OLDER AMERICANS ACT 

Title III Programs 

2020 PROGRAM 

RESULTS 
 

Acknowledgment 

Jennifer Tillery, Senior Aging and Disability Program 

Coordinator, in the Ofce of Performance and 

Evaluation, Center for Policy and Evaluation, 

Administration for Community Living (ACL) assisted 

with preparation of the module. U.S. Department of 

Health and Human Services (HHS) in partnership with 

New Editions Consulting, Inc., under contract number 

HHSP233201500113I/HHSP23337002T. 

Disclaimer 

The views, opinions, and content of this publication are 

those of the authors and do not necessarily reflect the 

views, opinions, or policies of OPE, ACL, or HHS. Nothing in 

this document constitutes a direct or indirect endorsement 

by ACL of any nonfederal entity’s products, services, or 

policies, and any reference to nonfederal entity’s products, 

services, or policies should not be construed as such. 

Public Domain Notice 

All material appearing in this publication is in the public 

domain and may be reproduced or copied without permission from ACL. Citation of the source is required. However, this publication may not be reproduced or distributed 

for a fee without specifc, written authorization by ACL. 

Electronic Access 

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

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

or https://agid.acl.gov. 

Recommended Citation 

Administration for Community Living (2022). Overview 

of Older Americans Act Title III, VI, and VII Programs: 

2020 Summary of Highlights and Accomplishments. U.S. 

Department of Health and Human Services. https://acl. 

gov/aging-and-disability-in-america/data-and-research. 
Title III | Table of Contents 

Title III Program Highlights and Accomplishments 2

List of Exhibits 4 

Abbreviations and Acronyms 4 

Impact of Coronavirus Disease of 2019 Pandemic on Title III Services 5 

Funding Use 5

Title III Services 5

Part 1 | 2020 State Performance Report Data Highlights 7

State Performance Report Data Categories 7

Number of Agencies and Providers 8 

Number and Characteristics of Service Recipients 11 

Service Units 25

Part 2 | 2019 National Survey of Area Agencies on Aging 30 

Program Structure 30 

Programs 32 

Partnerships 33 

Services 35 

Appendix A: Title III Definitions 37 

References 41 

Older Americans Act Title III | 2020 Program Results | 1 
Title III 

Program Highlights and Accomplishments 

Older Americans Act (OAA) Title III programs are comprehensive and provide 

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

and services touch almost every older American’s life, directly or indirectly. For 

instance, senior centers are important gathering places where adults participate 

in essential programs focused on health, wellness, education, and social participation. The nutrition programs support food security for thousands of low-income 

and food-insecure people each day. Caregiver support programs help ensure that 

older adults can stay in their homes.1

 At the local level, older adults, caregivers, 

and other community stakeholders directly determine how current and future 

programs are implemented, based on the needs of each community. 

Overall, the programs ofer an impressive return 

on investment by leveraging state, local, and 

private dollars and mobilizing volunteers to 

help millions of older adults and caregivers 

age in their homes and communities every 

year. Also, because people aging in place are 

less likely to need more costly hospital and 

institutional care paid for through Medicare 

and Medicaid, the programs save taxpayer 

dollars as they enable older adults to remain 

independent and healthy in their own homes, 

where they prefer to be.2 

In 2020, OAA Title III program data shows 

Title III funded 56 state agencies, 625 local 

agencies that coordinated and ofered services to older adults, 6,072 senior centers, 

and almost 30,000 service providers. More 

than 10.1 million older persons received 

Title III services, including more than 198.6 

million home-delivered meals; 39.6 million 

congregate meals; 26.9 million hours of personal care; 21.3 million hours of homemaker 

services; and 13.6 million rides to medical 

appointments, grocery stores, and other 

activities. In addition, Title III programs 

provided support to over 186,000 caregivers 

serving elderly individuals, delivering more 

than 5 million hours of respite care to these 

caregivers and more than 530,000 counseling/ 

support groups/caregiver training sessions. 

One of the key goals of the OAA Title III 

programs is ensuring the nation’s most 

2 | 
vulnerable older adults have the services 

they need to remain independent in their 

communities. Thus, even though all Americans over the age of 60 are eligible to receive 

OAA services, states must target individuals 

with the greatest economic and social need, 

with a particular emphasis on those who are 

most vulnerable. The 2020 OAA Title III program data show services are indeed reaching the most vulnerable older adults in the 

nation—those most in need of services to 

remain independent. Specifcally, the data 

reported by service recipients show that 

Title III services reached the following 

populations in 2020: 

■ Older adults living in poverty—over one

third of service recipients

■ Older adults living alone—almost half of

service recipients

■ Older adults living in rural areas—about

one third of service recipients

■ Older adults who require assistance with

activities of daily living (ADLs) or instrumental activities of daily living (IADLs)—

more than half of service recipients requiring assistance with ADLs, about three out

of four requiring assistance with IADLs

■ The oldest of the older adults—almost a

quarter of service recipients age 85+

> 1/3

OLDER ADULT 

SERVICE RECIPIENTS 

LIVE IN POVERTY 

1/2 

OLDER ADULT 

SERVICE RECIPIENTS 

LIVE ALONE 

1/3 

OLDER ADULT 

SERVICE RECIPIENTS 

LIVE IN RURAL AREAS 

1/4 

OLDER ADULT 

SERVICE RECIPIENTS 

ARE AGE 85+ 

Older Americans Act Title VII LTCOP | 2020 Program Results | 3 
4 |

 

 

 

 

 

 

 

 

List of Exhibits 

Exhibit 1. Number of Providers by Service Type 10

Exhibit 2. Number of Unduplicated Persons Served by Service Type 12

Exhibit 3. Title III Service Recipients by Gender 13

Exhibit 4. Title III Service Recipients by Age 14

Exhibit 5. Title III Service Recipients by Race/Ethnicity 16

Exhibit 6. Number of Clients With Difculty Performing Three or More ADLs 

by Cluster 1 Registered Service 22

Exhibit 7. Number of Clients With Difculty Performing Three or More IADLs 

by Cluster 1 Registered Service 24

Exhibit 8. Total Service Units, by Service Type 27

Exhibit 9. Units of Services, Caregivers Serving Older Adults 28

Exhibit 11. Average Number of Services Units Provided per Client by Service 29

Exhibit 12. AAA Structures (n=487) 30

Exhibit 13. Area Served by AAAs 31

Exhibit 14. Type of Entities AAAs Partner With 33

Exhibit 15. Most Commonly Services Provided by AAA 35

Abbreviations and Acronyms 

AAA Area Agency on Aging 

ADLs Activities of Daily Living 

COVID-19 Coronavirus Disease of 2019 

IADLs Instrumental Activities of Daily Living 

OAA Older Americans Act 

OMB Ofce of Management and Budget 

SHIP State Health Insurance 

Assistance Program 

SPR State Program Report 

SUA State Unit on Aging 
Impact of Coronavirus Disease of 2019 Pandemic on Title III Services 

Funding Use 

The president declared the coronavirus disease of 

2019 (COVID-19) pandemic as a national emergency on 

March 13, 2020, authorizing states to use OAA Title III 

funds for disaster relief as they saw ft without having 

to submit a transfer request to ACL.3 As a result, states 

were allowed to use Title III-B, C, D, and/or E funds 

for any disaster relief activities for older individuals 

or family caregivers served under the OAA, such as 

providing 

■ drive-through, take-out, or home-delivered meals;

■ well-being checks via phone, in person, or via

virtual means; and

■ homemaker, chore, grocery/pharmacy/supply

delivery, or other services.

