DEPARTMENT

of HEALTH

and HUMAN

SERVICES

ADMINISTRATION 

ON AGING

ADMINISTRATION FOR 

COMMUNITY LIVING

FY 2012 Report to Congress
ii
FROM THE ADMINISTRATION ON AGING

All Americans, regardless of age and disability, should be able to live with dignity, make their 

own choices, live at home with the supports they need, and participate fully in communities that 

value their contributions. To help meet these needs, during 2012 the U.S. Department of Health 

and Human Services (HHS) created the Administration for Community Living (ACL).

ACL brings together the efforts and achievements of the Administration on Aging (AoA), the 

Administration on Intellectual and Developmental Disabilities (AIDD), and the HHS Office on 

Disability to serve as the federal agency responsible for increasing access to community 

supports, while focusing attention and resources on the unique needs of older Americans and 

people with disabilities across the lifespan.

As part of this important mission, I am pleased to present AoA’s Report to Congress for Fiscal 

Year (FY) 2012. AoA advances the concerns and interests of older people, whether living in 

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

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

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

and their caregivers. 

The national aging services network is comprised of 56 state and territorial units on aging 

(SUA), including 53 state long-term care ombudsman programs, 629 area agencies on aging 

(AAA), 256 Indian tribal and Native Hawaiian organizations, nearly 20,000 direct service 

providers, and hundreds of thousands of volunteers. AoA’s core programs, authorized under the 

Older Americans Act (OAA), help seniors remain at home for as long as possible and advocate 

for quality of care and promotion of rights for individuals who live in long-term care facilities 

(nursing homes, board and care, assisted living and similar settings). These services complement 

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

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

bathing or preparing food. AoA and the national aging services network annually serve more 

than 12.7 million Americans aged 60 and over and their caregivers. 

An estimated 61 million older adults age 60 and over resided in the U.S. in 2012.

1

 By 2030,

when the last of the baby boomers turn age 65, twenty percent of the population, or one in five 

Americans will be age 65 or over.2 During this period, the number of seniors with severe 

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

April 1, 2010 to July 1, 2012. Source: U.S. Census Bureau, Population Division. 

http://www.census.gov/popest/data/national/asrh/2012/index.html. Estimates for U.S. Territories are taken from 

U.S. Census. International Data Base (IDB). 

<http://www.census.gov/population/international/data/idb/informationGateway.php> 2 Table 12. Projections of the Population by Age and Sex for the United States: 2010 to 2050 (NP2008-T12). 

Source: Population Division, U.S. Census Bureau. 

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

iii

 
disabilities who are at greatest risk of nursing home admission will increase substantially. As 

these baby boomers age, the ranks of the oldest old (age 85+) will continue to swell.

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

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

government expenditures in areas such as Medicaid.3 Several state efforts to measure the impact 

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

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

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

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

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

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

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

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

providing this care could fall upon already overtaxed government resources.

The goal of the OAA and AoA is to ensure that older Americans have the opportunity to live 

independently, with dignity, in their homes and communities for as long as they are able to do so. 

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

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

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

Kathy Greenlee

Assistant Secretary for Aging

Administrator, Administration for Community Living

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

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

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

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

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

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

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

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

iv

 
Table of Contents

 Page 

Number

 

Introduction iii

Executive Summary 3

• National Program Data on Services Provided 6

 

Part I: Health and Independence 8

• Home and Community-Based Supportive Services 8

• Nutrition Services 11

• Preventive Health Services 15

• Chronic Disease Self-Management Program 18

• Behavioral Health 19

• Caregiver Services 21

• National Family Caregiver Support Program 22

• Lifespan Respite Care 24

• Alzheimer’s Disease Supportive Services Program 28

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

• Nutrition and Supportive Services 30

• Caregiver Support Services 31

Part III: Protection of Vulnerable Older Americans 33

• Prevention of Elder Abuse & Neglect 34

• Elder Abuse Prevention Intervention Programs 36

• Model Approaches to Statewide Legal Assistance Systems 37

• National Legal Assistance and Support Projects 39

• Pension Counseling and Information 40

• Senior Medicare Patrol Program 42

• Health Care Fraud and Abuse Control 43

• Long-Term Care Ombudsman Program 45

Part IV: Supporting the National Aging Services Network 54

• Aging and Disability Resource Centers 54

• Aging Network Support Program Activities 57

Appendix: Formula Grant Funding Allocation by 61

 State, Territory and Tribal Organization
2
EXECUTIVE SUMMARY

The mission of the Administration on Aging (AoA), an agency within the Administration 

for Community Living (ACL) of the U.S. Department of Health and Human Services 

(DHHS), is to lead and support a comprehensive, coordinated and cost-effective system 

of home and community-based services. AoA advances the concerns and interests of 

older people, and works with and through the national aging services network, which is 

comprised of 56 state and territorial units on aging (SUA), 629 area agencies on aging 

(AAA), 254 tribal organizations, two Native Hawaiian organizations, nearly 20,000 direct 

service providers and hundreds of thousands of volunteers, to meet the needs and 

preferences of older Americans and their caregivers. 

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

keep their loved ones at home for as long as possible. These services complement efforts 

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

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

These programs also support family caregivers, address issues of exploitation, neglect 

and abuse of older adults, and adapt services to the needs of Native Americans. The most 

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

12.7 million elderly individuals age 60 and over (over 20 percent of the country’s elderly 

population) and their caregivers, including nearly three million clients who received 

intensive in-home services.4

 Critical supports, such as respite care and a peer support 

network, were provided to nearly 870,000 caregivers.

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

guided by a set of core values in developing and carrying out its mission. These values 

include listening to older people, their family caregivers, and AoA partners who serve 

them; responding to the changing needs and preferences of our increasingly diverse and 

rapidly growing elderly population; producing measurable outcomes that significantly 

impact the well-being of older people and their family caregivers; and valuing and 

developing AoA staff.

Overview of Performance 

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

that the national aging services network actively participate in supporting communitybased services with particular attention to serving economically and socially vulnerable 

elders, led AoA to focus on three measures of performance: 1) improving efficiency; 

2) improving client outcomes; and 3) effectively targeting services to vulnerable elder 

populations. Each measure is representative of several activities across OAA programs,

and progress towards achieving each measure is tracked using a number of indicators. 

The efficiency measure and corresponding indicators are reflective of the Office of 

Management of Budget (OMB) requirements to measure efficiency for all program 

4 Data from AoA’s FY 2012 State Program Report are preliminary and should not be taken as final.

3

 
activities. The client outcome measure includes indicators focusing on consumer 

assessment of service quality and outcome indicators focusing on nursing home 

predictors, successful caregiver program operation and protection of the vulnerable 

elderly. The targeting measure and indicators focus on ensuring that states and 

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

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

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

An analysis of AoA’s performance trends shows that through FY 2012, most outcome 

indicators have steadily improved and demonstrate that services are continuing to be 

effective in helping older persons remain at home. Some key successes are indicative of 

the potential of AoA and the national aging services network to meet the challenges 

posed by the growth of the vulnerable older adult population, the changing care 

preferences of aging baby boomers, the fiscal difficulties faced by federal and state 

budgets, and the expanding needs of both older Americans and their caregivers. Below 

are some examples of these successes: 

• OAA programs help older Americans with severe disabilities remain 

independent and in the community: Older adults who have three or more 

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

placement. Measures of the national aging services network’s success at serving this 

vulnerable population is a proxy for success at nursing home delay and diversion. In 

FY 2003, the national aging services network served home-delivered meals to 

280,454 clients with three or more ADL impairments. By FY 2012, that number has 

grown by 30 percent to 365,000 clients.5 Another approach to measuring AoA’s 

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

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

Performance Outcomes Measurement Project (POMP) which develops and tests 

performance measures. The components include such items as the percent of clients 

who are transportation disadvantaged and the percent of congregate meal clients who 

live alone. As the score increases, the prevalence of nursing home predictors in the 

OAA service population increases. In 2003, the nursing home predictor score was 

46.57. Preliminary data indicate it has increased to 62.53 in FY 2012, which exceeds 

the program performance target score of 62.00. 

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

quality services to the neediest elders and doing so in a very prudent and costeffective manner. Over the past decade, the number of clients served per million 

dollars of OAA Title III funding has increased significantly. During FY 2012, the 

national aging services network served 9,980 people per million dollars of OAA Title 

III funding. Since this measure’s introduction in FY 2005, AoA and the national 

aging services network have met or exceeded efficiency targets. 

5 Data from AoA’s FY 2012 State Program Report are preliminary and should not be taken as final.

4

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

intent to “encourage and assist state agencies and area agencies on aging to 

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

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

This is evident in the leveraging of OAA funds with state/local or other funds (over

$3 in other funds for every dollar of OAA funds expended), as well as in the 

expansion of projects such as the Aging and Disability Resource Center (ADRC) 

initiative, 509 ADRC sites have been established across 52 states, territories, and 

Washington, DC.

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

their independence and they express a high level of satisfaction with these 

services. In 2012, 97 percent of homemaker services clients reported that the services

help them to continue living at home and transportation clients use the service to 

travel to critical appointments such as healthcare appointments (70 percent).6

 Over 

90 percent of clients across all services are satisfied with OAA services. For 

example, over 97 percent of transportation clients rated services good to excellent and 

96 percent of caregivers rated services good to excellent. To help ensure the 

continuation of these trends in core programs, AoA uses its discretionary funding to 

test innovative service delivery models for state and local program entities that show 

promise for generating measurable improvements in program activities. For example, 

AoA has worked with the Centers for Medicare & Medicaid Services (CMS) and the 

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

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

Disability Resource Centers. 

The tables on the next page provide a summary of the persons served during FY 2012

through the OAA’s programs. Additionally, a listing of grant funding allocations by 

state, territory and tribal organization can be viewed in the Appendix.

6 2012 National Survey of Older Americans Act Participants. http://www.agid.acl.gov,

5

 
FY 2012 National Program Services Summary Report7

FY 2012

Total Clients 12,704,557

Total Registered Clients 2,855,661

% Minority Clients 25.82%

% Rural Clients 36.87%

% Clients Below Poverty 29.95%

# Senior Centers 10,000 (5,678 receive OAA funding)

Service Persons 

Served

Units of 

Service8

Title III 

Expenditure

Total 

Expenditure

Personal Care 108,213 14,882,605 $11,630,184 $272,404,419

Homemaker 148,692 13,125,230 $25,658,650 $258,921,820

Chore 34,387 933,638 $5,133,308 $19,608,152

Home Delivered 851,632 137,411,560 $235,586,439 $786,976,426

Adult Day Care 19,269 8,000,089 $10,270,274 $87,100,442

Case Mgt. 452,642 3,982,975 $26,367,636 $265,409,004

Assisted Trans. 31,942 1,159,420 $3,290,182 $14,772,045

Congregate 1,627,434 86,287,771 $278,335,435 $677,572,324

Nutrition 

Counseling

19,269 8,000,089 $1,288,159 $2,559,513

Transportation 24,539,535 $68,809,383 $227,291,764

Legal Assistance 809,721 $24,845,042 $47,686,128

Nutr. Education 2,974,059 $4,188,469 $6,920,008

I&A 12,914,243 $53,873,941 $157,151,739

Outreach 1,690,959 $10,271,347 $21,008,081

Other $84,687,224 $671,616,557

7 Data from AoA’s FY 2012 State Program Report are preliminary and should not be taken as final.

8 Service Units Definitions:

Personal Care = 1 Hour

Homemaker = 1 Hour

Chore = 1 Hour 

Home-Delivered Meal = 1 Meal. 

Adult Day Care/Adult Day Health = 1 Hour 

Case Management = 1 Hour 

Assisted Transportation = 1 One Way Trip 

Congregate Meal = 1 Meal

Nutrition Counseling = 1 session per participant

Transportation = 1 One Way Trip

Legal Assistance = 1 hour

Nutrition Education = 1 session per participant

Information and Assistance = 1 Contact

6

 
Caregivers Serving Elderly Individuals

Service Caregivers 

Served

Service 

Units9

Title III 

Expenditure

Total 

Expenditure

Counseling, Support Groups, Training 127,933 451,797 $18,375,637 $26,674,741

Respite 64,975 6,009,218 $46,322,757 $93,964,821

Supplemental 

Services 33,664 699,749 $10,918,213 $15,072,966

Access 

Assistance 601,635 1,021,321 $25,584,554 $37,191,181

Unduplicated 

Caregivers Provided 

Service or Access

879,868

9 Title III-E service units definition:

Counseling = 1 session per participant

Respite Care = 1 hour

Supplemental services = variable

Access Assistance = 1 contact

7

 
PART I: HEALTH AND INDEPENDENCE

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

older individuals to remain healthy and independent in their homes and communities, 

avoiding more expensive nursing home care. For example, 60 percent of congregate and 

91 percent of home-delivered meal recipients reported that the meals enabled them to 

continue living in their own homes and 53 percent of seniors using transportation services 

rely on them for the majority of their trips to doctors’ offices, pharmacies, meal sites, and 

other critical daily activities that help them to remain in the community.10

Between 2012 and 2020, the number of Americans age 60 and older will increase by 

nearly 16 million older adults, to reach 77 million seniors.

11 During this period, the 

number of seniors age 65 and over with severe disabilities (defined as 3 or more 

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

admission and Medicaid eligibility (through the “spend down” provisions) will increase 

by more than 30 percent.12 AoA’s Health and Independence programs help seniors in 

need maintain their health and independence.

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

individuals and caregivers. AoA’s services are especially critical for the nearly 

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

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

individuals from joining the 1.8 million seniors who live for extended periods of time in 

nursing homes.13 

Home and Community-Based Supportive Services

(Title III-B of OAA; FY 2012: $366,916,000)

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

1973, provides grants to states and territories based on their share of the population age 

60 and over to fund a broad array of services. AoA’s programs, including the HCBSS

program, serve seniors holistically; while each service is valuable in and of itself, it is 

often the combination of supports, when tailored to the needs of the individual that helps

102012 National Survey of Older Americans Act Participants. http://www.agid.acl.gov, select AGID. 11U.S. Census Bureau, “2012 National Population Projections,” Table 1. Projected Population by Single 

Year of Age (0-99, 100+), Sex, Race, and Hispanic Origin for the United States: July 1, 2012 to July 1, 

2060 released December 2012, <

http://www.census.gov/population/projections/data/national/2012/downloadablefiles.html> Accessed 

March 29, 2013. 12 Ibid and Centers for Medicare & Medicaid Services, The characteristics and perceptions of the Medicare 

population (2011) [data table 2.5a]. http://www.cms.gov/Research-Statistics-Data-andSystems/Research/MCBS/Data-Tables-Items/2011CharAndPerc.html . Accessed 25 July,2013. 13 Centers for Medicare & Medicaid Services, The characteristics and perceptions of the Medicare 

population (2011) [data table 1.1]. http://www.cms.gov/Research-Statistics-Data-andSystems/Research/MCBS/Data-Tables-Items/2011CharAndPerc.html. Accessed July 25, 2013.

8

 
older persons remain in their own homes and communities instead of entering nursing 

homes or other types of institutional care.

14 

The services provided to seniors through the HCBSS program include access services 

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

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

adult day care and physical fitness programs. In addition to these services, the HCBSS

program also funds multi-purpose senior centers, which coordinate and integrate services 

for the elderly.

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

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

age. Among those aged 85 and older, 59 percent are unable to perform critical activities 

of daily living and require long-term support15. Data also show that over 90 percent of 

seniors have at least one chronic condition and 75 percent have at least two.16 Providing 

a variety of supportive services that meet the diverse needs of these older individuals is 

crucial to enabling them to remain healthy and independent in their homes and 

communities, and therefore to avoiding unnecessary, expensive nursing home care. 

Services provided by the HCBSS program in FY 2012 include:17

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

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

activities. 

• Personal Care, Homemaker, and Chore Services provided nearly 29 million hours 

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

dressing, or bathing) or instrumental activities of daily living (such as shopping or 

light housework).

• Adult Day Care/Day Health provided 8 million hours of care for dependent adults 

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

day. 

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

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

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

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

population (2011) [data tables 2.1]. http://www.cms.gov/Research-Statistics-Data-andSystems/Research/MCBS/Data-Tables-Items/2011CharAndPerc.html. Accessed 25 July, 2013.

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

population (2011) [data tables 2.5a, 2.6a]. http://www.cms.gov/Research-Statistics-Data-andSystems/Research/MCBS/Data-Tables-Items/2011CharAndPerc.html. Accessed 25 July, 2013. 17 Data from AoA’s FY 2012 State Program Report are preliminary and should not be taken as final.

9

 
• Case Management Services provided nearly 4 million hours of assistance in 

assessing needs, developing care plans, and arranging services for older persons 

or their caregivers. 

Continuing AoA’s commitment to provide services to those in most need, 45 percent of 

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

car or if they do own a car they do not drive, and are not near public transportation.18 

Many of these individuals cannot safely drive a car, as nearly 75 percent of transportation 

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

to navigate safely:19

• 66 percent of riders had a doctor tell them they had vision problems (including 

glaucoma, macular degeneration or cataracts); 

• 6 percent have Alzheimer’s or dementia; 

• 2 percent have Multiple Sclerosis; 

• 16 percent have had a stroke;

• 5 percent have epilepsy; and 

• 2 percent have Parkinson’s disease. 

 

Of the transportation participants, 95 percent take daily medications, while 14 percent 

report taking 10 to 20 medications daily.20 Data from AoA’s national surveys of elderly 

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

information they report helps them to remain at home.21 For example, 80 percent of 

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

case manager they were better able to care for themselves.22 In addition, a study 

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

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

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

Nationally, about 25 percent of individuals 60 and older live alone.24 AoA programs 

serve a disproportionate number of people who live alone compared to the general 

population. For example, 64 percent of transportation clients live alone. Living alone is a 

key predictor of nursing home admission, and HCBSS services are critical for enabling 

them to remain at home, especially for those who do not have an informal caregiver to 

18 Ibid

19 Ibid 20 2012 National Survey of Older Americans Act Participants. http://www.agid.acl.gov, 21 Ibid.

22Ibid. 23 Chen, Ya Mei and Elaine Adams Thompson. Understanding Factors That Influence Success of Homeand Community-Based Services in Keeping Older Adults in Community Settings. 2010. Journal of 

Aging and Health. V. 22: 267. Available: http://jah.sagepub.com/cgi/content/abstract/22/3/267. 24 U.S. Census Bureau; American Community Survey, 2011, Special Tabulation on Aging; generated by 

AoA; using AoA’s Aging Integrated Database (AgID) ; http://www.agid.acl.gov/CustomTables/; 

Accessed July 25, 2013.

