979,000 108 FTE 

Budget Request 

The FY 2011 request for Program Administration is $22,508,000 an increase of +$2,529,000 and 

+4 FTE over the FY 2010 appropriation. 

The FY 2011 request builds upon expected FY 2010 progress towards addressing critical 

administrative resources to AoA. The FY 2011 request includes funding for pay raises and 

inflation to allow the agency to maintain its staffing level in the face of rising costs. FTE usage 

is expected to rise from 108 FTE to 112 FTE, reflecting the annualization of hiring begun in 

FY 2010 and a move towards lower cost, entry-level grades where possible for new hires. 

However, the majority of the additional resources requested for Program Administration 

represent pass-throughs required by other agencies, and do not provide AoA with additional 

resources to use to address its growing responsibilities. Specifically, the algorithms used to 

calculate AoA charges for accounting services, e-government and other external services 

provided by DHHS shared service provider organization will change in FY 2011. This will 

result in higher costs for some HHS Operating Divisions and lower costs for others, but will not 
PROGRAM ADMINISTRATION 

110

change the volume nor the nature of the services provided. For AoA, these changes are projected 

to add $950,000 in mandatory costs. In addition, $1,243,000 is needed up front by the General 

Services Administration (GSA) to pay for advance costs associated with lease renewal when 

AoA‘s current Headquarters lease expires in 2012 (e.g., modifying current space or preparing for 

a move should relocation prove necessary). 

Of the additional +$2,529,000: 

$293,000 is necessary to cover the projected FY 2011 pay increase. 

$950,000 would pay for rate changes approved by the Department‘s Service and Supply 

Fund Board for accounting and related Program Support Center (PSC) services. 

$1,243,000 is included to pay the General Services Administration for the initiation of the 

AoA Headquarters office relocation, which cannot begin until these resources have been 

made available. This cost planned for FY 2011 is approximately half of the required 

$2,500,000 needed to execute a lease that allows either for AoA‘s relocation, or for 

down-sizing at the existing location, by the expiration of the current lease; and, 

$43,000 will be used for non-pay inflation, including higher rent costs, and for cost 

increases in travel, contracts and external services. 

The aging population will continue to surge in the coming years. For AoA to effectively address 

this population‘s needs while also advancing the Administration‘s goals of innovation, 

transparency and accountability, it must receive these increases in administrative resources. 

HHS Enterprise Information Technology and Government-Wide E-Gov Initiatives: 

The AoA will use $276,437 of its FY 2011 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. 
PROGRAM ADMINISTRATION 

111

Of the amount specified above, $111,107 is allocated to developmental government-wide 

E-Government initiatives for FY 2011. This amount supports these government-wide 

E-Government initiatives as follows: 

FY 2011 Developmental E-Gov Initiatives1 Amount

 Line of Business - Human Resources $232

 Line of Business - Grants Management $5,751

 Line of Business - Financial $6,021

 Line of Business - Budget Formulation and Execution $4,000

 Disaster Assistance Improvement Plan $95,103

FY 2011 Developmental E-Gov Initiatives Total $111,107

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. HHS has been selected as a Center of Excellence and will be leveraging its HR 

investments to provide services to other Federal agencies. 

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 

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. 

Disaster Assistance Improvement Plan (DAIP): The DAIP, managed by Department of 

Homeland Security, assists agencies with active disaster assistance programs such as HHS to 

reduce the burden on other federal agencies which routinely provide logistical help and other 

critical management or organizational support during disasters. 

 

1

 Specific levels presented here are subject to change, as redistributions to meet changes in resource demands are 

assessed. 
PROGRAM ADMINISTRATION 

112

In addition, $142,094 is allocated to ongoing government-wide E-Government initiatives for 

FY 2011. This amount supports these government-wide E-Government initiatives as follows: 

FY 2011 Ongoing E-Gov Initiatives1 Amount

 Grants.Gov $138,136

 Integrated Acquisition Environment $3,958

FY 2011 Ongoing E-Gov Initiatives Total $142,094

HHS FY 2011 OMB Circular A-11, Exhibit 300: Capital Asset Plan and Business Case 

Summaries can be found at http://it.usaspending.gov/. AoA does not have an Exhibit 300. 