Title III Services 

Over the last year, OAA Title III grantees have 

described how the COVID-19 pandemic has impacted 

their programs.4,5 The bullets below provide a summary 

of the information shared by grantees for how the 

pandemic impacted Title III service needs and 

service provision. 

■ Shifed to remote work. Many providers, such as legal assistance providers, shifed to remote work to

continue operations and keep clients and staf safe.

For remote legal work, this shif entailed ensuring

access to communication tools, fles, documents,

case management systems, and mechanisms to

have meetings.

■ Experienced increase/decrease in demand for services. In Fiscal Year (FY) 2020, states overall provided about 24 million more meals overall and about

32% more home-delivered meals—using COVID-19

and other funds—compared to FY 2019. Grantees

also reported a large increase in calls for information, assistance, and referrals to services during 

the pandemic. The demand for in-home services 

decreased early in the pandemic, and public health 

orders led to the suspension of many in-person 

services, such adult day care centers. 

■ Changed spending patterns. Grantees reported

spending more funds for meal programs as food

costs increased and providers needed to purchase

additional supplies, such as personal protective

equipment and food delivery containers. Expenditures for some in-person services, such as homemaker services, remained steady, but expenditures

for adult day care and transportation decreased.

■ Transformed meal programs. Most states replaced

congregate meals with home-delivered meals

during the pandemic. While the number of congregate meals dropped, some states continued to

provide congregate meals during the pandemic,

and some providers replaced meals in traditional

congregate settings with grab-and-go meals paired

Older Americans Act Title III | 2020 Program Results | 5 
6 |

with in-person or virtual socialization. Grantees also 

adjusted meal delivery approaches. For instance, 

some localities made single deliveries with multiple 

days’ worth of meals, and some provided frozen 

meals instead of hot meals to limit the number of 

times they needed to make contact with the client. 

■ Delivered food boxes and groceries and care

packages. Grantees provided groceries, food

boxes, and care packages to their clients as either

a supplement or an alternative to home-delivered

meals. Care packages included shelf-stable foods

and household items such as toilet paper, along

with puzzles and games to provide their clients with

activities during the stay-at-home order.

■ Experienced staf shortages. Grantees reported

experiencing shortages of staf and volunteers and

implementing alternative solutions to continue

providing essential services. For instance, some

grantees reported that many of their traditional

volunteers, ofen older adults themselves, no longer felt comfortable serving during the pandemic

or were directed by state or local orders to stay at

home. In response, grantees shifed staf roles to

address most critical needs, used COVID-19 funding

to hire additional delivery drivers for their home-delivered meals, or used their transportation services’

vans to deliver meals to their clients.

■ Modifed transportation services. Many grantees

reported suspending or signifcantly reducing

their transportation services early in the pandemic

due to safety concerns. However, as the pandemic

continued, some localities modifed transportation

services to comply with social distancing measures

and ensure older adults were able to get to their

medical appointments. Once COVID-19 vaccines

were available for older adults, grantees provided

transportation services for older adults going to

and from their vaccination appointments.

■ Cancelled in-person activities. Evidence-based disease prevention and health promotion services program grantees reported having to cancel workshops

that had already been initiated and were scheduled

to be provided.

■ Shifed to virtual programs: Programs provided

virtual activities, including trainings, workshops,

and wellness classes (e.g., tai chi, chronic disease 

self-management, diabetes self-management). 

As part of this efort, grantees tested diferent 

platforms to determine whether programs were 

accessible to older adults. Grantees also developed 

statewide marketing tools to promote the use of 

technology and to reach target audiences, engaged 

a range of existing and new partners to deliver virtual programs, and developed materials to support 

activities and enhance communication with clients. 

■ Temporarily suspended or reduced in-home care

services. Grantees reported temporarily stopping or

reducing in-home supportive services for clients at

the beginning of the pandemic.

■ Conducted phone/virtual check-ins. Most programs

reported conducting well-being checks via telephone instead of going into clients’ homes. These

calls allowed them to assess the needs of their

clients and make sure clients had the support they

needed during stay-at-home orders.

■ Temporarily suspended or reduced caregiver support services. Early during the pandemic, several

grantees reported shutting down caregiver support

groups and respite care services. As the pandemic

continued, most programs shifed to provide virtual

support groups for caregivers and resumed ofering

limited respite care services to caregivers.
Older Americans Act Title III | 2020 Program Results | 7 

 

 

Part 1 | 2020 State Performance Report Data Highlights*

* Reporting year 2020 for SPRs was 

October 1, 2019–September 30, 2020. 

State Performance Report Data Categories 

Data in State Performance Reports (SPRs) are 

categorized into registered and unregistered services. 

Registered services are services that require demographic and client characteristics to be reported. 

Cluster 1 registered services require detailed client 

profles to be reported, whereas cluster 2 registered 

services require summary client profles only. 

■ Cluster 1 Registered Services: Personal care,

homemaker, chore, home-delivered meals, adult

day care/health services, and case management.

■ Cluster 2 Registered Services: Assisted transportation, congregate meals, and nutrition

counseling.

Unregistered services, also known as a cluster 3 

non-registered service, do not require demographic 

and consumer characteristics to be reported. 

■ Cluster 3 Non-registered Services: Transportation, 

legal assistance, nutrition education, information

and assistance, outreach, other services, health

promotion, and cash and counseling.

The SPRs also include Title III, Part E services (caregiver services) data. Data on caregiver services are 

grouped into two categories: 

■ caregivers serving elderly individuals (hereinafer

“caregivers serving older adults”) and

■ grandparents and other elderly caregivers

serving children (hereinafer “caregivers

serving children”).
8 |

 

 

Number of Agencies and Providers 

The majority of funding for OAA programs flows from 

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

level. Most states and territories have a state-level 

ofce on aging (State Unit on Aging, or SUA), responsible for developing and administering multiyear state 

plans that advocate for and aid older residents, their 

families, and, in many states, adults with physical 

disabilities. Most states and territories also have Area 

Agencies on Aging (AAAs).6 These are public or private 

nonproft agencies designated by a state to address 

the needs and concerns of all older persons at the 

regional and local levels. The AAAs work with service 

providers, such as senior centers, to deliver the 

services to eligible clients. 

Number of Agencies and Providers 

■ Total number of SUAs = 56

■ Total number of AAAs = 625

■ Total number of senior centers = 6,072

■ Total number of service providers†

† Excluding AAAs providing direct services. 

= 29,258 

• Minority = 2,775

• Rural = 7,102

Number of SUA Agency Staf 

■ Total number of paid staf = 5,212

Number of AAA Staf 

■ Total number of staf = 47,722

• Paid staf = 25,976

• Volunteers = 21,746

56 | State Units

on Aging 625 | Area Agencies

on Aging 
Older Americans Act Title III | 2020 Program Results | 9 

Number of Providers by Service Type 

In 2020, caregivers serving older adults programs 

reported by far the largest number of providers (10,877), 

followed by personal care programs (4,150), and 

congregate meal programs (4,076). Nutrition counseling 

program and adult day care/health care programs had 

the fewest providers (340 and 774, respectively). 