10

 
assist with their care. Recent research has also shown that childless seniors who live in a 

state with higher home and community-based service expenditures had significantly 

lower risk of nursing home admissions.25 

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

older American. These programs have strong partnerships with state and local 

governments, philanthropic organizations, and private donations that contribute funding. 

States typically have leveraged resources of $2 or $3 per every OAA dollar, significantly 

exceeding the programs’ match requirements.

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

Spending on Home and Community-Based Services Matter?” May 2007. Journal of Gerontology: 

Psychological Sciences.

11

 
Nutrition Services

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

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

facilities such as senior centers) and via home-delivery to seniors who are homebound 

due to illness, disability, or geographic isolation. Nutrition Services include:

• Congregate Nutrition Services (Title III-C1; FY 2012: $439,070,000): Provides 

funding for the provision of meals and related services in a variety of congregate 

settings, such as senior or community centers, which helps to keep older 

Americans healthy and prevents the need for more costly medical interventions. 

Established in 1972, the program also presents opportunities for social 

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

• Home-Delivered Nutrition Services (Title III-C2; FY 2012: $216,830,000): 

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

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

first in-home service that an older adult receives and serve as a primary access 

point for other home and community-based services. .

• Nutrition Services Incentive Program (Title III-A; FY 2012: $160,389,000): 

Provides additional funding to states, territories, and eligible tribal organizations 

that is used exclusively to provide meals and cannot be used to pay for other 

nutrition-related services or for administrative costs. Funds are awarded to states 

and tribes based on the number of meals served in the prior federal fiscal year. 

States and tribes have the option to purchase commodities directly from the U.S. 

Department of Agriculture (USDA) with any portion of their award if they 

determine that doing so will enable them to better meet the needs of seniors. 

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

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

Intake, as established by the Food and Nutrition Board of the Institute of Medicine of the 

National Academy of Sciences. 

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

need to stay healthy and decrease their risk of disability. Studies have found that 50 

percent of all persons age 85 and over are in need of assistance with instrumental 

activities of daily living (IADLs),

26 including obtaining and preparing food. These 

nutrition programs help address their needs. 

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

States. BMC Geriatrics 2011 11:47.

12

 
Multiple chronic conditions negatively affect quality of life, contribute to declines in 

functioning and the ability to remain in the community, adversely impact individuals’ 

health, and contribute to increased hospitalizations and health care costs.27 Many of the 

most common chronic conditions such as hypertension, heart disease, diabetes, and 

osteoporosis are impacted by nutrition as a primary prevention, risk reduction, or 

treatment modality. Medicare beneficiaries with multiple chronic conditions are the 

heaviest users of health care services. For example, two-thirds of beneficiaries with 2 or 

more chronic conditions account for 93 percent of Medicare spending, and one-third of 

beneficiaries with 4 or more chronic conditions account for almost three-fourths of 

Medicare spending.28

Because the prevalence of multiple chronic conditions is higher among congregate and 

home-delivered meal program participants than for the general Medicare population, the 

provision of healthy meals, access to lifestyle modification programs, and evidence-based 

advice such as nutrition education and counseling are important. Overall, 68.4 percent of 

Medicare beneficiaries have two or more chronic conditions and 36.4 percent had four or 

more chronic conditions.29 Data from AoA’s national survey of older adult participants 

indicate that 47 percent of congregate and 60 percent of home-delivered meal participants 

have six or more illnesses or conditions. About 21 percent of congregate and 39 percent 

of home-delivered participants take over 6 medications per day and some take more than 

20 medications.30 The congregate and home-delivered meal program participants are 

significantly less healthy than the general Medicare population and access to adequate 

healthy meals is essential to their well-being. 

Older adult participants served in the congregate and home-delivered nutrition programs 

demonstrate a need for healthy prepared meals, rather than simply access to food. Data 

from AoA’s national survey of older adult participants indicate that about 16 percent of 

congregate and 60 percent of home-delivered meal participants indicate that they have 

three or more impairments in instrumental activities of daily living (IADLs). The data 

also indicate that about 17 percent of congregate and 58 percent of home-delivered meal 

participants need help in getting outside the house, thus limiting their ability to shop for 

food themselves.31 Although many of these older adults may rely on family and friends 

for assistance, about 46 percent of congregate and 58 percent of home-delivered 

participants live alone.32 Living alone is a risk factor for social isolation, poorer health, 

and nursing home placement.

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

are effectively helping older adults improve their nutritional intake and remain at home. 

27 Lochner KA, Cox CS. Prevalence of Multiple Chronic Conditions among Medicare Beneficiaries, United 

States, 2010. Prev Chronic Dis 2013; 10:120137. DOI http://dix.doi.org/10.5888/pcd10.12037

28 Ibid.

29 Ibid. 30 2012 National Survey of Older Americans Act Participants. http://www.agid.acl.gov. 31 Ibid. 32 Ibid.

13

 
For example, data indicate that 77 percent of congregate and 83 percent of homedelivered meal participants say they eat healthier meals due to the programs, and 60 

percent of congregate and 91 percent of home-delivered meal recipients say that the 

meals enable them to continue living in their homes.33 The extra support provided by 

these programs can help older adults avoid more costly institutional care. Independent 

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

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

adjusting for several other factors.34 For every $25 per year per older adult that states 

spend on home-delivered meals, the state reduces their percentage of low-care nursing 

home residents by 1 percent when compared to the national average.35

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

valued by older individuals who need assistance in order to remain healthy and 

independent in their homes and communities. Ninety percent of home-delivered meal 

clients rate the service as good to excellent. Also, the number of home-delivered meal 

recipients with severe disabilities (3+ Activities of Daily Living) totaled nearly 365,000

in FY 2012. This level of disability is frequently associated with nursing home 

admission, and demonstrates the extreme frailty of a significant number of homedelivered meal clients. The most recent data on how these nutrition programs are 

helping seniors remain healthy and independent in their homes include:

• Home-Delivered Nutrition Services provided 137.4 million meals to over 

850,000 individuals in FY 2012.

• Congregate Nutrition Services provided over 86.3 million meals to nearly 

1.6 million seniors in a variety of community settings in FY 2012.

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

them maintain their health and independence, approximately 72 percent of homedelivered meal recipients have annual incomes at or below $20,000.36 Meals are 

especially critical for the 60 percent of recipients who report that these meals provide half 

or more of their food intake for the day.

37

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

programs have strong partnerships with state and local governments, philanthropic 

organizations, and private donations that contribute funding. In FY 2012, state and local 

funding comprised approximately 65 percent of all the funding for home-delivered meals 

and congregate meals.38 Though all programs funded through the OAA rely on state and 

33 Ibid. 34 Thomas, K & Mor, V. The relationship between Older Americans Act Title III State Expenditures & 

Prevalence of Low-Care Nursing Home Residents. Health Services Research. 12.3.12 

http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12015/abstract 35 Ibid. 36 2012 National Survey of Older Americans Act Participants. http://www.agid.acl.gov 37 Ibid 38 Data from AoA’s FY 2012 State Program Report are preliminary and should not be taken as final.

14

 
local funding in some part, funding for congregate and home-delivered meals leverages 

more state and local financial support than many other OAA services.

State and Territory Flexibility

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

Supportive Services and Nutrition Services, states and territories have the flexibility to 

allocate resources to best meet local needs through intra-state funding formulas which 

distribute funds to area agencies on aging (AAAs). These formulas vary by state and 

allow states to take into account their own local circumstances to best serve their 

population. States are required to submit their formulas to AoA for approval and must 

take into account the geographic distribution of older persons and the distribution of older 

persons in greatest social and economic need. AAAs administers these grants and 

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

The OAA allows a state to transfer up to 40 percent of the funds between congregate and 

home-delivered meals for use as the state considers appropriate to meet the needs of the 

area served. Additionally, for any fiscal year in which the transferred funds are 

insufficient to satisfy the need for nutrition services, the assistant secretary for aging may 

grant a waiver that permits the state to transfer an additional 10 percent of the funds to 

meet those needs. The OAA provides further flexibility to states by allowing them to 

transfer up to 30 percent for any fiscal year between Supportive Services programs and 

Nutrition Services programs, for use as the state considers appropriate. These are options 

open only to states and territories. A state agency may not delegate to an area agency on 

aging or any other entity the authority to make such transfers.

In FY 2012, states transferred over $82 million from congregate nutrition to home and 

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

Table 1. FY 2012 Transfer of Federal funds within Title III of the OAA

Part B –

Home and CommunityBased Supportive Services

Part C1 –

Congregate Nutrition

Part C2 –

Home-Delivered Meals

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

Final Allotment after 

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

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

Net Percent Change 13.83 (18.83) 14.73

Preventive Health Services

(Title III-D of OAA; FY 2012: $20,944,000)

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

territories based on their share of the population aged 60 and over to support activities 

that educate older adults about the importance of healthy lifestyles. These services also 

15
promote healthy behaviors that can help to prevent or delay chronic disease and 

disability, thereby reducing the need for more costly medical interventions. Preventive 

Health Services provide states and territories with the flexibility to allocate resources 

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

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

of the state or who have the greatest economic need. 

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

longer and more active lives. Average life expectancy has increased from less than 50 

years at the turn of the 20th century to over 78 years today. On average an American 

turning age 65 in 2010 can expect to live an additional 19.1 years.39 The population of 

older Americans, particularly the population age 85 and over, which is growing very 

rapidly, totals 5.9 million in 2012 and is projected to reach 8.9 million by the year 2030.40 

One consequence of this increased longevity is the higher incidence of chronic diseases 

such as obesity, arthritis, diabetes, osteoporosis, and depression, as well as the greater 

probability of injury from a fall, which quickly limits physical activity. 

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

support for evidence-based approaches, especially to help individuals manage chronic 

diseases. Since evidence-based programs have demonstrated their effectiveness, AoA

expects that states will be able to maximize the impact of these limited dollars. At the 

same time, if states wish to continue funding other health services, such as health 

screenings, they still have the flexibility to continue to use funds provided under the 

Home and Community-Based Services program for this purpose. 

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

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

behaviors, improve their health status, and reduce their use of hospital services and 

emergency room visits. Some examples of evidence-based interventions are:

• Enhanced fitness and wellness programs: Enhanced fitness is a multi-component 

group exercise program designed for community-based organizations and 

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

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

walking; and balance and posture exercises are used to increase the physical 

health of older adults. Exercise has been proven to improve depression, which 

studies have shown is experienced by nearly 20 percent of U.S. adults age 65 and 

older. Exercise may also act as a buffer against many illnesses impacted by 

stress.

39 National Center of Health Statistics, Health, U.S., 2012: With Special Feature on Emergency Care. Table 

18. Hyattsville, MD 2013.

40U.S. Census Bureau, “2012 National Population Projections,” Table 1. Projected Population by Single 

Year of Age (0-99, 100+), Sex, Race, and Hispanic Origin for the United States: July 1, 2012 to July 1, 

2060 released December 2012, accessed 29 March 2013.

16

 
• Falls prevention: Falls prevention programs help adults 65 and over improve 

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

and reduce fall risk factors. Programs designed for health care providers give 

clinicians the tools needed to educate and care for their adult patients. Actions

involve medication reviews and modifications; provide referrals for medical care 

management for fall risk factors. 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 their ability to get around or live 

independently. Many people limit their activity after a fall, which may reduce 

strength, physical fitness, and mobility.41 Annually, older adult falls are 

responsible for over 21,000 deaths, 2.3 million emergency department visits, and

over $30 billion in direct medical costs”

• Medication management: Medication management programs focus on reviewing 

the multitude of medications that older adults are prescribed, focusing especially 

on high-risk medications. Medication management programs have been shown to 

reduce unnecessary duplication of prescriptions and cardiovascular problems. 

These programs have also been shown to improve medication usage rates and 

decrease medication errors among older adults.

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

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

found that 11.1 percent of Medicare beneficiaries age 65 and older living in the 

community reported feeling “sad or depressed much of the time over the previous 

year”.42 Older adults with depression “visit the doctor and emergency room more, 

use more medication, and stay longer in the hospital” than those without 

depression.43 Those with depression and certain chronic conditions have been 

shown to have substantially higher total health care costs than those with these

conditions but no depression ($22,960 vs. $11,956 per year).44 Cost-effective, 

evidence-based interventions, such as the Program to Encourage Rewarding Lives 

for Seniors (PEARLS), developed in CDC’s Prevention Research Centers, have 

been shown to reduce depressive symptoms and improve quality of life in older 

adults.45

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

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

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

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

America, Healthy Aging Program, Issue Brief #1. 44 Unützer J, Schoenbaum M, et al. (2009). “Health care costs associated with depression in medically ill 

fee-for-service Medicare participants”, Journal of the American Geriatric Society, 57:3, 375–584. 45 Program to Encourage Rewarding Lives for Seniors (2012). Description available at: 

http://www.pearlsprogram.org/

17

 
Chronic Disease Self-Management Education Programs

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

University Chronic Disease Self-Management Program (CDSMP), are low-cost, 

evidence-based disease prevention models that use state-of-the-art techniques and lay 

leaders in the community to help individuals with chronic disease address issues related 

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

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

appropriate for any type of chronic condition, there are other proven CDSME programs,

including the Spanish CDSMP, the Diabetes Self-Management Program (DSMP), 

Spanish DSMP, Chronic Pain Self-Management Program, Positive Self-Management

Program for HIV, Arthritis Self-Management Program, and online versions of the

CDSMP and DSMP.

In the United States, over 75 percent of older adults have multiple (two or more) chronic 

conditions,

46 placing them at greater risk for premature death, poor functional status, 

unnecessary hospitalizations, adverse drug events, and nursing home placement.

47 48

Chronic conditions also impact health care costs: 93 percent of Medicare expenditures are 

for beneficiaries with chronic conditions.

49

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

randomized controlled experiments, with both English and Spanish speaking populations) 

to be effective at helping participants adopt healthy behaviors and improve their 

psychological and physical health status.

50 Some evidence suggests that CDSME 

programs may also significantly reduce the use of hospital care and physician services, as 

well as reduce health care costs.51

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

in-person programs consist of a series of workshops that are conducted once a week for 

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

population (2011) [data tables 1.1]. http://www.cms.gov/Research-Statistics-Data-andSystems/Research/MCBS/Data-Tables-Items/2011CharAndPerc.html Accessed 25 July, 2013.

47 Vogeli C, Shields AE, Lee TA, Gibson TB, Marder WD, Weiss KB, Blumenthal D. Multiple

chronic conditions: prevalence, health consequences, and implications for quality, care management,

and costs. J Gen Intern Med 2007;22(Suppl 3):391–395. http://www. ncbi.nlm.nih. gov/pmc/

articles/PMC2150598/

48 Kramarow E, Lubitz J, Lentzner H, et al. Trends in the health of older Americans, 1970–2005. Health Aff 

(Millwood). 2007 Sep–Oct;26(5):1417-25. http://content.healthaffairs. org/content/ 26/5/1417.full. pdf+html

49 Nawrocki J. CMS Provides Data on Care for Chronic Conditions to Find Better Care Models. NetNews. April 

2, 2013 http://health.wolterskluwerlb.com/2013/04/cms-provides-data-on-care-for-chronic-conditions-tohelp-find-better-care-models/ 50 Brady TJ, Murphy L, O’Colmain BJ, Beauchesne D, Daniels B, Greenberg M, et al. A Meta-Analysis of 

Health Status, Health Behaviors, and Health Care Utilization Outcomes of the Chronic Disease SelfManagement Program. Prev Chronic Dis 2013;10:120112. http://dx.doi.org/10.5888/pcd10.120112 51 Sobel, DS, Lorig,KR, Hobbs,M. Chronic Disease Self-Management Program: From Development to 

Dissemination. Permanente Journal; Spring 2002.

18

 
two and a half hours over six to seven weeks in community settings such as churches, 

libraries, YW/MCAs, senior centers, public housing projects, community health centers 

and cooperative extension programs. People with differing chronic health conditions 

attend workshops together, and the workshops are facilitated by two trained leaders. One 

or both of the leaders are non-health professionals or lay people with one or more chronic 

conditions themselves. Topics covered in the training include: 1) techniques to deal with 

problems such as frustration, fatigue, pain and isolation; 2) appropriate exercise for 

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

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

AoA funds CDSME through competitive grants awarded to states. External experts 

review project proposals, and AoA awards grants for periods of up to three years. In 

FY 2012, AoA tracked the progress of the 47 state grantees funded through the American 

Recovery and Reinvestment Act of 2009. By September 30, 2012, grantees had reached 

over 91,000 completers, exceeding their 2-year goal of 50,000 completers. Grantees were 

successful in reaching their targeted, underserved populations; 73 percent were age 60 or 

older, over 60 percent reported having multiple chronic conditions, and over 31 percent

were racial/ethnic minorities. A new round of grants, funded in September 2012 through 

the Prevention and Public Health Fund (PPHF), established by the Affordable Care Act, 

provided grants to 22 states to expand and target these activities. These three-year grants 

are allowing states to provide CDSME programs to approximately 80,000 older adults 

and adults with disabilities to help them better manage chronic conditions. All of the 

grantees identified underserved target populations and partnering organizations to reach 

these populations including tribal entities, Centers for Independent Living, and a variety 

of minority organizations. The funding is also fostering the development of 

comprehensive, integrated delivery systems to embed and sustain these programs within 

the long-term services and supports and health care systems. 

