2020 PROGRAM 

RESULTS 

OLDER AMERICANS ACT 

Title VI Programs
Acknowledgment 

Kristen Hudgins, Senior Social Science Analyst in the Offce of Performance and Evaluation (OPE), Center for Policy and Evaluation; and Leslie Green, Deputy Director in 

the Ofce for American Indian, Alaskan Native, and Native 

Hawaiian Programs, Administration on Aging, 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 specific, written authorization by ACL. 

Electronic Access 

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

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

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 VI | Table of Contents 

Program Highlights and Accomplishments 2 

List of Exhibits 4 

Abbreviations and Acronyms 4 

Impact of COVID-19 Pandemic on Title VI Services 5 

Service Units: Supportive Services— 

Service Units: Supportive Services— 

Service Units: Supportive Services— 

Service Units: Caregiver Support Services— 

Service Units: Caregiver Support Services— 

Unmet Needs 

Funding Use 5 

Title VI Services 5 

Part 1 | 2020 PPR Data Highlights 7 

Stafng 7 

Service Recipients 8 

Service Units 11 

Service Units: Nutrition Services 11 

Access Services 12 

In-Home Services 13 

Other Services 14 

Services for Caregivers 14 

Respite Care for Caregivers 15 

Part 2 | 2020 National Survey of Title VI Programs 16 

Program Structure 17 

Partnerships 18 

Services 20 

21 

Appendix A: Title VI Defnitions 22 

References 26 

Older Americans Act Title VI | 2020 Program Results | 1 
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2 

Title VI 

Program Highlights and Accomplishments 

A component of the Administration for Community Living’s (ACL’s) mission is to 

support American Indian, Alaskan Native (AI/AN), and Native Hawaiian elders in 

living with dignity and choice, while participating fully in their communities. ACL 

implements this mission in part through its Older Americans Act (OAA) Title VI 

programs. The programs help assure successful outcomes in part by recognizing 

the strengths and resiliency of tribal elders across the United States and respecting Native communities’ sovereignty, culture, and self-determination.1 

These programs are essential, especially in 

light of health disparities AI/AN and Native 

Hawaiian populations face. For example, 

in comparison with members of the overall 

population of the U.S., American Indians and 

Alaskan Natives have shorter life spans and 

higher death rates, experience more prevent 

able causes of death, and have more chronic 

conditions.2,3 They also experience dispropor 

tionately high rates of certain mental health 

conditions, such as depression and substance 

abuse.4 Combining federal funds, such as OAA 

Title VI funds, with state, local, and tribal funds, 

allows service providers to work collaboratively 

with tribal communities to address the needs 

of these communities while recognizing the 

health disparities they face. 

In the 2020-2023 grant cycle, there are 282 

Title VI grantees providing nutrition and 

supportive services and 251 Title VI grantees 

providing caregiver support services to 

tribal communities*. 

Results from the 2020 National Survey of Title 

VI Programs showed that the majority of Title VI 

programs served elders in rural or frontier 

areas.5 In addition, Title VI grantees partnered 

with a range of entities, including those within 

and external to their tribes. Survey respondents 

noted partnering with more than 20 diferent 

types of entities, such as Indian Health Services, 

the Veterans Administration, transportation 

agencies, and nontribal health care providers. 

Importantly, grantees, in collaboration with 

partners, provided an average of 26 services and 

supports to tribal communities that enabled trib 

al elders to live with independence and dignity 

in their homes and communities. 

Given these eforts, Title VI grantees were able 

to serve more than 200,000 individuals, includ 

ing 198,591 individuals who received nutrition 

and supportive services and 7,873 individuals 

who received caregiver support services. In 

2020 alone, providers ... 

* In the 2017-2020 grant cycle, there were 272 Title VI grantees 

providing nutrition and supportive services and 238 Title VI grantees 

providing caregiver support services to tribal communities. 

2 | 
TITLE VI GRANTEES SERVED MORE THAN 

INDIVIDU

200,000 

ALS WITH SERVICES SUCH AS ... 

 

 

Older Americans Act Title VI | 2020 Program Results | 3

DELIVERED 

6.4 M 

MORE THAN 

MEALS TO 

INDIVIDUALS’ HOMES 

550,000 

MADE MORE THAN 

CONTACTS TO PROVIDE 

INFORMATION/ASSISTANCE 

to access needed services 

450,000 

CONDUCTED MORE THAN 

VISITS TO ELDERS 

IN THEIR HOMES 

and more than 2,700 visits 

to elders in nursing facilities or 

residential care communities 

200,000+ 

PROVIDED MORE THAN 

ONE -WAY TRIPS 

to the grocery store, pharmacy, 

doctors’ ofce or other critical errands, 

to support elders’ independence 

1

PROVIDED MORE THAN 

C

13,000+ 

OUNSELING SESSIONS 

and more than 76,000 hours of respite care 

to caregivers who cared for elders or individuals 

of any age with Alzheimer’s disease and 

related disorders 

Older Americans Act Title VI | 2020 Program Results | 3 
 

 

 

 

 

 

 

 

4 | 

List of Exhibits 

Exhibit 1. Number of Title VI Service Recipients by Supportive Services Type 8 

Exhibit 2. Number of Title VI Service Recipients by Nutrition Services Type 9 

Exhibit 3. Number of Title VI Caregiver Services Recipients by Caregiver Type 9 

Exhibit 4. Number of Title VI Service Recipients by Caregiver Support Services Type 10 