Congregate Meal Programs 

4,076 Caregiver Programs 

10,877 Nutrition Counseling 

Programs 

Personal Care Programs 340 

4,150 Adult Day Care/ 

Health Care Programs 

774 

6,072 Senior

Centers 29,258 Service Providers: | | Minority = 2,775 | Rural = 7,102 
10 |

 

Exhibit 1. Number of Providers by Service Type 

Caregivers Serving Older Adults 9,263 

Personal Care 4,150 

Congregate Meals 4,076 

Home-Delivered Meals 3,862 

Homemaker 3,725 

Transportation 3,119 

Information and Assistance 2,421 

Health Promotion and 

Disease Prevention 2,133 

Nutrition Education 2,099 

Caregivers Serving Children 1,642 

Case Management 1,395 

Outreach 1,381 

Chore 1,032 

Legal Assistance 976 

Assisted Transportation 778 

Adult Day Care/Health 774 

Nutrition Counseling 340 

0 2,000 4,000 6,000 8,000 10,000 12,000 

Notes: Counts include registered and unregistered services as well as caregiver services. 
Older Americans Act Title III | 2020 Program Results | 11 

 

 

 

Number and Characteristics of Service Recipients 

Number of Title III Service Recipients‡ 

‡ Number does not include caregivers served. 

In 2020, states and territories reported an estimated 

total of more than 10 million (10,186,166) unduplicated 

Title III service recipients (including registered and 

unregistered service recipients). Of those, 2,740,755 

were recipients of registered services, and 8,419,937 

were recipients of unregistered services§

§ Count of registered and unregistered services recipients does 

not sum to 19,186,166 since individuals may be receiving both 

types of services. 

. Among 

clients receiving registered services, approximately 33% 

(908,174) represented ethnic/racial minority populations. 

The following sections provide data for registered 

services. When available, data on service recipients 

for Title III, Part E (caregiver services) are provided 

separately. 

Number of Title III Service Recipients by Service Type 

In 2020, home-delivered meal programs reported the 

highest number of service recipients (1,447,910), followed by congregate meal programs (1,329,203), and 

case management programs (487,548). 

Total Service Recipients 

10,186,166 

Number of Service Recipients by Service Type 

Home-delivered meals 

1,447,910 

Congregate meals 

1,329,203 

Case Management 

487,548 
12 |

 

 

Exhibit 2. Number of Unduplicated Persons Served by Service Type 

Home-Delivered Meals 1,447,910 

Congregate Meals 1,329,203 

Case Management 487,548 

Homemaker 193,958 

Caregivers Serving 

Older Adults 186,052 

Personal Care 122,614 

Assisted Transportation 48,722 

Chore 27,677 

Nutrition Counseling 22,221 

Adult Day Care/Health 16,776 

Caregivers Serving Children 12,237 

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

Notes: Clients may be receiving more than one service. Counts include those from all registered services and caregiver services (unduplicated 

number of caregivers). Counts for unregistered services (cluster 3 services) are not collected and thus not included. Caregiver services do not 

include data from the service categories of access assistance and information services. 
Older Americans Act Title III | 2020 Program Results | 13 

Number of Title III Service Recipients by Gender 

In 2020, more than three out of fve (61.5%) service recipients were female. The majority of caregivers serving 

older adults or children in 2020 (66.8% and 83.8%, respectively) were female also. 

Exhibit 3. Title III Service Recipients by Gender 3.3% 

35.2% 

Male 

955,484 

61.5% 

Female 

1,671,728 

Missing 

90,553 

TOTAL 

2,717,765 

Notes: Counts include those 

from all registered services. 

Counts do not include data 

from caregiver services. 

Caregivers Serving Older Adults by Gender 

Gender Number of Caregivers Percent 

Caregivers Serving Older Adults – Male 37,280 25.4 

Caregivers Serving Older Adults – Female 97,825 66.8 

Missing 11,405 7.8 

TOTAL 146,510 100 

Caregivers Serving Children – Male 1,328 14.0 

Caregivers Serving Children – Female 7,962 83.8 

Missing 208 2.2 

TOTAL 9,498 100 

Notes: Data are for Title III Part E Group 1 services only. Group 1 services include counseling/support groups/caregiver training, respite care, 

supplemental services, and self-directed care. 
14 |

Number of Title III Service Recipients by Age 

41% | In 2020, 41.3% of service recipients were between ages 60 and 74. One third (33.3%) of

service recipients were between ages 75 and 80, and almost a quarter (23.6%) of service 

recipients were 85 years and older. 

Exhibit 4. Title III Service Recipients by Age 

Age 60–74 1,098,933 

Age 75–84 886,370 

Age 85+ 628,362 

0 200,000 400,000 600,000 800,000 100,000 1,200,000 

Notes: Clients may be receiving more than one service. Counts include those from all registered services. Age was missing for 48,603 

service recipients. 
Older Americans Act Title III | 2020 Program Results | 15 

 

Caregivers Serving Older Adults by Age 

35% Most caregivers serving older adults (161,384 caregivers) were in the age range of 60–74

years (35%). Most caregivers serving children (9,713 caregivers) were in the age range of | 55–74 years (75.6%). 

Age Range Number of Caregivers Percent 

Caregivers Serving Individuals – Age < 60 39,926 24.7 

Caregivers Serving Older Adults – Age 60–74 56,536 35.0 

Caregivers Serving Older Adults – Age 75–84 27,465 17.0 

Caregivers Serving Older Adults – Age 85+ 10,650 6.6 

Missing 26,807 16.6 

TOTAL 161,384 100 

Caregivers Serving Children – Age 55–74 7,346 75.6 

Caregivers Serving Children – Age 75–84 1,154 11.9 

Caregivers Serving Children – Age 85+ 335 3.4 

Missing 599 9.0 

TOTAL 9,434 100 

Notes: Data are for Title III Part E Group 1 services only. Group 1 services include counseling/support groups/caregiver 

training, respite care, supplemental services, and self-directed care. 
16 |

 

Number of Title III Service Recipients by Race/Ethnicity 

70% | The majority of service recipients, approximately 70%, were white alone (Hispanic and not

Hispanic), making up approximately 70% of service recipients. 

Exhibit 5. Title III Service Recipients by Race/Ethnicity 

American Indian or 

Alaska Native Alone 

1.3% 

Two or More Races 

1.7% 

Other Race 

1.9% 

Asian Alone, 

4.6% 

White Alone, 

Hispanic 

10.5% 

Black/African American 

Alone 

13.2% 

White Alone, 

Not Hispanic 

58.1% 

Missing 

8.3% 

Hawaiian Pacifc 

Islander Alone 

0.4% 

Notes: Counts include those from all registered services. “Alone,” when appended to a racial category, means that the individual designated 

only one race category. 
Race/Ethnicity Number of Service Recipients Percent 

White Alone, Not Hispanic 1,570,420 58.1 

Black/African American Alone 357,110 13.2 

White Alone, Hispanic 283,378 10.5 

Asian Alone 123,365 4.6 

Other Race 50,222 1.9 

Two or More Races 46,578 1.7 

American Indian or Alaska Native Alone 35,678 1.3 

Native Hawaiian/Pacifc Islander Alone 11,843 0.4 

Missing 224,278 8.3 

TOTAL 2,702,872 100 

Caregivers Serving Older Adults 

60% |

A majority of the caregivers serving older adults (60%) were white alone

(Hispanic and not Hispanic). 