Through financing from the FY2012 PPHF, AoA also funded a National Resource Center 

to provide technical assistance to the state grantees, evaluate progress in building 

sustainable distribution and delivery systems, and implement a national study to assess 

the impact of CDSMP activities in settings across the country. This study of over 1,100

participants is evaluating self-reported participant outcomes in general health, health 

interference in daily activities, symptoms, physical activity, use of medications, 

communication with health providers, and health care utilization. The PPHF also 

financed a contract to help expand access and sustainability of diabetes self-management 

programs by building the business acumen of the aging network and facilitating 

agreements with Medicare providers to obtain reimbursement for delivering those 

programs.

Behavioral Health 

Good mental and behavioral health is essential to overall health. Mental and behavioral 

health issues, such as depression, anxiety, substance abuse and misuse, and suicidal 

thoughts or actions, are not a normal part of aging – yet one in four persons aged 55 and 

19
over experience a behavioral health disorder.

52 Behavioral health issues can greatly 

impact the independence, health, and well-being of older adults and their family 

caregivers. Untreated mental and behavioral health disorders can exacerbate health 

conditions, decrease life expectancy, and increase overall healthcare costs.53,54,55

Distinctive barriers to the treatment of mental and behavioral health disorders among the 

older adult population exist, such as stigma, under-diagnosis, and inappropriate treatment.

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

from mental and behavioral health disorders are possible for individuals of all ages, 

including older adults. The national aging services network is working closely with 

behavioral health, primary care, and other partners to reach older adults with mental and 

behavioral health interventions. Evidence-based programs, such as Screening, Behavioral 

Intervention and Referral to Treatment (SBIRT) and the Program to Encourage 

Rewarding Lives for Seniors (PEARLS), are being implemented through aging, 

behavioral health, and primary care partnerships. ADRCs in 40 states are collaborating 

with their state mental health authority to reach older adults who are at risk for mental 

and behavioral health disorders. In 38 of these states, ADRCs are partnering with 

community mental health clinics for a variety of prevention, assessment, and treatment 

services.56

While the 2006 reauthorization of the OAA included new provisions focused on the 

prevention and treatment of mental health disorders, there is no funding in the OAA 

specifically designated for prevention, intervention, and treatment services. States and 

communities have had to be creative in how they support these programs and services. 

Some that invest in mental and behavioral health services use a braided funding approach 

(i.e., use a combination of funds, such as those from the OAA – Title III-D, Substance 

Abuse and Mental Health Administration block grants, private foundations, etc.)

Beginning in June 2010, and continuing through FY 2012, AoA and the Substance Abuse 

and Mental Health Services Administration (SAMHSA) formally partnered to provide 

technical assistance aimed at increasing states’ capacities for reaching older adults who 

are at-risk for behavioral health disorders. This partnership supported the development of 

a variety of tangible materials, such as epidemiological profiles, issue briefs, webinars, 

and a series of five older adult policy academy regional meetings (attended by 43 states, 

DC, PR, and the VI). The materials developed through this partnership have been 

1

. Jeste DV, Alexopoulos GS, Bartels SJ, et al. Consensus statement on the upcoming crisis in geriatric 

mental health: Research agenda for the next 2 decades. Archives of General Psychiatry. 1999; 56(9):848-

853.2

53 U.S. Department of Health and Human Services, Mental Health: A Report of the Surgeon General

(Rockville, MD: 1999). 

54 Husaini, B,A, et. Al (2000). Prevalence and cost of treating mental disorders among elderly recipients of 

Medicare services. PsychiatricServices, 51, 1245-1247. 55 Katon,W., Ciechanowski, P. (2002). Impact of major depression on chronic medical illness. Journal of 

Psychosomatic Research, 53, 859-863. 56 Lugo, Joseph. (July 2013). “National Perspective NWD/ADRC System Activities”. Presentation to the 

National Coalition of Mental Health and Aging.

20

 
successful in helping many states enhance their efforts to reach older adults who are atrisk for behavioral health disorders. 

Caregiver Services

Families are the nation’s primary providers 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 often are strapped for both. AoA’s caregiver 

programs provide services that address the needs of unpaid, informal caregivers, allowing 

many of them to continue to work while providing critically needed care. 

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

whether they are informal family caregivers or unrelated friends and neighbors who 

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

home. In 2009, approximately 43.5 million adult caregivers provided uncompensated 

care to those 50 years of age and older.57 AARP estimated the economic cost of replacing 

unpaid caregiving in 2009 to be about $450 billion, an increase from $375 billion in 2007 

(i.e., the cost if that care had to be replaced with paid services).58 

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

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

the care recipient. Caregivers suffer from higher rates of depression than non-caregivers 

of the same age, and research indicates that caregivers suffer a mortality rate that is 

63 percent higher than non-caregivers.59 Providing support that makes caregiving easier 

for family caregivers, such as information, counseling and training, respite care, or 

supplemental services, is critical to sustaining caregivers’ ability to continue in that role. 

Seventy-seven percent of the caregivers served by OAA programs report that these 

services allow them to provide care longer than they otherwise could.60 

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

caregivers every day. By 2020, it is projected that there will be 16.2 million noninstitutionalized seniors age 65 and over with 1+ ADL deficits, an increase of four

million seniors (or a 35 percent increase between 2011 and 2020) needing caregiver 

assistance.61

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

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

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

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

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

JAMA December 15, 1999;282:2215-9. 60 2012 National Survey of Older Americans Act Participants. http://www.agid.acl.gov 61 U.S. Census Bureau, “2012 National Population Projections,” Table 1. Projected Population by Single 

Year of Age (0-99, 100+), Sex, Race, and Hispanic Origin for the United States: July 1, 2012 to July 1, 

2060 released December 2012, <

http://www.census.gov/population/projections/data/national/2012/downloadablefiles.html> Accessed 

21

 
National Family Caregiver Support Program

(Title III-E of OAA; FY 2012: $153,621,000)

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

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

supports that assist family and informal caregivers in caring for their loved ones at home 

for as long as possible. The NFCSP includes five basic system components: information;

access assistance; counseling and training; respite care; and supplemental services. These 

services work in conjunction with other OAA services - including transportation services, 

homemaker services, home-delivered meals, and adult day care - to provide a coordinated 

set of supports for seniors which caregivers can access on their behalf.

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

2012, these services included:62

• Access Assistance Services, which provided over 1.1 million contacts with 

caregivers, assisting them in locating services from a variety of public and private 

agencies.

• Counseling and Training Services, which provided over 138,000 caregivers with 

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

stresses of caregiving.

• Respite Care Service, which provided nearly 68,000 caregivers with 6.3 million 

hours of temporary relief - at home, or in an adult day care or nursing home 

setting - from their caregiving responsibilities. This number represents only 0.16 

percent of the 43.5 million caregivers who provide uncompensated care for older 

Americans.

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

system. On a daily basis, these individuals assist relatives and other loved ones with 

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

interventions like medication administration and wound care. Research has shown that 

caregiving exacts a heavy emotional, physical, and financial toll. As reported in AoA’s 

2012 National Survey of OAA Participants, 21 percent of caregivers are assisting two or 

more individuals. Seventy-one percent of Title III caregivers are 60 or older, making 

them more vulnerable to a decline in their own health, and 34 percent describe their own 

health as fair to poor.63 The demands of caregiving can lead to a breakdown of the 

March 29, 2013 and Centers for Medicare & Medicaid Services, The characteristics and perceptions of the 

Medicare population (2011) [data table 2.5a]. http://www.cms.gov/Research-Statistics-Data-andSystems/Research/MCBS/Data-Tables-Items/2011CharAndPerc.html . Accessed July 25,2013. 62 Data from AoA’s FY 2012 State Program Report are preliminary and should not be taken as final. 63 2012 National Survey of Older Americans Act Participants. http://www.agid.acl.gov.

22

 
caregiver’s health. The illness, hospitalization, or death of a caregiver increases the risk 

for institutionalization of the care recipient. Additionally, caregivers often experience 

conflicts between work and caregiving, with 25 percent reporting that they have had to 

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

responsibilities.

Studies have shown that the types of supports provided through the NFCSP can reduce 

caregiver depression, anxiety, and stress and enable them to provide care longer while 

often continuing to work, thereby avoiding or delaying the need for institutional care for 

their loved ones. For example, a recent study indicates that counseling and support for 

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

home at significantly less cost, on average, for an additional year before being admitted 

to a nursing home.64

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

that OAA services, including those provided through the NFCSP, are effective in helping 

caregivers keep their loved ones at home. Approximately 77 percent of caregivers of 

program clients reported in 2012 that services enabled them to provide care longer than 

otherwise would have been possible.65 Caregivers receiving services were also asked 

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

services had not been available. Forty-one percent of the caregivers indicated that the 

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

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

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

recipient would most likely be living in a nursing home or assisted living (see the chart 

on the next page).

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

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

of the American Association, 276(21), 1725-1731. 65 Ibid.

23

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

Lifespan Respite Care

(FY 2012: $2,490,000)

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

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

ages and disabilities. Most do so willingly, and often for many years. AARP estimated 

in 2009 that 65.7 million people served as unpaid family caregivers to an adult or child 

with special needs. For many of these caregivers, providing care can take a toll: a 

majority of caregivers (51 percent) caring for someone over age 18 have medium or high 

levels of burden and 31 percent of all family caregivers indicated they experienced high 

levels of stress.66

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

supportive service for family caregivers.67, 68 Respite care is second only to direct 

financial assistance as a key policy priority of surveyed family caregivers. Even though 

respite services are often the preferred mode of family caregiver support, they are often 

under used, difficult to find and access, and are often unaffordable or in short supply. A 

2009 survey found that “finding time for myself” was reported as a priority by 32 percent 

of family caregivers along with managing both physical and emotional stress (34 percent) 

66 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 67 The Arc. (2011). Still in the Shadows with Their Future Uncertain: A Report on Family and Individual 

Needs for Disability Supports (FINDS 2011). Wash, DC: Author 68 National Family Caregivers Association. (2011). Allsup Family Caregiver Survey. Kensington, MD.

24

 
and balancing work and family responsibilities (27 percent). Despite these compelling 

numbers, nearly 90 percent of family caregivers receive no respite care at all.69 

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

populations such as family caregivers of individuals with multiple sclerosis, persons with 

intellectual and developmental disabilities, and for caregivers of veterans and individuals 

with Alzheimer’s disease, spinal cord injuries, autism, and serious emotional disorders. 

70, 71 The population-specific barriers reported by caregivers include provider shortages 

and inadequate training, mistrust of formal service delivery systems, hesitancy to ask for 

help and lack of awareness of available programs and supports.

The Lifespan Respite Care program, authorized under the Lifespan Respite Care Act,

focuses on easing the burdens of caregiving by providing grants to eligible state 

organizations to improve the quality of, and access to, respite care for family caregivers 

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

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

NFCSP, which focuses on broad caregiver support via a number of services, Lifespan 

Respite Care Programs focus on providing a mechanism for coordinating needed 

infrastructure changes at state and local levels, and on filling gaps by putting in place 

coordinated systems of accessible, community-based respite care services for family 

caregivers of children and adults with special needs. 

The systems funded through the Lifespan Respite CareProgram bring together and seek 

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

respite care workers and volunteers; and provision of information, outreach, and access 

assistance. They also seek to identify and fill gaps in services. Within this context, 

Lifespan Respite Care Program grantees have focused their efforts in a number of broad 

areas, including: 

• Conducting needs assessments/environmental scans to determine the respite care 

funding streams available, existing programs, populations served and gaps in each 

area;

• Broadening stakeholder collaborations to ensure representation of all age and 

disability groups, as well as the broadest possible cross section of the provider 

network;

• Integrating lifespan respite care principles and practice into statewide activities 

designed to improve systems and services for family caregivers of individuals of all 

ages with disabilities;

• Engaging respite care consumers to inform project activities; and 

69 National Alliance for Caregiving and AARP, 2009. 70 National Alliance for Caregiving. (2012). Multiple Sclersosis Caregivers. Washington, DC: Author. 71 The Arc, 2011.

25

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

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

partnerships with universities, community-based organizations and communities of 

faith.

The Lifespan Respite Care Program also supports Technical Assistance Resource Center 

(TARC) activities as authorized by statute. To date, the Lifespan Respite Care TARC has 

greatly expanded and enhanced a national database on lifespan respite care; provided 

extensive training, technical assistance and other print and electronic resources to 

grantees and state, community, and nonprofit respite care programs; and conducted 

public information, referral, and education programs on respite care. 

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

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

Care program helps to sustain family caregiver health and well-being, reduces the 

likelihood of abuse and neglect, and allows care recipients to remain in their own homes 

for as long as possible.

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

recipients a random sample of 1,926 caregivers (which represented over 186,450 active 

caregivers) answered questions about the impact of the caregiver program on their 

lives.72 Fifty-six percent of caregivers received respite care services from the National 

Family Caregiver Support Program within the past twelve months. The respite care 

service recipients reported that as a result of the services they received:

• 79 percent had less stress; 

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

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

• 95 percent reported the care recipient benefited from the service; and

• 81 percent said that the services enabled them to care longer. 

Since 2009, AoA has held competitive grant competitions each year to make Lifespan 

Respite Care Program funds available to states interested in enhancing or building 

statewide programs. To date, thirty states and the District of Columbia have been 

awarded initial grants of up to $200,000 each for three year projects. These projects have 

enabled the grantees to establish or enhance state infrastructures necessary to more 

effectively address the respite and related needs of family caregivers across the lifespan.

Additionally, a total of ten states (eight in FY 2011 and two in FY 2012) were awarded 

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

identified service gaps, and gather information about the impact of respite services on 

consumers. Finally, in FY 2012, seven of the original FY 2009 states received Integration 

722012 National Survey of Older Americans Act Participants. http://www.agid.acl.gov.

26

 
and Sustainability Grants to continue their work by focusing grant activities on service 

provision, respite care workforce development and training, performance measurement, 

and further program integration efforts. Examples of grantee accomplishments include:

• Development or enhancement of existing training programs for respite care 

providers and volunteers to expand the cadre of trained respite professionals;

• Replication and expansion of respite care delivery models with a particular focus 

on person centered planning and consumer direction;

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

available respite care programs.

• The development and adoption of statewide respite care plans and/or policies to 

guide future development of respite care and other caregiver support services;

• Development and deployment of marketing and awareness campaigns designed to 

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

break;

• Development and launch of dedicated web sites to facilitate access to information 

about, and referral to, respite care services;

• The creation or expansion of respite care voucher programs;

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

respite care options; 

• The development of respite care programs and services within communities of 

faith; and 

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

outcomes development.

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

25 percent matching requirement. Eligible state agencies include any of the following: 

the state agency that administers OAA programs; the state’s Medicaid program; or any 

other state-level agency designated by the governor. Additionally, the eligible state 

agency must work in collaboration with Aging and Disability Resource Centers and a 

public or private non-profit statewide respite care coalition or organization. Priority 

consideration is given to applicants that demonstrate the greatest likelihood of 

implementing or enhancing lifespan respite care statewide and are building or improving 

the capacity of their long-term care systems to respond to the comprehensive needs of 

care recipients. 

27
Alzheimer’s Disease Supportive Services Program

(FY 2012: $4,010,000)

Established under Section 398 of the Public Health Services Act, as amended, (42 U.S.C. 

280c-3), the Alzheimer’s Disease Supportive Services Program (ADSSP) funds 

competitive grants to states to expand the availability of evidence-based diagnostic and 

support services for persons with the disease, their families, and their caregivers, as well 

as to improve the responsiveness of home and community-based services systems to 

persons with dementia. The primary components of the ADSSP include delivering 

evidence-based supportive services; translating and replicating evidence-based 

interventions for persons with dementia and their caregivers at the community level; 

incorporating evidence-based research in the formulation of innovative projects; and 

advancing changes to a state’s overall system of home and community-based care. 

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

their families by providing individualized and public information, education, and referrals 

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

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

long-term care services and support system.

The most recent grant projects focused on integration of a statewide set of programs that 

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

to a comprehensive, sustainable set of high quality services for persons with dementia. 

These three-year projects are being implemented in Georgia, Minnesota, New York and 

Ohio. 

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

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

evidence-based interventions is the New York University caregiver intervention, a 

spousal caregiver support program that, in a randomized controlled trial, delayed 

institutionalization of persons with dementia by an average of 557 days.73 In 2012, the 

average nursing home cost was $222 daily for a semi-private room and $248 daily for a private 

room ($81,030 and $90,520 annually), which would mean an average savings of between 

$124,000 and $138,000 in institutional costs per person with dementia.

74 California, Florida, 

Georgia, Minnesota, Utah and Wisconsin are currently implementing this intervention.

Preliminary results indicate findings similar to those from the original study. 

Additionally, 23 states, DC and Puerto Rico are offering innovative programming for 

73Mittleman M, et al. (1996). “A Family Intervention to Delay Nursing Home Placement of Patients with 

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

1725-1731. 74 Metlife. (November 2012), “MetLife Market Survey of Nursing Home, Assisted Living, Adult Day 

Services, and Home Care Costs”,p.4, Accessed 5 June, 2013 

from: https://www.metlife.com/assets/cao/mmi/publications/studies/2012/studies/mmi-2012-marketsurvey-long-term-care-costs.pdf

28

 
caregivers and their loved ones with dementia. States funded to implement innovative 

programs are focusing on areas of great need, such as working to ensure their 

long-term care services and support systems are dementia-capable. 

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

families, as well as supporting the continuous quality improvement and evaluation of 

long-term care services and supports. Family caregivers remain the major source of 

support for most people with Alzheimer’s disease. The nature of the disease - a slow loss 

of cognitive and functional/physical independence - means that most people with 

Alzheimer’s disease are cared for in the community for years. They may access a variety 

of services from many different systems including the aging, medical, and mental health 

service systems. As the number of people with Alzheimer’s disease grows, it is 

increasingly important that service delivery and health care systems are responsive to 

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

availability of dementia capable community-based long-term care services and supports.

29
PART II: OLDER AMERICAN INDIANS, ALASKA 

NATIVES

& NATIVE HAWAIIANS

Nutrition and Supportive Services

(FY 2012: $27,601,000)

Native American Nutrition and Supportive Services provides grants to eligible tribal 

organizations for the delivery of nutrition and home and community-based supportive 

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

the 2010 Decennial Census, approximately 325,000 persons age 60 and over identified 

themselves as Native Americans or Alaskan Natives, and another 267,000 persons age 60 

and over identified themselves as part Native American or Alaskan Native.