 

1

 Specific levels presented here are subject to change, as redistributions to meet changes in resource demands are 

assessed. 
113

PAGE INTENTIONALLY LEFT BLANK 
114

Budget Authority by Object 

Administration on Aging 

FY 2011 Budget Submission 

(Dollars in Thousands) 

Object Class

FY 2010

Estimate 1/

FY 2011 

Estimate

Increase or 

Decrease

Personnel Compensation:

Full-time Permanent (11.1) ................................................ 10,854 11,253 399 

Other than Full-Time Permanent (11.3) .............................. 309 327 18 

Other Personnel Compensation (11.5) ................................ 305 321 16 

Military Personnel (11.7) ................................................... -- -- --

Subtotal, Personnel Compensation...................... 11,468 11,901 433

Personnel Benefits (12.1)....................................................... 2,671 2,820 149 

Military Benefits (12.2) ......................................................... -- -- --

Total, Pay Costs....................................................... 14,139 14,721 582

Travel and Transportation of Persons (21.0) ........................... 283 287 4 

Transportation of Things (22.0).............................................. 25 25 -- 

Rental Payments to GSA (23.1).............................................. 1,710 1,734 24 

Communications, Utilities, and Miscellaneous (23.3).............. 226 229 3 

Printing and Reproduction (24.0) ........................................... 14 14 -- 

Other Contractual Services:

Advisory and Assistance Services (25.1) ............................ 11,652 19,815 8,163 

Other Services (25.2)......................................................... 69 70 1 

Purchases from Government Accounts (25.3) ..................... 4,617 10,531 5,914 

Operation and Maintenance of Equipment (25.7). ............... 41 42 1 

Subtotal, Other Contractual Services ................. 16,379 30,458 14,079

Supplies and Materials (26.0)................................................. 47 65 18 

Equipment (31.0)................................................................... 8 15 7 

Grants, Subsidies and Contributions (41.0)............................. 1,483,466 1,577,185 93,719 

Total, Non-Pay Costs............................................... 1,502,158 1,610,012 107,854

Total, Budget Authority by Object Class ................... 1,516,297

 

1,624,733

 

108,436 

 

1/ FY 2010 does not include funds appropriated under the American Recovery and Reinvestment Act. 
115

Salaries and Expenses 

Administration on Aging 

FY 2011 Budget Submission 

(Dollars in Thousands) 

Object Class

FY 2010

Estimate 1/

FY 2011

Estimate

Increase or 

Decrease

Personnel Compensation: 

Full-time Permanent (11.1) ......................................... 10,854 11,253 399 

Other than Full-Time Permanent (11.3)....................... 309 327 18 

Other Personnel Compensation (11.5) ......................... 305 321 16 

Military Personnel (11.7) ............................................ -- -- -- 

Subtotal, Personnel Compensation ....................... 11,468 11,901 433

Personnel Benefits (12.1)................................................ 2,671 2,820 149 

Military Benefits (12.2)................................................... -- -- -- 

Total, Pay Costs ........................................................ 14,139 14,721 582

Travel and Transportation of Persons (21.0).................... 283 287 4 

Transportation of Things (22.0)....................................... 25 25 -- 

Communications, Utilities, and Miscellaneous (23.3) ...... 226 229 3 

Printing and Reproduction (24.0) .................................... 14 14 -- 

Other Contractual Services:

Advisory and Assistance Services (25.1) ..................... 11,652 19,815 8,163 

Other Services (25.2) .................................................. 69 70 1 

Purchases from Government Accounts (25.3).............. 4,617 10,531 5,914 

Operation and Maintenance of Equipment (25.7)......... 41 42 1 

Subtotal, Other Contractual Services................... 16,379 30,458 14,079

Supplies and Materials (26.0).......................................... 47 65 18 

Total, Non-Pay Costs ................................................ 16,974 31,078 14,104

Total, Salaries and Expenses........................................ 31,113

 

45,799

 

14,686

Direct FTE ....................................................................