Race/Ethnicity Number of Caregivers Percent 

White Alone, Not Hispanic 80,513 49.9 

Black/African American Alone 20,238 12.5 

White Alone, Hispanic 16,130 10.0 

Asian Alone 4,992 3.1 

Other Race 2,758 1.7 

Two or More Races 1,566 1.0 

American Indian or Alaska Native Alone 610 0.4 

Native Hawaiian/Pacifc Islander Alone 483 0.3 

Missing 34,113 21.1 

TOTAL 161,403 100 

Notes: Data are for Title III Part E Group 1 services only. Group 1 services include counseling/support groups/caregiver training, respite care, 

supplemental services, and self-directed care.

 | 17 
18 |

Caregivers Serving Children 

30% The largest racial/ethnic minority group of grandparents and other older caregivers serving

children were Black/African American, making up over 30% of these caregivers. | 

Race/Ethnicity Number of Caregivers Percent 

White Alone, Not Hispanic 4,361 45.8 

Black/African American Alone 3,074 32.3 

White Alone, Hispanic 1,058 11.1 

American Indian or Alaska Native Alone 149 1.6 

Other Race 119 1.3 

Two or More Races 101 1.1 

Asian Alone 58 0.6 

Native Hawaiian/Pacifc Islander Alone 47 0.5 

Missing 545 5.7 

TOTAL 9,512 100 

Notes: Data are for Title III Part E Group 1 services only. Group 1 services include counseling/support groups/caregiver training, respite care, 

supplemental services, and self-directed care. 
Older Americans Act Title III | 2020 Program Results | 19 

Number of Title III Service Recipients by Living Alone Status 

44% People who live by themselves are at higher risk of nursing home entry because they may

be isolated or lack supports to assist with ADLs. In part because of this risk, OAA targets | services to those who live alone, and participants in many Title III programs are more likely 

to live by themselves than older Americans nationally.7 

In 2020, approximately equal percentages of service recipients reported living alone 

(44%) and not living alone (45.4%). 

TOTAL 

2,740,755 

10.6% 

Missing 

45.4% 

Not Living Alone¶ 

¶ Number of service recipients not living 

alone was calculated by taking the total 

number of service recipients and subtracting the number of service recipients who 

reported they lived alone and the number 

of service recipients for whom “living 44% alone” data were missing. 

Living 

Alone 

Notes: Counts include those 

from all registered services. 

Number of Title III Service Recipients by Poverty Status 

36% About one third (35.8%) of Title III service recipients in 2020 lived in poverty. | 

TOTAL 

2,740,755 

17.1% 

Missing 

47.6% 

With income above 

poverty line** 

** Number of service recipients 

with an income above the poverty 

line was calculated by taking the 

total number of service recipients 

and subtracting the number of 

service recipients who reported 

income below the poverty line and 

the number of service recipients from 

whom poverty data were missing. 

35.3% 

With income below 

poverty line 

Notes: Counts include those 

from all registered services. 
20 |

 

Number of Title III Service Recipients by Rurality 

33% In 2020, about one third (33.2%) of service recipients reported living in rural areas. | 

TOTAL 

2,740,755 

4.4% 

Missing 

62.5%

 Nonrural†† 

†† Number of non-rural service 

recipients was calculated by taking 

the total number of service recipients 

and subtracting the number of service 

recipients who reported living in 

rural areas and the number of service 

recipients from whom rurality data 

were missing. 

33.2% 

Rural 

Notes: Counts include those 

from all registered services. 

23% In 2020, almost one in four caregivers serving older adults (23.1%) reported living in rural

settings. Among grandparents and other older caregivers serving children, 27.9% reported 

living in rural settings. | 

TOTAL 

161,403 

67.9% 

Caregivers Serving 

Older Adults – Nonrural‡‡ 

‡‡ Number of non-rural service 

recipients was calculated by taking 

the total number of service recipients and subtracting the number 

of service recipients who reported 

living in rural areas and the number 

of service recipients from whom 

rurality data were missing. 

9% 

Missing 

23.1% 

Caregivers Serving 

Older Adults – Rural 

Notes: Data are for Title III Part E Group 1 

services only. Group 1 services include 

counseling/support groups/caregiver 

training, respite care, supplemental 

services, and self-directed care. 
Older Americans Act Title III | 2020 Program Results | 21 

 

TOTAL 

10,312 

5.4% 

Missing 

66.8% 

Caregivers Serving Children 

– Nonrural* 

* Number of non-rural service recipients was calculated by taking the 

total number of service recipients and 

subtracting the number of service 

recipients who reported living in 

rural areas and the number of service 

recipients from whom rurality data 

were missing. 

27.9% 

Caregivers Serving Children 

– Rural 

Notes: Counts include those 

from all registered services. 

Need for Assistance With ADLs for Title III Service Recipients 

31% | People who have difculty performing three or more ADL or IADLs are at increased risk of 

nursing home placement. Among ADLs are eating, dressing, bathing, toileting, transferring in 

and out of bed/chair, and walking. Among IADLs are preparing meals, shopping for personal 

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

doing light housework, and transportation ability (i.e., the individual’s ability to make use of 

available transportation without assistance).8 Thus, it is critical that people who need assistance with ADLs or IADLS receive services that allow them to remain in their homes. 

Almost one third of service recipients (31.1%) reported requiring assistance with three 

or more ADLs. Most clients who had difculty performing three or more ADLs were 

home-delivered meal service recipients (406,466). 

ADL Group Number of Service Recipients Percent 

0 ADLs 536,945 30.8 

1 ADL 166,471 9.6 

2 ADLs 155,447 8.9 

3+ ADLs 541,676 31.1 

Missing 341,772 19.6 

Notes: Results include clients receiving Cluster 1 registered services. Cluster 1 registered services include personal care, homemaker, chore, 

home-delivered meals, adult day care/health, and case management. Counts of impairment in ADLs are based on the inability to perform 

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

toileting, transferring in and out of bed/ chair, and walking.9 
22 |

Exhibit 6. Number of Clients With Difculty Performing Three or More ADLs by Cluster 1 Registered Service 

800,000 

600,000 

400,000 

200,000 

0 

jjjj jjjj jjjj 

Homemaker 

93,265 

llllllllnnn nnn nnn 

Home-Delivered 

Meals 

406,466 

Case Management 

171,050 

Notes: Results include clients receiving Cluster 1 registered services. Cluster 1 registered services include personal care, homemaker, chore, 

home-delivered meals, adult day care/health, and case management. Counts of impairment in ADLs are based on the inability to perform 

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

toileting, transferring in and out of bed/chair, and walking.10 
Older Americans Act Title III | 2020 Program Results | 23 

 

Need for Assistance With IADLs for Title III Service Recipients 

56% | More than half of service recipients (56.2%) reported requiring assistance with three or

more IADLs. Most clients who required assistance with three or more IADLS were recipients 

of home-delivered meal services (764,948). 

IADL Group Number of Service Recipients Percent 

0 IADLs 254,448 14.6 

1 IADL 85,467 4.9 

2 IADLs 77,291 4.4 

3+ IADLs 981,131 56.2 

Missing 348,019 19.9 

Notes: Results include clients receiving Cluster 1 registered services. Cluster 1 registered services include personal care, homemaker, chore, 

home-delivered meals, adult day care/health, and case management. Counts of impairment in IADLs are based on the inability to perform 

one or more of the following eight IADLs without personal assistance, stand-by assistance, supervision, or cues: preparing meals, shopping 

for personal items, medication management, managing money, using telephone, doing heavy housework, doing light housework, and 

transportation ability (the individual’s ability to make use of available transportation without assistance).11 
24 |

Exhibit 7. Number of Clients With Difculty Performing Three or More IADLs by Cluster 1 Registered Service 

1,400,000 

1,200,000 

1,000,000 

800,000 

600,000 

400,000 

200,000 

0 

Homemaker 

150,789 

Case Management 

320,405 

jjjjjjjj jjjjjjjj jjjjjjjjllll llll llll llllnnnnnn

Home-Delivered 

Meals 

764,984 

Notes: Results include Cluster 1 registered services. Cluster 1 registered services include personal care, homemaker, chore, home-delivered 

meals, adult day care/health, and case management. Counts of impairment in IADLs are based on the inability to perform one or more of the 

following eight IADLs without personal assistance, stand-by assistance, supervision, or cues: preparing meals, shopping for personal items, 

medication management, managing money, using telephone, doing heavy housework, doing light housework, and transportation ability (the 

individual’s ability to make use of available transportation without assistance).12 
Older Americans Act Title III | 2020 Program Results | 25 

 

Service Units 

The following section provides data highlights for 

delivered Title III service units. Service units refer to a 

specifed quantity of a service. 