75 

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

services to older Native Americans, including adult day care, transportation, congregate 

and home-delivered meals, information and referral, personal care, help with chores, and 

other supportive services. Currently, AoA’s congregate meal program reaches over onefifth of eligible Native American seniors in participating tribal organizations, homedelivered meals reach 10 percent of such persons, and supportive services reach 

41 percent of such persons.76 These programs, which can help to reduce the need for 

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

diversity of Native American communities and are an important part of each 

community’s comprehensive services. 

Services provided by this program in FY 2012 include:77 

• Transportation Services, which provided over 713,000 rides to meal sites, 

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

• Home-Delivered Nutrition Services, under which 2.6 million meals were provided 

to over 22,000 homebound Native American elders. The program also provides 

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

experienced by many home-bound Native American elders.

75 U.S. Census Bureau, “2010 Decennial Census,” QT-P1. Age Groups and Sex. Population Group: 

American Indian Alaska Native alone, American Indian Alaska Native alone or in combination with one or 

more other races. released April 26, 2012, <

http://factfinder2.census.gov/faces/nav/jsf/pages/searchresults.xhtml?refresh=t > Accessed August 26,

2013. 76 Title VI of the Older Americans Act permits tribes to establish age of eligibility for services below age 

60. Calculation based on eligible population as reported in grantee applications. 77 Title VI FY 2012 data are preliminary. Missing data have been imputed.

30

 
• Congregate Nutrition Services, which provided 2.3 million meals to more than 

48,000 Native American elders in community-based settings, as well as an 

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

including cultural and wellness programs.

• Information, Referral and Outreach Services, which provided over 917,000 hours 

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

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

their service and care needs.

The Native American Nutrition and Supportive Services program also provides training 

and technical assistance to tribal organizations to support the development of 

comprehensive and coordinated systems of services to meet the needs of Native 

American elders. Training and technical assistance is provided through national 

meetings, site visits, e-newsletters, telephone and written consultations, and through the 

Native American Resource Centers (funded under Aging Network Support Activities).

Eligible tribal organizations receive nutrition and supportive services formula grants 

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

population age 60 and over. Tribal organizations must represent at least 50 Native 

American elders age 60 and over to receive funding. There is no requirement for 

matching funds. In addition, tribes may decide the age at which a member is considered 

an elder and thus eligible for services. 

Caregiver Support Services

(FY 2012: $6,364,000)

Native American Caregiver Support Services provide grants to eligible tribal 

organizations to provide support for family and informal caregivers of Native American, 

Alaskan Native and Native Hawaiian elders. This program, which helps to reduce the 

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

diversity of Native American communities and represents an important part of each 

community’s comprehensive services. 

Native American Caregiver Support Services funding is allocated to eligible tribal 

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

Hawaiian population aged 60 and over. Tribal organizations must represent at least 

50 Native American elders age 60 and over and be receiving a grant under Title VI Part 

A or B to receive funding. There is no requirement for matching funds. Tribes may also 

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

addition, there is no limit on the percentage of funds that can be used for services to 

grandparents caring for grandchildren. 

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

older relatives with chronic illness or disability and grandparents caring for 

31
grandchildren. The program provides a variety of direct services that meet a range of 

caregiver needs, including information and outreach, access assistance, individual 

counseling, support groups and training, respite care, and other supplemental services. 

Tribal organizations coordinate with other programs, including the Volunteers In Service 

To America (VISTA) program, to help support and create sustainable caregiver programs 

in Native American communities (many of which are geographically isolated). A core 

value of the Native American Caregiver Support Services, as expressed by tribal leaders, is 

that the program should not replace the tradition of families caring for their elders. Rather, 

it provides support that strengthens the family caregiver role. 

32
PART III: PROTECTION OF VULNERABLE OLDER 

ADULTS

Protection of Vulnerable Americans consists of several distinct but complementary 

programs designed to prevent, detect, and respond to elder abuse, neglect, and 

exploitation. As the population of older Americans increases, the problem of elder abuse, 

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

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

exploitation are on the rise. A 2004 national survey of state Adult Protective Services

(APS) programs conducted by AoA’s National Center on Elder Abuse showed a 

16 percent increase in the number of elder abuse cases from an identical study conducted 

in 2000.78 According to a 1998 national incidence study (the only such study ever 

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

reported case of abuse there are over five that go unreported.79 Together, these data 

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

annually.

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

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

forms of abuse have dramatically higher (300 percent) morbidity and mortality rates than 

non-abused older people.80 Additional adverse health impacts include an increased 

likelihood of heart attacks, dementia, depression, chronic diseases and psychological 

distress. The result of these unnecessary health problems is a growing number of seniors 

who access the healthcare system more frequently (including emergency room visits and 

hospital admissions), and are ultimately forced to leave their homes and communities 

prematurely.

81 Protection of Vulnerable Adults programs address this problem through a 

full array of services designed to prevent, detect, and respond to elder abuse, neglect, and 

exploitation, both at home and in institutional settings.

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

practices for states to develop programs to expand and improve the protection of 

individuals living in their communities and in long-term care settings; increase the 

information and technical assistance available to the public, states, and localities in 

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

Age and Older. http://www.ncea.aoa.gov/NCEAroot/Main_Site/pdf/2-14-

06%20FINAL%2060+REPORT.pdf 79 Tatara, Toshio, et al. The National Elder Abuse Incidence Study Final Report. 1998. 

http://www.aoa.gov/AoARoot/AoA_Programs/Elder_Rights/Elder_Abuse/docs/ABuseReport_Full.pdf 80 Lachs, M.S., Williams, C.S., O'Brien, S., Pillemer, K.A., & Charlson, M.E. (1998). “The Mortality of 

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

Vulnerability, and Early Mortality.” Journal of the American Psychiatric Nurses Association, Vol. 12, 

No. 6, 313-321. 81 Lachs M. S., Williams C., O'Brien S., Hurst L., Kossack A., Siegal A., et al. (1997). “ED use by older 

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

33

 
preventing and addressing abuse; protect the rights of older adults and prevent their 

exploitation; reduce health-care fraud and abuse; and provide assistance to Tribes in 

developing elder justice systems. This multifaceted approach to preventing, detecting, 

and resolving elder abuse, neglect, and exploitation is essential to successfully fulfilling 

the shared mission of the Older Americans Act and the Elder Justice Act to maintain the 

health and independence of older Americans and adults with disabilities.

Prevention of Elder Abuse and Neglect

(FY 2012: $5,036,000)

The Prevention of Elder Abuse and Neglect program (Title VII, Section 721) provides 

state formula grants for training and education, promoting public awareness of elder 

abuse, and supports state and local elder abuse prevention coalitions and multidisciplinary teams. These activities are important elements of AoA’s enhanced focus in 

FY 2012 on elder justice. The program coordinates activities with state and local adult 

protective services programs (over half of which are directly administered by State Units 

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

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

the fact that states significantly leverage OAA funds to obtain other funding for these 

activities, including Social Services Block Grant and state general funds. Annually, more 

than $35 million of expenditures for elder abuse prevention services come from nonOAA funds, a ratio of approximately $7 of non-OAA funds for every $1 investment of 

federal 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 and resource information to assist victims of elder abuse. 

Kentucky also 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 was developed and 

aired, which has 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 

34
family, as well as of the risks and signs of abuse in later life. The information is 

available at: http://dhfs.wisconsin.gov/aps/Publications/publications.htm. 

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

commitment to protecting the rights of vulnerable seniors and promoting their dignity and 

autonomy. Through education efforts, exposing problems that would otherwise be hidden 

from view, and providing a voice for those who cannot act for themselves, the program 

helps ensure that all older Americans are able to age with dignity in a safe environment.

National Center on Elder Abuse

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

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

disseminates information to professionals and the public and provides technical assistance 

and training to states and community-based organizations. The NCEA makes available news 

and resources; collaborates on research; provides consultation, education, and training; 

identifies and provides information about promising practices and interventions; answers 

inquiries and requests for information; operates a listserv forum for professionals; and 

advises on program and policy development. NCEA also facilitates the exchange of strategies 

for uncovering and prosecuting fraud in areas such as telemarketing and sweepstakes scams. 

In FY 2012, the NCEA:

• Continued its outreach by serving over 3,459 subscribers to its newsletter and over 

1,800 members of the elder abuse listserv.

• Responded to over 450 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 maintained the NCEA training library with over 230 

resources.

• Supported systems change by identifying 342 local elder justice community 

coalitions and beginning to reach out to those communities to learn how they 

leverage local resources and expertise to prevent and combat elder abuse, neglect, and 

exploitation. 

• Compiled the first comprehensive inventory of tribal elder abuse codes, currently 

consisting of 48 codes from 17 states, the purpose of which is to provide best practice 

examples to other tribes in developing new codes to address elder abuse, neglect, and 

exploitation. 

35
National Adult Protective Services Resource Center

In response to the growing need for Adult Protective Services (APS) programs to 

improve investigation and response, train APS staff, and develop and disseminate best 

practices for interventions into reported incidents of elder abuse, neglect, and 

exploitation, AoA funded the first ever federal grant program to provide a national APS 

resource center (NAPSRC) in FY 2011. The goal of the NAPSRC is to provide current 

and relevant information and support to enhance the quality, consistency, and 

effectiveness of APS programs across the country. In FY 2012, the NAPSRC continued 

its work to enable state APS programs to enhance their critical role in responding to 

elders and adults with disabilities who are facing abuse, neglect, and exploitation by:

• Maintaining a NAPSRC webpage and social media accounts with best practices, 

promising practices, research, webinars, and other materials;

• Identifying evidence-based best practices for APS programs and interventions;

• Conducting an assessment of how state APS programs have successfully 

navigated the economic downturn and disseminating these “best practices” to 

other states; and

• Continuing to develop and disseminate information for APS programs.

Elder Abuse Prevention Interventions Program

In FY 2012, ACL received $5.5 million from the Prevention and Public Health Fund, 

established by the Affordable Care Act, to test and evaluate comprehensive approaches to 

preventing elder abuse involving multiple disciplines and systems, with the ultimate goal 

to use the findings to inform and improve state, local and tribal APS efforts.82 This 

prevention project is focused on evaluating replicable best practices in support of the 

development of secondary and tertiary prevention and intervention strategies for elder 

abuse, neglect, and exploitation using a multidisciplinary approach that involves social 

services and health care providers, adult protective services, and the legal and justice 

systems. Using the results of these prevention projects, AoA is working to develop a 

compendium of best practices and lessons learned that APS programs across the nation 

can use to improve their programs. The cumulative results of these projects will allow 

AoA to establish a strong evidence-base for current and future projects. 

Five states and three tribes received funding to conduct a three-year project to test their 

proposed interventions. These grantees were awarded all of their grant funding up-front 

to be used over a three-year budget period.

82 This program is authorized by Section 411 of the Older Americans Act, Section 2042 of the Patient 

Protection and Affordable Care Act, and Section 4002 of the Affordable Care Act (PPHF)

36

 
Model Approaches to Statewide Legal Assistance Systems

(FY 2012: $1,992,228)

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

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

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

Approaches grants, which seek to address the nationwide challenge of coordinating what 

are often fragmented and inconsistent legal service delivery systems that do not always 

provide access to quality services for older Americans who are most in need. Model 

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

integrating SLHs and other essential low-cost mechanisms into the broader spectrum of 

state legal service delivery networks. Ultimately, legal assistance provided through wellintegrated and cost-effective service delivery systems as demonstrated through Model 

Approaches directly impacts the ability of seniors to remain independent, healthy, and 

financially secure in their homes and communities.

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

delivery integration objectives. State legal assistance developers have demonstrated 

effective leadership in incorporating the use of SLHs and other low-cost mechanisms into 

the state legal services planning and development process. Key project partners and 

service delivery components also include Title III-B legal services providers, private bar 

pro bono attorneys, law school clinics, and self-help sites. By promoting the seamless 

integration of these vital legal service delivery components, Model Approaches enables 

seniors most in need to access quality legal services in priority legal issue areas involving 

income security, healthcare financing, consumer fraud, housing and foreclosure 

prevention, and elder abuse. This approach is also designed to increase the leveraging of 

limited resources within statewide legal service delivery systems.

In addition, by ensuring strong leadership at the state level, Model Approaches projects 

have created important partnerships and linkages between the existing legal assistance 

community and the broader community-based aging and elder rights networks, including 

AAAs, ADRC, state long-term care ombudsmen, and Adult Protective Services. 

As a key centerpiece of the Model Approaches projects, SLHs assist seniors in accessing 

quality legal services to ensure their rights and enhance their independence and financial 

security. In 2012, Model Approaches projects assisted 24,379 older consumers with the 

most social or economic needs on a wide range of priority legal issues related to public 

benefits, health care, housing, advance planning, and consumer protection. Some recent 

examples of the success of SLHs’ experience in assisting seniors include:

o A 93 year-old woman with a very low income called a SLH seeking assistance with a 

rental termination notice. She had recently come home from a hospital admission and 

brief stay in a rehab facility convalescing from a fall. The hospital and her doctor 

cleared her to return home. She had prearranged a support system that included a 

visiting nurse, a housekeeper/shopper, and regular visits by her daughter and son. 

37
The SLH lawyer helped the client write a letter of response to the Housing Manager 

asserting her rights under the federal Fair Housing Act. The letter resulted in the 

rescission of the termination notice and allowed the client to stay in her residence.

o A 71 year-old man and his wife were struggling to pay their adjustable rate mortgage 

on a fixed income. They applied for a mortgage modification through a lender 

designated by the federal government to offer loan modifications to qualified 

homeowners. Due to inaction on the part of the lender, interest and late fees continued 

to accrue on the loan balance. A SLH attorney called the lender reminding them of 

federal rules governing loan modifications and provided additional documentation. 

Two weeks later, the lender offered the senior a mortgage modification, which 

resulted in a 20 percent reduction in the monthly mortgage.

o A 64 year-old woman was granted a portion of her ex-husband’s pension in her 

divorce decree. She desperately needed the pension income to pay her monthly bills, 

but could not afford to hire an attorney to draft the necessary Qualified Domestic 

Relations Order (QDRO) that would allow her to receive the benefits. The HelpLine 

attorney drafted a QDRO pursuant to the rules and regulations of the ex-spouse’s 

pension plan, and the woman immediately began to receive monthly payments.

In addition to providing assistance on priority legal issues, SLHs under Model 

Approaches have been very successful in reaching low income populations with over 71 

percent of older clients having incomes at or below 200 percent of the federal poverty 

guidelines. Minority clients receiving assistance through SLHs in the last reporting 

period constituted 37 percent of all clients served. These figures illustrate the 

effectiveness of Model Approaches states in reaching key target populations under the 

OAA with much needed “priority” legal assistance.

An important purpose of the Model Approaches demonstrations is to position SLHs as 

coordinated and essential components of high quality and high impact legal service 

delivery systems that effectively target scarce resources to older persons most in need. 

Model Approaches partners across the country recognize the enormous value of the 

network relationships that have been forged in pursuit of essential project goals and 

objectives. Several Model Approaches states with completed grant award cycles (e.g. 

CT, FL, IA, KY, MD, MI, ND, NV, and PA) demonstrate that SLHs continue to serve 

seniors as well-integrated and essential components of statewide senior legal services 

delivery systems, thus illustrating the sustainability of these projects beyond the 

demonstration period.

Other legal service delivery system outcomes achieved in FY 2012 and anticipated for all 

Model Approaches projects include:

• Comprehensive statewide legal needs assessments that identify the legal issues 

impacting seniors in target populations and assess the capacity of existing service 

delivery systems to meet those identified needs;

38
• Enhanced collaboration among area agencies on aging, ADRCs, SLHs, and legal 

providers in identifying and serving seniors most in need of assistance on priority 

legal issues;

• Enhanced service delivery capacity of legal services programs and SLHs through the 

leveraging of low cost service delivery mechanisms such as SLHs, private bar pro

bono attorneys, law school clinics, and self-help sites; and

• Strengthened systems that reach underserved and hard-to-reach seniors most in need 

through effective targeting and outreach methodologies.

National Legal Assistance and Support Projects

(FY 2012: $743,592)

National Legal Assistance and Support grants fund a comprehensive national legal 

assistance support system serving professionals and advocates working in legal and aging 

services networks. These grants collectively form the National Legal Resource Center 

(NLRC), which is designed to empower professionals in aging and legal networks with 

the tools and resources necessary to provide older clients and consumers with high 

quality legal assistance in areas of critical importance to their independence, health, and 

financial security. 

As a streamlined and accessible point of entry, the NLRC supports the leadership, 

knowledge, and systems capacity of legal and aging provider organizations in order to 

enhance the quality, cost-effectiveness, and accessibility of legal assistance and elder 

rights protections available to older persons with social or economic needs. The audience 

targeted to receive support services through the NLRC includes a broad range of legal, 

elder rights, and aging services professionals and advocates. These include legal 

assistance providers, legal assistance developers, long-term care ombudsmen, state unit 

on aging directors, AAA and ADRC personnel, senior legal helplines (SLHs), and others 

involved in protecting the rights of older persons.

The NLRC provides core resource support through a strategic combination of case 

consultation, training, and technical assistance on a broad range of legal issues and 

systems development issues. Examples of common legal issues on which the NLRC 

provides assistance include preventing the loss of a senior’s home through foreclosure; 

protecting against consumer scams and creditor harassment; addressing elder abuse in the 

community and in long-term care facilities; and difficulties in accessing public benefits 

essential to financial security, independence, and health. The NLRC also provides 

technical assistance on the efficient, cost-effective, and targeted provision of state-wide 

legal and elder rights advocacy services.