 

108 

 

112 

 

4 

 

1/ FY 2010 does not include funds appropriated under the American Recovery and Reinvestment Act. 
116

Detail of Full Time Equivalent Employment (FTE) 

Administration on Aging 

FY 2011 Budget Submission 

2009

Actual 

Civilian

2009

Actual 

Military

2009

Actual 

Total 

2010

Est. 

Civilian

2010

Est. 

Military

2010

Est. 

Total

2011

Est. 

Civilian

2011

Est. 

Military

2011

Est. 

Total

Immediate Office of the 

Assistant Secretary.............................................

Direct............................................................. 12 12 15 15 15 15

Reimbursable .................................................

Total .............................................................. 12 12 15 15 15 15

Center for Policy and 

Management ......................................................

Direct............................................................. 32 1 33 35 35 38 38

Reimbursable. ................................................

Total .............................................................. 32 1 33 35 35 38 38

Center for Program 

Operations.........................................................

Direct............................................................. 25 25 25 25 26 26

Reimbursable ................................ 2 ................. 2 2 2 2 2

Total .............................................................. 27 27 27 27 28 28

Office of Regional 

Operations.........................................................

Direct............................................................. 26 26 26 26 26 26

Reimbursable ................................ 5 ................. 5 5 5 5 5

Total .............................................................. 31 31 31 31 31 31

AoA FTE Total................................ 102 ................. 1 103 108 0 108 112 0 112

Centers for Policy and Management and Program Operations: The increase of 4 FTE in FY 2011 is needed to 

ensure that AoA is efficiently staffed to manage the rising demand for services under its core programs, reflecting the 

sharp increases nationally in the numbers of seniors, as well as to accommodate AoA's growing involvement within and 

outside the Department in reform of health and long-term care issues. 

Average

GS Grade 1/

2006 ......................................................................... 12.4

2007 ......................................................................... 12.5

2008 ......................................................................... 12.9

2009 ......................................................................... 13.0

2010 ......................................................................... 12.9

 

1/ The average GS grade reflects a mathematical average of the number of positions at each grade level, not grade and 

step. 
117

Detail of Positions 

Administration on Aging 

FY 2011 Budget Submission 

2009

Actual

2010

Estimate

2011

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 1/ $99,000 $190,000 $193,900 

ES-6 ..........................................................

ES-5 ..........................................................

ES-4 ..........................................................

ES-3 .......................................................... 1 1 1

ES-2 ..........................................................

ES-1 .......................................................... 2 2 2

Subtotal ................................................ 3 3 3

 Total - ES Salary

 

$597,800 

 

$602,000 $614,500 

GS-15........................................................ 21 22 22

GS-14........................................................ 14 15 15

GS-13........................................................ 42 42 42

GS-12........................................................ 8 8 8

GS-11........................................................ 5 5 7

GS-10........................................................ 1 1 1

GS-9.......................................................... 4 8 10

GS-7.......................................................... 2 2 2

GS-6.......................................................... 1 1 1

Subtotal ................................................. 98 104 108

 Total - GS Salary

 

$13,312,200 

 

$14,287,000 

 

$15,155,600 

Average ES Level...................................... 1.7 1.7 1.7

Average ES Salary..................................... $199,267 $200,667 $204,833 

Average GS Grade 2/................................. 13.0 12.9 12.8

Average GS Salary .................................... $135,839 $137,375 $140,330 

 

1/ The Executive Level salary for FY 2009 is stated at the actual lower level due to the position being vacant during 

the transition period. 

2/ The average GS grade reflects a mathematical average of the number of positions at each grade level within the 

Agency. 

Note: This table does not reflect Commissioned Corps FTE. 
118

Programs Proposed for Elimination 

AoA has no programs proposed for elimination. 
119

PAGE INTENTIONALLY LEFT BLANK 
120

Significant Items in House and Senate Appropriations Committee Reports 

FY 2010 House of Representatives Appropriations Committee Report Language 

(House Report 111-220) 

Item 

Nutrition Services - The Older Americans Act provides States with significant flexibility to 

transfer funds between Home-Delivered and Congregate Nutrition Services to meet the varying 

demands for nutrition services in different States. The Older Americans Act also provides States 

flexibility to transfer funds between Nutrition Services programs and Home and 

Community-Based Supportive Services. This allows States with a higher demand for congregate 

meals to also provide transportation services to meal sites. The Committee recognizes this need 

for flexibility. In order to get a more accurate sense of the demand for different services, the 

Committee requests AoA to include in future Congressional budget justifications the actual 

amount obligated by States for Home Delivered Nutrition Services, Congregate Nutrition 

Services, and Home and Community-Based Supportive Services, including transfers between 

programs. (p. 181)

Action taken or to be taken 

AoA has addressed the report by providing information in the Health and Independence 

Summary. 