Defnition of Service Units for Diferent Services 

■ Access Assistance (1 contact) – A service that assists

caregivers in obtaining access to the services and

resources that are available within their communities. To the maximum extent practicable, it ensures

that the individuals receive the services needed by

establishing adequate follow-up procedures.

■ Adult Day Care/Adult Day Health (1 hour) – Personal

care for dependent elders in a supervised, protective, and congregate setting during some portion

of a day. Services ofered in conjunction with adult

day care/adult day health typically include social

and recreational activities; training; counseling;

and services such as rehabilitation, medications

assistance, and home health aide services for adult

day health.

■ Assisted Transportation (1 one-way trip) – Assistance and transportation, including escort, provided to a person who has difculties (physical or

cognitive) using regular vehicular transportation.

■ Case Management (1 hour) – Assistance in the form

of either access or care coordination in circumstances where the older person is experiencing diminished functioning capacities, personal conditions,

or other characteristics which require the provision

of services by formal service providers or family

caregivers. Activities of case management include

such practices as assessing needs, developing care

plans, authorizing and coordinating services among

providers, and providing follow-up and reassessment, as required.

■ Chore (1 hour) – Assistance such as heavy housework, 

yard work, or sidewalk maintenance for a person. 

■ Congregate Meal (1 meal) – A meal provided to an

eligible individual in a congregate or group setting. 

The meal as served meets all requirements of the 

OAA and state/local laws. 

■ Counseling (1 session per caregiver) – Counseling

to caregivers to assist them in making decisions

and solving problems relating to their caregiver

roles. This service includes counseling to individuals, support groups, and caregiver training (of

individual caregivers and families).

■ Homemaker (1 hour) – Assistance such as preparing

meals, shopping for personal items, managing money, using the telephone, or doing light housework.

■ Home-Delivered Meal (1 meal) – A meal provided

to an eligible individual in their place of residence.

The meal is served in a program administered by

SUAs and/or AAAs and meets all requirements of

the OAA and state/local laws.

■ Information Services (1 activity) – A service for

caregivers that provides the public and individuals

with information on resources and services available to the individuals within their communities.

Note: Service units for information services are for

activities directed to large audiences of current or

potential caregivers, such as disseminating publications, conducting media campaigns, and other

similar activities.

■ Legal Assistance (1 hour) – Legal advice, counseling

and representation by an attorney or other person

acting under the supervision of an attorney.

■ Nutrition Education (1 session per participant) –

A program to promote better health by providing

accurate and culturally sensitive information about

nutrition, physical ftness, or health (as it relates

to nutrition) and instruction to participants, caregivers, or participants and caregivers in a group or

individual setting overseen by a dietician or individual of comparable expertise.

■ Nutrition Counseling (1 session per participant)

– Individualized guidance to individuals who are at 
26 |

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

use, or to caregivers. Counseling is provided oneon-one by a registered dietician and addresses the 

options and methods for improving nutrition status. 

■ Outreach (1 contact) – Intervention with individuals initiated by an agency or organization for the

purpose of identifying potential clients (or their

caregivers) and encouraging their use of existing

services and benefts.

■ Personal Care (1 hour) – Personal assistance, standby assistance, supervision, or cues.

■ Respite Care (1 hour) – Services which ofer temporary, substitute supports or living arrangements for

care recipients in order to provide a brief period of

relief or rest for caregivers. Respite care includes Inhome respite (personal care, homemaker, and other

in-home respite); respite provided by attendance of

the care recipient at a senior center or other nonresidential program; institutional respite provided by

placing the care recipient in an institutional setting

such as a nursing home for a short period of time as

a respite service to the caregiver; and (for grandparents caring for children) summer camps. 

■ Services for caregivers – Counseling (1 session

per participant); respite care (1 hour); supplemental services; information services (1 activity); and

access assistance (1 contact).

■ Supplemental services – Services provided on a

limited basis to complement the care provided by

caregivers. Examples of supplemental services

include, but are not limited to, home modifcations,

assistive technologies, emergency response systems, and incontinence supplies.

■ Transportation (1 one-way trip) – Transportation

from one location to another. Does not include any

other activity.
Older Americans Act Title III | 2020 Program Results | 27 

 

Number of Service Units by Service Type 

In 2020, the largest number of service units by far 

was provided for home-delivered meal programs 

(198,643,363), followed by congregate meal 

programs (48,849,070). The fewest service units 

were provided for nutrition counseling (38,644). 

Exhibit 8. Total Service Units, by Service Type 

Home-Delivered Meals 198,643,363 

Congregate Meals 48,849,070 

Personal Care 26,992,021

Homemaker 21,360,688 

Transportation 13,696,714 

Services for Caregivers 

Older Adults 8,673,083 

Adult Day Care/Health 7,585,833 

Case Management 3,391,290 

Nutrition Education 3,194,701 

Outreach 2,693,168

Assisted Transportation 1,820,428 

Legal Assistance 906,953 

Chore 632,459 

Services for Caregivers 

Serving Children 312,690

Nutrition Counseling 38,644 

0 50M 100M 150M 200M 

Notes: Counts include those from all registered and unregistered services and caregiver services (except self-directed care). 
28 |

 

 

Number of Service Units by Caregiver Services 

For caregivers serving older adults, programs provided 

more than 5 million hours of respite care, approximately 1.5 million contacts to assist caregivers with access 

to assistance, 719,000 activities to provide information 

services, and over 530,000 counseling/support group/ 

caregiver training sessions. Programs also provided 

more than 825,000 supplemental services. 

Exhibit 9. Units of Services, Caregivers Serving Older Adults 

Respite Care 5,028,432 

Access Assistance 1,561,633 

Supplemental Services 825,925 

Information Services 719,203 

Counseling/Support Groups/ 

Caregiver Training 

0 

537,890 

1.5M 3M 4.5M 6M 

Exhibit 10. Units of Services, Caregivers Serving Children 

Respite Care 107,012 

Supplemental Services 92,886 

Access Assistance 64,739 

Counseling/Support Groups/ 

Caregiver Training 42,023 

Information Services 6,030 

0 40,000 80,000 120,000 
Older Americans Act Title III | 2020 Program Results | 29 

 

For caregivers serving children, programs provided 

more than 100,000 hours of respite care, approximately 64,000 contacts to assist caregivers with access to 

assistance, over 42,000 counseling/support group/ 

caregiver training sessions, and 6,000 activities to 

provide information services. Programs also provided 

more than 92,000 supplemental services. 

Total Units per Client by Service Type 

The most service units per client were provided for 

adult day care/health programs (204 units per client 

on average), followed by home-delivered meal programs (137.8 units per client on average). The fewest 

service units per client were provided for nutrition 

counseling (0.8 units per client on average) and case 

management (6.1 units per client on average). 