In FY 2012, economic circumstances gave rise to a host of legal challenges for older 

consumers and the legal providers who serve them. In response to an increasing demand 

39
for legal resource support, the NLRC provided training and case consultation to over 

9,700 aging and legal service professionals nationwide. NLRC partners also provided 

important technical support in the implementation of the Model Approaches projects in 

nine states, featuring the provision of expertise in legal needs and capacity assessments, 

effective targeting and outreach methodologies, statewide reporting systems, and legal 

service delivery standards. With regard to technical support directed at SLHs, the NLRC 

provided assistance to 18 SLHs and provided resources to aging service professionals in 

an additional ten states. 

An essential premise of the NLRC is that the combined efforts of several partnering 

organizations with high levels of subject matter expertise are required to achieve its broad 

resource support objectives. Through effective collaborations, interlocking work plans, 

and the leveraging of organizational resources, NLRC partners have demonstrated the 

ability to achieve effective national coverage on high priority legal issue areas. In FY 

2012, over 97 percent of professionals responding to surveys rated the quality and 

usefulness of the support service provided by the NLRC as either good or excellent. 

In addition, the NLRC website continues to serve as a single entry point into a national 

legal assistance support system providing high quality resources and expertise on a broad 

range of legal and systems development issues (see www.nlrc.gov). 

Pension Counseling and Information Program

(FY 2012: $1,712,757)

In 1992, Congress directed AoA to develop demonstration projects specifically designed 

to help individuals with pension problems. These demonstrations were so successful that 

Congress established pension counseling as a permanent program under Title II of the 

OAA in 2000.

Today, there are more than 700,000 private (as well as thousands of public) pension and 

retirement plans in the United States. Thousands of Americans reach retirement age each 

year, only to be told that they will not receive the pension benefits they expected.

Because individuals have generally worked for several employers, which may have 

merged, sold their plans, or gone bankrupt, it is very difficult for most persons to know 

where to get help in finding out whether or not they are receiving all of the pension 

benefits to which they are entitled. 

Benefits from employer-sponsored pensions and retirement savings plans are as critical 

today to the retirement security of Americans as they were when the pension counseling 

program was first established. The pension questions that people face are just as 

complex, and good help is just as hard to find – even more so for those with only modest 

benefits at stake. The role of the Pension Counseling and Information Program is to help 

ensure that all older Americans have access to the help they need in order to secure the 

employer-sponsored retirement benefits they have earned --- benefits that are critical to 

their ability to live independently and with dignity after a lifetime of productive 

40
employment. The Pension Counseling and Information Program provides help that 

would be otherwise unavailable, by assisting individuals in understanding and exercising 

their pension rights. The program promotes the financial security of older individuals by 

offering them the help they need to receive the pension benefits they have earned. The 

income, in turn, provides increased opportunities for choice and independence. 

AoA currently funds six regional counseling projects covering 29 states and a technical 

assistance resource center to assist older Americans in accessing information about their 

retirement benefits and to help them negotiate with former employers or pension plans 

for due compensation. The projects help with cases that private pension professionals are 

reluctant to take, where the benefits in question are small, as is often the case with lowincome workers and those with limited English proficiency, but to whom these modest 

amounts make a huge difference in maintaining their financial security and independence.

Data show that since the program’s inception in 1993, the Pension Counseling projects 

have recovered over $175 million in retirement benefits for individual claimants. With a 

relatively small federal investment, the program has brought in a return of more than 

$8.00 for every federal dollar invested in the program. These recoveries demonstrate that 

pension counseling is not only necessary, but that it can be provided efficiently and 

effectively. For example, during the six-month period of July through December 2012, 

the projects recovered over $43 million in client benefits and assisted approximately

8,675 individuals. 

The significance of the projects’ work is best demonstrated through discussion of a 

typical case successfully resolved during this period:

• A 79-year-old widow contacted one of the regional counseling projects for 

assistance in obtaining survivor’s benefits from her late husband’s pension plan.

Her husband had died in 2010 at the age of 79 without ever receiving his pension.

The pension plan administrator incorrectly stated that the widow was ineligible 

for a survivor’s benefit because her late husband had failed to file an election 

form giving her a Qualified Pre-Retirement Survivor Annuity. Project staff 

explained that the 50 percent survivor annuity is the automatic form of benefit 

payment for any vested participant who was alive as of August 23, 1984, and 

whose benefits were not yet in pay status on that date. After filing a claim on 

behalf of the widow, the company agreed to calculate and pay the survivor’s 

benefit, retroactive to the date of her late husband’s death.

As this case demonstrates, improper plan administration can deprive a plan participant 

and/or the surviving spouse of the benefit that he or she has legitimately earned. The 

project’s expertise, knowledge and diligence were needed by the client to make sure that 

the plan had correctly interpreted and complied with pension law. Due to the complexity 

of the matter and the pension plan administrator’s failure in applying the law, it is 

extremely unlikely either that the widow would have been able to pursue the case on her 

own, or that she could have found an attorney, agency, or organization to assist her.

41
Without the assistance of the project, she may well have been deprived of a lifetime 

retirement benefit. The retroactive lump sum and ongoing monthly lifetime benefits 

which the project secured have a value of over $27,000, which will have a significant 

impact on this individual’s life and on her economic security. 

Even when Pension Counseling projects are unable to secure benefits for clients, the 

information and assistance the projects provide can bring peace of mind to vulnerable 

elderly individuals, often after months or even years of searching for answers. By 

producing fact sheets and other publications, hosting websites, and conducting outreach 

and education, Pension Counseling projects also provide indirect services to tens of 

thousands of seniors and their families.

A critical component of the program is the National Pension Assistance Resource Center 

(the Center), which provides support to the counseling projects and facilitates 

coordination among the projects, SUAs, AAAs, legal services providers, and others by 

providing substantive legal training, technical assistance, and programmatic consultation.

The Center also assists individuals in states not currently served by AoA’s pension 

counseling projects by providing nationwide referral and information services, both by 

telephone and through the PensionHelp America website, a nationwide database of 

pension assistance and information resources (see http://www.PensionHelp.org). 

Senior Medicare Patrol Program

(FY 2012: $9,402,196)

The Senior Medicare Patrol (SMP) program provides competitive grants to 54 states and 

territories to support a national network of volunteers whose purpose is to educate 

Medicare beneficiaries on preventing and identifying healthcare fraud and abuse. Projects 

use the skills of these volunteers to conduct community outreach and education and 

provide information that empowers Medicare beneficiaries, their families, and caregivers

to prevent, identify, and report fraud. Activities are carried out in partnership with the 

Centers for Medicare & Medicaid Services, the HHS Office of Inspector General (OIG), 

healthcare providers, and other aging and elder rights professionals from around the 

country.

Annually, the OIG gathers and analyzes the data housed in the SMARTFACTS data 

tracking system. These data are published as a report on the SMP program. This report 

for Calendar Year 2012 shows that SMP projects:

• Had 5,137 active volunteers who worked 120,953 hours to educate beneficiaries 

about how to prevent Medicare and Medicaid fraud;

• Educated 449,509 beneficiaries in 14,748 group education sessions and held 

113,457 one-on-one counseling sessions with or on behalf of beneficiaries; 

• Conducted 10,032 community outreach education events; and

42
• Resolved 83,856 requests for information or assistance from beneficiaries.

In addition, the report shows that since the program’s inception in 1997, SMP projects 

have:

• Educated nearly four million beneficiaries in 108,825 group education sessions 

and held 1,292,647 one-on-one counseling sessions; 

• Conducted 93,894 community outreach education events; and 

• Documented over $112 million in savings, including Medicare and Medicaid 

funds recovered, beneficiary savings, and other savings directly attributable to 

the project as a result of beneficiary complaints. This does not attempt to 

quantify the total savings that occur as a result of the SMP program’s sentinel 

effect, impact on fraud deterrence, or calls to fraud hotlines or other non-SMP 

contacts.

Health Care Fraud and Abuse Control (HCFAC)

(FY 2012: $10,769,050)

The Administration on Aging (AoA) has received Health Care Fraud and Abuse Control 

(HCFAC) funding since FY 1997, as authorized by the Health Insurance Portability and 

Accountability Act (HIPAA) of 1996 (P.L. 104-191), as a partner in the Department’s 

efforts to fight error, fraud and abuse in the Medicare and Medicaid programs. HCFAC 

funds provide federal support (including infrastructure, technical assistance, program 

support and capacity building) to the Senior Medicare Patrol (SMP) program. 

HCFAC funds allow ACL to maintain effective oversight of and partnerships with each 

of the 54 SMP Projects. The National Consumer Protection Technical Resource Center

(the Center), which provides training, technical assistance, support and information to 

SMP grantees, is supported by HCFAC funding. The Center has focused on: 

• information and strategies to increase awareness of current scams and fraud 

schemes, such as wheelchair and scooter fraud; 

• outreach strategies for educating minority and non-English-speaking individuals, 

information and training, including fraud awareness information; 

• volunteer recruitment and training; 

• education to rural, geographically isolated, and low literacy individuals, including 

tribal members; and 

43
• partnership strategies to involve health care providers, family caregivers, and 

health care professionals. 

Approximately 8.5 FTEs, supported with HCFAC funds, provide technical assistance and 

oversight in support of SMP projects. HCFAC funds also are used to provide ongoing 

technical support for the SMP management, tracking and reporting system.

In addition to the infrastructure and technical assistance described above, in FY 2012,

SMP projects received an additional $7.3 million from HCFAC funds to increase 

program capacity and to expanded outreach and education efforts. These capacitybuilding activities were originally supported in 2010 and again in 2011 by CMS, which

provided funding for the award of an additional $9 million in grants from its Program 

Integrity funding, and are targeted to help the 54 SMP programs fight Medicare fraud in 

high fraud states and expand the capacity of the program to reach more beneficiaries. 

44
Long-Term Care Ombudsman Program

(FY: $16,761,000)

The Long-Term Care Ombudsman Program serves individuals living in long-term care 

facilities (nursing homes, board and care, assisted living and similar settings), and works 

to resolve resident problems related to poor care, violation of rights, and quality of life. 

Ombudsmen also advocate at the local, state and national levels to promote policies and 

consumer protections to improve residents’ care and quality of life. 

Each state has an Office of the State Long-Term Care Ombudsman, headed by a full-time 

state long-term care ombudsman who directs the program statewide. Thousands of local 

ombudsman staff and volunteers, designated by the state ombudsman as representatives, 

assist residents and their families by resolving complaints and providing information 

related to long-term care services and supports. The long-term care ombudsman is the 

local problem-solver for individuals living in long-term care facilities and is an 

invaluable resource to residents, their families and facility staff. 

Section 712 of the Older Americans Act requires state long term care ombudsmen to:

• Identify, investigate and resolve complaints made by or on behalf of residents;

• Provide information to residents about long-term care services; 

• Ensure that residents have regular and timely access to ombudsman services;

• Represent the interests of residents before governmental agencies and seek 

administrative, legal and other remedies to protect residents; and

• Analyze, comment on, and recommend changes in laws and regulations 

pertaining to the health, safety, welfare and rights of residents.

This report provides data for FY 2012 from the Long-Term Care Ombudsman Program 

nationwide, based on state and local level activities. The data and other information 

presented and analyzed in this report are collected annually by AoA from State LongTerm Care Ombudsmen through the National Ombudsman Reporting System (NORS). 

Complaint Investigation and Resolution

Long-Term Care Ombudsmen provide an alternative dispute resolution service, resolving 

complaints for or on behalf of long-term care facility residents. In FY 2012: 

 Ombudsmen nationwide resolved 193,650 complaints.

 Ombudsmen resolved or partially resolved 73 percent of these complaints to the 

satisfaction of the resident or complainant. 

45
 Of the 126,398 cases closed by ombudsmen,83 93,311 (74 percent) were associated 

with nursing facility settings. Of the remaining cases, 30,194 (24 percent) were 

related to board and care and other similar facilities (including assisted living), and 

2,893 (two percent) were associated with non-facility settings or services to facility 

residents by an outside provider. 

 Most cases were initiated by residents or friends and relatives of residents, with the 

residents themselves initiating 39 percent of cases in nursing facilities and 32 

percent in board and care and other similar facilities (including assisted living). 

 Ombudsmen proactively identified issues in nearly 13 percent of cases in all 

settings. 

The five most frequent nursing facility complaints were: 

• improper eviction or inadequate discharge/planning;

• unanswered requests for assistance;

• lack of respect for residents, poor staff attitudes;

• quality of life, specifically resident/roommate conflict; and

• administration and organization of medications.

The five most frequent board and care complaints were:

• administration and organization of medications;

• inadequate or no discharge/eviction notice or planning;

• quality, quantity, variation and choice of food;

• lack of respect for residents, poor staff attitudes; and

• equipment or building hazards. 

Improper Eviction/Inadequate Discharge Planning – a troubling trend:

Long-term care ombudsmen are often the primary responders to complaints about 

eviction or inadequate discharge/planning. This complaint has consistently been among 

the top ten complaint issues investigated and responded to by long-term care 

ombudsmen, with the issue’s prevalence rising to the top five within the last three years, 

and to the top complaint in nursing homes during FY 2012 and 2011. See Figure 1.

83 In FY 2012, ombudsmen opened 127,896 new cases (a case contains one or more complaints originating 

from the same person(s), and completed resolution work on 126,398 closed cases, containing 193,650 

complaints.

46

 
Figure 1

Reasons for the increase include the complexity of residents’ needs, requiring additional 

training and skill of facility staff; a lack of understanding of Medicaid requirements,

which has made some nursing home residents ineligible and therefore lacking a payment 

source; or financial exploitation, where a responsible party chooses to not pay the bill.

Barriers to successful resolution include a lack of available resources (including legal 

services) to assist residents and families in responding and appealing transfer/discharge 

notices; and unnecessary and prolonged hospitalizations of residents who linger because 

a nursing home has refused to readmit them in accordance with federal regulation and/or 

an administrative ruling. Eviction from what is often considered the resident’s home 

creates risk of displacement from their community, family and friends, risk of 

homelessness and unnecessary and costly hospitalizations.

Ombudsmen Advocacy Efforts - Evictions and Improper Discharge Planning

 Legal Advocacy: An ombudsman attorney contested a discharge of a resident who 

was being moved from a skilled nursing home without the required notice and 

information on the location where the resident was to move. During the hearing, 

the judge granted a continuance and stayed the discharge. Although the facility 

allowed the resident to stay, they terminated all therapy services, which the family 

believed were essential to her recovery. The ombudsman attorney filed for 

clarification of the order and the judge confirmed that when he stayed the 

discharge, all services should continue. When the facility refused to comply, the 

attorney filed again to request compliance. The facility complied with the order 

and the resident received all of her necessary therapy services. 

Eviction & Discharge Complaints as Percent of All Complaints by Setting

0%

1%

2%

3%

4%

5%

6%

7%

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Nursing Facilities

Board & Care

Facilities

3.30% 3.15% 3.29% 3.85% 4.35% 4.56% 4.99% 5.44% 5.95% 6.05%

3.95% 3.99% 4.12% 4.44% 4.84% 4.51% 4.42% 4.97% 5.38% 5.39%

47
 Agency Coordination & Education: A state ombudsman, in collaboration with 

Medicaid and the Department of Public Health, made it a priority to address all 

nursing home discharges, including those for non-payment, to ensure that no 

resident is discharged because family/sponsors are not aware of, or are 

uninformed about, Medicaid application processes or their responsibility to 

provide documents to the Medicaid agency. The state ombudsman program 

contracted with a local law school to develop a toolkit on Medicaid eligibility 

application processes, and inappropriate discharges to educate local ombudsmen, 

facility staff, residents and family members on these topics. Training was held 

with local ombudsmen, family caregiver coordinators, and information and 

referral coordinators from area agencies on aging. The state ombudsman also 

coordinated efforts with the Medicaid agency to serve in an advisory capacity on 

Medicaid’s Discharge Appeals Committee, and is now copied on all discharges 

from nursing homes. 

Ombudsmen in Action

In addition to receiving, responding to, and resolving complaints, ombudsmen carry out a 

variety of duties designed to prevent problems, including routine visits to residents, 

consultations, and technical assistance to residents, their families and facility staff. In FY 

2012, ombudsmen staff and volunteers nationwide provided:

 Routine visits to promote a regular presence to facility residents, visiting 

residents of 68 percent of nursing facilities and 25 percent of board and 

care and similar homes (including assisted living) at least quarterly.

 309,423 consultations to individuals. Consultations most frequently 

addressed: alternatives to institutional care, information on Medicaid, 

transfer, discharge and eviction, residents’ rights, and federal and state 

rules and policies impacting residents;

 111,353 consultations to long-term care facility staff on a wide range of 

issues, including residents’ rights, observations about care, working with 

resident behavioral issues, and transfer and discharge issues; and

 Resident and family council support – providing technical assistance, 

training and information to resident councils (21,365 sessions) and family 

councils (2,858 sessions).

They also:

 Trained long-term care facility staff (5,049 sessions);

 Educated the community (10,764 sessions); and

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Successful Complaint Resolution Supporting Resident Choice

“Mrs. Jones,” a 90 year old veteran contacted her local ombudsman for assistance to return to her own 

home. She discussed her wish to return home and her passion for her work as a volunteer HAM 

operator. Mrs. Jones explained that she had become dehydrated while working in her yard and 

collapsed. After a stay in the hospital, she agreed to be admitted to a personal care home so that she 

could regain her strength.

After regaining her mobility and strength, she began to believe that her daughter did not want her to 

return home. She felt isolated in the remote area, far away from friends and family, and missed her 

association with fellow HAM operators. She explained that, in her community, she had access to 

everything she needed to remain independent at home, including elder transportation services. She 

was pleased with the care she received at the personal care home but she just wanted to go home.

With Mrs. Jones’s approval, the ombudsman went to work to help her. The ombudsman explained her 

rights, including her right to self-determination, and arranged a meeting with the facility's 

administrative staff to discuss ways to help support Mrs. Jones’s choice to move back into the 

community. 

Today, she is living in her own home and reports to the ombudsman that she feels empowered and in 

control of her life again.

 Served as resident advocates and provided information to surveyors as part 

of long-term care facility surveys conducted by regulatory agencies 

(participating in 20,838 survey related activities).