Item 

Community Innovations for Aging in Place — Within the funds provided, the Committee 

includes $8,000,000 for the Community Innovations for Aging in Place program, which is 

$3,000,000 more than the fiscal year 2009 funding level and the budget request. This funding 

will provide grants to community-based organizations for model aging in place initiatives, such 

as the coordination and delivery of services to elderly residents living in naturally occurring 

retirement communities. The Committee encourages AOA to ensure that these initiatives are 

coordinated with existing programming under the Older Americans Act, including Aging and 

Disability Resource Centers, Nursing Home Diversion, and Evidence-Based Prevention 

activities. (p. 181-182)

Action taken or to be taken 

The Older Americans Act envisions for AoA and the Aging Services Network to assist older 

Americans in their efforts to remain safely in their own homes and communities. The 

Community Innovations for Aging in Place (CIAIP) program provides AoA the opportunity to 

support innovative community based efforts designed to implement that vision at the local level. 

 During FY 2009 AoA funded fourteen local CIAIP grants and a technical assistance resource 

center to support their efforts. The fourteen grants, in line with Congressional intent, represent a 

diverse array of initiatives including the creative delivery of services to elders living in naturally 

occurring retirement communities. Funded projects indicate a clear understanding of the 

importance of program coordination with Area Agencies on Aging, Aging and Disability 

Resource Centers, and Evidence-Based Prevention activities. AoA notes that the final 

appropriation for CIAIP was $5,000,000, not $8,000,000. 
SIGNIFICANT ITEMS IN HOUSE AND SENATE 

APPROPRIATIONS COMMITTEE REPORTS 

121

FY 2010 Senate Appropriations Committee Report Language (Senate Report 111-66) 

Item 

Civic Engagement - The Committee strongly supports the multigenerational and civic 

engagement activities authorized under section 417 of the Older Americans Act. The Committee 

is aware of a program using older volunteers as tutors that has significantly improved the reading 

skills of students, as well as improved the mental and physical health of volunteers. The 

Committee encourages AoA to continue its work in advancing the field of civic engagement for 

older Americans by partnering with organizations with proven experience in creating innovative 

opportunities for older Americans to serve their communities. (p. 154) 

Action taken or to be taken 

AoA strongly supports civic engagement programs designed to expand volunteer opportunities 

for older individuals and continues to fund a three-year national Multi-Generational and Civic 

Engagement (MGCE) Initiative through the National Council on Aging (NCOA). The purpose 

of the initiative is to discover, document, and support existing exceptional locally-developed 

program models and volunteer engagement strategies using volunteers who serve one of three 

target populations: 

a) Older relatives caring for grandchildren; 

b) Families of children with special needs; and 

c) Caregivers of frail elderly. 

Local groups funded under this initiative must demonstrate an exceptional locally-developed 

program model with a significant volunteer engagement strategy that is sustainable and 

replicable in other communities. 

Nineteen local grants have been awarded. Through the Memorandum of Understanding with the 

Corporation for National and Community Service, twelve Volunteers in Service to America 

(VISTA) volunteers are supporting six of these grantees. We plan to meet with the Corporation 

for National and Community Service to discuss further collaboration opportunities. 

Technical assistance is offered to local grantees through site visits, Webinars assistance, 

meetings, performance monitoring and assessment, and evaluation. 

A three-day meeting was held in February 2009 for all the MGCE grantees, national 

collaborating organizations, and key technical and expert facilitators. The meeting reinforced 

common program expectations, grant requirements, measures of success, and built a sense of 

MGCE ―community‖ and network exchange. 