Exhibit 11. Average Number of Services Units Provided per Client by Service 

0 50 100 150 200 250 

Adult Day Care/Health 204.0 

Home-Delivered Meals 137.8 

Personal Care 72.5 

Homemaker 52.1 

Congregate Meals 47.2 

Assisted Transportation 41.6 

Chore 15.3 

Case Management 6.1 

Nutrition Counseling 0.8 
30 |

 

Part 2 | 2019§§

§§ The survey is conducted every 2 years in odd-numbered years (i.e., 2013, 2015, 2017, 2019). The 2019 survey was administered from 

June 2019 to September 2019. 

 National Survey of Area Agencies on Aging 

With a grant from ACL, the National Association of Area 

Agencies on Aging partnered with Scripps Gerontology 

Center of Excellence to conduct the 2019 national survey 

of AAAs. The results presented in Part 2 of this report 

are directly taking from the AAA National Survey Report: 

Meeting the Needs of Today’s Older Adults. The complete 

report can be accessed here¶¶

¶¶ https://www.usaging.org/Files/AAA-Survey-Report-2020%20Update-508.pdf 

. 

The web-based survey was distributed to 618 AAAs with 

78.5% of AAAs (n=485) responding. Some questions were 

asked of every respondent, and other questions were 

shown to a subset based on their responses to earlier 

questions. The number of respondents to a particular 

question (n) is always reported in all tables. In the 

cases of text without accompanying tables, the n can 

be assumed to be the number of respondents overall, 

485, unless noted otherwise. 

Program Structure 

Program Location 

39% |

More than one third (39%) of

AAAs are independent nonproft 

agencies. A little over one 

quarter (27%) are housed in 

councils of government or 

regional planning and development agencies, and 

the same percentage is located within parts of county 

government. Few AAAs are part of city government 

(2%) or other structures (5%). 

Exhibit 12. AAA Structures (n=487) 5% 

Other 

27% 

Part of a council 

of governments or 

regional planning 

and development 

agency 

27% 

Part of county

 government 

2% 

Part of city 

government 

39% 

Independent 

nonprofit 

agency 
Older Americans Act Title III | 2020 Program Results | 31 

 

Areas Served by Area Agencies on Aging*** 

*** Survey respondents were asked to choose the type of area they believed best represented their region. 

82% |

Area Agencies on Aging vary in terms of the type of areas they serve. Reflecting the OAA

requirement that AAAs target those with the highest economic and social need, a large proportion of AAAs (82%) serve rural, remote, or frontier areas. The largest proportion of AAAs 

(43%) serve a predominantly rural area, with 25% serving a mixture of urban, suburban, 

and rural areas. 

Exhibit 13. Area Served by AAAs 

Type of Area Served Percent of AAAs Serving 

That Type of Area (n=478) 

Predominantly rural 43% 

A mix of urban, suburban, and rural 25% 

A mix of suburban and rural 11% 

A mix of urban and suburban 11% 

Predominantly urban 4% 

Predominantly suburban 4% 

Predominantly remote or frontier 3% 
32 |

Programs 

Sixty-fve percent of AAAs lead or take part in Aging 

and Disability Resource Centers (ADRCs), which take 

a No Wrong Door approach to coordinating long-term 

resources and supports. This approach helps ensure 

that all individuals can fnd the information and help 

they need, regardless of where they start their search.13 

Sixty-two percent of AAAs administer local State 

Health Insurance Assistance Programs (SHIPs), which 

help Medicare-eligible consumers and their caregivers 

make decisions about their health insurance coverage 

through no-cost and unbiased counseling, assistance, 

and outreach. 

Fify-three percent of AAAs operate local long-term 

care ombudsman programs (LTCOP), which advocate 

for the rights of residents of nursing homes, assisted 

living facilities, and other adult care facilities. They 

also investigate and mediate any problems with or 

concerns about residents’ care. 

65% 

Lead or take part in Aging 

and Disability Resource 

Centers 

AAAs 

62% 

Administer local State 

Health Insurance Assistance 

Programs 

53% 

Operate local long-term 

care ombudsman programs 
Older Americans Act Title III | 2020 Program Results | 33 

Partnerships 

Type of Partners 

Creating and strengthening partnerships is a hallmark 

of the way that AAAs operate in the community. The 

survey results showed that, on average, AAAs leverage 

17 formal and informal partnerships with other agencies and organizations to expand the reach and impact 

of their programs in their communities. 

Consistent with their core focus on elder justice, nearly 

all AAAs (92%) partner with adult protective services 

programs. Other common partners include transportation agencies (88%), SHIPs (86%), emergency 

preparedness agencies (83%), and federal programs/ 

departments (81%). Additional partnership types are 

shown in Exhibit 14. 

Exhibit 14. Type of Entities AAAs Partner With 

Type of Entity Percent of AAAs That Partner 

With Entity (n=482) 

Adult protective services 92% 

Transportation agencies 88% 

SHIPs 86% 

Emergency preparedness agencies 83% 

Federal programs/departments (e.g., Social Security, Veterans Health 

Administration Medical Center, Bureau of Indian Afairs) 81% 

Medicaid 80% 

Mental health/behavioral health organization 80% 

Public housing authority of other housing programs 79% 

Disability service organizations (e.g., Centers for Independent Living) 78% 

Long-term care facilities (e.g., nursing homes, skilled nursing facilities, 

assisted living residences) 78% 

Advocacy organizations 77% 

Hospitals and health care systems 74% 

Exhibit 14 continued on page 34 
34 |

Exhibit 14 continued from page 33 

Type of Entity Percent of AAAs That Partner 

With Entity (n=482) 

Charitable organizations (e.g., United Way, Easter Seals, Red Cross) 72% 

Department of health 72% 

Law enforcement/frst responders 72% 

Other social service organizations 70% 

Faith-based organizations 68% 

Educational institutions 66% 

Health plans (e.g., commercial health plan, Medicaid managed care) 62% 

Community health clinics (e.g., Federally Qualifed Health Centers) 60% 
Older Americans Act Title III | 2020 Program Results | 35 

 

Services 

Area Agencies on Aging ofer a set of core services as 

required by the OAA. These services fall in the service 

categories of Title III and VII. For Title III, AAAs ofer supportive services (Title III, Part B), nutrition services (Title 

III, Part C), and evidence-based prevention and health 

promotion services (Title III, Part D). Title VII services include, among others, training to help providers identify 

elder abuse, outreach and education campaigns, and 

support for coalitions or multidisciplinary teams. 

Survey results showed that, on average, AAAs provide 

27 services. Many of the most common AAA services are 

provided through Title III, Part B funding, which allows 

AAAs to provide supportive services that can be tailored 

to meet individual needs. Exhibit 15 shows the services 

most commonly ofered by AAAs, not including the core 

services previously mentioned. 

Exhibit 15. Most Commonly Services Provided by AAA 

Service Percent of AAAs That Provide 

the Service (n=489) 

Transportation 89% 

Case management 86% 

Other meals/nutrition programs (e.g., nutrition counseling, senior farmers’ 

market program) 84% 

Benefts/health insurance counseling 83% 

Homemaker 81% 

Benefts/health insurance enrollment assistance 80% 

Options counseling 79% 

Other health promotion services/programs (e.g., health screening, health 

fairs) 79% 

Personal assistance/personal care 79% 

Assessment for care planning 73% 

Elder abuse prevention/intervention 69% 

Senior center programming and activities 67% 

Chore services 66% 

Long-term care ombudsman 66% 

Assessment of long-term care service eligibility 64% 

Exhibit 15 continued on page 36 
36 |

Exhibit 15 continued from page 35 

Service Percent of AAAs That Provide 

the Service (n=489) 

Home modifcation and repair 61% 

Adult day care 57% 

Personal emergency response systems 57% 

Telephone reassurance/friendly visiting 55% 

Translator/interpreter assistance 53% 
Appendix A: Title III Defnitions14

Adult Day Care/Adult Day Health: Personal care for 

dependent elders in a supervised, protective, and congregate setting during some portion of a day. Services 

ofered in conjunction with adult day care/adult day 

health typically include social and recreational activities, training, counseling, and services such as rehabilitation, medications assistance, and home health aide 

services for adult day health. 