Systemic Advocacy, including work on laws, regulations and government policies

A vital long-term care ombudsman function is systemic advocacy: analyzing, 

commenting on and recommending changes in laws, regulations, and government 

policies and actions to benefit long-term care residents. The following are a few examples

of long-term care ombudsman systems advocacy efforts:

 Seeking legislative changes to strengthen protections against illegal or improper 

evictions; working with the provider industry to develop training and model forms 

to promote practices that support a resident’s rights during discharge; training of 

ombudsmen and consumers on transfer and discharge rights.

 Promoting community living options and assisting nursing home residents who 

wish to return to the community to access transition programs, such as the 

Medicaid “Money Follows the Person” program. 

49
 Recommending laws and government actions to prevent and improve responses to 

abuse, neglect and financial exploitation of vulnerable adults, including elders.

 Training of facility staff on strategies to reduce the use of anti-psychotic

medications in nursing homes.

Providing Ombudsman Services

There are 53 state ombudsmen (50 states, plus the District of Columbia, Puerto Rico, and 

Guam). In most states, the office of the State Long-Term Care Ombudsman is housed 

within the state unit on aging or another state agency. In others, the office is housed in a 

Partnerships to Identify and Eliminate Abusive Practices

Two local ombudsman programs participated with law enforcement, Adult Protective Services 

(APS), and the regulatory agency in a crackdown on unlicensed board and care providers who 

exploited vulnerable adults for their government benefits. These providers are subject to 

licensure as personal care homes, but have ignored the requirements, financially exploited the 

residents, and failed to provide adequate services.

Using an address list provided by the police department, teams located and inspected 

numerous houses, where residents with varying levels of mental and physical disabilities, were 

found living in deplorable conditions. The houses were filthy, roach infested, dark, hazardous, 

and lacked heat and food supplies. Many of these residents were afraid to talk to team 

members, and others were so afraid they requested to leave with the teams immediately. 

Residents recounted stories of physical abuse, withholding of medications, and financial 

exploitation. Throughout this long and arduous day, the long-term care ombudsmen served as 

a listening ear for the residents who had endured this situation, advocated for their rights and 

protections and provided support for the other team members.

This effort proved to be a resounding success. All of the residents who were living in these 

homes were relocated elsewhere. The operator of these homes, as well as some of her family 

members and employees, were arrested and charged with numerous counts of abuse, neglect, 

and exploitation of vulnerable adults.

A second collaborative effort with law enforcement, regulators, Adult Protective Services and 

the Ombudsman Program successfully closed a similar operation. The perpetrator in that case 

is also awaiting prosecution.

In response to the on-going problem of unlicensed homes, the long-term care ombudsman,

along with other aging advocates, testified in support of, and advocated successfully with 

policy makers for, passage of a law that makes it a misdemeanor on the first offense to operate 

an unlicensed personal care home, and a felony on the second offense.

50
private non-profit agency. Most states have contracts with or through area agencies on 

aging to provide direct ombudsman services to residents locally. There are 573

designated local entities across the nation.

In FY 2012, long-term care ombudsman services to residents were provided by 1,180 

full-time equivalent staff and 8,712 volunteers, trained and certified to investigate and 

resolve complaints. An additional 3,257 volunteers also served residents or assisted in 

program operations in ways other than complaint resolution. 

Program Funding

Total FY 2012 funding from all sources for the Ombudsman Program nationwide was 

$90,418,662, an overall increase of three percent from the FY 2011 level. 

The federal government is the primary funder of the Ombudsman Program, providing 

58 percent of total funding in FY 2012. States provided 36 percent of funds, and other 

non-federal sources funded the remaining six percent. Figure 2 shows the percentage of 

total program funding by source

Figure 2 - FY 2012 Funding by Category:

Where Long-Term Care Facility Residents Live

Increasingly, long-term care residents live in residential settings other than nursing 

homes, including board and care homes and assisted living (known by various names 

51
under state laws). While the number of beds and facilities in nursing homes are relatively 

stagnant, the growth of beds in these other residential settings is steadily increasing. 

Federal policy continues to accelerate the growth of home and community-based longterm care services. In many states, Medicaid funding provides long-term care services in 

home and community-based settings as an alternative to institutional care. 

In the five years between 2008 and 2012, the number of board and care and similar 

facilities (including assisted living) increased by six percent to 52,928, while the number 

of nursing facilities decreased by one percent from 16,749 in 2008 to 16,528 in 2012. 

National Long-Term Care Ombudsman Resource Center Activities

In order to effectively advocate for residents, ombudsmen must remain up-to-date on the 

latest long-term care developments. Therefore, AoA supports the National Ombudsman 

Resource Center (NORC), which provides training, technical assistance, and program 

management expertise to state and local ombudsmen. In FY 2012, the NORC was 

operated by the National Consumer Voice for Quality Long-Term Care (formerly 

NCCNHR), in conjunction with the National Association of States United for Aging and 

Disabilities (NASUAD).

In FY 2012, NORC provided ombudsmen with training from national experts on such 

issues as:

• Volunteer management training and technical assistance;

• Training on the National Ombudsman Reporting System (NORS) data 

coding and collection;

• Long-Term Services, Supports and Housing: Choices and Advocacy

• Resident transitions from nursing homes to other settings, including 

through implementation of federal initiatives such as:

- Culture Change and Person-Centered Care.

- Ombudsman coordination with ADRCs.

• Support for Centers for Medicaid & Medicare Services (CMS) Nursing 

Home Quality Initiatives such as:

- Reduction of Antipsychotic Medication use in nursing homes

- Ombudsmen training on Quality Assessment and Performance 

Improvement (QAPI) for Nursing Homes 

The NORC provided access to quarterly orientation training activities for all new state 

ombudsmen and developed resource materials, the NORC website 

(www.ltcombudsman.org), and monthly newsletters, customized for long-term care 

ombudsman staff and volunteers.

52
Program Results and Challenges

Value of volunteers – Over $20 million donated in FY 2012.

84 Volunteers designated to 

act on behalf of the state long-term care ombudsman add an invaluable service which 

benefits residents, their families and facility staff. Volunteers across the county donated 

their time, talents and energy to visit residents, listen to their concerns and take action. 

For some residents the ombudsman may be their only visitor. Volunteer ombudsmen 

frequently provide the routine ombudsman presence in many facilities and provide costeffective complaint resolution. The Independent Sector places the value of the volunteer 

time at $22.14 per hour placing the value of 919,749 hours at $20,363,243.

Ombudsmen solve problems at the facility level -- Long-term care ombudsman programs 

resolve hundreds of thousands of complaints every year on behalf of long-term care 

facility residents. The largest group that requested ombudsman assistance in resolving 

complaints were residents themselves, indicating that residents depend on ombudsmen to 

help them resolve their concerns. By resolving the vast majority of these complaints to 

the satisfaction of the resident or complainant, the work of ombudsmen improved the 

quality of life and quality of care for many residents of our nation’s long-term care 

facilities.

Home and community-based services are increasing demands for ombudsman services --

Originally created as a service for nursing facility residents in 1978, providing a regular 

presence for nursing home residents continued to be a priority for ombudsman programs. 

Since the program authority expanded to other types of long-term care facilities in 1981, 

and as the number of residents in these settings has been rapidly increasing since that 

time, ombudsman programs are challenged to also serve individuals living in board and 

care and other similar facilities.

Long-term care ombudsman programs are credible sources of information --

Ombudsman programs served as a credible source of information for residents (including 

through resident councils), their families (including through family councils), and facility 

staff. Based on their extensive experience resolving resident problems, ombudsmen 

represented resident interests to policymakers, influencing public policy related to longterm care.

Ombudsman programs leverage federal dollars -- Federal funds leveraged resources 

from other sources for ombudsman programs. 42 percent of program funds came from 

non-federal sources during FY 2012. 

84 The Independent Sector places the value of volunteer time at $ $22.14 per hour placing the estimated 

value of 919.749 hours at $20,363,243 $. . http://independentsector.org/volunteer_time

53

 
PART IV: SUPPORTING THE NATIONAL 

AGING SERVICES NETWORK

Older Americans and Americans with disabilities face a vast array of choices when trying 

to determine the right services and supports to assist them to remain active and 

independent in their communities. As the number of choices available to assist them 

grows, so too does the complexity of navigating these programs and selecting among 

them to determine which best suit the needs of each individual. 

A key part of AoA’s emphasis on community living is providing consumers with the 

information and assistance they need to make decisions about their independence and 

connecting them with the right services. An Aging and Disability Resource Centers

(ADRCs) system helps to address this need by providing information, outreach, and 

assistance to seniors and people with disabilities so that they can access the services 

necessary for their independence. ADRCs serve as community-level “one stop shop” 

entry points into long-term care - including home and community-based services that can 

enable people to remain in their homes - for people of all ages who have chronic 

conditions and disabilities. 

Aging and Disability Resource Centers

(FY 2012: $6,457,000)

Aging and Disability Resource Centers (ADRCs) “No Wrong Door System”85 supports

state efforts to develop more efficient, cost-effective, and consumer-responsive systems 

of information and integrated access by creating “one-stop shop” entry points into longterm care at the community-level. ADRCs help states make better use of taxpayer dollars 

by streamlining access to community services and supports and diverting individuals 

from more costly forms of care, including institutional care and unnecessary hospital readmissions.

ADRCs are a key component in transforming states’ long-term supports and services 

programs. Since 2003, the Administration on Aging and the Centers for Medicare & 

Medicaid Services (CMS) have provided grants to states to develop the foundational 

infrastructure for delivering person-centered systems of information, one-on-one 

counseling, and access that make it easier for individuals to learn about and access their 

health and long-term services and support options. The Veterans Health Administration 

has partnered alongside AoA and CMS to help states develop a single ADRC No Wrong 

Door System for all populations and all payers. ADRCs grew out of best practice 

85 In a “No Wrong Door” entry system, multiple agencies retain responsibility for their respective services 

while coordinating with each other to integrate access to those services through a single, standardized entry 

process that is administered and overseen by a coordinating entity (Allison Armor-Garb, Point of Entry 

Systems for Long-Term Care: State Case Studies, prepared for the New York City Department of Aging, 

2004).

54

 
innovations known as “No Wrong Door” and “Single Points of Entry” programs, where 

people of all ages may turn for objective information on their long-term services and 

support options. ADRCs provide services including:

• “one-on-one” person-centered options counseling and assistance to help 

consumers, including private pay individuals, and their caregivers fully 

understand the options available to them.

• streamlined access to all publicly supported long-term care services and support 

programs;

• targeted discharge planning, care transition and diversion support that integrates 

the medical and social service systems on behalf of older adults and individuals 

with disabilities to help them remain in their own homes and communities after a 

hospitalization, rehabilitation or skilled nursing facility visit; 

• outreach and assistance to Medicare beneficiaries on their Medicare benefits 

including prevention and low-income subsidies; and

• integrated options counseling and access-point to care transition and diversion 

support for veterans served through the ACL/Department of Veterans Affairs 

(VA) Veteran-Directed Home and Community-Based Services program 

partnership.

AoA and CMS have invested over $100 million in the ADRC program since 2003. As a 

result of these investments: 

• More than 509 ADRC sites have been established across 52 states, territories, and 

Washington, DC, by increasing the coordination and capacity of existing 

infrastructure in the aging, disability and Medicaid networks. Together these

ADRC sites can reach roughly 77 percent of the U.S. population.

• Thirty-two states and territories have achieved statewide coverage, and an 

additional 13 states have achieved 50 percent or more of statewide coverage. 

• Forty-one states with ADRC programs sites currently conduct care transitions 

through formal intervention 

• Thirty-seven states have developed statewide web-based directories available to 

consumers and service providers which improve the quality and consistency of 

the aging services network information and assistance provided across the state. 

Person centered ADRC No Wrong Door System performs the following operational 

functions:

 

55
• Access Points of Referral to Option Counseling: ADRCs include numerous 

participating agencies which serve as local access points to refer individuals to 

their local ADRC Options Counseling Program. ADRCs serve as a highly visible 

and trusted source of objective information and assistance where people of all 

ages, disabilities, income levels and cultural backgrounds know they can turn to 

help in accessing the full range of long-term service and support options available 

in their communities. These referral partnerships should involve a wide array of 

local agencies and organizations within states’ systems, including all agencies 

providing services to older adults and individuals with disabilities across the 

lifespan. An ADRC system should also ensure that individuals can access the 

system virtually or in person and receive the same set of information from any 

location within the state and have the knowledge to refer individuals to One-onOne Options Counseling.

• One-on-One Person-Centered Options Counseling: ADRCs provide options 

counseling to all persons and their respective family caregivers making long-term 

support decisions regardless of their income or financial assets. This includes

individuals who can pay for supports, but can also be targeted across various 

settings and/or populations. Options Counseling is a seamless approach to helping 

individuals and their families to identify and understand their needs and assist 

them in making informed decisions about appropriate long-term service and 

support choices, with the goal of meeting individuals at the moment when they 

seek out services, including before they need them. Options Counseling includes 

the following key components: (1) Conduct One-to-One Person-Centered 

Interview & Preliminary Assessment; (2) Support Individual Decision-Making to 

Develop Person-Centered LTSS Plans; (3) Facilitate Streamlined Access to LTSS;

and (4) Ongoing Follow-Up and Documentation.

• Streamline Access to Public Programs: ADRCs serve as the front door for 

publicly-funded long-term services and supports through a standardized process 

by which all individuals enroll, including those funded by Medicaid, the OAA, 

and other state and federal programs and services. ADRCs must have the 

necessary protocols and procedures in place to facilitate an integrated and fully 

coordinated approach to performing the administrative functions for home and 

community-based and institutional-based publicly funded programs. The goal is 

to create a process that is seamless for consumers regardless of which service they 

choose. This should include assisting and/or completing the comprehensive 

assessment, helping individuals in completing and submitting all required 

information and documentation, determining eligibility for programs and services, 

and ensuring that people receive the services need and want, and for which they 

are eligible.

• Person-Centered Transition Support: ADRCs create formal linkages between and 

among the major pathways that people travel while transitioning from one service 

setting to another (e.g. hospital, nursing home, community, etc.), or from one 

56
public program payer to another. These linkages ensure that people, including 

those with chronic conditions and disabilities, have the information they need to 

make informed decisions about their service and support options as they pass 

through critical transition points in the health and long-term services and support 

systems that cut across all payers and settings. These critical activities help 

individuals break the cycle of readmission to the hospital,

86 avoid unnecessary 

admission to a nursing home or other institution, and live longer in the community

with enhanced quality of life.

• Quality Assurance: ADRCs must ensure they adhere to the highest standard of 

service in all areas. ADRCs should continually monitor the quality of their 

services and evaluate their impact on consumers’ lives, system efficiencies and 

public and private investments. 

ADRCs will continue, with Department of Veterans Affairs (VA) funding, to serve 

clients under the current ACL/VA partnership. In FY 2008, the VA and AoA began 

working together to develop the Veterans Directed Home and Community-Based 

Services Program (VD-HCBS), which is designed to serve veterans of any age who are at 

risk of admission to a nursing home by providing them the opportunity to self-direct their 

care and access services to help them remain in the community. Rather than build a 

separate infrastructure to serve veterans, the VA made a strategic decision to use the 

aging network infrastructure – including using the ADRC as the integrated access point 

to empower the veterans to set-up their own service plan for long-term supports and 

services – as a delivery vehicle for VD-HCBS. Since inception of the program the VA 

has invested over $41 million to expand this program nationwide. HHS and the VA have 

worked together to develop program guidelines/national standards, web-based tools to 

track program activities and implement a national training program for the VD-HCBS. 

Currently, 25 states and the District of Columbia are operating VD-HCBS programs with 

43 operational VAMCs, 102 operational AAA/ADRCs and over 1,500 veterans served 

with 23 percent under age 60. 

Aging Network Support Program Activities

(FY 2012: $8,184,000)

Aging Network Support Activities provide competitive grants and contracts to support 

ongoing activities of national significance which help seniors and their families to obtain 

information about their care options and benefits, and which provide technical assistance 

to help states, tribes, and community providers of aging services to develop service 

systems that help older people remain independent and able to live in their own homes 

and communities. These activities provide critical and ongoing support for the national 

aging services network and help support the activities of AoA’s core service delivery 

programs. 

86 Brock, J. et al. (1998). “Association Between Quality Improvement for Care Transitions in Communities 

and Rehospitalizations Among Medicare Beneficiaries.” JAMA. 309: 381-391.

57

 
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. 

National Eldercare Locator

Older Americans and their caregivers face a complicated array of choices and decisions 

about health care, pensions, insurance, housing, financial management, and long-term 

care. The Eldercare Locator, created in 1991, helps seniors and their families navigate 

this complex environment by connecting those needing assistance with state and local 

agencies on aging that serve older adults and their caregivers. The Eldercare Locator can 

be accessed through a toll-free nationwide telephone line (800-677-1116) or website 

(http://www.eldercare.gov). The phone line and website both connect those in need to 

providers in every zip code in the nation. The Eldercare Locator website continues to 

grow as a resource tool for older adults and their caregivers, serving over 525,000 

individuals a year. 

National Alzheimer’s Call Center

The National Alzheimer’s Call Center is a national information and counseling service 

for persons with Alzheimer’s disease, their family members, and informal caregivers. In 

the 12-month period ending January 31, 2013, the National Alzheimer’s Call Center 

handled over 294,000 calls through its national and local partners, and its on-line 

message board community recorded over five million page views and over 113,000 

individual postings.

The National Alzheimer’s Call Center is available to people in all states, 24 hours-a-day, 

seven days-a-week, 365 days–a-year to provide expert advice, care consultation, and 

information and referrals at the national and local levels regarding Alzheimer’s disease.

Trained professional customer service staff and masters degree social workers are 

available at all times. The Call Center is accessible by telephone, website or e-mail at no 

cost to the caller. Services focus on consumers, not professionals. Information provided 

may include basic information on caregiving; handling legal issues; resources for longdistance caregiving; and tips for working with the medical community. Local 

community-based organizations are directly involved to ensure local, on-the-ground 

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.