Exhibit 5. Total Service Units, by Nutrition Service Type 11 

Exhibit 6. Total Service Units, by Access Service Type 12 

Exhibit 7. Total Service Units, by In-Home Service Type 13 

Exhibit 8. Total Service Units, by Caregiver Service Type 15 

Exhibit 9. Total Respite Service Units, by Caregiver Type 15 

Exhibit 10. Title VI Program Location (n=230) 16 

Exhibit 11. Area Served by Title VI Programs 17 

Exhibit 12. Type of Entities Title VI Programs Partner With 18 

Exhibit 13. Partnership Activities 19 

Exhibit 14. Services Provided Exclusively Through Title VI Funds 20 

Exhibit 15. Unmet Needs Among Elders (n=231) 21 

Abbreviations and Acronyms 

AAA Area Agency on Aging HHS U.S. Department of Health 

and Human Services 

ACL Administration for 

Community Living OAA Older Americans Act 

AI/AN American Indian and 

Alaskan Native 

OPE Ofce of Performance 

and Evaluation 

COVID-19 Coronavirus disease of 2019 PPR Program Performance Report 

4 | 
Impact of COVID-19 Pandemic on Title VI Services 

Funding Use 

With the President declaring the coronavirus disease 

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

March 13, 2000, flexibility was provided for tribes— 

without the need for a separate application or request 

for a waiver—to use existing allocations already made 

to them under Title VI Part A/B and Part C for disaster 

relief.6 As a result, tribes could use Title VI Part A/B 

and/or Part C for any disaster relief activities for older 

individuals or family caregivers served under the OAA, 

which may have included providing: 

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

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

means, and 

■ homemaker, chore, grocery/pharmacy/supply 

delivery, or other services. 

Title VI Services 

As part of an evaluation conducted by ACL in 2020 

with a select number of ACL Title VI program grantees, 

participating grantee staf described their experiences related to the COVID-19 pandemic, including the 

impact the pandemic had on services and the strategies they implemented to continue to meet needs in 

their communities. For the full report, use this link.

† 

In addition, as part of their fscal year 2020 Annual 

Program Performance Report (PPR), Title VI grantees 

provided examples of how the Title VI program has 

helped individuals and their communities, including 

how programs have adjusted to meet needs of AI/AN 

and Native Hawaiian elders during the pandemic. The 

bullets below provide a summary of the information 

shared by grantees about the challenges they experienced during the pandemic in meeting Title VI service 

needs and the ways they met those challenges. 

† https://acl.gov/sites/default/fles/programs/2021-05/ACL_TitleVI_Evaluation_Final_Report_508.pdf 

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

 

■ Increased demand for meals. Many grantees reported a signifcant increase in the overall demand 

for meals. 

■ Experienced limited availability of supplies. Several grantees reported a loss of critical resources and 

supplies from vendors, such as food containers, 

paper products, and Styrofoam food trays, making meal provision more difcult. Others reported 

shortages of supplies for elders, such as tissues, 

paper towels, toilet paper, and cleaning products. 

■ Delivered food boxes and groceries and care packages. To continue meeting essential needs, grantees packaged and delivered food boxes and care 

packages (containing items such as toilet paper, 

face masks, hand sanitizer, gloves, etc.) to elders 

and worked with local grocery stores to order and 

deliver basic grocery items. Grantees also provided 

craf or activity care packages to elders to help keep 

them engaged. 

■ Suspended congregate meals. Grantees suspended 

in-person congregate meals for elders and caregivers. 

■ Transformed and expanded home-delivered meals. 

Grantees transformed the home-delivered meal program during the pandemic by establishing a socially distanced drive-up/pickup and take-out service 

approach that allowed elders to safely collect meals 

to take home. Some grantees also expanded their 

home-delivered meal program to include elders 

who normally participated in congregate meals and 

elders who had not previously participated in the 

nutrition program. 

■ Suspended in-person activities and events. Grantees suspended in-person activities and events, 

such as educational events, physical activity 

programs, and community events (e.g., holiday 

celebrations, powwows) for elders and caregivers. 

■ Implemented virtual and socially distanced activities. Grantees implemented virtual and socially 

distanced activities, such as nutritional counseling 

done by phone, virtual bingo and parking lot bingo, 

and virtual elders’ talking circle. Some grantees 

also purchased phones and tablets for elders so 

they could participate in virtual activities. 

■ Suspended or limited transportation for elders. 

Grantees who normally provided transportation 

services for elders (e.g., taking elders to medical 

appointments, the post ofce, the senior center, 

and shopping), had to either suspend or limit these 

services. 

■ Reduced caregiver program services. Most grantees reported that caregiver support services, such 

as respite care and other in-home services, were 

suspended. 

■ Increased check-ins. To address elders’ emotional 

well-being, including feelings of isolation, grantees 

conducted check-ins via phone or in person while 

maintaining social distance. Grantees also provided 

newsletters and used other innovative strategies to 

stay connected with elders (e.g., leaving notes in 

food boxes and care packages). 

■ Provided support for obtaining vaccines. Grantees 

also helped elders register for appointments to receive their COVID-19 vaccinations and arranged for 

transportation to and from these appointments. 
Older Americans Act Title VI | 2020 Program Results | 7 

Number of Grantee Staf — 

Nutrition and Supportive Services 

* 

 

Part 1 | 2020 PPR Data Highlights‡ 

Stafng 

The majority of funding for OAA programs flows from 

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

level. However, for OAA Title VI programs, funds are 

allocated by ACL directly to Indian tribal organizations, 

Native Alaskan organizations, and nonproft groups 

representing Native Hawaiians. To be eligible for funding, a tribal organization of federally recognized tribes 

must represent at least 50 Native Americans aged 60 

and older. Separate formula grant awards are made for 

nutrition and supportive services (Part A and B), and 

caregiver support services (Part C). 