In July 2009, AoA also partnered with the National Council on Aging (NCOA) and the National 

Association of Area Agencies on Aging (n4a) for a workshop ―Taking a Fresh Look at 

Volunteers.‖ The keynote speaker addressed the Kennedy Serve America Act and the 

implications for an aging America, while leadership from the AoA, n4a and NCOA spoke about 

their roles in civic engagement and volunteerism. AoA and NCOA also organized a conference 

workshop: ―Model Approaches for Volunteer Engagement: Building Your Local Capacity.‖
SIGNIFICANT ITEMS IN HOUSE AND SENATE 

APPROPRIATIONS COMMITTEE REPORTS 

122

Next steps include synthesis and dissemination of best practices and setting the stage for 

widespread replication of the most promising models, using strategies and on-line tools grounded 

in diffusion of innovations theory and practice. 

Item 

Older Adults and Mental Health - The Committee recognizes that older adults are among the 

fastest growing subgroups of the U.S. population. Approximately 20 to 25 percent of older adults 

have a mental or behavioral health problem. Older white males (age 85 and over) currently have 

the highest rates of suicide of any group in the United States. The Committee acknowledges the 

importance of addressing the mental and behavioral health needs of older adults and encourages 

AoA 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. (p. 155)

Action taken or to be taken 

AoA is an active partner with the Substance Abuse and Mental Health Services Administration 

(SAMHSA), including through the SAMHSA Mental Health Transformation initiative. Through 

this initiative AoA actively participates in the Federal Executive Steering Committee, the Federal 

Partner Senior Workgroup, the Suicide Prevention Workgroup, and the Rural Mental Health 

Workgroup. In addition, through our Evidence-Based Disease Prevention programs, AoA has 

encouraged States and Area Agencies on Aging to use evidence-based mental health prevention 

interventions including Healthy IDEAS, an evidence-based depression screening and prevention 

program. State plan guidance developed by AoA for FY 2011, 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. 

Item 

Transportation - The Committee is aware of the rapidly growing need for transportation services 

for older Americans. In order to expand resources to meet this need, the Committee encourages 

AoA to fund section 416 of the Older Americans Act. Such funding could support successful, 

entrepreneurial models of economically sustainable transportation that supplement publicly 

funded services by accessing private resources and voluntary local community support, and that 

do not rely on Federal or other public financial assistance after 5 years. (p. 155)

Action taken or to be taken 

While section 416 of the Older Americans Act was not funded in FY 2010, AoA recognizes the 

importance of supporting and fostering innovation in serving older consumers and their 

caregivers. Since 2004, AoA has been a key partner in the United We Ride initiative, to promote 

the participation of the Aging Services Network in the coordination of transportation services at 

the State and local levels. AoA has provided guidance to State Units on Aging in the 

development of their State plans on aging and have encouraged their describing coordination 

activities and discussions with State and local entities. 
SIGNIFICANT ITEMS IN HOUSE AND SENATE 

APPROPRIATIONS COMMITTEE REPORTS 

123

AoA continues to be involved in United We Ride and is taking a leadership role in the new 

Health, Wellness, and Transportation workgroup. This workgroup focuses on ensuring that 

1) transportation is not a barrier for transportation-disadvantaged populations seeking to access 

their health care, general health, and wellness needs (i.e. preventive care, hospitals, nutritional 

resources, and exercise); and 2) transportation options provide these populations the mobility 

that keeps them active and healthier, and therefore out of expensive nursing home care and acute 

treatment. 

AoA has also been closely involved in the development and ongoing operation of the National 

Center on Senior Transportation (NCST) (http://www.seniortransportation.net), a Technical 

Assistance center funded by the Federal Transit Administration and administered by Easter Seals 

Project Action and the National Association of Area Agencies on Aging. One of the major 

activities of the NCST has been the funding of demonstration grants to promote innovations in 

the coordination and delivery of transportation services to older adults and their caregivers. 