58
National Education and Resource Center on Women and Retirement Planning

The National Education and Resource Center on Women and Retirement Planning, 

established in 1998, provides women with access to a one-stop gateway that integrates 

financial information and resources on retirement, health, and planning for long-term 

care. This project has made user-friendly financial education and retirement planning 

tools available to traditionally hard-to-reach women, including low-income women, 

women of color, women with limited English speaking proficiency, rural, and other 

“underserved” women. Information is offered through financial and retirement planning 

programs, workshops tailored to meet women’s special needs, and publications in hard 

copy and web-based formats. Since its establishment, the Center has conducted more 

than 20,000 workshops on strategies to access financial and retirement planning 

information for women and disseminated financial and retirement planning information 

tailored to the specific needs of hard-to-reach women. 

National 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.

. 

AoA awarded individual cooperative agreements to four national organizations that form 

a consortium with the goal of assisting the aging network effectively serve an 

increasingly diverse older population. Each NMAO project pilots a practical, 

nontraditional, community-based intervention for reaching older individuals who 

experience barriers to accessing home and community-based services. Interventions focus 

on barriers due to language and low literacy, as well as those directly related to cultural 

diversity. Strategies developed under this program incorporate the latest technology and 

facilitate the generation and dissemination of knowledge in forms that can assist racial 

and ethnic minority older individuals to practice positive health behaviors and strengthen 

their capacity to maintain active, independent life styles. Examples of products resulting 

from these grants include a culturally appropriate caregiver manual/toolkit for American 

Indian and Alaska Native caregivers of elders with dementia, chronic disease self 

management curricula and manual tailored for racial and ethnic minority seniors, a series 

of bilingual health promotion materials, information about heart disease and prostate 

cancer among Hispanic elders and a referral database of Chronic Disease SelfManagement (CDSMP) workshops.

59
60
Appendix

Formula Grant Funding

Allocation by 

State, Territory and 

Tribal Organization

U.S. Administration on Aging 

Department of Health and Human Services

61
62
State

Supportive 

Services

Congregate 

Meals

Home 

Meals

Preventive 

Services NFCSP Total Title III

Alabama $5,571,772 $6,686,908 $3,373,334 $331,874 $2,351,563 $18,315,451 

Alaska $1,823,319 $2,181,871 $1,077,497 $104,722 $763,390 $5,950,799 

Arizona $7,406,195 $8,888,476 $4,483,954 $403,699 $3,164,166 $24,346,490 

Arkansas $3,502,121 $4,203,036 $2,120,299 $210,763 $1,503,924 $11,540,143 

California $36,265,662 $43,523,886 $21,956,423 $2,123,744 $15,442,307 $119,312,022 

Colorado $4,885,597 $5,863,402 $2,957,901 $255,177 $1,926,424 $15,888,501 

Connecticut $4,404,337 $5,241,452 $2,564,007 $260,160 $1,874,713 $14,344,669 

Delaware $1,823,319 $2,181,871 $1,077,497 $104,722 $763,390 $5,950,799 

District of Columbia $1,823,319 $2,181,871 $1,077,497 $104,722 $763,390 $5,950,799 

Florida $26,219,739 $31,467,368 $15,874,292 $1,551,522 $12,070,518 $87,183,439 

Georgia $9,116,311 $10,940,853 $5,519,314 $485,765 $3,547,261 $29,609,504 

Hawaii $1,823,319 $2,181,871 $1,077,497 $104,722 $763,390 $5,950,799 

Idaho $1,823,319 $2,181,871 $1,077,497 $104,722 $763,390 $5,950,799 

Illinois $14,524,890 $17,286,541 $8,216,052 $837,894 $5,898,667 $46,764,044 

Indiana $7,109,911 $8,532,891 $4,304,574 $425,464 $3,054,144 $23,426,984 

Iowa $4,260,878 $5,081,501 $2,243,949 $231,350 $1,723,829 $13,541,507

Kansas $3,432,908 $4,089,903 $1,895,772 $190,952 $1,408,146 $11,017,681 

Kentucky $4,946,975 $5,937,065 $2,995,061 $291,198 $2,059,860 $16,230,159 

Louisiana $4,795,898 $5,734,142 $2,892,693 $294,553 $1,991,274 $15,708,560 

Maine $1,823,319 $2,181,871 $1,086,279 $104,924 $766,439 $5,962,832 

Maryland $6,117,674 $7,342,067 $3,703,841 $359,750 $2,524,149 $20,047,481 

Massachusetts $8,209,095 $9,780,267 $4,599,080 $463,658 $3,349,110 $26,401,210 

Michigan $11,516,437 $13,821,341 $6,972,430 $691,299 $4,947,620 $37,949,127 

Minnesota $5,744,649 $6,894,385 $3,477,999 $337,777 $2,521,552 $18,976,362 

Mississippi $3,272,711 $3,891,114 $1,954,691 $195,489 $1,363,666 $10,677,671 

Missouri $7,118,429 $8,467,047 $4,231,795 $421,608 $3,049,893 $23,288,772 

Montana $1,823,319 $2,181,871 $1,077,497 $104,722 $763,390 $5,950,799 

Nebraska $2,294,938 $2,738,802 $1,235,914 $124,415 $933,179 $7,327,248 

Nevada $2,835,544 $3,403,051 $1,716,732 $151,173 $1,095,922 $9,202,422 

New Hampshire $1,823,319 $2,181,871 $1,077,497 $104,722 $763,390 $5,950,799 

New Jersey $10,262,972 $12,190,488 $6,019,557 $618,534 $4,381,530 $33,473,081 

New Mexico $2,298,174 $2,758,132 $1,391,391 $126,899 $949,699 $7,524,295 

New York $24,283,431 $28,963,855 $13,307,414 $1,371,257 $9,679,695 $77,605,652 

North Carolina $10,572,477 $12,688,457 $6,400,925 $575,417 $4,360,720 $34,597,996 

North Dakota $1,823,319 $2,181,871 $1,077,497 $104,722 $763,390 $5,950,799 

Ohio $13,816,810 $16,393,785 $8,262,220 $832,633 $5,998,353 $45,303,801 

Oklahoma $4,278,286 $5,092,422 $2,568,966 $256,429 $1,822,471 $14,018,574 

Oregon $4,591,896 $5,510,920 $2,780,085 $253,923 $1,908,337 $15,045,161 

Pennsylvania $17,879,977 $21,279,716 $9,761,855 $1,014,597 $7,379,177 $57,315,322 

Rhode Island $1,823,319 $2,181,871 $1,077,497 $104,722 $763,390 $5,950,799 

South Carolina $5,443,562 $6,533,039 $3,295,711 $294,285 $2,184,482 $17,751,079 

South Dakota $1,823,319 $2,181,871 $1,077,497 $104,722 $763,390 $5,950,799 

Tennessee $7,303,508 $8,765,235 $4,421,784 $415,196 $3,006,252 $23,911,975 

Texas $22,531,556 $27,041,031 $13,641,345 $1,248,379 $9,176,247 $73,638,558 

Utah $2,118,857 $2,542,925 $1,282,826 $114,654 $888,363 $6,947,625 

Vermont $1,823,319 $2,181,871 $1,077,497 $104,722 $763,390 $5,950,799 

Virginia $8,467,596 $10,162,304 $5,126,561 $483,047 $3,445,502 $27,685,010 

Washington $7,217,466 $8,661,973 $4,369,691 $396,147 $2,923,761 $23,569,038 

West Virginia $2,773,538 $3,305,947 $1,527,382 $152,542 $1,079,225 $8,838,634 

Wisconsin $6,509,748 $7,812,612 $3,941,216 $389,928 $2,887,461 $21,540,965 

Wyoming $1,823,319 $2,181,871 $1,077,497 $104,722 $763,390 $5,950,799 

American Samoa $472,317 $594,843 $136,498 $13,090 $95,424 $1,312,172 

Guam $911,660 $1,090,936 $538,748 $52,361 $381,695 $2,975,400 

Northern Mariana 

Islands $227,915 $272,734 $134,687 $13,090 $95,424 $743,850 

Puerto Rico $4,534,616 $5,442,176 $2,745,406 $268,699 $1,923,559 $14,914,456 

Virgin Islands $911,660 $1,090,936 $538,748 $52,361 $381,695 $2,975,400 

TOTAL $364,663,840 $436,374,287 $215,499,366 $20,944,340 $152,678,078 $1,190,159,911 

63
State Ombudsman Elder Abuse Total Title VII

Alabama $261,779 $77,420 $339,199 

Alaska $83,616 $25,125 $108,741 

Arizona $347,967 $102,909 $450,876 

Arkansas $164,541 $48,662 $213,203 

California $1,703,874 $503,913 $2,207,787

Colorado $229,541 $67,886 $297,427 

Connecticut $198,974 $59,907 $258,881 

Delaware $83,616 $25,125 $108,741 

District of Columbia $83,616 $25,125 $108,741 

Florida $1,231,886 $364,324 $1,596,210 

Georgia $428,313 $126,671 $554,984 

Hawaii $83,616 $25,125 $108,741 

Idaho $83,616 $25,125 $108,741 

Illinois $637,587 $197,384 $834,971 

Indiana $334,046 $98,793 $432,839 

Iowa $174,136 $55,927 $230,063 

Kansas $147,117 $45,843 $192,960 

Kentucky $232,425 $68,738 $301,163 

Louisiana $224,480 $68,518 $292,998 

Maine $84,298 $25,125 $109,423 

Maryland $287,428 $85,005 $372,433 

Massachusetts $356,900 $109,606 $466,506 

Michigan $541,079 $160,862 $701,941 

Minnesota $269,902 $79,822 $349,724 

Mississippi $151,689 $45,198 $196,887 

Missouri $328,398 $97,643 $426,041 

Montana $83,616 $25,125 $108,741 

Nebraska $95,910 $29,770 $125,680 

Nevada $133,223 $39,400 $172,623 

New Hampshire $83,616 $25,125 $108,741 

New Jersey $467,133 $143,950 $611,083 

New Mexico $107,975 $31,933 $139,908 

New York $1,032,690 $318,066 $1,350,756 

North Carolina $496,728 $146,905 $643,633 

North Dakota $83,616 $25,125 $108,741 

Ohio $641,170 $197,185 $838,355 

Oklahoma $199,358 $60,208 $259,566 

Oregon $215,742 $63,805 $279,547 

Pennsylvania $757,545 $242,944 $1,000,489 

Rhode Island $83,616 $25,125 $108,741 

South Carolina $255,756 $75,639 $331,395 

South Dakota $83,616 $25,125 $108,741 

Tennessee $343,142 $101,483 $444,625 

Texas $1,058,604 $313,077 $1,371,681 

Utah $99,550 $29,442 $128,992 

Vermont $83,616 $25,125 $108,741 

Virginia $397,834 $117,658 $515,492 

Washington $339,099 $100,287 $439,386 

West Virginia $118,529 $36,736 $155,265 

Wisconsin $305,849 $90,453 $396,302 

Wyoming $83,616 $25,125 $108,741 

American Samoa $10,452 $3,141 $13,593 

Guam $41,808 $12,563 $54,371 

Northern Mariana Islands $10,452 $3,141 $13,593 

Puerto Rico $213,051 $63,009 $276,060 

Virgin Islands $41,808 $12,563 $54,371 

TOTAL $16,723,160 $5,025,014 $21,748,174 

64
State/Territory

Nutrition Services Incentive 

Program

Alabama $2,933,316 

Alaska $372,212 

Arizona $2,118,282 

Arkansas $2,637,872 

California $12,976,341 

Colorado $1,499,399 

Connecticut $1,423,479 

Delaware $495,729 

District of Columbia $505,439 

Florida $7,187,763 

Georgia $2,768,572 

Hawaii $483,221 

Idaho $701,581 

Illinois $6,902,253 

Indiana $1,788,180 

Iowa $2,119,990 

Kansas $1,972,161 

Kentucky $1,831,731 

Louisiana $3,277,072 

Maine $629,641 

Maryland $1,648,593 

Massachusetts $4,885,300 

Michigan $7,257,628 

Minnesota $1,956,106 

Mississippi $1,365,451 

Missouri $4,070,380 

Montana $930,440 

Nebraska $1,168,951 

Nevada $953,138 

New Hampshire $1,180,291

New Jersey $3,667,607 

New Mexico $2,015,025 

New York $15,385,497 

North Carolina $3,330,755 

North Dakota $814,498 

Ohio $5,706,030 

Oklahoma $2,337,289 

Oregon $1,793,200 

Pennsylvania $7,112,252 

Rhode Island $449,215 

South Carolina $1,589,875 

South Dakota $965,896 

Tennessee $1,675,968 

Texas $12,079,291 

Utah $1,368,532 

Vermont $779,950 

Virginia $2,280,760 

Washington $2,093,766 

West Virginia $1,657,818 

Wisconsin $2,689,202 

Wyoming $793,487 

Guam $371,257 

Northern Mariana Islands $58,148 

Puerto Rico $2,893,191 

Virgin Islands $180,074 

TOTAL $154,129,095 

65
State

Tribe 

No. Grantee Name TITLE6 A/B TITLE6 C NSIP

AK 01 Aleutian Pribilof Islands Association $93,050 $26,720 $20,270

AK 02 Association of Village Council Presidents $134,330 $3,429

AK 03 Bristol Bay Native Association $134,330 $46,770 $4,126

AK 04 Central Council Tlingit & Haida Indian Tribes of AK $176,380 $53,450 $1,951

AK 06 Copper River Native Association $81,940 $20,040 $2,240

AK 07 Hoonah Indian Association $72,220 $13,360 $1,437

AK 08 Kodiak Area Native Association (Northern Section) $72,220 $13,360 $1,206

AK 09 Kodiak Area Native Association (Southern Section) $72,220 $13,360 $1,914

AK 10 Metlakatla Indian Community $93,050 $26,720 $4,761

AK 11 Native Village of Barrow $93,050 $26,720 $5,321

AK 12 Tanana Chiefs Conference for Kuskokwim subregion $72,220 $13,360 $2,522

AK 13 Tanana Chiefs Conference for Lower Yukon Subregion $72,220 $13,360 $4,157

AK 14 Tanana Chiefs Conference for Yukon Flats Subregion $72,220 $13,360 $3,341

AK 15 Tanana Chiefs Conference for Yukon Koyukuk Subregion $81,940 $20,040 $1,173

AK 16 Tanana Chiefs Conference for Yukon Tanana Subregion $72,220 $13,360 $2,443

AK 17 Fairbanks Native Association $134,330 $46,770

AK 19 Maniilaq Association $134,330 $46,770 $13,996

AK 20 Native Villiage of Unalakleet $72,220 $13,360 $5,137

AK 21 Chugachmiut $81,940 $20,040 $5,139

AK 22 Arctic Slope Native Association, Limited $72,220 $13,360 $8,325

AK 23 Denakkanaaga, Inc. $81,940 $20,040

AK 24 Klawock Cooperative Association $72,220 $13,360 $1,216

AK 25 Kootznoowoo Inc. $72,220 $13,360 $1,191

AK 26 Gwichyaa Zhee Gwich'in Tribal Government $72,220 $13,360 $4,454

AK 27 Native Village of Point Hope $72,220 $13,360 $2,984

AK 28 Seldovia Village Tribe, IRA $72,220 $462

AK 30 Sitka Tribes of Alaska $93,050 $26,720 $1,504

AK 32 Ketchikan Indian Community $134,330 $46,770 $2,109

AK 33 Kuskokwim Native Association $81,940 $20,040 $2,676

AK 35 Southcentral Foundation $176,380 $53,450 $8,198

AK 36 Kenaitze Indian Tribe $115,980 $40,100 $5,030

AK 37 Wrangell Cooperative Association $72,220 $13,360 $1,324

AK 38 Native Village of Savoonga $72,220 $13,360 $9,558

AK 39 Native Village of Gambell $72,220 $13,360 $6,366

AK 40 Native Village of Eyak $72,220 $13,360 $625

AK 41 Organized Village of Kake $72,220 $13,360 $1,690

AK 42 Chickaloon Native Village $81,940 $1,627

AK 43 Yakutat Tlingit Tribe & Craig Community Association $72,220 $13,360 $2,326

AK 44 Galena Village (aka Louden Village Council) $72,220 $13,360 $9,959

AK 45 Asa'carsarmiut Tribal Council $72,220 $5,505

AK 46 Orutsararmuit Native Council $93,050 $13,735

AK Total Total $3,686,120 $808,360 $175,427

AL 01 Poarch Creek Indians $134,330 $46,770 $17,133

AL Total Total $134,330 $46,770 $17,133

AZ 02 Colorado River Indian Tribes $104,860 $33,400 $5,990

AZ 03 Gila River Indian Community $134,330 $46,770 $17,591

AZ 04 Hopi Tribe $134,330 $46,770 $9,870

AZ 05 Hualapai Tribe $81,940 $20,040 $6,152

AZ 06 Navajo Nation $176,380 $53,450 $13,835

66
AZ 07 Pascua Yaqui Tribe $134,330 $46,770 $40,499

AZ 09 Salt River Pima-Maricopa Indian Community $104,860 $33,400 $7,440

AZ 10 San Carlos Apache Tribe $134,330 $46,770 $5,824

AZ 11 Tohono o'Odham Nation $134,330 $46,770 $3,426

AZ 12 White Mountain Apache Tribe $134,330 $46,770 $17,851

AZ 13 Ak-Chin Indian Community $72,220 $13,360 $2,081

AZ 14 Yavapai Apache Tribe $81,940 $2,910

AZ 15 Havasupai Tribe $72,220 $13,360 $8,487

AZ 16 Inter-Tribal Council of Arizona, Inc. $72,220 $13,360 $1,464

AZ 17 Cocopah Indian Tribe $72,220 $13,689

AZ 18 Quechan Indian Tribe $81,940 $20,040 $18,112

AZ Total Total $1,726,780 $481,030 $175,221

CA 01 Bishop Tribal Council $81,940 $20,040 $30,175

CA 02 Blue Lake Rancheria $81,940 $20,040 $21,951

CA 06 Karuk Tribe of California $81,940 $20,040 $3,107

CA 07 Pit River Health Services, Inc. $72,220 $4,069

CA 08 Picayune Rancheria of the Chukchansi Indians $72,220 $5,561

CA 09 Riverside-San Bernardino Co. Indian Health-for Morongo $72,220 $13,360 $9,031