For the 2020–2023 grant cycle, more grants were 

awarded to nutrition and supportive services (282) than 

to caregiver support services (251). In 2020, nutrition 

and supportive services had more than twice as many 

staf (1,209) as caregiver support services (553). 

‡ PPR reporting year 2020: April 1, 2020–March 31, 2021 

Number of Grantees 

For the 2020–2023 grant cycle, ACL awarded 

3-year grants for nutrition 

and supportive services 

3-year grants for 

caregiver support services 

282 |

251 |

Number of Grantee Staf— 

Caregiver Support Services 

Full time Part time Full time Part time 

754 464 329 224 

* Grantee staf are defned as staf that are fully or partially paid by 

Title VI funding. 
8 | 

 

 

 

 

Service Recipients 

In 2020, OAA Title VI grantees served more than 

206,464 persons. (Service recipients may be receiving 

more than one service and may be counted more than 

once.) They provided nutrition and supportive services 

to 198,591 persons§ and caregiver support services to 

7,873 caregivers. 

§ Persons served received the following services: congregate 

meals, home-delivered meals, nutrition counseling, case management, transportation, homemaker, personal care/home health aide, 

chore, and/or health promotion and wellness activities. 

Number of Title VI Service Recipients 

by Supportive Services Type 

In 2020, 98,603 persons received supportive services. 

The largest number of persons received other services. 

That number includes 58,141 who received health promotion and wellness activities; 27,631 who received 

access related services, including case management 

and/or transportation services; and 12,831 who received in-home related services, including homemaker, 

personal care/home health aide, and/or chore services. 

Number of persons 

served by grantees 

> 206,464 

Exhibit 1. Number of Title VI Service Recipients by Supportive Services Type 

Other 

Transportation 

Case Management 

Chore 

Homemaker 

Personal Care/ 

Home Health Aide 

0 20,000 40,000 60,000 

58,141 

13,905 

13,726 

4,373 

4,273 

4,185 

Notes: Service recipients may be receiving more than one service. Other = health and promotion wellness activities.
Older Americans Act Title VI | 2020 Program Results | 9 

 

 

 

 

 

Number of Title VI Service Recipients 

by Nutrition Services Type 

In 2020, 99,988 persons received nutrition services. 

Home-delivered meal programs served the most 

persons (76,062), followed by nutrition counseling 

programs (14,336 persons). The number served via 

congregate meal programs was smaller (9,590 

persons) than the numbers served via the other 

two service types due to COVID-19. 

Number of Title VI Caregiver Support Services 

Recipients by Caregiver Type 

In 2020, the caregiver support services program 

served 7,873 caregivers. Most caregivers who received 

services cared for elders or individuals of any age with 

Alzheimer’s disease and related disorders (4,149), followed by those who cared for children under the age of 

18 (2,521) and those who cared for adults 18–59 years 

old with disabilities (1,203). 

Exhibit 2. Number of Title VI Service Recipients by Nutrition Services Type 

Home-Delivered Meals 

Nutrition Counseling 

Congregate Meals 

14,336 

9,590 

20,000 40,000 60,000 80,000 

76,062 

0 

Notes: Service recipients may be receiving more than one service. 

Exhibit 3. Number of Title VI Caregiver Services Recipients by Caregiver Type 

Elders or Individuals 

with AD and Related 

Disorders 4,149 

Children Under 18 2,521 

Adults 18-59 with 

Disabilities 1,203

0 2,500 5,000

Notes: AD = Alzheimer’s Disease. 
10 | 

 

 

Number of Title VI Service Recipients 

by Caregivers Support Services Type 

Number of persons who received 

supplemental services 

In 2020, the largest number of persons received supplemental services (15,279), which consist of homemaker/chore/personal care services (5,558 persons), 

the provision of consumable items (4,375 persons), 

other¶ (3,295 persons), lending closets (1,292 persons), fnancial support (418 persons), and/or home 

modifcations or repairs (341 persons). Caregivers 

also received counseling (2,735 persons), caregiver 

training (1,365 persons), and/or respite services 

(1,916 persons). 

15,279 

¶ For example, care packages 

Exhibit 4. Number of Title VI Service Recipients by Caregiver Support Services Type 

Homemake/Chore/ 

Personal Care 

Consumable Items 

Other 

Counseling 

Respite Care

Caregiver Training 

Lending Closet 

Financial Support 

Home Modifications/ 

Repairs 

0 2,000 4,000 6,000 8,000 

2,735 

1,916 

1,365 

1,292 

418 

341 

5,558 

4,375 

3,295 

Notes: Service recipients may be receiving more than one service. Other = health and promotion wellness activities. 
Older Americans Act Title VI | 2020 Program Results | 11 

 

 

 

 

Service Units 

The following section provides data highlights 

for delivered Title VI service units. A service unit 

denotes a specifed quantity of a service. 

Number of Service Units by Nutrition Service Type 

In 2020, the largest number of service units for nutrition services was provided for home-delivered meal 

services (6,426,032), followed by congregate meal 

services (321,095), and nutrition education services 

(44,897). The fewest service units were provided for 

nutrition counseling services (12,186). 