American Indian or Alaskan Native: A person who has 

origins in any of the original peoples of North America 

(including Central America) and who maintains tribal 

afliation or community attachment. 

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

and concerns of all older persons at the regional and 

local levels. The term AAA is a general one; names of 

local AAAs may vary. The AAAs coordinate and ofer 

services that help older adults remain in their homes, 

if that is their preference, aided by services such as 

home-delivered meals, homemaker assistance, and 

whatever else it may take to make independent living a 

viable option. 

Asian: A person having origins in any of the original 

peoples of the Far East, Southeast Asia or the Indian 

subcontinent, including, for example, Cambodia, 

China, India, Japan, Korea, Malaysia, Pakistan, the 

Philippine Islands, Thailand, and Vietnam. 

Assisted Transportation: Assistance and transportation, including escort, to a person who has difculties 

(physical or cognitive) using regular vehicular transportation. 

Black or African American: A person having origins in 

any of the black racial groups of Africa. 

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

community care to an older individual. “Informal” 

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

or private formal service program. 

Case Management: Assistance in the form of either 

access or care coordination in circumstances where the 

older person is experiencing diminished functioning 

capacities, personal conditions, or other characteristics which require the provision of services by formal 

service providers or family caregivers. Activities of 

case management include such practices as assessing needs, developing care plans, authorizing and 

coordinating services among providers, and providing 

follow-up and reassessment, as required. 

Child: An individual who is not more than 18 years of 

age or an individual 19–59 years of age who has a disability. The term relates to a grandparent or other older 

relative who is a caregiver of a child. 

Chore Service: Assistance such as heavy housework, 

yard work, or sidewalk maintenance for a person. 

Congregate Meals: Meals provided to an eligible 

individual in a congregate or group setting. The meal 

as served meets all of the requirements of the OAA and 

state/local laws. 

Elderly Client: An eligible elderly individual (60 years 

of age or older, or who is less than 60 and has a 

diagnosis of early onset dementia) who receives OAA 

services. 

Grandparent or Other Older Relative Caregiver of a 

Child: A grandparent, step-grandparent or other relative of a child, by blood or marriage, who is 55 years of 

age or older and 

■ lives with the child;

■ is the primary caregiver of the child because the biological or adoptive parents are unable or unwilling

to serve as the primary caregiver of the child; and

■ has a legal relationship to the child, as such legal

custody or guardianship, or is raising the child

informally.

Health Promotion and Disease Prevention: Services 

that include health screenings and assessments; 

Older Americans Act Title III | 2020 Program Results | 37 
organized physical ftness activities; evidence-based 

health promotion programs; medication management; 

home injury control services; and/or information, education, and prevention strategies for chronic disease 

and other health conditions that would reduce the 

length or quality of life of the person 60 or older. 

Hispanic or Latino: A person of Cuban, Mexican, Puerto 

Rican, South or Central American, or other Spanish 

culture or origin, regardless of race. 

Home-Delivered Meals: Meals provided to an eligible 

individual in his/her place of residence. The meal is 

served in a program administered by SUAs and/or 

AAAs and meets all of the requirements of the OAA and 

state/local laws. 

Homemaker: Assistance such as preparing meals, 

shopping for personal items, managing money, using 

the telephone, or doing light housework. 

Information and Assistance: A service that provides 

individuals with information on services available 

within the communities and links individuals to those 

services and opportunities, establishing adequate follow-up procedures to the maximum extent practicable. 

Web site “hits” are to be counted only if information is 

requested and supplied. 

Impairment in Activities of Daily Living (ADLs): The inability to perform one or more of the following six ADLs 

without personal assistance, stand-by assistance, supervision, or cues: eating, dressing, bathing, toileting, 

transferring in and out of bed/chair, and walking. 

Impairment in Instrumental Activities of Daily Living 

(IADLs): The inability to perform one or more of the following eight IADLs without personal assistance, standby assistance, supervision, or cues: preparing meals, 

shopping for personal items, medication management, 

managing money, using telephone, doing heavy 

housework, doing light housework, and transportation 

ability (the ability to make use of available transportation without assistance). 

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

the supervision of an attorney. 

Living Alone: A one-person household (using the census defnition of household) where the householder 

lives by themself in an owned or rented place of residence not in an institutional setting, such as a board 

and care facility, assisted living unit, or group home. 

Native Hawaiian or Other Pacifc Islander: A person 

having origins in any of the original peoples of Hawaii, 

Guam, Samoa, or other Pacifc Islands. 

Nutrition Counseling: Individualized guidance to 

individuals who are at nutritional risk because of their 

health or nutrition history, dietary intake, chronic 

illnesses, or medications use, or to caregivers. Counseling is provided one-on-one by a registered dietician 

and addresses the options and methods for improving 

nutrition status. 

Nutrition Education: A program to promote better 

health by providing accurate and culturally sensitive 

information on nutrition, physical ftness, or health (as 

it relates to nutrition) and instruction to participants, 

caregivers, or participants and caregivers in a group or 

individual setting overseen by a dietician or individual 

of comparable expertise. 

Outreach: Intervention with individuals initiated by an 

agency or organization for the purpose of identifying 

potential clients (or their caregivers) and encouraging 

their use of existing services and benefts. 

Personal Care: Personal assistance, stand-by assistance, supervision, or cues. 

Poverty: Persons considered to be in poverty are those 

whose income is below the ofcial poverty guideline 

(as defned each year by the Ofce of Management and 

Budget (OMB)and adjusted by the Secretary of Health 

and Human Services [HHS]) in accordance with subsection 673 (2) of the Community Services Block Grant Act 

38 | 
(42 U.S.C. 9902 (2)). The annual HHS poverty guidelines provide dollar thresholds representing poverty 

levels for households of various sizes. 

Provider: An organization or person which provides 

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

where direct cash payment is made to a caregiver and 

the ultimate provider is unknown, the number of providers may be omitted. 

Race/Ethnicity Status: The following reflects the 

requirements of OMB for obtaining information from 

individuals regarding race and ethnicity. It constitutes 

what OMB classifes as the “two-question format.” 

When questions on race and ethnicity are administered, 

respondents are to be asked about their ethnicity and 

race as two separate questions. Respondents should 

ideally be given the opportunity for self-identifcation 

and are to be allowed to designate all categories that 

apply to them. Consistent with OMB requirements, the 

following are the race and ethnicity categories to be 

used for information collection purposes: 

Ethnicity: 

■ Hispanic or Latino

■ Not Hispanic or Latino

Race: 

■ American Indian or Alaska Native

■ Asian

■ Black or African American

■ Native Hawaiian or Other Pacifc Islander

■ White

Registered Client: A registered client is an individual who received at least one unit of the following 

specifed services within the reported fscal year: 

congregate meals, nutrition counseling, assisted 

transportation, personal care, homemaker, chore, 

home-delivered meals, adult day care/health, or case 

management. The count of registered clients does not 

include caregivers. 