CA 10 Riverside-San Bernardino Co. Indian Health-for Pechanga $72,220 $13,360 $3,328

CA 11 Riverside-San Bernardino Co. Indian Health-for Soboba $72,220 $13,360 $6,621

CA 12 Sonoma County Indian Health Project - Sonoma $72,220 $8,751

CA 13 Southern Indian Health Council, Inc. $72,220 $13,360 $12,477

CA 15 Toiyabe Indian Health Project, Inc. - Northern $72,220 $13,360 $5,691

CA 16 Tule River Indian Health Center, Inc. $81,940 $20,040 $17,929

CA 17 Coast Indian Community of Resighini Rancheria $81,940 $20,040 $8,202

CA 18 United Indian Health Services for Smith River $93,050 $26,720 $10,853

CA 20 Indian Senior Center, Inc. $81,940 $20,040 $11,438

CA 21 Sonoma County Indian Health Project - Manchester $72,220 $3,275

CA 25 Pala Band of Mission Indians $81,940 $14,028

CA 26 Redding Rancheria $134,330 $46,770 $5,808

CA 28 Toiyabe Indian Health Project, Inc. - Southern $72,220 $13,360 $3,672

CA 29 Hoopa Valley Tribe, K'ima:w Medical Center $81,940 $7,873

CA 30 Round Valley Indian Tribes $93,050 $2,826

CA 31 Fort Mojave Indian Tribe $72,220 $13,360 $5,051

CA 33 CA Indian Manpower Consortium, Inc. - Chico, $72,220 $13,360 $7,093

CA 34 CA Indian Manpower Consortium, Inc. - Big Sandy, $72,220 $13,360 $8,322

CA 35 CA Indian Manpower Consortium, Inc. - Berry Creek, $72,220 $13,360 $5,762

CA 36 CA Indian Manpower Consortium, Inc. - Coyote Valley, $81,940 $20,040 $3,998

CA 37 CA Indian Manpower Consortium, Inc. - Enterprise, $81,940 $20,040 $7,382

CA 38 Santa Ynez Band of Mission Indians $72,220 $2,125

CA Total Total $2,223,130 $367,410 $236,399

CO 01 Southern Ute Indian Tribe $81,940 $20,040 $3,364

CO 02 Ute Mountain Ute Tribe $81,940 $13,589

CO Total Total $163,880 $20,040 $16,953

HI 01 Alu Like, Inc. $1,505,000 $53,450 $31,556

HI 02 Hana Health $81,940 $5,085

HI Total Total $1,586,940 $53,450 $36,641

IA 01 Sac & Fox Tribe of the Mississippi in Iowa $93,050 $26,720 $9,217

IA Total Total $93,050 $26,720 $9,217

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ID 01 Coeur d'Alene Tribe $81,940 $20,040 $16,265

ID 02 Nez Perce Tribe $115,980 $40,100 $26,923

ID 03 Shoshone-Bannock Tribes $134,330 $46,770 $24,149

ID Total Total $332,250 $106,910 $67,337

KS 01 The Kickapoo Tribe in Kansas $72,220 $13,360 $6,912

KS 02 Prairie Band of Potawatomi Nation $93,050 $26,720 $20,786

KS 03 Iowa Tribe of Kansas and Nebraska $72,220 $13,360 $6,088

KS Total Total $237,490 $53,440 $33,786

LA 01 Institute for Indian Development, Inc. $81,940 $13,998

LA Total Total $81,940 $13,998

MA 01 Wampanoag Tribe of Gay Head (Aquinnah) $72,220 $13,360 $1,216

MA Total Total $72,220 $13,360 $1,216

ME 01 Pleasant Point Passamaquoddy Tribe $93,050 $26,720 $21,431

ME 02 Penobscot Indian Nation $81,940 $5,067

ME 04 Aroostook Band of Micmacs $72,220 $13,360 $2,639

ME Total Total $247,210 $40,080 $29,137

MI 01 Grand Traverse Band of Ottawa & Chippewa Indians $93,050 $26,720 $16,901

MI 02 Inter-Tribal Council of Michigan, Inc. $81,940 $20,040 $6,207

MI 03 Keweenaw Bay Indian Community $81,940 $20,040 $13,338

MI 04 Sault Ste. Marie Tribe of Chippewa Indians $134,330 $22,010

MI 05 Little Traverse Bay Bands of Odawa Indians $81,940 $4,385

MI 07 Bay Mills Indian Community $81,940 $20,040 $5,264

MI 08 Pokagon Band of Potawatomi Indians $81,940 $3,914

MI 09 Little River Band of Ottawa Indians $93,050 $26,720 $2,032

MI 10 Nottawaseppi Huron Band of the Potawatomi $72,220 $13,360 $3,631

MI Total Total $802,350 $126,920 $77,682

MN 01 Bois Forte Reservation Tribal Government $81,940 $20,040 $8,269

MN 02 Fond du Lac Band of Lake Superior Chippewa $115,980 $40,100 $41,604

MN 03 Leech Lake Band of Ojibwe $176,380 $53,450 $19,370

MN 07 Red Lake Band of Chippewa Indians $115,980 $38,748

MN 08 White Earth Reservation Tribal Council $104,860 $33,400 $7,732

MN 09 Grand Portage Band of Lake Superior Chippewa $72,220 $4,009

MN 10 Mille Lacs Band of Ojibwe $81,940 $20,040 $15,876

MN Total Total $749,300 $167,030 $135,608

MO 99 Eastern Shawnee Tribe of Oklahoma $93,050 $26,720 $16,848

MO Total Total $93,050 $26,720 $16,848

MS 01 Mississippi Band of Choctaw Indians $134,330 $46,770 $18,255

MS Total Total $134,330 $46,770 $18,255

MT 01 Assiniboine and Sioux Tribes $115,980 $40,100 $32,454

MT 02 Blackfeet Tribe - Eagle Shield Center $134,330 $46,770 $31,814

MT 03 Chippewa Cree Tribe $104,860 $33,400 $52,553

MT 04 Confederated Salish and Kootenai Tribes $134,330 $46,770 $7,846

MT 05 Fort Belknap Indian Community $104,860 $33,400 $13,747

MT 06 Northern Cheyenne Elderly Program $104,860 $33,400 $19,252

MT 07 Crow Tribal Elders Program $134,330 $46,770 $39,137

MT Total Total $833,550 $280,610 $196,803

NC 01 Eastern Band of Cherokee Indians $176,380 $53,450 $42,888

NC Total Total $176,380 $53,450 $42,888

ND 01 Spirit Lake Tribe $93,050 $26,720 $15,940

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ND 02 Standing Rock Sioux Tribe $134,330 $46,770 $97,042

ND 03 Three Affiliated Tribes $134,330 $46,770 $15,654

ND 04 Trenton Indian Service Area $93,050 $26,720 $2,746

ND 05 Turtle Mountain Band of Chippewa Indians $134,330 $46,770 $17,458

ND Total Total $589,090 $193,750 $148,840

NE 01 Omaha Tribe of Nebraska $81,940 $20,040 $9,154

NE 02 Santee Sioux Nation $72,220 $2,780

NE 03 Winnebago Senior Citizen Center $81,940 $20,040 $21,497

NE Total Total $236,100 $40,080 $33,431

NM 01 Eight Northern Indian Pueblos Council (Picuris, etc.) $176,380 $53,450 $16,545

NM 02 Eight N. Indian Pueblos Council(San Ildefonso, etc.) $93,050 $26,720 $5,172

NM 03 Five Sandoval Indian Pueblos, Inc. $93,050 $13,717

NM 04 Jicarilla Apache Nation $104,860 $33,400 $18,581

NM 05 Laguna Rainbow Corporation $134,330 $46,770 $15,905

NM 06 Mescalero Apache Tribe $93,050 $8,850

NM 07 Pueblo de Cochiti $81,940 $20,040 $6,413

NM 09 Pueblo of Isleta $115,980 $40,100 $23,846

NM 10 Pueblo of Jemez $104,860 $33,400 $4,991

NM 11 Pueblo of San Felipe $104,860 $33,400 $9,815

NM 12 Pueblo of Taos $104,860 $33,400 $7,828

NM 13 Zuni Tribe $134,330 $46,770 $25,790

NM 14 Ohkay Owingeh Senior Citizens Program $134,330 $46,770 $13,674

NM 15 Santa Clara Pueblo $176,380 $53,450 $15,287

NM 16 Santo Domingo Pueblo $134,330 $46,770 $12,021

NM 17 Pueblo of Tesuque $72,220 $13,360 $6,618

NM 18 Pueblo of Acoma $93,050 $26,720 $10,946

NM Total Total $1,951,860 $554,520 $215,999

NV 01 Fallon Paiute-Shoshone Tribes $81,940 $20,040 $19,901

NV 02 Inter-Tribal Council of Nevada, Inc. (McDermitt, etc.) $81,940 $20,040 $9,029

NV 03 Inter-Tribal Council of Nevada, Inc. (Duckwater, etc.) $81,940 $20,040 $4,857

NV 04 Inter-Tribal Council of Nevada, Inc. (Ely, etc.) $72,220 $13,360 $6,184

NV 05 Shoshone-Paiute Tribes $81,940 $20,040 $10,033

NV 06 Walker River Paiute Tribe $81,940 $9,989

NV 07 Washoe Tribe of Nevada and California $81,940 $20,040 $41,386

NV 08 Yerington Paiute Tribe $72,220 $4,563

NV 09 Pyramid Lake Paiute Tribe $93,050 $26,720 $4,612

NV 10 Elko Band Council $72,220 $13,360 $7,896

NV 11 Reno-Sparks Indian Colony $81,940 $20,040 $12,423

NV Total Total $883,290 $173,680 $130,873

NY 01 St. Regis Mohawk Tribe $134,330 $46,770 $14,017

NY 02 Seneca Nation of Indians $134,330 $46,770 $19,883

NY 04 Oneida Indian Nation $72,220 $13,360 $3,766

NY 05 Shinnecock Indian Nation $72,220 $13,360 $4,727

NY Total Total $413,100 $120,260 $42,393

OK 01 Apache Tribe of Oklahoma $134,330 $46,770 $11,218

OK 02 Caddo Nation of Oklahoma $81,940 $20,040 $5,015

OK 03 Cherokee Nation $177,704 $54,689 $42,113

OK 04 Cheyenne & Arapaho Tribes $134,330 $46,770 $11,158

OK 06 Choctaw Nation of Oklahoma $176,380 $53,450 $28,107

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OK 07 Citizen Potawatomi Nation $176,380 $53,450 $13,675

OK 08 Comanche Nation $134,330 $46,770 $17,096

OK 09 Delaware Nation $78,960 $13,360 $6,897

OK 10 Iowa Tribe of Oklahoma $134,330 $46,770 $8,092

OK 12 Kickapoo Tribe of Oklahoma $100,000 $20,040 $16,534

OK 13 Kiowa Tribe of Oklahoma $134,330 $46,770 $5,363

OK 14 Miami Tribe of Oklahoma $115,980 $40,100 $23,045

OK 15 Muscogee (Creek) Nation $176,380 $53,450 $147,442

OK 17 Otoe-Missouria Tribe of Indians $72,220 $13,360 $6,656

OK 18 Ottawa Tribe of Oklahoma $134,330 $46,770 $27,972

OK 19 Pawnee Nation of Oklahoma $81,940 $20,040 $12,522

OK 20 Peoria Tribe of Indians of Oklahoma $104,860 $33,400 $15,984

OK 21 Ponca Tribe of Oklahoma $81,940 $20,040 $14,814

OK 22 Quapaw Tribe of Oklahoma $115,980 $40,100 $19,163

OK 23 Sac and Fox Nation $81,940 $20,040 $11,552

OK 24 Seminole Nation of Oklahoma $176,380 $53,450 $13,319

OK 25 Seneca-Cayuga Tribe of Oklahoma $134,330 $46,770 $1,339

OK 26 Wichita and Affiliated Tribes $134,330 $46,770 $7,712

OK 27 Wyandotte Nation $134,330 $46,770 $15,476

OK 28 Absentee Shawnee Tribe $176,380 $53,450 $29,889

OK 29 Fort Sill Apache Tribe $104,860 $33,400 $5,217

OK 31 United Keetoowah Band of Cherokee Indians $134,330 $46,770 $17,572

OK 32 Chickasaw Nation $176,380 $53,450 $110,082

OK 33 Kaw Nation $81,940 $23,981

OK 34 Osage Nation of Oklahoma $176,380 $53,450 $28,277

OK 35 Delaware Tribes of Indians $134,330 $4,518

OK 36 Alabama-Quassarte Tribal Town $72,220 $13,360 $10,121

OK Total Total $4,064,774 $1,183,819 $711,921

OR 01 Confederated Tribes of Siletz Indians of Oregon $104,860 $33,400 $731

OR 02 Confederated Tribes of the Umatilla Indian Reservation $115,980 $40,100 $7,652

OR 03 Confederated Tribes of Warm Springs $104,860 $33,400 $19,327

OR 04 Confederated Tribes of Grand Ronde $93,050 $26,720 $10,982

OR 05 The Klamath Tribes $134,330 $46,770 $3,664

OR 06 Confed. Tribes of Coos, Lower Umpqua & $81,940 $20,040 $8,357

OR Total Total $635,020 $200,430 $50,713

RI 01 Narragansett Indian Tribe $93,050 $26,720 $2,178

RI Total Total $93,050 $26,720 $2,178

SC 01 Catawba Indian Nation Eldercare Program $81,940 $20,040 $10,816

SC Total Total $81,940 $20,040 $10,816

SD 01 Cheyenne River Elderly Nutrition Services, Inc. $134,330 $46,770 $11,943

SD 02 Crow Creek Sioux Tribe $81,940 $16,305

SD 03 Lower Brule Sioux Tribe $81,940 $20,040 $13,609

SD 04 Oglala Sioux Tribe $176,380 $53,450 $115,259

SD 05 Rosebud Sioux Tribe $176,380 $53,450 $74,639

SD 06 Sisseton Wahpeton Oyate of $134,330 $33,826

SD 08 Yankton Sioux Tribe $93,050 $26,720 $6,444

SD Total Total $878,350 $200,430 $272,025

TX 01 The Alabama-Coushatta Tribe of Texas $81,940 $20,040 $9,898

TX 02 Kickapoo Traditional Tribe of Texas $72,220 $15,748

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TX Total Total $154,160 $20,040 $25,646

UT 01 Ute Indian Tribe, Unitah & Ouray $93,050 $26,720 $8,318

UT Total Total $93,050 $26,720 $8,318

WA 01 Confederated Tribes of the Colville Reservation $134,330 $46,770 $17,782

WA 02 Lower Elwha Klallam Tribe $81,940 $20,040 $4,647

WA 03 Lummi Tribe $115,980 $40,100 $13,694

WA 04 Makah Nation $81,940 $20,040 $7,479

WA 05 Muckleshoot Indian Tribe $134,330 $46,770 $23,142

WA 09 Puyallup Tribe of Indians $134,330 $7,113

WA 10 Quinault Indian Nation $104,860 $33,400 $24,178

WA 13 Swinomish Indian Tribal Community $72,220 $13,360 $3,113

WA 14 Spokane Tribe of Indians $81,940 $20,040 $13,874

WA 16 The Tulalip Tribes $134,330 $13,026

WA 17 Jamestown S'Klallam Tribe $81,940 $20,040 $3,934

WA 19 Quileute Tribal Council $81,940 $20,040 $5,625

WA 20 S. Puget Intertribal Planning Agency - Shoalwater Bay $93,050 $26,720 $6,110

WA 21 Stillaguamish Tribe of Indians $93,050 $26,720 $1,709

WA 22 Upper Skagit Indian Tribe $72,220 $13,360 $2,479

WA 24 The Suquamish Tribe $93,050 $26,720 $10,753

WA 25 Port Gamble S'Klallam Tribe $72,220 $13,360 $2,441

WA 26 Samish Indian Nation $81,940 $20,040 $1,689

WA 27 Cowlitz Indian Tribe $93,050 $26,720 $4,673

WA 28 Skokomish Indian Tribe $93,050 $26,720 $3,404

WA 29 Confederated Tribes of the Chehalis Reservation $93,050 $26,720 $2,714

WA 30 Nooksack Indian Tribe $81,940 $20,040 $7,401

WA 31 Yakama Nation $72,220 $13,360 $3,350

WA 32 Snoqualmie Tribe $72,220 $13,360 $2,060

WA 33 S. Puget Intertribal Planning Agency - Nisqually $115,980 $40,100 $3,589

WA 34 S. Puget Intertribal Planning Agency - Squaxin Island $72,220 $13,360 $4,962

WA Total Total $2,439,340 $587,900 $194,941

WI 01 Bad River Band of Lake Superior Chippewa $81,940 $20,040 $12,551

WI 02 Forest County Potawatomi Community $81,940 $20,040 $8,630

WI 03 Lac Courte Oreilles Band of Lake Superior Chippewa $93,050 $26,720 $10,348

WI 04 Lac du Flambeau Band of Lake Superior Chippewa Indians $93,050 $26,720 $22,011

WI 05 Menominee Indian Tribe of Wisconsin $134,330 $46,770 $3,311

WI 06 Oneida Tribe Elder Services $134,330 $46,770 $5,417

WI 07 Red Cliff Band of Lake Superior Chippewa $81,940 $20,040 $7,450

WI 08 St. Croix Chippewa Indians of Wisconsin $81,940 $20,040 $5,182

WI 09 Stockbridge-Munsee Community $81,940 $20,040 $2,672

WI 10 Ho-Chunk Nation $104,860 $33,400 $12,022

WI Total Total $969,320 $280,580 $89,594

WY 01 Northern Arapaho Tribe $81,940 $11,201

WY 03 Eastern Shoshone Tribe $93,050 $13,170

WY Total Total $174,990 $24,371

Total Total Total $27,031,734 $6,348,039 $3,262,608

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