6,426,032 

Service Units provided for 

home-delivered meals 

Exhibit 5. Total Service Units, by Nutrition Service Type 

Service Units: Nutrition Services 

Defnition of Nutrition Service Units 

■ Home-delivered meal (1 meal): A meal 

provided to an eligible individual in their 

place of residence. 

■ Congregate meal (1 meal): A meal provided to an eligible individual in a congregate or group setting. 

■ Nutrition education (1 session): A 

session spent with an elder to provide 

nutrition education. The session may be 

a meeting or a gathering dedicated to a 

specifc activity. A nutrition education 

session does not include the time spent 

on preparing the program or compiling 

the information. 

■ Nutrition counseling (1 hour): An hour 

spent with an elder to provide nutrition 

counseling. A nutrition counseling hour 

does not include the time spent on 

preparing for the counseling meeting or 

compiling the advice or guidance. 

Home-Delivered Meals 

Congregate Meals 

Nutrition Education 

Nutrition Counseling 

0 2,000,000 4,000,000 6,000,000 8,000,000 

6,426,032 

321,095 

44,897 

12,186
12 | 

 

 

Service Units: Supportive Services— 

Access Services 

Defnition of Access Service Units 

■ Information/assistance (1 contact): A contact with an eligible individual to provide 

information or assistance to access services. 

■ Outreach (1 activity): A public outreach 

activity and providing information directed 

at individuals and groups to encourage 

potential elders (or their caregivers) to use 

existing services and benefts. 

■ Case management (1 hour): An hour spent 

on providing case management. Case management includes such activities as assessing needs and developing service plans— 

arranging, coordinating, and monitoring 

services to meet the needs of the elder. The 

service includes periodic reassessment and 

revision based on the needs of the elder. 

■ Transportation (1 one-way trip): One-way 

trip of transportation for an eligible person. 

A round trip is considered two one-way trips. 

Exhibit 6. Total Service Units, by Access Service Type 

Information/ 

Assistance 

Transportation 

Outreach 

Case Management 

587,098 

Service Units provided for 

information/access services 

Number of Service Units by Access Service Type 

In 2020, the largest number of service units for access 

services was provided for information/assistance 

services (587,098), followed by transportation services 

(202,512), outreach services (111,392), and case management services (90,991). 

0 

587,098 

202,515 

111,392 

90,991 

200,000 400,000 600,000 
Older Americans Act Title VI | 2020 Program Results | 13 

 

461,858

Service Units: Supportive Services— 

In-Home Services 

Defnition of In-Home Service Units 

■ Homemaker (1 hour): One hour spent providing homemaker services for an elder. 

■ Personal care/home health aide (1 hour): 

One hour spent with an elder to provide 

personal care/home health aide services. 

■ Chore (1 hour): An hour spent with an elder 

to provide chore services. 

■ Visiting (1 contact): A visit provided to an 

elder in their place of residence. Visit contacts are for visits in personal homes only. 

■ Telephoning (1 contact): A telephone call to 

an elder at their place of residence, including a call to a housing facility like a nursing 

home or assisted living facility or a call 

directly to their personal cell phone. 

Exhibit 7. Total Service Units, by In-Home Service Type 

Visiting 

Telephoning 

Homemaker 

Chore 

Personal Care/Home 

Health Aide 

461,858 

Service Units provided for 

visiting services 

Number of Service Units by In-Home Service Type 

In 2020, the largest number of service units for 

in-home services was provided for visiting services 

(461,858), followed by telephoning services (363,352), 

homemaker services (66,900), and chore services 

(48,278). The fewest service units were provided for 

personal care/home health aide services (35,851). 

461,858 

363,352 

66,900 

48,278 

35,851 

0 200,000 400,000 600,000 
14 | 

 

 

Service Units: Supportive Services— 

Other Services 

Defnition of Other Service Units 

■ Social event (1 event): An event held for 

elders. 

■ Nursing facilities/home or residential care 

communities visit (1 visit): A visit provided 

to an elder living in a nursing home or 

assisted living facility 

Number of Service Units by Other Service Type 

In 2020, 2,771 visits to nursing facilities/homes or 

residential care communities were conducted under 

Title VI (compared to 461,858 visits to personal 

homes). Title VI providers also held 2,201 social 

events for elders. 

Service Units: Caregiver Support Services— 

Services for Caregivers 

Defnition of Caregiver Service Units 

■ Information services (1 activity): An 

informational activity held for caregivers. 

Information services activities can include 

an in-person interactive presentation to 

the public or a social media post or radio 

announcement that is shared with the 

broader community. 

■ Information and assistance (1 contact): 

A contact with an eligible caregiver to 

provide information and assistance. 

■ Counseling (1 hour): An hour spent on 

providing counseling to a caregiver. 

■ Support group (1 session): A session 

spent on providing a support group to 

caregivers. It may be a meeting or a 

gathering dedicated to a specifc activity. 

A support group session does not include 

the time spent on preparing the program 

or compiling the information. 

■ Caregiver training (1 hour): An hour spent 

on providing caregiver training to informal 

caregivers. 