Registered Services: Services that require demographic and client characteristics to be reported: personal 

care, homemaker, chore, home-delivered meals, adult 

day care/health, case management, congregate meals, 

nutrition counseling, or assisted transportation. Does 

not include caregiver services. 

Cluster 1 Registered Services: Personal care, 

homemaker, chore, home-delivered meals, adult 

day care/health, and case management. 

Cluster 2 Registered Services: Assisted transportation, congregate meals, and nutrition counseling. 

Rural: A rural area is any area that is not defned as 

urban. Urban areas comprise urbanized areas—with a 

central place and adjacent densely settled territories 

having a combined minimum population of 50,000— 

and incorporated places or census-designated places 

with 20,000 or more inhabitants. 

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

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

independent. More than 60% of senior centers are 

designated focal points for delivery of OAA services, 

allowing older adults to access multiple services in one 

place. Senior centers ofer a wide variety of programs 

and services, including meal and nutrition programs; 

Information and assistance; health, ftness, and wellness programs, transportation services public benefts 

counseling; employment assistance; volunteer and 

civic engagement opportunities; social and recreational activities; educational and arts programs; and 

intergenerational programs. To maintain operations, 

senior centers must leverage resources from a variety 

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

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

on three to eight diferent funding sources. 

Older Americans Act Title III | 2020 Program Results | 39 
 

 

Services to Caregivers: 

■ Access Assistance: A service that assists caregivers in obtaining access to the services and resources that are available within their communities. To 

the maximum extent practicable, it ensures that 

the individuals receive the services needed by 

establishing adequate follow-up procedures. 

■ Counseling: Counseling to caregivers to assist

them in making decisions and solving problems

relating to their caregiver roles. This service

includes counseling to individuals, support

groups, and caregiver training (of individual

caregivers and families).

■ Information Services: A service for caregivers

that provides the public and individuals with information on resources and services available to

the individuals within their communities. (Note:

Service units for information services are for

activities directed to large audiences of current

or potential caregivers, such as disseminating

publications, conducting media campaigns, and

other similar activities.)

■ Respite Care: Services which ofer temporary,

substitute supports or living arrangements for

care recipients in order to provide a brief period of

relief or rest for caregivers. Respite care includes

In-home respite (personal care, homemaker,

and other in-home respite); respite provided by

attendance of the care recipient at a senior center

or other nonresidential program; institutional

respite provided by placing the care recipient in

an institutional setting, such as a nursing home,

for a short period of time as a respite service to

the caregiver; and (for grandparents caring for

children) summer camps. If the specifc service

units purchased via a direct payment (cash or

voucher) can be tracked or estimated, report

those service unit hours. If not, a unit of service in

a direct payment is one payment.

■ Supplemental Services: Services provided on a

limited basis to complement the care provided

by caregivers. Examples of supplemental services include, but are not limited to, home modifcations, assistive technologies, emergency

response systems, and incontinence supplies.

Transportation: Transportation from one location to 

another. Does not include any other activity. 

Unduplicated refers to individual people counted only 

once a year for a service. 

Unregistered Services (also known as a non-registered 

services): Services that do not require demographic 

and consumer characteristics to be reported. They 

include transportation, legal assistance, nutrition 

education, information and assistance, outreach, other 

services, health promotion, and cash and counseling. 

Volunteer: An uncompensated individual who provides 

services or support on behalf of older individuals. Only 

staf working under the AAA, not the AAA contractors, 

shall be included. 

White: A person having origins in any of the peoples 

of Europe, the Middle East, or North Africa. “Alone,” 

when appended to a racial category—e.g., “white 

alone”—means that the individual designated only 

one race category. 

40 | 
 

 

References 

1 Godfrey, M. D. (2015). Celebrating 50 years of the 

OAA: The Older Americans Act: Seeking to improve 

lives BIFOCAL: A Journal of the ABA Commission 

on Law and Aging, 36(6), 134–135. https://www. 

americanbar.org/content/dam/aba/publications/ 

bifocal/BIFOCALJuly-August2015.pdf 

2 National Association of Area Agencies on Aging. 

(2019, March). Recommendations for the reauthorization of the Older Americans Act [Policy brief). 

https://www.n4a.org/Files/n4a_PolicyBrief_OAA_ 

Reauth_2019_FinalWeb.pdf 

3 Administration for Community Living. (2020). 

Older Americans Act disaster relief. https://acl. 

gov/sites/default/fles/COVID19/OAADisasterRelief_2020-03-16.pdf 

4 National Council on Aging. (2021). Navigatiwng Older Americans Act Title IIID during the 

COVID-19 pandemic. https://www.ncoa.org/ 

article/navigating-older-americans-act-title-iiid-during-the-covid-19-pandemic 

5 U.S. Government Accountability Ofce. (2021). 

COVID-19: Selected states modifed meal provisions and other Older Americans Act services to 

prioritize safety. https://www.gao.gov/assets/ 

gao-22-104425.pdf 

6 Godfrey, D. M. (2015). Celebrating 50 years of the 

OAA: The Older Americans Act: Seeking to improve 

lives. BIFOCAL: A Journal of the ABA Commission 

on Law and Aging, 36(6), 134–135. https://www. 

americanbar.org/content/dam/aba/publications/ 

bifocal/BIFOCALJuly-August2015.pdf 

7 Altshuler, N., & Schimmel, J. (2010, July). Aging 

in place: Do Older Americans Act Title III services 

reach those most likely to enter nursing homes? 

(Research Brief Number 1). Administration on 

Aging. https://acl.gov/sites/default/fles/programs/2017-01/AoA_1_NursingHomes_041311.pdf 

8 Administration for Community Living. (2020). Title 

III and VII state program report data elements, state 

program report transmittal requirements, state 

program report defnitions. https://acl.gov/sites/ 

default/fles/programs/2020-01/State_Program_ 

Report_0985-0008_Expires12312022.pdf 

9 Administration for Community Living. (2020). Title 

III and VII state program report data elements, state 

program report transmittal requirements, state 

program report defnitions. https://acl.gov/sites/ 

default/fles/programs/2020-01/State_Program_ 

Report_0985-0008_Expires12312022.pdf 

10 Administration for Community Living. (2020). Title 

III and VII state program report data elements, state 

program report transmittal requirements, state 

program report defnitions. https://acl.gov/sites/ 

default/fles/programs/2020-01/State_Program_ 

Report_0985-0008_Expires12312022.pdf 

11 Administration for Community Living. (2020). Title 

III and VII state program report data elements, state 

program report transmittal requirements, state 

program report defnitions. https://acl.gov/sites/ 

default/fles/programs/2020-01/State_Program_ 

Report_0985-0008_Expires12312022.pdf 

12 Administration for Community Living. (2020). Title 

III and VII state program report data elements, state 

program report transmittal requirements, state 

program report defnitions. https://acl.gov/sites/ 

default/fles/programs/2020-01/State_Program_ 

Report_0985-0008_Expires12312022.pdf 

13 U.S. Administration for Community Living. (2017). 

Aging and disability resource centers. https://acl. 

gov/programs/aging-and-disability-networks/aging-and-disability-resource-centers 

14 Administration for Community Living. (2020). Title 

III and VII state program report data elements, state 

program report transmittal requirements, state 

program report defnitions. https://acl.gov/sites/ 

default/fles/programs/2020-01/State_Program_ 

Report_0985-0008_Expires12312022.pdf 

Older Americans Act Title III | 2020 Program Results | 41