Item 

Alzheimer’s Disease Demonstration Grants to States - The Committee recommends a funding 

level of $11,464,000 for Alzheimer‘s disease demonstration grants to States, which is the same 

as the comparable fiscal year 2009 level and the administration request. This program provides 

competitively awarded matching grants to States to encourage program innovation and 

coordination of public and private services for individuals with Alzheimer‘s disease and their 

families. The Committee urges the AoA to continue this program with a focus on early 

intervention and chronic care management, particularly among underserved populations. (p. 156)

Action taken or to be taken 

AoA continues to expand the availability of coordinated supportive services for persons with 

Alzheimer‘s disease and their families. In FY 2008 and 2009, 44 cooperative agreements were 

awarded to States to deliver evidence-based and innovative care coordination for persons with 

Alzheimer‘s disease and their families through the Aging Services Network, community-based 

organizations, and institutions of higher education partnerships. In particular, AoA awarded 

innovation grants for supportive services that enable individuals with Alzheimer‘s disease to 

remain in the community longer, promote early intervention and chronic care management, and 

enhance the ability of state systems to provide effective and cost-efficient supportive services for 

persons with Alzheimer‘s disease and their families. A key focus of the evaluation criteria for 

awarding Alzheimer‘s disease supportive services grants is reaching underserved and 

culturally-diverse populations. 

In FY 2010, grants will expand the repertoire of evidence-based and innovative Alzheimer‘s 

disease interventions, particularly those that promote early intervention and chronic care 

management, and promote the embedding of successful interventions into State health and 

long-term care services and supports across the country. 
SIGNIFICANT ITEMS IN HOUSE AND SENATE 

APPROPRIATIONS COMMITTEE REPORTS 

124

Item 

Lifespan Respite Care - The Committee recognizes the essential role of family caregivers who 

provide a significant proportion of our Nation‘s health and long-term care for the chronically ill 

and aging. Respite care can provide family caregivers with relief necessary to maintain their own 

health, bolster family stability and well-being, and avoid or delay more costly nursing home or 

foster care placements. The Committee urges AoA to ensure that State agencies and Aging and 

Disability Resource Centers use the funds to serve all age groups, chronic conditions and 

disability categories equitably and without preference. (p. 156)

Action taken or to be taken 

In implementing the Lifespan Respite Care Program in FY 2009, AoA has carefully considered 

the requirements of the Lifespan Respite Care Act as well as Congressional intent as specified in 

the Committee Report accompanying the authorizing statute. Both the Act and Committee 

Report were consulted in the development of the Program Announcement, especially where 

service to all age groups, chronic conditions and disability categories was concerned. To help 

ensure that State agencies and Aging and Disability Resource Centers use the funds to serve all 

age and disability groups, AoA employed the following strategies in FY 2009 and will continue 

to employ these strategies in FY 2010 and beyond: 

First, applications from eligible State agencies are minimally required to: 

1. Demonstrate the support and active involvement of a range of government and 

non-government, private, nonprofit and other organizations with a stake in serving 

all populations eligible to receive services under the Lifespan Respite Care Act; 

2. Demonstrate thorough understanding of the population to be served, including 

knowledge of the family caregiver population for whom lifespan respite program 

services are to be provided, or for whom respite care workers and volunteers will 

be recruited and trained; 

3. Demonstrate stakeholder collaboration and full implementation. Successful 

applications must demonstrate the broadest possible collaboration with relevant 

respite stakeholders from across the age and disability spectrum. Further, 

applicants must propose a program that immediately addresses the respite needs 

of all ages and special needs categories. No phase-in or preferences for age 

groups or disability categories are permitted. 

Second, grantees will be monitored via semi-annual and annual reports as well as through 

ongoing communication with the AoA Program Officer to ensure the required elements outlined 

above are being fulfilled. Additionally, AoA facilitates regular email and telephone 

communications with the individual grantees and the group to share information and strategies. 

Finally, AoA recognizes the critical importance of providing technical assistance to both the 

grantees as well as States yet to be funded under the Lifespan Respite Program. To that end, 

AoA has a Cooperative Agreement with the Family Caregiver Alliance in San Francisco with a 
SIGNIFICANT ITEMS IN HOUSE AND SENATE 

APPROPRIATIONS COMMITTEE REPORTS 

125

sub-contract to the ARCH National Respite Center to develop training and materials on a range 

of issues associated with Lifespan Respite Care Program development and implementation.