Number of Service Units by Caregiver Service Type 

In 2020, the largest number of service units for services for caregivers was provided for information and 

assistance (134,945), followed by counseling (113,042) 

and information services (96,481). The fewest service 

units were provided for caregiver training (1,365) and 

support groups (1,120). 
Older Americans Act Title VI | 2020 Program Results | 15 

 

 

 

 

Service Units: Caregiver Support Services— 

Respite Care for Caregivers 

Defnition of Respite Service Units 

■ Respite care for caregivers (1 hour): 

An hour spent on providing respite care 

for eligible caregivers. 

Exhibit 8. Total Service Units, by Caregiver Service Type 

Number of Respite Service Units by Caregiver Type 

In 2020, the largest number of respite service units was 

provided to caregivers who cared for elders or individuals of any age with Alzheimer’s disease and related 

disorders (76,282), followed by those who cared for children under the age of 18 (21,568) and those who cared 

for adults 18–59 years old with disabilities (14,471). 

Information 

and Assistance 

Counseling 

Information Services 

Caregiver Training 

Support Group 

0 20,000 40,000 60,000 80,000 100,000 120,000 140,000 

113,042 

96,481 

1,365 

1,120 

134,945 

Exhibit 9. Total Respite Service Units, by Caregiver Type 

Elders or Individual with 

AD and Related 

Disorders 

Children Under 18 

Adults 18-59 with 

Disabilities 

21,568 

14,471 

76,282 

0 

Notes: AD = Alzheimer’s Disease. 

20,000 40,000 60,000 80,000 
16 | 

Part 2 | 2020 National Survey of Title VI Programs ** 

With a grant from ACL, the National Association of Area 

Agencies on Aging partnered with Scripps Gerontology 

Center of Excellence to conduct the 2020 Title VI Native 

American aging program survey, which was the fourth 

comprehensive survey of Title VI programs. The results 

presented in Part 2 of this report are directly taken 

from the National Survey of Title VI Programs 2020 

Report: Serving Tribal Elders Across the United States. 

The complete report can be accessed here.

†† 

†† https://www.usaging.org/Files/TitleVI-Survey-Report-508.pdf 

Exhibit 10. Title VI Program Location (n=230) 

Intertribal 

Council 

5% 

Tribal 

Consortium 

17% 

The web-based survey was distributed to 276 Title VI 

grantees in 2020, with 84% (n=231) of Title VI programs 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 reported in all tables. In the cases of text without 

accompanying tables, the n can be assumed to be of 

the respondents overall, 231, unless noted otherwise. 

Other 

1% 

Individual 

Tribe 

77% 

** The data do not represent data from the National Survey of Older Americans Act Participants. 
Older Americans Act Title VI | 2020 Program Results | 17 

 

Program Structure 

Program Location 

Title VI grants are awarded to tribal entities in federally 

recognized tribes, as well as to organizations representing Native Hawaiian elders. Survey respondents 

noted that Title VI programs are most frequently part 

of an individual tribe (77%), with 17% being part of 

a tribal consortium,‡‡ 5% being part of an intertribal 

council,§§ and 1% being part of other administrative 

structures. Exhibit 10 shows this distribution of administrative locations. 

‡‡ Grantees comprised of a group of federally recognized tribes or 

villages that do not meet the eligibility requirements of 50 elders age 

60 or older may combine their smaller elder populations to form a 

population that is large enough to apply for the grants. A tribe or village that has enough elders to meet the eligibility requirements may 

choose to band together with other tribes/villages and authorize an 

administrative body to apply for and administer their grant on behalf 

of the tribe/village. 

§§ Intertribal councils are similar to consortia in that they are made 

up of multiple tribes/villages and have authorized a representative 

body to apply for and administer the grant on their behalf. 

Exhibit 11. Area Served by Title VI Programs 

Area Served by Program¶¶ 

Reflecting the location of tribal lands, approximately 

92% of Title VI programs serve regions that include 

rural areas. Nearly two-thirds (64%) of programs serve 

an area that is predominantly rural, remote, or frontier. 

Only about 9% of programs serve an area that is predominantly urban or suburban. 

¶¶ Survey respondents were asked to choose the type of area they 

believed best represented their region. 

Type of Area Served 

Percent of Title VI programs 

that serve type of area 

(n=230) 

Predominantly rural 58% 

A mix of suburban and rural 16% 

A mix of urban, suburban and rural 12% 

Predominantly urban, predominantly suburban, or a mix 9% 

Predominantly remote or frontier 6% 
18 | 

Partnerships 

Type of Partners 

Title VI programs partner with other entities both within and external to their tribes or organizations to meet 

the needs of elders. The most common partnerships 

are with tribal health care and the Indian Health 

Exhibit 12. Type of Entities Title VI Programs Partner With 

Service (both 81%), tribal housing (80%), adult protective services (79%), tribal health department/tribal 

public health (77%) and the local Area Agencies on 

Aging or Title III providers (76%). Additional partnership types are shown in Exhibit 12. 

Type of Entity 

Percent of Title VI programs 

that partner with entity 

(n=218) 

Tribal health care (e.g., tribal health clinic or center) 81% 

Indian Health Service 81% 

Tribal housing 80% 

Adult Protective Services 79% 

Tribal health department/tribal public health 77% 

Area Agency on Aging/Title III provider 76% 

Veterans Administration 70% 

State unit or department of aging 68% 

Medicaid 67% 

Medicare 66% 

Disability service organizations 65% 

Nursing home, assisted living facility or group home 65% 

Transportation agencies 64% 

Bureau of Indian Afairs 62% 

Nontribal health care providers (e.g., hospital, clinic, physician ofce) 62% 

Nontribal health department/nontribal public health 61% 

County government 61% 

State Health Insurance Assistance Program 60% 

Charitable organizations 60% 

Churches 59% 

Bureau of Indian Education 51% 

Tribal colleges 46% 

Other colleges and universities 46% 
Older Americans Act Title VI | 2020 Program Results | 19 

Partnership Activities 

Title VI programs partner with tribal health care departments or entities to support the health needs of elders. 

The most common health care support activities that 

Title VI programs collaborate on with partners are shown 

Exhibit 13. Partnership Activities 

in Exhibit 13. They include activities to provide nutrition 

and/or health education (78%), wellness checks (73%), 

and transportation (70%). Title VI programs also partner with entities to provide services such as diabetes 

wellness programs (67%), COVID-19 preparedness and 

response (67%), and annual health fairs (63%). 

Activity 

Percent of Title VI programs 

that implement activity with 

partners (n=194) 

Provide nutrition and/or health education 78% 

Conduct wellness checks 73% 

Provide transportation 70% 

Coordinate on diabetes wellness programs 67% 

Coordinate COVID-19 preparedness and response 67% 

Coordinate on annual health fair 63% 

Make home visits or deliver meals 58% 

Coordinate on flu clinic 58% 

Deliver medications 56% 

Approve meals and/or help with menu planning 55% 
20 | 

Services 

Title VI program directors noted that, overall, elders in 

their tribal communities have access to an average of 26 

services. These services are funded fully through Title 

VI, or partially through Title VI, or through other funding 

sources. Exhibit 14 shows the services most likely to be 

delivered entirely with Title VI dollars. More than half of 

Title VI recipients fund their home-delivered and congregate meals programs only with Title VI funds. More 

than one-third provide family caregiver support and 

respite services that rely wholly on Title VI funding. 

Exhibit 14. Services Provided Exclusively Through Title VI Funds 

Service 

Percent of Title VI programs 

that deliver the service 

through Title VI funds only 

(n=231) 

Home-delivered meals 55% 

Congregate meals 54% 

Information and referral/assistance 39% 

Family caregiver support services 37% 

Outreach 37% 

Respite care 36% 

Telephone reassurance/friendly visiting 36% 

Senior center activities 29% 

Assistive devices or loan closet 27% 

Special events for elders 25% 

Homemaker help 24% 

Care/case management 24% 

Transportation (medical or nonmedical) 22% 

Help in home/personal care 22% 

Supportive services for grandparents raising grandchildren 20% 
Older Americans Act Title VI | 2020 Program Results | 21 

Percent with 

signifcant unmet need Unmet Need Percent with some unmet need 

46% Home repair (e.g., replacing a 

broken window, repairing leaks) 89% 

42% Money management 89% 

36% Help in home/personal care 89% 

36% Home modifcation (e.g., ramps, 

grab bars, widened doorways) 86% 

36% Legal assistance 80% 

33% Chore services (e.g., yard work) 79%

32% Emergency response system 75% 

29% Mental health services 76% 

28% Homemaker help 81% 

27% Help with medication 74% 

25% Supportive services for grandparents 

raising grandchildren 77% 

24% Dementia awareness 77% 

 

 

Unmet Needs 

Title VI grantees provide a wide range of services to 

elders, but available funding and/or staf levels cannot always meet every need. As shown in Exhibit 15, 

the most common signifcant unmet need reported by 

Title VI program directors was for home repair services 

Exhibit 15. Unmet Needs Among Elders (n=231) 

(46%). Other commonly reported signifcant unmet 

needs are money management (42%) and legal 

assistance (36%), with more than 80% of Title VI 

programs reporting at least some unmet need in each 

of these areas. 
22 | 

Appendix A: Title VI Defnitions7 

American Indian or Alaskan Native: A person having 

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. To help older adults remain 

in their homes, if that is their preference, AAAs coordinate and ofer services including home-delivered 

meals, homemaker assistance, and whatever else it 

may take to make independent living a viable option. 

Caregiver to elders or Individuals of any age with 

Alzheimer’s disease and related disorders: An informal 

caregiver who 

■ is 18 years or older and 

■ provides services or support to an elder or elders 

(tribally determined age) or an individual or individuals of any age with Alzheimer’s disease and 

related disorders (such as dementia). 

Caregiver training: A service that provides family caregivers with instruction to improve knowledge and performance of specifc skills related to their caregiving 

roles and responsibilities. Skills may include activities 

related to health, nutrition, and fnancial management; 

providing personal care; and communicating with 

health care providers and other family members. Training may include use of evidence-based programs and 

may be conducted in person or online, in individual or 

group settings. 

Case management: A service provided to an elder, at the 

direction of the elder or a family member or caregiver. 

■ The service should be provided by a trained or experienced person with case or care management skills. 

■ The service includes individual needs assessment 

and developing a service plan for, arranging, 

coordinating, and monitoring services to meet the 

22 | 

needs of the elder. The service should include periodic reassessment and revision based on the needs 

of the elder. 

Chore service: Performance of heavy household tasks 

provided in an elder’s home. Tasks may include yard 

work or sidewalk maintenance in addition to heavy 

housework—tasks such as heavy cleaning, yard work, 

walk maintenance, minor home repair, wood chopping, 

hauling water, and other heavy-duty activities which 

the elder is unable to handle on their own and which 

do not require the services of a trained homemaker or 

other specialist. 

Congregate meal: A meal provided to and consumed 

by an eligible person at a nutrition site, senior center, 

or other congregate/group setting. The meal meets all 

the requirements of the OAA and state and local laws. 

Congregate meal eligible person: An eligible person is 

an elder, a spouse of an elder, or an individual providing volunteer services for the Title VI program during 

the meal hour. It may also be a nonelder person with a 

disability who resides at home with and accompanies 

an elder to the meal or who resides in a housing facility occupied primarily by older adults. 

Consumable items: Single-use items, such as incontinence supplies, Ensure®, school supplies, uniforms for 

school or sports, cleaning supplies, groceries, etc. 

Counseling: A service designed to support caregivers 

and assist them in their decision-making and problem 

solving. Counselors may be degreed service providers, 

trained to work with individuals, older adults, and families and specifcally understanding and addressing 

the complex physical, behavioral, and emotional problems related to their caregiver roles. Informal counselors, like peers who are or have been informal caregivers, may also be used for this service. Counseling 

may be provided to individuals or in group meetings. 

Counseling is a separate function from support group 

activities or training. Caregivers eligible to receive 

counseling are those caring for older adults, persons 
Older Americans Act Title VI | 2020 Program Results | 23 

 

 

 

with disabilities, or children not their own by birth 

or adoption. Counseling may be provided via phone, 

text, email, webinar, video chat, or other means with 

an individual or a group to help participants navigate 

physical, behavioral, and emotional issues related 

to caregiving. 

Elder caregivers caring for children under the age of 18: 

An informal caregiver who 

■ is an elder, 

■ provides care for a child or children not their own by 

birth or adoption, and 

■ is caring for a child or children under the age of 18. 

Elder caregivers providing care to adults 18–59 with 

disabilities: An informal caregiver who 

■ is an elder, 

■ may be the parent of the adult with disabilities, and 

■ provides care to an adult or adults 18–59 years old 

with disabilities. 

An individual with a disability is defned by the 

Americans with Disabilities Act as a person who has 

a physical or mental impairment that substantially 

limits one or more major life activities, a person 

who has a history or record of such an impairment, 

or a person who is perceived by others as having 

such an impairment. 

Financial support: Limited (emergency) help with 

utility bills. 

Full-time staf: People who work 35 hours or more per 

week in paid positions for the Title VI program, paid 

fully or partially with Title VI A/B or C funds. The term 

refers to the number of full-time positions in the Part 

A/B or C program. These positions may be permanent 

or temporary in nature. 

Health promotion and wellness: Activities conducted 

to improve the mental and physical health of persons, 

including walking groups, exercise classes, and presentations on health and wellness topics. 

Home-delivered meal: A meal provided to a qualifed eligible person in their place of residence or via 

carry-out or drive-through. Does not include meals 

supported by other funds (e.g., Title III, Medicaid Title 

XIX waiver, state-funded means-tested programs). 

Home-delivered meal eligible person: An eligible person is a qualifed elder, a spouse of a qualifed elder, a 

volunteer providing services during the meal hours, a 

nonelder person with a disability who resides at home 

with a qualifed elder, or a person with a disability who 

resides in a housing facility occupied primarily by 

older adults. 

Home modifcation/repairs: Putting ramps or handrails 

into a home. 

Homemaker service: Providing light housekeeping tasks 

in an elder’s place of residence. Tasks may include, 

but are not limited to, preparing meals, shopping for 

personal items, laundry, managing money, or using the 

telephone in addition to other light housework. 

Informal caregiver: An unpaid provider of in-home and 

community care who may be a family member, neighbor, friend, or someone else. 

Information services: A public or media activity that 

conveys information to caregivers about available 

services. Information services activities may include 

an in-person interactive presentation to the public, 

a social media post, or a radio announcement that is 

shared with the broader community. 

Information and assistance: A service for caregivers that 

■ provides the individual with current information on 

opportunities and services available within their 

community, including information related to assistive technology; 

■ assesses the problems and capacities of the 

individual; 

■ links the individual to the opportunities and 

services that are available; and 
■ ensures, by establishing adequate follow-up procedures, that the individual receives the services 

needed and is aware of the opportunities available 

to them and serving the entire community 

of caregivers. 

Lending closet: Items returnable to the Title VI program: clothing exchange; durable medical equipment 

(chair lifs, wheelchairs, walkers, emergency response 

systems), telephone, tablet, anything else lent on a 

short-term basis. 

Native Hawaiian or other Pacifc Islander: A person 

having origins in any of the original peoples of Hawaii, 

Guam, Samoa, or other Pacifc islands that are U.S. 

territories. 

Nutrition counseling: Provision of individualized advice and guidance to individuals who are at nutritional 

risk—because of their health or nutritional history, 

dietary intake, medication use, or chronic illnesses— 

about options and methods for improving their nutritional status. Counseling is performed by a registered 

dietitian or other health professional and addresses 

the options and methods for improving nutrition status 

with a measurable goal. Nutrition counseling can be 

provided in person or virtually to counsel older adults 

on an individual basis (via phone, text, email, webinar, 

video chat, or other means). 

Nutrition education: A targeted educational program 

provided by a dietitian or a similarly knowledgeable 

person. The program promotes better health by providing accurate and culturally sensitive nutrition, physical 

ftness, or health (as it relates to nutrition) information 

and instruction to participants, caregivers, or participants and caregivers in a group setting (two or more 

participants). Sessions include distribution of printed 

materials, provided in person or virtually by conducting 

a group call or online meeting (via phone, text, email, 

webinar, video chat, or other means) around how to 

continue to eat healthily and stay physically active. 

One-way trips: When transporting an elder, every stop 

that is made is considered a one-way trip. 

Other supportive service: Any additional supportive 

service the Title VI program ofers that was not listed in 

the Program Performance Report form. It may include, 

but is not limited to, services such as consumable 

items or lending closet. 

Outreach: Conducting public outreach activities and 

providing information directed at individuals and 

groups to encourage potential elders (or their caregivers) to use existing services and benefts. 

Part-time staf: People who work less than 35 hours 

per week in a paid position for the Title VI program, 

paid fully or partially with Title VI A/B or C funds. The 

term refers to the number of part-time positions in a 

Part A/B or C program, whether permanent or temporary in nature. 

Personal care/home health aide service: Providing an 

elder assistance with activities of daily living, such as 

eating, dressing, and bathing, toileting, transferring in 

and out of bed/chair, or walking. This service may also 

include assistance with an elder’s health-related tasks, 

such as checking blood pressure and blood glucose, 

and assistance with personal care. Personal care may 

include assistance with instrumental activities of daily 

living, such as cleaning and maintaining the home, 

managing money, or preparing meals. 

Respite care: A service for caregivers which ofers temporary, substitute supports or living arrangements for 

care recipients in order to provide them a brief period 

of relief or rest. Respite care is provided to assist the 

informal caregiver. 

Social event: An event involving a public performance 

or entertainment or a function to promote social 

interaction and decrease isolation. A social event 

should involve contact among more than two people, 

via phone, text, email, webinar, video chat, or other 

means, to provide reassurance and/or socialization to 

older adults. 

Supplemental services: Services provided on a limited 

basis to support informal caregivers so that they might 

continue to provide care to the elder, person with 

Alzheimer’s Disease and related disorder of any age, 

person 18–59 years old with disability, or grandchild 

under the age of 18. Examples are home modifcations/repairs, consumable items, lending closet, 

homemaker/chore/personal care service, and 

fnancial support. 

24 | 
Support group: A service led by an individual, moderator, or professional to facilitate caregivers discussing 

their common experiences and concerns and developing a mutual support system. Support groups are 

typically held on a regularly scheduled basis and may 

be conducted in person, over the telephone, or online. 

Caregiver support groups would not include caregiver 

education/training groups or other groups primarily 

aimed at teaching skills or meeting on an informal basis without a facilitator. Support groups are intended 

to facilitate caregivers sharing their experiences with 

each other and fnding support within the group. 

Telephoning: Telephone services include phoning 

to provide comfort or check in on the elder. The elder 

should be reached and spoken to for the contact to 

be counted. 

Transportation: Services or activities that provide 

or arrange for travel of an elder, including costs of 

individuals’ travel from one location to another. This 

service may include escort or other appropriate assistance for a person who has difculties using regular 

transportation. 

Visiting: Visiting services include going to see an elder 

to reduce social isolation and/or perform a wellness 

check (a visual check of an elder to see if they need 

anything), etc. This service would include visiting in 

a personal home. Visiting involves a minimum of 15 

minutes talking with an elder or an adequate amount 

of time to make an informed decision about the elder’s 

well-being. 

Visits to persons in nursing facilities/homes or 

residential care communities: Visits conducted to 

persons living in skilled nursing homes or facilities, 

or living in a long-term care facility that provides, at 

a minimum, room and board, around-the-clock onsite supervision, and help with personal care such as 

bathing and dressing or health-related services such 

as medication management. Facility types include, 

but are not limited to, assisted living, board and care 

homes, congregate care, enriched housing programs, 

homes for the aged, personal care homes, adult foster/ 

family homes, and shared housing establishments that 

are licensed, registered, listed, certifed, or otherwise 

regulated by a state. 

Older Americans Act Title VI | 2020 Program Results | 25 
 

References 

1 Administration for Community Living. (2017, October 27). New issue briefng on community living for 

American Indian, Alaskan Native, and Native Hawaiian elders. https://acl.gov/news-and-events/ 

announcements/new-issue-briefng-community-living-american-indian-alaskan-native 

2 Espey, D. K., Jim, M. A., Cobb, N., Bartholomew, 

M., Becker, T., Haverkamp, D., & Plescia, M. 

(2014). Leading causes of death and all-cause 

mortality in American Indians and Alaska Natives. 

American Journal of Public Health, 104(S3), S303– 

S311. 

3 Urban Indian Health Institute, Seattle Indian 

Health Board. (2016). Community health profle: 

National aggregate of Urban Indian Health Program service areas. Urban Indian Health Institute. 

4 Indian Health Service, U.S. Department of Health 

and Human Services. (2015, March). Trends in 

Indian health: 2014 edition. https://www.ihs.gov/ 

dps/publications/trends2014/ 

5 National Association of Area Agencies on Aging. (n.d.). National Survey of Title VI Programs 

2020 report: Serving tribal elders across the 

United States. https://www.usaging.org/Files/ 

TitleVI-Survey-Report-508.pdf 

6 Administration for Community Living. (2020, 

March 16). Older Americans Act disaster relief. 

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

7 Administration for Community Living. (2021). Title 

VI Program Performance Report (PPR) reporting 

defnitions for the grant year April 1, 2020–March 

31, 2023. https://oaaps.acl.gov/api/upload/ 

download?title=VI&downloadType=VIComponentsAndDefs 

26 |